Diagnosis of ulnar nerve entrapment anterior to the medial epicondyle by ultrasound elastography and diffusion tensor imaging with fiber tractography: a case report

Ulnar/cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb. Permanent location of the ulnar nerve anterior to the medial epicondyle is extremely rare, with only five cases reported in the literature. Using ultrasound elastography and diffusion tensor imaging with fiber tractography, we diagnosed a case in which ulnar nerve entrapment was associated with anterior nerve location. Surgical release confirmed the diagnosis and the patient was symptom free 3 months after surgery.

Peroneal/posterior tibial nerves delayed dysfunction due to traumatic popliteal artery pseudoaneurysm resulting from trivial stab wound: A case report

Background: Popliteal artery pseudoaneurysms due to stab wounds are extremely rate. Even more infrequently, they can contribute to the compression of multiple peripheral nerves. Case Description: A 23-year-old male, following a trivial stab wound, developed the delayed occurrence of a pseudoaneurysm of the popliteal artery. This resulted in the delayed onset of a compressive popliteal/posterior tibial neuropathy. Following restoration of blood flow through the popliteal artery utilizing saphenous vein grafting, additional neurolysis resulted in resolution of the compressive neuropathy. Conclusion: A 23-year-old male developed a pseudoaneurysm following minor trauma that resulted in peripheral nerve dysfunction.

Conservative treatment for Carpal Tunnel Syndrome caused by persistent median artery: a case report

Knowledge of a persistent median artery, defined as an anatomical vascular variation, is of clinical importance because it can be an unusual etiology of carpal tunnel syndrome. This report describes the case of a 42-year-old female patient with acute pain and paresthesia involving the volar aspect of the first, second, and third fingers of the left hand. The clinical manifestations pointed to compressive neuropathy of the median nerve, and diagnostic imaging showed anatomical vascular variation. Details were collected through interviews with the patient, and photographic records of imaging exams were thoroughly analyzed. This case study shows the importance of the identification and knowledge about anatomical variations considering that under specific pathological conditions, they can be a cause of clinical syndromes. Such knowledge is also important in the field of surgery for the prevention of iatrogenic injuries.

PHYSIOTHERAPEUTIC INTERVENTION RELIEVING TARSAL TUNNEL SYNDROME IN A RUNNER

“Tibial Nerve Dysfunction” or “Posterior Tibial Nerve Neuralgia” are terms used to describe Tarsal Tunnel Syndrome (TTS). It is a form of compressive neuropathy that emerges when the structures in the tarsal tunnel are compressed. In athletic individuals, TTS tends to be associated with running, jumping or impacted sports and so, is very common in middle aged runners. The symptoms include pain, paresthesia and numbness is the most common clinical presentation. A well designed physical therapy program plays an important role in recovering from such hampering conditions, a physical therapy rehabilitation program consist of pain reduction by using hot fermentation, contrast bath or paraffin wax bath. Strengthening of the musculature around ankle to avoid unnecessary forces on the joint along with balance training, agility training and education regarding footwear is essential for a complete recovery. Here, we report a case of 21 year old male, a Track Runner, presenting to the physiotherapy department at Acharya Vinoba Bhave Hospital Sawangi (M), Wardha with the complaints of severe pain and numbness in his right ankle over medial region of foot for past 5 days. Investigatory findings revealed that he was diagnosed with Tarsal Tunnel Syndrome over his right foot. Thereafter, he was treated conservatively with physical therapy interventions such as ankle exercises, stretching techniques, taping, theraband, strengthening etc. The purpose of this case study is to: To study the physiotherapeutic interventions, playing a major role in managing the case of tarsal tunnel syndrome. Conclusion: This case study concludes that physiotherapeutic interventions and exercises plays an important role in managing the signs and symptoms of tarsal tunnel syndrome.

The effect of ergonomic educational intervention on the exacerbation rate of carpal tunnel syndrome (CTS) among employees of governmental banks

Introduction: Carpal tunnel syndrome (CTS) is the most common peripheral nerve compressive neuropathy. Some occupational factors influence the development of this syndrome, such as frequent and prolonged work with hands and fingers. The purpose of this study was to evaluate the symptoms and functional status of CTS and to evaluate the effect of ergonomic educational intervention on the exacerbation rate of CTS among employees of governmental banks. Materials and Methods: This descriptive-analytical study was conducted in the state banks of Torbat Heydariyeh. Symptoms severity and functional status of Carpal Tunnel Syndrome were assessed using Boston Questionnaire. The wrist ratio was measured with a caliper. Data were analyzed by SPSS 23 software using Wilcoxon and Chi-square tests. Results: The results showed that staff with wrist dimensions greater than 0.7 (square wrist) had more severe CTS symptoms and functional status. Also, there was a significant relationship between the dominant hand and CTS symptoms. (p<0.0001). Results of comparing the severity of symptoms and functional status of carpal tunnel syndrome in the two groups before and after the intervention show that the percentage of the severity of symptoms of severe and moderate carpal tunnel syndrome in the post-intervention group was significantly lower than before; (Z= -3.317, p<0.0001). Conclusion: The results show that the severity of symptoms, functional status of carpal tunnel syndrome among bank employees at three levels of mild, moderate, and severely decreased significantly after ergonomic intervention. Ergonomics training intervention is an easy, low-cost, and practical method that can be used as an effective program to improve the symptoms of people with carpal tunnel syndrome in banks.

