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Boyd, Carter J., Nikhi P. Singh, Joseph X. Robin, and Sheel Sharma. "Compression Neuropathies of the Upper Extremity: A Review." Surgeries 2, no. 3 (2021): 320–34. http://dx.doi.org/10.3390/surgeries2030032.
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Compressive neuropathies of the forearm are common and involve structures innervated by the median, ulnar, and radial nerves. A thorough patient history, occupational history, and physical examination can aid diagnosis. Electromyography, X-ray, and Magnetic Resonance Imaging may prove useful in select syndromes. Generally, first line therapy of all compressive neuropathies consists of activity modification, rest, splinting, and non-steroidal anti-inflammatory drugs. Many patients experience improvement with conservative measures. For those lacking adequate response, steroid injections may improve symptoms. Surgical release is the last line therapy and has varied outcomes depending on the compression. Carpal Tunnel syndrome (CTS) is the most common, followed by ulnar tunnel syndrome. Open and endoscopic CTS release appear to have similar outcomes. Endoscopic release appears to incur decreased cost baring a low rate of complications, although this is debated in the literature. Additional syndromes of median nerve compression include pronator syndrome (PS), anterior interosseous syndrome, and ligament of Struthers syndrome. Ulnar nerve compressive neuropathies include cubital tunnel syndrome and Guyon’s canal. Radial nerve compressive neuropathies include radial tunnel syndrome and Wartenberg’s syndrome. The goal of this review is to provide all clinicians with guidance on diagnosis and treatment of commonly encountered compressive neuropathies of the forearm.
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Ross, Robert G. "Nerve Compression Syndromes of the Upper Limb." Journal of Hand Therapy 15, no. 4 (2002): 379–80. http://dx.doi.org/10.1016/s0894-1130(02)80011-4.
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Slavik, E. E., B. M. Djurovic, D. V. Radulovic, et al. "Neurovaskularna kompresija (konflikt)." Acta chirurgica Iugoslavica 55, no. 2 (2008): 161–68. http://dx.doi.org/10.2298/aci0802161s.
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Since Dandy first reported vascular compression of the trigeminal nerve, the concept of neurovascular compression syndrome for trigeminal neuralgia and hemifacial spasm (HFS) has been accepted, and neurovascular decompression has been performed for this condition. The further investigations indicated that some other clinical syndromes such as glossopharyngeal neuralgia, disabling positional vertigo, tinnitus, geniculate neuarlgia, spasmodic torticolis, essential hypertension, cyclic oculomotor spasm with paresis and superior oblique myokymia also may be initiated by vascular compression of the glosopharyngeal, cochleovestibular, intermediate, accessory, oculomotor and trochlear nerves or the ventrolateral medulla oblongata. In this study several hypotheses regarding the development of cranial nerves vascular compression syndromes are presented. It is also emphasized the value of high-resolution magnetic resonance tomographic angiography for visualization of vascular compression. The most frequent clinical syndromes caused by vascular compression of the cranial nerves are discussed regarding the pathogenesis, symptoms and therapy. We present our series of 124 patients with preoperative evidently positive finding of vascular compression to the trigeminal nerve (MRI). Microvascular decompression (MVD)was performed in all of them. Initial postoperative result was excellent in 110/124 (89%) patients, while in 11/124 (9%) patients the pain relief was satisfactory. In the remaining three patients MVD failed. Recurrence of pain after two years reached 19 %. Complications were related to diplopia associated with transient fourth nerve dysfunction in 5 (4%) patients, facial motor dysfunction in 4 (3%) patients, transient facial hypesthesia in 27 (22%) patients and partially hearing loss in 4 (3%) patients. Cerebellar hemorrhagic infarction occurred in 1 ( 0,8 %) patient and cerebrospinal fluid leaks appeared in two (1,6%) cases. There was no lethal outcome.
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Filatova, Elena Vladimirovna, Irina Ivanovna Ivanova, Olga Aleksandrovna Bulakh, Olga Viktorovna Trunova, and Marina Valentinovna Supova. "The experience of using fermenkol phonophoresis in complex therapy of carpal tunnel syndrome." Fizioterapevt (Physiotherapist), no. 2 (February 1, 2021): 38–44. http://dx.doi.org/10.33920/med-14-2104-05.
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The issue of compression ischemic syndromes, in particular, carpal tunnel syndrome, is currently extremely relevant. Prolonged compression of the nerve leads to irreversible consequences and degeneration of its fibers, followed by neurogenic muscle atrophy and permanent loss of function. Standard medical and physical therapy methods of treatment do not always achieve a positive effect. The paper considers the results of the use of phonophoresis of hydrocortisone and fermenkol in 35 patients with carpal tunnel syndrome. Positive dynamics was noted in both groups, which increases the possibility of treatment tactics selection for patients of this profile.
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Pjevic, Miroslava, Erzebet Patarica-Huber, Dragana Radovanovic, and Sanja Vickovic. "Neuropathic pain due to malignancy: Mechanisms, clinical manifestations and therapy." Medical review 57, no. 1-2 (2004): 33–40. http://dx.doi.org/10.2298/mpns0402033p.
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Introduction Neuropathic pain in cancer patients requires a focused clinical evaluation based on knowledge of common neuropathic pain syndromes. Definition Neuropathic pain is a non-nociceptive pain or "differentiation" pain, which suggests abnormal production of impulses by neural tissue that is separated from afferent input. Impulses arise from the peripheral nervous system or central nervous system. Causes of neuropathic pain due to malignancy Neuropathic pain is caused directly by cancer-related pathology (compression/infiltration of nerve tissue, combination of compression/infiltration) or by diagnostic and therapeutic procedures (surgical procedures, chemotherapy, radiotherapy). Mechanisms Pathophysiological mechanisms are very complex and still not clear enough. Neuropathic pain is generated by electrical hyperactivity of neurons along the pain pathways. Peripheral mechanisms (primary sensitization of nerve endings, ectopically generated action potentials within damaged nerves, abnormal electrogenesis within sensory ganglia) and central mechanisms (loss of input from peripheral nociceptors into dorsal horn, aberrant sprouting within dorsal horn, central sensitization, loss of inhibitory interneurons, mechanisms at higher centers) are involved. Diagnosis The quality of pain presents as spontaneous pain (continuous and paroxysmal), abnormal pain (allodynia, hyperalgesia, hyperpathia), paroxysmal pain. Clinical manifestations Clinically, neuropathic pain is described as the pain in the peripheral nerve (cranial nerves, other mononeuropathies, radiculopathy, plexopathy, paraneoplastic peripheral neuropathy) and relatively infrequent, central pain syndrome. Therapy Treatment of neuropathic pain remains a challenge for clinicians, because there is no accepted algorithm for analgesic treatment of neuropathic pain. Pharmacotherapy is considered to be the first line therapy. Opioids combined with non-steroidal antiinflammatory drugs are warrented. If patient is relatively unresponsive to an opioid, a trial with adjuvant analgesics might be considered. Tricyclic antidepressants might be selected for patients with continuous dysesthesia, and anticonvulsants might be used if the pain is predominanty lancinating or paroxysmal. The complexity of neuropathic syndromes and underlying etiologic mechanisms warrant clinical trials to determine appropriate treatment.
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Schlosshauer, Burkhard, Lars Dreesmann, Hans-Eberhard Schaller, and Nektarios Sinis. "Synthetic Nerve Guide Implants in Humans: A Comprehensive Survey." Neurosurgery 59, no. 4 (2006): 740–48. http://dx.doi.org/10.1227/01.neu.0000235197.36789.42.
