Ultrasonographic evaluation of the median nerve: normal and variant anatomy and appearance

The median nerve is a mixed sensory and motor nerve that innervates part of the flexor muscles in the anterior compartment of the forearm and muscles in the lateral part of the hand; palmar cutaneous and digital cutaneous nerves branch from the median nerve, which provides sensory innervation to the skin on the radial side of the palm. Also, the median nerve is an object of interest because neuropathy of the median nerve at the level of the carpal tunnel is the most common entrapment neuropathy which increases dramatically in patients with diabetes. Neuromuscular ultrasound provides extensive diagnostic information and has proved itself as a useful complementary test to electrodiagnostic examinations in cases involving median nerve neuropathy. It often happens that the cause of nerve entrapment and neuropathy are variants of several anatomical structures along the course of the median nerve. It is important to be aware and report such anatomical variations of the median nerve in order to avoid damaging the nerve during surgical treatment. Despite the frequently documented abnormalities in the pathway of the brachial plexus and the median nerve, the anatomical variations are unusual to see and are rarely reported. Moreover, there are variations that do not fit under any of the classifications described in the literature.

Venipuncture-Related Median Nerve Palsy Disguised as Intraoperative Brachial Plexus Injury

Iatrogenic peripheral nerve injuries may result from transection, stretch, compression, injections, ligature, heat, anticoagulant use, and radiation. Iatrogenic median nerve palsy has been reported rarely. We report a case of a woman who underwent craniectomy for treatment of trigeminal neuralgia. Intraoperatively, a transient decline in the amplitude of the left upper extremity somatosensory evoked potentials (SSEPs) was noted. This finding was presumed to be due to the traction on the brachial plexus as it improved with repositioning. Immediately upon waking from anesthesia, the patient experienced sensorimotor deficits in the left median nerve distribution. Ecchymoses from venipuncture were observed in this area. Electrodiagnostic studies confirmed a left median nerve neuropathy localized in the antebrachial area. Neurosurgeons and neurologists should be alert to potential iatrogenic median nerve palsy following vascular access at the antebrachial region. Vascular access could be performed under the ultrasound guidance when a patient is under anesthesia or unable to give sensory feedback. Furthermore, placing an additional recording electrode over the proximal upper arm during intraoperative SSEP monitoring aids in distinguishing between brachial plexus and peripheral nerve injuries.

A rare and severe case of pronator teres syndrome

We present the case of a patient with severe symptoms of proximal forearm median nerve neuropathy. Over the course of 5 years his condition progressed to encompass rare features of combined pronator teres syndrome (PTS) and anterior interosseous nerve syndrome (AINS). The aetiology was found to be pronator teres compression and was managed successfully by surgical decompression. Proximal forearm median nerve compression should be considered as a continuum with two classic endpoints. At one end of the spectrum pure PTS presents with solely or mainly sensory symptoms, whereas at the other end AINS presents with pure motor symptoms. Hence, all possible anatomical sites of compression must be surgically explored in all cases of PTS or AINS, regardless of symptomatology. Timely referral to an experienced specialist is encouraged to ensure good outcomes, whenever a primary care practitioner encounters an atypical carpal tunnel syndrome-like presentation.

Acute Upper Limb Ischemia Due to Delayed Presentation of a Brachial Artery Pseudoaneurysm Post-Venipuncture

Brachial artery pseudoaneurysms (BAPs) are rare but could lead to complications of high morbidity. We report a case of a BAP presenting with hand ischemia and median nerve neuropathy nearly a decade after the inciting iatrogenic trauma, successfully treated with excision and direct repair. This report highlights that untreated pseudoaneurysms can be indolent and present late with both symptoms of embolization and local compression.

ANALISIS FAKTOR PENYEBAB CARPAL TUNNEL SYNDROME PADA IBU RUMAH TANGGA DI POLI SARAF RSUD SOEDONO MADIUN 2019

Carpal Tunnel Syndrome (CTS) is the most frequent median nerve neuropathy. It causes by compression of median nerve at the wrist. Edema, tendon inflammation, hormonal changes, and manual activity can contribute to increased nerve compression and sometimes cause pain. Sometimes it is resulting in weakness of hands. The estimated prevalence of CTS show between 4% to 5% of the population especially between the ages 40-60 years old. CTS has been reported to affect mostly women. The suspected risk factor include diabetes mellitus, menopause, obesity, arthritis, and pregnancy. CTS happens when carpal tunnel pressure increase that leads to axonal degeneration of median nerve and neuritis. A housewife does many works such as washing clothes, cooking, sweeping, and many more. That works use wrist hand frequently and mostly affected to median nerve.