Epidemiology and approach in Carpal Tunnel Syndrom: An analysis of the impact on return on labor

Background: Carpal Tunnel Syndrome (CTS) is defined as a focal, chronic and symptomatic compressive neuropathy of the median nerve at the wrist. It is the most prevalent neuropathy in the population. The objective of the study to describe the epidemiological, clinical and occupational profile of patients with CTS who underwent median nerve neurolysis in the carpus and the Occupational Therapy intervention attended by the Sistema Único de Saúde (SUS). Methods: This is a descriptive study, carried out from january 2014 to december 2017 at Centro Estadual de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), in the city of Goiânia, located in the Center-West region of Brazil. The Reference population covered the medical records of patients submitted to the surgical procedure and rehabilitation. During this period, 698 patients underwent surgery and rehabilitation, and the sample of 249 charts analyzed was defined by means of a sample calculation using the finite sample proportion test. A margin of error of 5% was considered in the calculation. Out-of-time-range patients and those with other associated hand injuries were excluded. Our study was approved by the Research Ethics Committee registered under number 97279.121. The data were analyzed with the aid of the SPSS 23 statistical package. In all analyzes, thes ignificancel evel adopted was 5% (p <0.05).Results: The demographic profile was composed of 223 women, representing 89.6% of the sample, in the age group between 40 and 59 years, being 74.7% of right-handed patients. Comorbidities were present in 63.1% of the patients and the main ones are Systemic Arterial Hypertension (SAH), Diabetes Mellitus (DM) and Fibromyalgia. The vast majority of cases were classified as severe or very severe staging. The labor distribution was categorized into 12 distinct groups, with workers doing domestic work prevailing. Conclusion: A greater bilateral involvement was observed in the studied sample, classified in the severe or very severe stages, which resulted in the surgical treatment and early intervention and systematization of occupational therapy, which favored the patient to be replaced in work activities in about 84, 7% of the cases surveyed.

Shear wave elastography of ulnar nerve in arm: An observational study for evaluation of performance

Objectives: The performance of shear wave elastography (SWE) for peripheral nerve pathology, predominantly compressive neuropathy, has been studied with the median nerve, sciatic nerve, and tibial nerve. However, studies for ulnar nerve are limited in literature. The aim of the study was to study the performance of SWE for ulnar nerve in arm by analyzing the correlation of elasticity value by two transducers of the same ultrasound system. Material and Methods: This was a prospective observational study. Elasticity of ulnar nerve was measured in the mid-arm and supracondylar region in longitudinal and transverse planes with two different transducers of the same ultrasound system. The reliability of measurement was assessed by interclass correlation of values obtained. Results: Ninety-two ulnar nerve measurement sets were analyzed. The ages of the patients ranged from 14 years to 76 years, with a median age of 50. The SWE values obtained by two probes showed a weak interclass correlation coefficient value <0.5. Conclusion: Quantitative SWE measurements of the ulnar nerve in the arm by two transducers showed a weak interclass correlation. It should be used with caution as a diagnostic tool with a universally acceptable cut off values.

High resolution ultrasonography of peripheral nerves in diabetic patients to evaluate nerve cross sectional area with clinical profile

Objectives: The aim of this observational study was ultrasound evaluation of peripheral nerves cross-sectional area (CSA) in subjects with probable diabetic peripheral sensorimotor neuropathy (DPN). CSA was analyzed with reference to clinical and nerve conduction study’s (NCS) parameters for early diagnosis and pattern of involvement. Methods: A total of 50 patients with probable DPN due to Type 2 diabetes and 50 age-matched healthy controls underwent sonographic examinations of ulnar nerve at the lower arm, median nerve proximal to carpal tunnel, the common peroneal nerve proximal to fibular head, tibial nerve proximal to the tarsal tunnel, and sural nerve at lower third leg. Results: CSA was increased in cases of DPN as compared to healthy controls. Area changes were more marked with demyelinating pattern. Probable DPN cases with normal NCS had significantly higher number of peripheral nerves showing increased CSA as compared to healthy control. A cut-off of >4 nerve thickening showed a sensitivity of 86 %, and specificity of 56%. The neuropathy pattern in the lower limb was axonal, whereas in the upper limb, it was demyelinating with the majority showing sonographic feature of associated compressive neuropathy. Conclusion: There is an increase in CSA of peripheral nerve in diabetic patients. It can be used as a morphological marker for classifying DPN with changes being picked up earlier to NCS abnormality. Clinical neurological presentation in probable DPN can also be due to compressive neuropathy in early phases, and ultrasound can be a useful tool. Advances in knowledge: Early pick up of DPN cases shall be useful for early therapy and motivating the patients to actively participate in the treatment. Morphological changes on ultrasonography precedes the electrodiagnostic change in DPN. Symptoms of DPN is not only due to metabolic changes but also compressive neuropathy.

Investigation of Neuropathology after Nerve Release in Chronic Constriction Injury of Rat Sciatic Nerve

Peripheral compressive neuropathy causes significant neuropathic pain, muscle weakness and prolong neuroinflammation. Surgical decompression remains the gold standard of treatment but the outcome is suboptimal with a high recurrence rate. From mechanical compression to chemical propagation of the local inflammatory signals, little is known about the distinct neuropathologic patterns and the genetic signatures after nerve decompression. In this study, controllable mechanical constriction forces over rat sciatic nerve induces irreversible sensorimotor dysfunction with sustained local neuroinflammation, even 4 weeks after nerve release. Significant gene upregulations are found in the dorsal root ganglia, regarding inflammatory, proapoptotic and neuropathic pain signals. Genetic profiling of neuroinflammation at the local injured nerve reveals persistent upregulation of multiple genes involving oxysterol metabolism, neuronal apoptosis, and proliferation after nerve release. Further validation of the independent roles of each signal pathway will contribute to molecular therapies for compressive neuropathy in the future.