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Abstract OBJECTIVE: Lesions of the peripheral nervous system result in the loss of sensory and motor function and may in addition be accompanied by severe neuropathic syndromes originating from aberrant axonal regrowth. The transplantation of autologous nerve grafts represents the current “gold standard” during reconstructive surgery, despite obvious side effects. Depending on the demands of the lesion site, various donor nerves may be used for grafting (e.g., the sural, saphenous), sacrificing native functions in their target areas. Recently, several synthetic nerve guide implants have been introduced and approved for clinical use to replace autologous transplants. This alternative therapy is based on pioneering studies with experimental nerve guides. METHODS: We present a comprehensive review of all published human studies involving synthetic nerve guides. RESULTS: Data from some 300 patients suggest that for short nerve defects of a few centimeters, resorbable implants provide promising results, whereas a number of late compression syndromes have been documented for nonresorbable implants. CONCLUSIONS: To treat longer defects, further implant development is needed, a goal that could be achieved, for example, by more closely imitating the intact nerve architecture and regulatory cell-cell interactions.
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Kvasnitskyi, M. V. "SANOGENESIS OF PAIN SYNDROMES CAUSED BY DEGENERATIVE-DYSTROPHIC SPINE DAMAGE." Клінічна та профілактична медицина 2, no. 16 (2021): 86–98. http://dx.doi.org/10.31612/2616-4868.2(16).2021.11.
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Aim. Explore different treatment approaches for degenerative-dystrophic damage of the spine and formulate the most effective treatment methods, their stage from accounting pathogenetic basis of pain syndromes.
Research methods – bibliosemantic, comparative, systemic.
Results. Diverse treatments for degenerative-dystrophic damage of the spine does not facilitate but even complicates general practitioner’s work due to the fact that information on clinical benefits of various drugs and techniques as well as various types of surgery is too contradictory; there is no single method of consistent, combination therapy for vertebrogenic pain. There is no universal therapy or surgery that would provide sustainable relief of symptoms of nonspecific back pain and/or radicular syndrome. The pathogenesis of development of specific clinical manifestations of the disease and the ratio of clinical manifestations and pathomorphological changes are crucial in choosing the treatment. The general principles of treatment are unchanged: rest, analgesics and movement should be combined in appropriate sanogenic proportions in each case. Reduction of oedema and swelling of the intervertebral disc and the spinal nerve root, nerve endings are crucial in regression of pain syndrome. There is no doubt that nonsteroidal anti-inflammatory drugs (NSAIDs) are the most effective in relieving lumbar and radicular pain at the beginning of treatment. In the absence of significant improvement after the use of NSAIDs and the necessary sanogenic motor loads, a more dynamic treatment should be used. First of all, different methods of local administration of pharmacological drugs: starting with the banal subcutaneous injection of painful areas and finishing with ultrasound and MRI-controlled injections directly into the area around the damaged nerve root, the epidural space, or the facet joint. In most cases, epidural injections can reach areas of disc-radicular conflict – after the drug is injected into the epidural space, favourable conditions are created for diffusion of glucocorticoids (or other pharmacological agents) into surrounding tissues, as well as the nerve root, regardless of its compression or irritation.
Conclusions. And only after the ineffectiveness of NSAIDs and puncture treatments, as well as epidural injection and in the case of persistent mechanical compression of nerve roots in comparison with clinical manifestations, appropriate surgical treatments, both minimally invasive and open, are necessary.
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CAETANO, EDIE BENEDITO, JOÃO PAULO NUNES TOLEDO, SÉRGIO APARECIDO DO AMARAL JÚNIOR, LUIZ ANGELO VIEIRA, BEATRIZ D’ANDREA PIGOSSI, and RENATO ALVES DE ANDRADE. "INNERVATION OF THE MEDIAN NERVE MOTOR BRANCHES IN THE FOREARM AND ITS CLINICAL SIGNIFICANCE." Acta Ortopédica Brasileira 28, no. 5 (2020): 251–55. http://dx.doi.org/10.1590/1413-785220202805235028.
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ABSTRACT Objective: To analyse the anatomical variations of the median nerve motor branches in the elbow region. Methods: Twenty upper limbs of 10 adult male cadavers were prepared by intra-arterial injection of a solution of 10% glycerol and formaldehyde. All cadavers belonged to the institution anatomy laboratory. Results: We found a great variability within the distribution of median nerve branches leading to forearm muscles. Only three limbs (14%) presented the normal standard of innervation described in anatomy treatises. The pronator teres muscle (PTM), flexor carpi radialis (FCR), palmaris longus (PL), and the flexor digitorum superficialis (FDS) received exclusive innervation from the median nerve in all forearms. The anterior interosseous nerve (AIN) also originated from the median nerve in all dissected limbs. Conclusion: A thorough understanding of the anatomy of the median nerve branches is important for performing surgeries such as: approach to the proximal third of the forearm, alleviation of pronator teres and anterior interosseous nerve compression syndromes, and distal nerve transfers. It also enables a better understanding the recovery of muscle function after a nerve injury. Level of Evidence IV, Case series.
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Richter, Hans-Juergen, Roger Berbig, and Pietro Segantini. "Bilateral Radial Nerve Compression Syndrome in an Elite Swimmer." American Journal of Sports Medicine 30, no. 4 (2002): 614–17. http://dx.doi.org/10.1177/03635465020300042301.
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Lupo, F. A., and A. Paladini. "Magnetic Resonance Imaging in Non-Traumatic Canalicular Peripheral Neuropathy of the Arm." Rivista di Neuroradiologia 11, no. 1 (1998): 39–42. http://dx.doi.org/10.1177/197140099801100104.
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The term canalicular neuropathy is applied to nerve lesions arising on nerve segments passing through the osteofibrous canals or other narrow orifices and resulting in nerve compression and entrapment. We studied 31 patients referred to us for non-traumatic canalicular syndromes in the upper limbs. After clinical, electrophysiological and morphological analysis of each case, we emphasize the role of MR imaging in establishing prognosis and selecting treatment. Anatomosurgical specimens correlated well with MR features, whereas there was little correlation between electrophysiological severity and anatomical changes. In summary, canalicular neuropathy is a clinical syndrome. The aim of MR investigation is to document the morphological changes which will serve to institute appropriate treatment. When patients have clinical and electrophysiological evidence of neuropathy without MR demonstration of the nerve lesion, therapy will be conservative, thus saving the cost and risk of surgery. On the other hand, when clinical and electrophysiological findings are flanked by MR demonstration of the neuropathy, the disease is known to be advanced and surgery will be indicated to prevent neurotmesis.
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BALINT, Nela Tatiana. ""PHYSICAL THERAPY IMPLICATIONS IN THE REHABILITATION OF NERVE COMPRESSION SYNDROME PATIENTS "." Series IX: Sciences of Human Kinetics 12(61), no. 1 (2019): 195–202. http://dx.doi.org/10.31926/but.shk.2019.12.61.26.
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Deolankar, Apurva. "EFFECT OF MATRIX RHYTHM THERAPY ON A CHRONIC CASE OF MEDIAN NERVE ENTRAPMENT AT THE ELBOW JOINT." Journal of Medical pharmaceutical and allied sciences 10, no. 3 (2021): 2745–46. http://dx.doi.org/10.22270/jmpas.v10i3.1080.
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Pronator teres syndrome is a rare condition, in which compression on the median nerve occurs at the elbow joint. It is a very rare condition compare to carpel tunnel syndrome. Compression can cause pain and numbness in the hand. The most common cause of pronator teres syndrome is compression of the median nerve in between the two belley’s of pronator teres muscles. In the case of advanced disease, the pain and numbness can be managed by prednisolone injections. Some of the literature shows massage therapy also works on relieving the symptoms. Matrix rhythm therapy (MaRhyThe) has shown to be beneficial in the treatment of pain and movement disturbances. Matrix rhythm therapy is invented by Dr.Randoll from Germany for the treatment of pain and does not have side effects. The case report was aimed to evaluate the effect of matrix rhythm therapy on pronator teres syndrome which lasted for 60 minutes each day for 3 days and was divided into 3 zones along with other physiotherapy interventions. It showed a positive result in pronator teres syndrome as the pain was reduced on the 3rd day of the session.
