Unique case of anterior interosseous nerve injury following distal volar radial plating: A case report

Trauma itself, surgery, nerve entrapments, amyotrophic neuropathy, or neuritis may result in anterior interosseous nerve (AIN) palsy. A 76-year-old woman who was operated for distal end radius fracture with plating was referred back referred back to the clinic by her general practitioner with complaints of inability to flex the interphalangeal joint of the thumb and index finger approximately 3 years after the index surgery. The proximal interphalangeal joint flexion (flexor digitorum superficialis) of the index finger was intact and the pinch power was reduced. She had normal function of her other forearm and hand muscles. Ultrasonography and nerve conduction velocity (NCV) studies were done to investigate further to rule out either tendon flexor pollicis longus (FPL) or nerve injury (AIN). NCV studies reported subacute denervation within the FPL. The patient recovered to near normal without any surgical intervention in 18 months. Literature reported various treatment options in the form of conservative as well as surgical depending on the cause and evidence of recovery.

Laparoscopic approach to refractory extraspinal sciatica and pudendal pain caused by intrapelvic nerve entrapment

Entrapments of the intrapelvic portions of the lumbosacral plexus are an important extraspinal cause of sciatica and pudendal neuralgia. They can be treated using Laparoscopic Neuronavigation (LANN), a minimally invasive technique that has set the foundations of an emerging field in Medicine—Neuropelveology. This retrospective-prospective study analyzes the outcomes of 63 patients treated with the LANN technique over a 10 year time period. One year after surgery, 78.3% of patients reported clinically relevant pain reduction, defined as ≥ 50% reduction in Numeric Rating Scale (NRS) score; these results were maintained for a mean follow up of 3.2 years. Preoperative chronic opioid use (≥ 4 months of ≥ 10 mg morphine equivalents/day) was a predictor of poor surgical outcome—clinically relevant pain reduction was observed in only 30.8% in this group of patients, compared to 91.5% in patients not regularly taking opioids preoperatively (p < 0.01). Perioperative complication rate was 20%. Our results indicate that the LANN technique is an effective and reproducible approach to relieve pain secondary to intrapelvic nerve entrapments and that preoperative chronic opioid therapy significantly reduces the likelihood of a successful surgical outcome. This study provides detailed information on perioperative complication and postoperative course, which is essential for patient consenting.

Percutaneous Needle Electrolysis Reverses Neurographic Signs of Nerve Entrapment by Induced Fibrosis in Mice

Nerve entrapments such as carpal tunnel syndrome are the most common mononeuropathies. The lesional mechanism includes a scarring reaction that causes a vascular compromise. The most effective treatment is surgery, which consists of removing the scarred area, thus reverting the vascular impairment. In the present study, a more conservative therapeutic approach has been undertaken to release the nerve by means of galvanic current (GC) applied with a needle: percutaneous needle electrolysis (PNE). For this purpose, a mouse model of sciatic nerve entrapment has been created using albumin coagulated by glutaraldehyde (albumin 35% and glutaraldehyde 2% volume applied, 10 μl). After two weeks, a fibrous reaction was obtained which entrapped the nerve to the extent of causing atrophy of the leg musculature (14.7%, P < 0.05 compared to the control leg). Ultrasound imaging confirmed that the model’s image was compatible with that of nerve entrapment in patients. To quantify the degree of entrapment, nerve conduction recordings were made. The amplitude (peak-to-peak) of the compound muscle action potential (CMAPs) decreased by 32.2% ( P < 0.05 ), and the proximal latency increases by 17.7% ( P < 0.05 , in both cases). In order to release the sciatic nerve, PNE was applied (1.5 mA for 3 seconds and 3 repetitions; 1.5/3/3) by means of a solid needle in the immediacy of perineural fibrosis before and 5 minutes after the application of GC, and the proximal latency shows a decrease of 16% ( P < 0.05 ). The recovery of CMAPs amplitude was about 48.7% ( P < 0.05 ). Three weeks later, the CMAPs amplitude was almost completely recovered (94.64%). Therefore, with the application of GC by means of a solid needle, the sciatic nerve was definitively released from its fibrous entrapment.

Actualización en el diagnóstico y tratamiento de la Fascitis plantar.

Plantar fasciitis is a very common pathology. Over time, some aspects of this entity have generated controversy, so our objective is to group the latest available scientific evidence. Plantar fasciitis has its origin in a degenerative process resulting from repetitive microtrauma. In addition, multiple risk factors are involved that contribute to its overload the fascia and its collagen degeneration. Its diagnosis is clinical, reserving the performance of complementary tests to perform differential diagnosis with other entities, which may originate in the plantar fascia or adjacent structures, paying special attention to nerve entrapments. There are numerous treatments that have proven effectiveness, obtaining better results by individualizing each patient and with a combination of treatments.

Forensic Engineering Analysis of Upper Extremity Nerve Entrapment Injury Mechanisms as Related to Rear-End Collisions

Nerve entrapments of the median nerve, i.e., carpal tunnel syndrome (CTS) and the ulnar nerve, i.e., cu-bital syndrome (CT) are relatively common, reflecting traumatic and atraumatic mechanisms. Claims of such injuries in relation to rear-end collisions (particularly low-velocity or < 10 mph collisions) are often contested by the defense, acknowledging that there is no obvious relationship between the collision and the claimed inju-ries. Of the collision types (frontal, side, rear-end), it is the least clear how a rear-end collision can establish mechanisms for such injuries. Direct blunt trauma to the carpal tunnel region or the cubital tunnel region are unlikely in a rear-end collision. Also, “stretch” injuries due to hypermotion of either the wrist or elbow are unlikely, reflecting occupant kinematics, vehicle interior geometry, and other factors. A case study involving CTS and CT claims as a result of a low-velocity rear-end collision will be presented.

Ultrasound-Guided Nerve Hydrodissection for Pain Management: An Updated Review of Anatomy and Techniques

Nerve hydrodissection (HD), a technique used when treating nerve entrapments, involves using an anesthetic or solution such as saline or 5% dextrose solution to separate the nerve from the surrounding tissue, fascia, or adjacent structures. This technique aims to treat neuropathic pain, or pain caused by the nerve. Ultrasound-guided HD of peripheral nerves has gained significant attention in the medical profession and pain management fields in recent years. This is due to a number of high impact publications of randomized control trials demonstrating the efficacy and safety of this technique for the treatment of carpal tunnel syndrome. Even the 20th edition of Harrison&rsquo;s Principles of Internal Medicine textbook lists injection of 5% dextrose as an alternative local treatment that does not have the side effects of corticosteroids. At present, there is no review of the current literature on this technique. This manuscript will summarize and discuss the following: 1) the different approaches to doing ultrasound-guided HD of nervous structures, 2) its usages in different clinical situations, 3) its clinical pearls, 4) the solution used, and 5) the postulated mechanisms of action.