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Osipova, Liliya L., L. M. Kuzenkova, A. L. Kurenkov, et al. "DYNAMICS OF CLINICAL AND ELECTROPHYSIOLOGICAL CHARACTERISTICS OF CARPAL TUNNEL SYNDROME IN CHILDREN WITH MUCOPOLYSACCHARIDOSES AGAINST THE BACKGROUND OF ENZYME-REPLACEMENT THERAPY." Russian Pediatric Journal 21, no. 3 (2019): 152–56. http://dx.doi.org/10.18821/1560-9561-2018-21-3-152-156.
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Introduction. Mucopolysaccharidoses are the most common cause of the carpal tunnel syndrome in children. Enzyme-replacement therapy, which is available in clinical practice within last 10-15 years for mucopolysaccharidoses I, II and VI demonstrated the efficacy regarding somatic symptoms of the diseases, however, the impact of this new pathogenetic treatment on neuropathy of median nerve, arising from compression in the carpal tunnel, is poorly described. Objective. To study the dynamics of clinical and electrophysiological characteristics of carpal tunnel syndrome in children with mucopolysaccharidoses during enzyme-replacement therapy. Materials and methods. 18 children with mucopolysaccharidoses I, II and VI, received enzyme-replacement therapy, are included in the study. Dynamics of clinical symptoms of the carpal tunnel syndrome and EMG indices of median nerve testing are described against the background of enzyme-replacement therapy. Results. Objective and subjective clinical manifestations of the carpal tunnel syndrome persisted or appeared in children, receiving enzyme-replacement therapy for 21±12 months. However, there were no statistically significant changes in EMG-characteristics of median nerves testing during enzyme-replacement therapy in children with mucopolysaccharidoses Conclusion. Enzyme-replacement therapy in children with mucopolysaccharidoses I, II and VI may suspend and/or delay progressive damage of median nerves in the carpal canal, thus indicating prevention and slowing down in glycosaminoglycans storage in the carpal tunnel.
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NATHAN, P. A., R. C. KENISTON, and K. D. MEADOWS. "Outcome Study of Ulnar Nerve Compression at the Elbow Treated with Simple Decompression and an Early Programme of Physical Therapy." Journal of Hand Surgery 20, no. 5 (1995): 628–37. http://dx.doi.org/10.1016/s0266-7681(05)80125-1.
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Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper limb. This paper presents the experience of treating cubital tunnel syndrome with simple decompression in 131 patients (164 ulnar nerves) over the past 12 years. 85% of these patients had mild or moderate ulnar nerve disease. In 146/164 ulnar nerves (89%), simple decompression resulted in good or excellent immediate post-operative relief of symptoms. After an average follow-up of 4.3 years (range, 0.8–12.0 years), 130/164 (79%) still reported good or excellent relief. The independent predictors of a better long-term outcome were absence of post-operative subluxation, greater body weight, normal pre-operative two-point discrimination (2-PD), and a more recent date of operation. A physical therapy rehabilitation program generally began on the day after surgery. Active participation in this predicted a rapid return to work or activities of daily living. The average time to return to work with simple decompression was 20 workdays.
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Koshenkova, E., and V. Belash. "Osteopathic Correction of Compression-ischemic Neuropathy of the Median Nerve in the Carpal Tunnel." Russian Osteopathic Journal, no. 3-4 (December 30, 2015): 59–67. http://dx.doi.org/10.32885/2220-0975-2015-3-4-59-67.
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Annisa, Devi, Sri Budhi Rianawati, Masruroh Rahayu, Neila Raisa, and Shahdevi Nandar Kurniawan. "CARPAL TUNNEL SYNDROME (DIAGNOSIS AND MANAGEMENT)." JPHV (Journal of Pain, Vertigo and Headache) 2, no. 1 (2021): 5–7. http://dx.doi.org/10.21776/ub.jphv.2021.002.01.2.
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Carpal Tunnel Syndrome (CTS) is a neuropathy disease that affects the median nerve with an incidence of around 90%. Carpal Tunnel Syndrome appears in 3.8% of the general population, with the highest prevalence occurring in women. There are several risk factors associated with CTS, namely medical and non-medical factors. The mechanism of carpal tunnel syndrome until now is still very complex and is not known with certainty, but compression and traction factors in the median nerve are thought to be the most common cause of CTS. Carpal Tunnel Syndrome can manifest clinically with subjective signs such as paresthesia, proprioceptive changes, and paresis, as well as objective signs, such as changes in motor sensitivity and function, positive Tinel and Phallen tests, and thenar muscle atrophy. The diagnosis of Carpal Tunnel Syndrome is based on the classic symptoms of pain, numbness, tingling, and/or burning sensation in the distribution of the median nerve in the hand, as well as the abnormal function of the median nerve based on nerve conduction studies. Conservative therapy is an option. Especially in Carpal Tunnel Syndrome patients with mild to moderate symptoms. Conservative therapy can be given in the form of corticosteroid and physical therapy. Patients with severe CTS or whose symptoms have not improved after four to six months of conservative therapy should be considered for surgical treatment.
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Ghahramani, Aria, Mona L. Camacci, Rucha Borkhetaria, Anne Poulsen, Samuel Beckstead, and Christopher Weller. "Traumatic Optic Nerve Sheath Hematoma." Case Reports in Ophthalmology 12, no. 2 (2021): 569–73. http://dx.doi.org/10.1159/000514188.
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The aim of this report is to present a patient with traumatic optic nerve sheath hematoma (ONSH), a rare diagnosis with high potential for visual sequelae. This case involves a 41-year-old male who presented promptly following blunt trauma to the right eye and orbit that resulted in acute vision loss. Following computed tomography and ophthalmic examination, a diagnosis of ONSH was made and medical therapy with methylprednisolone was initiated. He reported significant improvements in visual symptoms following intravenous corticosteroid therapy. Although the patient reported significant improvements and had normal Snellen visual acuities in follow-up, he continued to have an inferior visual field defect at 1 week in the affected eye. ONSH causing subsequent localized compression of the optic nerve is a rare mechanism of traumatic optic neuropathy in patients following head trauma. The localized compartment syndrome of the optic nerve and subjective visual symptoms were relieved following corticosteroid therapy with no initial need for surgical decompression. Although central visual acuity returned to baseline, the patient had a persistent visual field defect and relative afferent pupillary defect.
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Bokov, Dr Andrey. "An Analysis of Reasons for Failed Back Surgery Syndrome and Partial Results after Different Types of Surgical Lumbar Nerve Root Decompression." Pain Physician 6;14, no. 6;12 (2011): 545–57. http://dx.doi.org/10.36076/ppj.2011/14/545.
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Background: Despite the evident progress in treating vertebral column degenerative diseases, the rate of a so-called “failed back surgery syndrome” associated with pain and disability remains relatively high. However, this term has an imprecise definition and includes several different morbid conditions following spinal surgery, not all of which directly illustrate the efficacy of the applied technology; furthermore, some of them could even be irrelevant. Objective: To evaluate and systematize the reasons for persistent pain syndromes following surgical nerve root decompression. Study Design: Prospective, nonrandomized, cohort study of 138 consecutive patients with radicular pain syndromes, associated with nerve root compression caused by lumbar disc herniation, and resistant to conservative therapy for at least one month. The minimal period of follow-up was 18 months. Setting: Hospital outpatient department, Russian Federation Methods: Pre-operatively, patients were examined clinically, applying the visual analog scale (VAS), Oswestry Disability Index (ODI), magnetic resonance imaging (MRI), discography and computed tomography (CT). According to the disc herniation morphology and applied type of surgery, all participants were divided into the following groups: for those with disc extrusion or sequester, microdiscectomy was applied (n = 65); for those with disc protrusion, nucleoplasty was applied (n = 46); for those with disc extrusion, nucleoplasty was applied (n = 27). After surgery, participants were examined clinically and the VAS and ODI were applied. All those with permanent or temporary pain syndromes were examined applying MRI imaging, functional roentgenograms, and, to validate the cause of pain syndromes, different types of blocks were applied (facet joint blocks, paravertebral muscular blocks, transforaminal and caudal epidural blocks). Results: Group 1 showed a considerable rate of pain syndromes related to tissue damage during the intervention; the rates of radicular pain caused by epidural scar and myofascial pain were 12.3% and 26.1% respectively. Facet joint pain was found in 23.1% of the cases. Group 2 showed a significant rate of facet joint pain (16.9%) despite the minimally invasive intervention. The specificity of Group 3 was the very high rate of unresolved or recurred nerve root compression (63.0%); in other words, in the majority of cases, the aim of the intervention was not achieved. The results of the applied intervention were considered clinically significant if 50% pain relief on the VAS and a 40% decrease in the ODI were achieved. Limitations: This study is limited because of the loss of participants to follow-up and because it is nonrandomized; also it could be criticized because the dynamics of numeric scores were not provided. Conclusion: The results of our study show that an analysis of the reasons for failures and partial effects of applied interventions for nerve root decompression may help to understand better the efficacy of the interventions and could be helpful in improving surgical strategies, otherwise the validity of the conclusion could be limited because not all sources of residual pain illustrate the applied technology efficacy. In the majority of cases, the cause of the residual or recurrent pain can be identified, and this may open new possibilities to improve the condition of patients presenting with failed back surgery syndrome. Key words: microdiscectomy, nucleoplasty, epidural scar, facet joint pain, recurrent herniation, myofascial pain
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Musalatov, H. A., A. G. Aganesov, M. N. Elizarov, and N. E. Khoreva. "Ossification of posterior longitudinal ligament: its role in the development of nerve root syndrome in lumber osteochondrosis." N.N. Priorov Journal of Traumatology and Orthopedics 3, no. 1 (1996): 16–18. http://dx.doi.org/10.17816/vto64065.
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The results of surgical treatment of 222 patients with lumbar osteochondrosis complicated by nerve root syndrome with proved nerve compression show that prolonged conservative treatment including physiotherapy, distraction, manual therapy aggravates the patients condition due to stimulation of the proliferative processes in spinal canal. Timely surgical treatment allows to prevent the complications, decrease the disability duration and to return the patient to everyday life and work with minimum economic and time costs.
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Abd Elrazik Gad Elhak, Reda Kotb, Hanan Hosny M. Battesha, and Sara Mohamed Samir. "Muscle energy technique versus active release technique on motor functions in patients with carpal tunnel syndrome." International Journal of Therapy and Rehabilitation 28, no. 7 (2021): 1–11. http://dx.doi.org/10.12968/ijtr.2020.0114.
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Introduction Carpal tunnel syndrome is the most common median nerve neuropathy, accounting for 90% of all neuropathies, with prevalence in the general UK adult population ranging from 7–16% and bilateral symptoms reported in more than 50% of all cases. The pathophysiological mechanisms involved in the median nerve compression and traction are thought to be complex. This study compared the effectiveness of muscle energy technique and active release technique in patients with carpal tunnel syndrome. Methods This study involved a total of 30 male and female patients with carpal tunnel syndrome, aged between 30 and 50 years. The patients were randomly assigned to two equal groups, group A and group B. Group A received muscle energy technique, and group B received active release technique. Results Independent one-tailed t-tests revealed that the intragroup comparisons showed statistically significant increases in pinch grip strength and motor nerve conduction velocity of the median nerve post-treatment in group A (P=0.001 and 0.0001 respectively), while in group B, there were statistically significant increases in pinch grip strength and motor nerve conduction velocity post-treatment (P=0.037 and 0.043 respectively). The intergroup comparisons showed statistically significant differences in favour of group A. Conclusions Because there was little significant difference between the two groups, this study concluded that both treatment techniques were effective in increasing median motor nerve conduction and hand grip strength. However, muscle energy technique increased motor nerve conduction velocity and pinch grip muscle strength more than active release technique.
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Hill, Elspeth J. R., Lorna C. Kahn, Lynne M. Sterni, Susan E. Mackinnon, and John M. Felder. "Median Neuropathy After Blood Draw Mimics Painful Clenched Fist Syndrome in a Child." HAND 15, no. 2 (2019): NP31—NP36. http://dx.doi.org/10.1177/1558944719837674.
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Background: Clenched fist syndrome is a rare disorder, often attributed to a conversion disorder without anatomic basis. Here, we review the literature surrounding clenched fist syndrome and challenge the assumption it is always psychiatric in origin, via description of a case of clenched fist syndrome responsive to surgical nerve decompression. Methods: An unusual case of clenched fist syndrome is reviewed and discussed. Results: A child presenting with clenched fist syndrome failed conservative measures consisting of formal hand therapy, multidisciplinary pain management, and psychiatric treatment. On clinical examination, she had findings consistent with median nerve entrapment. After undergoing surgical decompression of the median nerve in the forearm and carpal tunnel, the clenched fist resolved immediately. Conclusions: Nerve compression may be an unrecognized factor underlying some cases of clenched fist syndrome. Evaluation by a hand surgeon or a hand therapist skilled in the detection of peripheral nerve entrapment or injury should be considered as part of the workup for this rare disorder.
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Santi, Mark D., and Michael J. Botte. "Volkmann's Ischemic Contracture of the Foot and Ankle: Evaluation and Treatment of Established Deformity." Foot & Ankle International 16, no. 6 (1995): 368–77. http://dx.doi.org/10.1177/107110079501600610.
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Fibrotic contracture of skeletal muscle can follow weeks or months after the severe ischemic insult of compartment syndrome. Commonly known as Volkmann's ischemic contracture, the affected limb often becomes dys-functional and painful, and may lose sensibility. The pathogenesis of the muscle contracture includes prolonged ischemia, myonecrosis, fibroblastic proliferation, contraction of the cicatrix, and myotendinous adhesion formation. Resultant shortening or overpull of involved muscles leads to stiffness and deformity. Simultaneously, nerve injury from initial ischemia or subsequent soft tissue fibrotic compression leads to muscle paresis or paralysis of the involved compartment and of those muscles more distally innervated. The resultant deformity is thus a combination of varying degrees of contracture and weakness depending on which muscles and nerves are affected. Deformity and functional impairment in the foot and ankle secondary to ischemia are determined by many factors, including: (1) which leg compartment, if any, has been affected and to what degree extrinsic flexor or extensor overpull is exhibited, (2) degree of nerve injury sustained causing weakness or paralysis of extrinsic or intrinsic foot and ankle muscles, (3) which foot compartment, if any, has been affected and to what degree intrinsic overpull is exhibited, and (4) degree of sensory nerve injury leading to anesthesia, hypoesthesia, or hyperesthesia of the foot. Therefore, a variety of clinical presentations can be encountered following compartment syndrome of the leg and foot. Treatment is based on an appreciation of the patho-anatomy of the deformity. Nonoperative therapy is aimed at obtaining or preserving joint mobility, increasing strength, and providing corrective bracing and accom-modative footwear. Operative management is usually reserved for treatment of residual nerve compression or severe and problematic deformities. Established surgical protocols are performed in a stepwise fashion, to include: (1) release of residual or secondary nerve compression, (2) release of fixed contractures, using infarct excision, myotendinous lengthening, muscle recession, or tenotomy, (3) tendon transfers or arthrodesis to increase function, and (4) ostectomy or amputation for severe, refractory deformities.
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Kriachok, Iryna, and Katerina Ulianchenko. "THE COMPLICATIONS OF DIFFERENTIAL DIAGNOSTICS OF HODGKIN LYMPHOMA." EUREKA: Health Sciences 6 (November 30, 2016): 63–68. http://dx.doi.org/10.21303/2504-5679.2016.00249.
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In the article are presented the questions of classification, pathogenesis and clinical diagnostics of Hodgkin Lymphoma with soft-tissue paravetebral component. The difficulties of early diagnostics, expressed at the expanse by oncological process localization, not typical for this disease, are shown on clinical case. The symptoms, conditioned by the compression of organs by tumor masses depend on pathological process localization: intrahepatic and extrahepatic obstruction of bile duct is manifested by jaundice; obstruction of lymphatic ducts in groin zone or in zone of small pelvic – by legs edema; at tracheobronchial compression is observed the pant and hoarse breathing; pulmonary abscesses or caverns can take place as a result of infiltration of pulmonary parenchyma that can stimulate lobar consolidation or bronchopneumonia; paraplegia can be observed because of epidural invasion with spine cord compression; compression of sympathetic cervical recurrent guttural nerve by increased lymph nodes can cause Horner’s syndrome and laryngoparalysis; neuralgias can be the result of nerve-root incarceration. Differential diagnostics can take a long time that lowers the effectiveness of therapy and decreases chances for recovery because of special treatment delay. The setting of correct diagnosis and choice of adequate therapy raises the chances for recovery, even at spead stage of tumor process that is attained at Hodgkin lymphoma in most cases.
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Ellis, Jo, Helen Mckenna, and Frank D. Burke. "Hand Therapy for Carpal Tunnel Syndrome Part I: Overview of Disease and Non-surgical Management." British Journal of Hand Therapy 7, no. 2 (2002): 45–49. http://dx.doi.org/10.1177/175899830200700201.
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Carpal tunnel syndrome is the commonest peripheral nerve compression neuropathy and as such is frequently seen by hand therapists. Patients presenting with carpal tunnel syndrome are seen both in the primary and tertiary (hospital) settings and are referred for treatment at various stages of the disease process. The provision of splintage alone is viewed by some healthcare providers as conservative management for this condition. The purpose of this paper is to give a broad overview of conservative management options including posture and exercise, task modifications, splints, nerve and tendon-gliding exercises and ultrasound. It is the view of the authors that early and comprehensive treatment may relieve symptoms and potentially decrease the need for operative intervention, in the short to middle term at least, for patients with mild to moderate symptoms.
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Martins, Roberto Sérgio, and Mário Gilberto Siqueira. "Conservative therapeutic management of carpal tunnel syndrome." Arquivos de Neuro-Psiquiatria 75, no. 11 (2017): 819–24. http://dx.doi.org/10.1590/0004-282x20170152.
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ABSTRACT Carpal tunnel syndrome is the most prevalent nerve compression and can be clinically or surgically treated. In most cases, the first therapeutic alternative is conservative treatment but there is still much controversy regarding the most effective modality of this treatment. In this study, we critically evaluated the options of conservative treatment for carpal tunnel syndrome, aiming to guide the reader through the conventional options used in this therapy.
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Marcioli, Marieli Araujo Rossoni, Josinéia Gresele Coradini, Regina Inês Kunz, Lucinéia de Fátima Chasko Ribeiro, Rose Meire Costa Brancalhão, and Gladson Ricardo Flor Bertolini. "Nociceptive and Histomorphometric Evaluation of Neural Mobilization in Experimental Injury of the Median Nerve." Scientific World Journal 2013 (2013): 1–6. http://dx.doi.org/10.1155/2013/476890.
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The carpal tunnel syndrome is the most common peripheral neuropathy in the upper limb, but its treatment with conservative therapies such as neural mobilization (NM) is still controversial. The aim of this study was to investigate the efficacy of the NM as treatment in a model of median nerve compression. 18 Wistar rats were subjected to compression of the median nerve in the right elbow proximal region. Were randomly divided into G1 (untreated), G2 (NM for 1 minute), and G3 (NM for 3 minutes). For treatment, the animals were anesthetized and the right forelimb received mobilization adapted to humans, on alternated days, from the 3rd to the 13th day postoperatively (PO), totaling six days of therapy. Nociception was assessed by withdrawal threshold, and after euthanasia histomorphometric analysis of the median nerve was performed. The nociceptive evaluation showed in G2 and G3 delay in return to baseline. Histomorphometric analysis showed no significant differences in the variables analyzed. It is concluded that the NM was not effective in reducing nociceptive sensation and did not alter the course of nerve regeneration.
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Gohritz, Andreas, and Arnold Lee Dellon. "Bladder Pain Syndome/Interstitial Cystitis due to Pudendal Nerve Compression: Described in 1915—A Reminder for Treating Pelvic Pain a Century Later." Journal of Brachial Plexus and Peripheral Nerve Injury 15, no. 01 (2020): e5-e8. http://dx.doi.org/10.1055/s-0039-1700538.
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Abstract Background Interstitial cystitis (IC) or bladder pain syndrome (BPS) is highly painful and disabling and probably the most misdiagnosed urologic condition. Its classic symptoms of perineal pain, urinary urgency, and frequency despite sterile urine cultures were already described more than a century ago in a report on soldiers during World War (WW) I due to chronic pudendal nerve compression. Objectives This article translates a report from 1915 on pudendal neuropathy and discusses its author Georg Zülzer (1870–1949). Methods An English translation of the German original is provided with the biography and work of Zülzer, his clinical observations are discussed regarding modern diagnosis and therapy of pudendal nerve compression. Results In his article entitled “Irritation of the Pudendal Nerve (Neuralgia). A Frequent Clinical Picture during War Feigning Bladder Catarrh,” Zülzer describes his observation of soldiers during WW I, presenting with a triad of perineal pain, urinary urgency, and frequency despite sterile urine cultures excluding urinary infections. He also documented a characteristic skin hypersensibility of the perineum in a rhomboid shape which corresponds to the innervation area of the pudendal nerve with its two branches deriving from the “pudendal plexus.” He regards this symptomology as rare during peace, but as disease of trench warfare which can be easily diagnosed regarding clear urine and a painful skin island overlying the area of the pudendal nerve as tested by simple needle examination. Zülzer, born in Germany, was forced to emigrate to the United States in 1934, was also an important pioneer of diabetes research using pancreas extracts from dogs as early as 1907. Conclusion In this historical description, dating from about a century ago, Georg Zülzer probably gave the first exact clinical description of symptoms due to pudendal nerve compression. Pudendal nerve compression should always be taken into account when examining and treating patients with symptoms of IC/BPS.
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Ginting, Raynald Ignasius, Sabirin Berampu, Siti Sarah Bintang, Ni Nyoman Ayu Tamala Hardis, and Engraini Teja. "WORKSHOP NERVE GLIDING EXERCISE DAN PEMBERIAN ULTRA SOUND (US) TERHADAP PENURUNAN NYERI PADA KASUS CARPAL TUNNEL SYNDROME DI GRANDMED LUBUK PAKAM." JURNAL PENGMAS KESTRA (JPK) 1, no. 1 (2021): 120–24. http://dx.doi.org/10.35451/jpk.v1i1.747.
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The problem that often occurs for workers is Carpal tunnel syndrome (CTS). Carpal tunnel syndrome is a disorder of the hand due to compression of the median nerve in the carpal tunnel, either due to adhesions or abnormalities of the small bones of the hand. The median nerve innervates the thumb, index finger, middle finger and part of the ring finger, so that pain and parathesia can be felt in these areas. One way of non-pharmacological therapy that can be used in CTS is through the provision of nerve gliding exercise. Nerve gliding exercise and the administration of ultra sound (US) modality are done with the aim of reducing pressure on the wrist so that pain can be reduced. The results of this service activity stated that as many as 94% of participants as physiotherapists had understood and were able to use nerve gliding exercise and Ultra Sound (US) for pain reduction in CTS cases.
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Glazer, Ciprian, and Corina Pantea. "Systematic review of treatment methods for the carpal tunnel syndrome." Timisoara Physical Education and Rehabilitation Journal 12, no. 22 (2019): 7–12. http://dx.doi.org/10.2478/tperj-2019-0001.
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AbstractThe carpal tunnel syndrome is a common condition, localized at the hand and knuckle level, caused by a compression of the median nerve as it travels the rigid structures of the carpal tunnel. This phenomenon is, essentially, a compressive neuropathy.Aim: The purpose of our research is to comparatively analyze the treatment methods of the carpal tunnel syndrome: treatment by acupuncture, fascial manipulation, low-level laser therapy, cupping treatment, kinesiotaping, surgical treatment, orthosis method, nerve and tendon gliding exercises, and ultrasound therapy, based on the review of specialized articles relevant for the last 10 years.Methods: The research method consisted of 3 steps. First, we analyzed and selected 160 specialized articles, based on titles and key words; in the second step, we analyzed the summaries of the articles, thus, reducing the number to 50 articles. The third step consisted of selecting 7 relevant articles based on an article content review.Results: The results of treatment comparisons have proved that non-invasive therapies are superior to surgical treatments, taking into consideration symptom improvement, the maximum period up to noticeable results, relapse situations, patients’ preferences, etc.Conclusions: The results of manual, traditional and non-invasive therapies are similar to those of surgical treatments, and even better in a very large number of cases.
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Huang, Jason H., and Eric L. Zager. "Thoracic Outlet Syndrome." Neurosurgery 55, no. 4 (2004): 897–903. http://dx.doi.org/10.1227/01.neu.0000137333.04342.4d.
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Abstract OBJECTIVE: Thoracic outlet syndrome (TOS) is one of the most controversial clinical entities in medicine. We provide a review of this difficult-to-treat disorder, including a brief overview, clinical presentations, surgical anatomy, treatment options, and outcomes. METHODS: TOS represents a spectrum of disorders encompassing three related syndromes: compression of the brachial plexus (neurogenic TOS), compression of the subclavian artery or vein (vascular TOS), and the nonspecific or disputed type of TOS. Neurovascular compression may be observed most commonly in the interscalene triangle, but it also has been described in the costoclavicular space and in the subcoracoid space. Patients present with symptoms and signs of arterial insufficiency, venous obstruction, painless wasting of intrinsic hand muscles, paresthesia, and pain. A careful and detailed medical history and physical examination are the most important diagnostic tools for proper identification of TOS. Electromyography, nerve conduction studies, and imaging of the cervical spine and the chest also can provide helpful information regarding diagnosis. Clinical management usually starts with conservative treatment including exercise programs and physical therapy; when these therapies fail, patients are considered for surgery. Two of the most commonly used surgical approaches are the supraclavicular exposure and the transaxillary approach with first rib resection. On occasion, these approaches may be combined or, alternatively, posterior subscapular exposure may be used in selected patients. CONCLUSION: TOS is perhaps the most difficult entrapment neuropathy encountered by neurosurgeons. Surgical intervention is indicated for vascular and true neurogenic TOS and for some patients with the common or nonspecific type of TOS in whom nonoperative therapies fail. With careful patient selection, operative intervention usually yields satisfactory results.
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Brown, Jeffrey A., Michael A. Braun, and Thomas C. Namey. "Pyriformis Syndrome in a 10-Year-old Boy as a Complication of Operation with the Patient in the Sitting Position." Neurosurgery 23, no. 1 (1988): 117–19. http://dx.doi.org/10.1227/00006123-198807000-00023.
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ABSTRACT We present a case of sciatic neuropathy due to the pyriformis syndrome after operation in the sitting position. Neither sciatic nerve injury nor the pyriformis syndrome has been reported after operation in the sitting position, although a low incidence of common peroneal nerve injury has been reported as a complication of operation on patients who are in the sitting position. The clinical findings of sciatic neuropathy, external rotation of the ipsilateral foot in the position of comfort, and a therapeutic response to local anesthetic injection into the pyriformis muscle are diagnostic of the syndrome. Nerve conduction studies should be performed to aid in the differentiation between a common peroneal and sciatic neuropathy. The syndrome may occur because of extreme flexion of the hips and prolonged pressure while in the sitting position, leading to pyriformis muscle trauma, resultant spasm, and sciatic compression. The prognosis is for complete recovery after symptomatic treatment with nonsteroidal antiinflammatory medication and physical therapy.
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Warrington, Joan, Ian Winspur, and Daniel Steinwede. "Upper-extremity Problems in Musicians Related to Age." Medical Problems of Performing Artists 17, no. 3 (2002): 131–34. http://dx.doi.org/10.21091/mppa.2002.3021.
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This is a review of 140 musicians referred to a specialist hand therapy department in London, England. Musicians are referred from different sources and represent a fair cross-section. The musicians were analyzed in three different age groups: under 25 years of age, 25–40 years of age, and over 40 years of age; and by three different pathological groups: “trauma,” “degenerative,” and “non-specific arm and hand pain.” The results highlight three points: 1) Musicians of all ages are injured in coincidental accidents (“trauma”). 2) As musicians age, they are more likely to develop “degenerative” upper limb conditions such as Dupuytren’s contracture, nerve compression syndromes, or degenerative arthrosis in critical joints. 3) Non-specific arm and hand pain is overwhelmingly prevalent in young musicians and music students but is much less prevalent in the older age groups. This last point is the most worrisome statistic and perhaps the most preventable.
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Soyuer, Ferhan. "Effectiveness of current physiotherapy in carpal tunnel syndrome." International Journal of Family & Community Medicine 5, no. 3 (2021): 87–89. http://dx.doi.org/10.15406/ijfcm.2021.05.00228.
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Carpal Tunnel Syndrome (CTS) is a constellation of symptoms associated with compression of the median nerve at the wrist in the carpal tunnel. The main symptoms of CTS are numbness, pain and tingling of the first three fingers and radial side of the ring finger, nocturnal awakening is due to pain and impaired fine motor control because of weakness of the hand. Until now, the study results in which conservative methods have been applied in the treatment of CTS are contradictory. CTS rehabilitation includes laser therapy, ultrasound therapy, manual therapy, neurodynamic techniques, functional massage, splint, exercises etc. Alternative treatments for CTS include: acupuncture, massages, the Chinese cupping massage. The aim of this review is to explain the current physiotherapy methods applied in CTS patients and the research results on this subject.
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Safi, Ali Shahad. "Comparison of surgical out come between virgin carpal tunnel syndrome and previous local steroid injected tunnel." Muthanna Medical Journal 7, no. 2 (2020): 18–40. http://dx.doi.org/10.52113/1/7.2/2020.40.
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"Carpal tunnel syndrome(CTS) is the most commonly occurring peripheral nerve compression neuropathy and its condition characterized by an abnormality of the median nerve function due to compression of the nerve within the carpal tunnel. Surgical release of the transverse carpal ligament is an effective treatment for patients with CTS. Non-steroidal anti-inflammatory drugs, diuretics, vitamin B6 injection, ultrasound therapy, laser therapy, acupuncture, magnetic therapy, bracing and local steroid injections have been used for closed treatment of CTS and effective results in the short-term treatment have been demonstrated clearly only for bracing and local steroid injections. Aim: was to identify the effect of local steroid injection on the outcome of surgical release of CTS. A prospective study that was conducted in the Orthopedic Department of at Basra General Hospital during the period from 1st of July 2005 till end of September 2006 on 40 patients, 20 of them with received local steroid injection (group A) and 20 without local steroid injection (group B virgin carpal tunnel) operations done to release the tunnel with monthly follow up by telephone call because of social and security problems at time of study. Pearson’s Chi–square test was used to assess statistical association between injection of local steroid and outcome of CTS surgery. A level of P – value less than 0.05 was considered significant. Postoperatively, in Group A, night pain and grip power were found to be improved in 17 (85%) and 11 (55%) of women, respectively, while 16 (80%) relieved from night pain, paresthesia and numbness. On the other hand, the postoperative follow up of women in group B showed that the improvement of night pain was occurred in 20 cases (90%), relieving of night pain, paresthesia and numbness in 17 (85%), and improvement of grip power was reported in 12 (60%). The analysis of association didn’t show statistical significant difference (P > 0.05) in surgical outcome between study groups. In conclusion; local steroid injection for CTS prior to surgery didn’t affect outcome of surgical release."
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Safi, Ali Shahad, Hussein A. Alseady, and Mohammed H. Younise. "Comparison of surgical out come between virgin carpal tunnel syndrome and previous local steroid injected tunnel." Muthanna Medical Journal 7, no. 2 (2020): 33–40. http://dx.doi.org/10.52113/1/7.2/20.33.
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Carpal tunnel syndrome(CTS) is the most commonly occurring peripheral nerve compression neuropathy and its condition characterized by an abnormality of the median nerve function due to compression of the nerve within the carpal tunnel. Surgical release of the transverse carpal ligament is an effective treatment for patients with CTS. Non-steroidal anti-inflammatory drugs, diuretics, vitamin B6 injection, ultrasound therapy, laser therapy, acupuncture, magnetic therapy, bracing and local steroid injections have been used for closed treatment of CTS and effective results in the short-term treatment have been demonstrated clearly only for bracing and local steroid injections. Aim: was to identify the effect of local steroid injection on the outcome of surgical release of CTS. A prospective study that was conducted in the Orthopedic Department of at Basra General Hospital during the period from 1st of July 2005 till end of September 2006 on 40 patients, 20 of them with received local steroid injection (group A) and 20 without local steroid injection (group B virgin carpal tunnel) operations done to release the tunnel with monthly follow up by telephone call because of social and security problems at time of study. Pearson’s Chi–square test was used to assess statistical association between injection of local steroid and outcome of CTS surgery. A level of P – value less than 0.05 was considered significant. Postoperatively, in Group A, night pain and grip power were found to be improved in 17 (85%) and 11 (55%) of women, respectively, while 16 (80%) relieved from night pain, paresthesia and numbness. On the other hand, the postoperative follow up of women in group B showed that the improvement of night pain was occurred in 20 cases (90%), relieving of night pain, paresthesia and numbness in 17 (85%), and improvement of grip power was reported in 12 (60%). The analysis of association didn’t show statistical significant difference (P > 0.05) in surgical outcome between study groups. In conclusion; local steroid injection for CTS prior to surgery didn’t affect outcome of surgical release.
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Elakkad, S. E., J. M. Yetto, M. D. Landon, and M. R. Cathey. "Stuck in the Middle: Nervus Intermedius‐Related Neuropathologic Imaging Spectrum." Neurographics 9, no. 5 (2019): 330–43. http://dx.doi.org/10.3174/ng.1900006.
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The nervus intermedius is a complex nerve that traverses the cerebellopontine angle and is associated with a wide range of pathologies for which imaging plays a crucial diagnostic role. Cerebellopontine angle masses or neurovascular compression may directly involve the nervus intermedius. Alternatively, pathologies that involve branches of the nervus intermedius may present with symptoms referable to the nervus intermedius, including sinonasal tumors, perineural tumor spread, or viral reactivation such as in Ramsay Hunt syndrome. Overlapping innervation with branches of the trigeminal, glossopharyngeal, and vagus nerves can confound diagnosis and/or lead to mislocalization, which may result in delayed diagnosis or inappropriate therapy. This review article provides an in-depth overview of nervus intermedius anatomy and physiology, and the wide spectrum of pathologies that can involve the nervus intermedius or its branches, with an emphasis on clinical relevance.Learning Objective: To understand the normal anatomy and physiology of the nervus intermedius as well as the clinical relevance and imaging findings of the neuropathologic spectrum of disease referable to the nervus intermedius and its branches: the greater superficial petrosal nerve, the chorda tympani, and the sensory auricular branch.
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Bubnov, R., and L. Kalika. "POS1284 FASCIAL ULTRASOUND: THE CONTEXT FOR DRY NEEDLING TRIGGER POINTS IN TREATMENT OF MYOFASCIAL PAIN, POSTURAL IMBALANCE." Annals of the Rheumatic Diseases 80, Suppl 1 (2021): 924.3–925. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3843.
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Background:Muscles and fascia are the major source of pain in rheumatic diseases. Dry needling under ultrasound guidance (DN-US) is a crucial therapeutic approach to treat muscle pain [1,2], the definition `myo-fascial` calls for searching trigger points (TrPs) in fascia to improve the treatment effectiveness.Objectives:Aim was to evaluate the relevance of fascial ultrasound for DN-US in myo-fascial pain.Methods:We included 36 patients (21 females, 20-69 years old) with myofascial pain different localisations (low back, limbs, shoulder, neck pain), postural imbalance; did DN-US protocol according to R. Bubnov [1]: trigger points were identified according, fine (28G) steel needle DN-US was applied. Additionally considered fascial structures for detecting areas of abnormalities (hypervascularity, heterogeinity, hypomotility, adhesions) aka `trigger points` and potental nerve compression/irritation and did precise DN-US where appropriate.Results:In all patients movement restored and pain decreaed after muscles DN; in 30 patients additionally we detected and did successful DN-US the major fascial points as follows: thoracolumbar fascia, sacroiliac joint, pelvis ligaments, rotator cuff; potential nerve compressions (e.g., arcade of Frochse, soleus arcade); nerve sheath surrounding nerves (sciatic nerve, brachial plexus) and vessels (thoracic outlet syndrome), smaller fascia, joint capsule thickening. We detected higher rates of motility, improvement postural balance and pain decrease, fewer sessions needed in patients after extensive protocol.Conclusion:Fascia dry needling is accessible and effective method for myo-fascial pain treatment, may provide additional mechanical benefit and help to maintain treatment effect. Affected fascia can be considered as relevant trigger points, specific ultrasound symptoms should be validated.References:[1]Bubnov R Trigger Points Dry Needling Under Ultrasound Guidance for Low Back Pain Therapy. Comparative Study. Annals of the Rheumatic Diseases2015;74:624. http://dx.doi.org/10.1136/annrheumdis-2015-eular.2323[2]Bubnov R, Kalika L, Babenko L. Dynamic ultrasound for multilevel evaluation of motion and posture in lower extremity and spine. Annals of the Rheumatic Diseases 2018;77:1699. http://dx.doi.org/10.1136/annrheumdis-2018-eular.3949Disclosure of Interests:None declared
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Drapkina, O. M., A. A. Zeynapur, A. S. Klevina, and O. B. Vasileva. "Thoracalgia in a Patient with Determined Coronary Heart Disease. Is there Always a Relapse of Angina Pectoris?" Rational Pharmacotherapy in Cardiology 16, no. 1 (2020): 46–50. http://dx.doi.org/10.20996/1819-6446-2020-02-05.
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This article presents a clinical case of a 62-year-old man with a long history of coronary heart disease and smoking, whose main complaint upon admission to the hospital was voice hoarseness and atypical pain syndrome in the chest. During a preliminary medical examination, attention was paid to the clinical picture, atypical for a coronary heart disease – voice hoarseness was identified as a manifestation of the recurrent nerve compression, or cardio-vocal syndrome. Given the lack of connection between the chest pain and physical exertion, a high index of a smoking person as well as signs of the recurrent nerve compression syndrome, a multi-spiral computer tomography with contrasting of the chest organs was performed (in line with official recommendations of the Russian Associations of Oncologists and Otolaryngologists). The results revealed a proliferative lesion of the mediastinum and multiple focal lesions of both lungs. A subsequent thoracoscopy and biopsy confirmed the mediastinal form of a lung cancer. Promptly initiated poly-chemotherapy allowed stabilizing the patient’s condition and significantly improving his prospects. In this context, the article discusses the complexity of a timely diagnosis of a primary lung cancer and emphasizes the need to focus on specific and unique features of the disease course as well as on a broader clinical picture. Tactics of a multidisciplinary approach allows making a diagnosis in a timely manner, significantly improving the effectiveness of therapy and patient’s survival prognosis.
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Akhundov, Parvis Yа, and Sadagat G. Huseynova. "Clinical and electromyographic evaluation of the effectiveness of the use of interference currents and traction therapy in the treatment of patients with vertebral radiculopathy." Russian Journal of Physiotherapy, Balneology and Rehabilitation 19, no. 6 (2020): 384–90. http://dx.doi.org/10.17816/1681-3456-2020-19-6-6.
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Background. Relevance of elaboration of lumbosacral radiculopathy (LSR) treatment methods is сonditioned by widespread of this pathology. Pain syndrome (PS) reducing activity and life quality of workable patients is the most prevailing clinical manifestation of this disease. Сonservative treatment methods of LSR directed to decrease pain, oedema and compression of nerve roots as well as contributing to сonductivity improvement include medication, physiotherapeutic and orthopaedic treatment.
Aims: Clinical neurophysiological justification of combined use of interference therapy (IT) and spine traction (ST) in complex treatment of vertebral LSR.
Materials and methods. The first-control group (n=32) who were treated by using ST as a treatment. The second ― treatment group (n=32) included those who were treated by using the IT and ST on the same day. All patients had radicular syndromes. All patients passed the lumbar MRI scan. PS was estimated according to the visual-analogic scale (VAS) and McGills questionnaire. Estimation of life quality of patients was based on Roland-Morris questionnaire. Electromyography registered dynamics of impulse conduction on motor fibres, as well as parametеrs of compound muscle action potential and H-reflex.
Results. Positive effect of combined use of interference therapy with spine traction in complex treatment of vertebral radiculopathy patients are proved. It has been established that the therapeutic effect of the complex application of IT and ST lies in the improvement in the afferent and efferent links of the neuromotor apparatus, as well as the functional state of the spinal alpha-motoneurons associated with the acceleration of the regenerative processes.
Conclusion. Results of the clinical neurophysiological investigation, carried out before and after rehabilitative treatment allow to recommend combined therapy of IT and ST for treatment of vertebral LSR.
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Hu, Amanda, Murray Morrison, and Christopher R. Honey. "Hemi-laryngopharyngeal Spasm (HeLPS): Defining a New Clinical Entity." Annals of Otology, Rhinology & Laryngology 129, no. 9 (2020): 849–55. http://dx.doi.org/10.1177/0003489420916207.
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Objective: Hemi-laryngopharyngeal spasm (HeLPS) has recently been described in the neurosurgical literature as a cause of intermittent laryngopharyngeal spasm and cough due to vascular compression of the vagus nerve at the cerebellopontine angle. We present the diagnostic criteria for this syndrome. Methods: A retrospective chart review of six patients with HeLPS and three patients misdiagnosed with this condition are presented. All patients were diagnosed and treated at a tertiary care academic centre from July 2013 to July 2017. Results: Patients with HeLPS had five defining characteristics: 1) All patients had symptoms of episodic laryngopharyngeal spasm and coughing. Patients were asymptomatic between episodes and were refractory to speech therapy and reflux management. 2) Laryngoscopy showed hyperactive twitching of the ipsilateral vocal fold in two of the six patients. No other inter-episodic abnormalities were seen. 3) Botulinum toxin A injections into the thyroarytenoid muscle on the affected ipsilateral side reduced laryngopharyngeal spasms. Botulinum toxin injection in the contralateral thyroarytenoid muscle did not improve laryngopharyngeal spasm. 4) Magnetic resonance imaging revealed ipsilateral neurovascular compression of the vagus nerve rootlets by the posterior inferior cerebellar artery. 5) Microvascular decompression (MVD) surgery of the ipsilateral vagus nerve resolved all symptoms (follow-up 2-4 years). Conclusion: The diagnostic criteria for hemi-laryngopharyngeal spasm (HeLPS) are proposed. Otolaryngology recognition of this new clinical entity may lead to a surgical cure and avoid the unnecessary therapies associated with misdiagnosis. Level of Evidence: 4
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Abd-Elsayed, Alaa, Michael J. Gyorfi, and Sung P. Ha. "Lateral Femoral Cutaneous Nerve Radiofrequency Ablation for Long-term Control of Refractory Meralgia Paresthetica." Pain Medicine 21, no. 7 (2020): 1433–36. http://dx.doi.org/10.1093/pm/pnz372.
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Abstract Background Meralgia paresthetica is a term used to describe a clinical pain syndrome related to the compression or irritation of the lateral femoral cutaneous nerve (LFCN). The LFCN is a pure sensory nerve that is susceptible to compression injury. The most common compression locations are: as it courses from the lumbosacral plexus, through the abdominal cavity, under the inguinal ligament, and into the subcutaneous tissue of the thigh. Methods This case series is a retrospective single-center review of six patients with medically intractable meralgia paresthetica who were treated with radiofrequency ablation. To be considered for radiofrequency ablation, the patient must have been unsuccessful with medical management alone for more than two months and have a clinical diagnosis of meralgia paresthetica. Temporary relief of pain of 50% or greater was considered a positive result. Average pain scores were measured pre- and postprocedure, along with one-, two-, three-, and six-month intervals postoperation. Results All patients demonstrated immediate relief in self-reported pain scores, averaging a 75.5% reduction in pain. At the one-, two-, three-, and six-month follow-ups, patients averaged a reduction of 60.0%, 58.0%, 51.4%, and 40.5%, respectively. Both the postop and one-month follow-up pain scores were lower, statistically significantly so (P < 0.05), whereas the two-, three-, and six-month follow-ups were not statistically different from pretreatment scores. Conclusions Although our study was small, radiofrequency ablation showed a clear reduction in average pain scores in a subset of patients who had failed standard medical therapy with a reduction in pain at one-month follow-up with relief of symptoms sometimes lasting longer than 12 months.
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Frolov, V. A., and M. S. Akopyan. "Manual therapy and visual color-impulse therapy in the rehabilitation of patients with piriformis syndrome." Russian Osteopathic Journal, no. 3 (September 18, 2020): 95–101. http://dx.doi.org/10.32885/2220-0975-2020-3-95-101.
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Introduction. Piriformis syndrome (PS) is a condition accompanied by tension of the piriformis muscle and followed then by compression of the sciatic nerve passing through the piriformis muscle. According to statistics, PS occurs in 6–35 % of patients with lower back pain. Practitioners still face difficulties in treating patients with PS, and it necessitates the searching of new therapy methods and assessment of their compatibility.The goal of research — to study the clinical efficacy of the combined use of manual therapy and visual colorimpulse therapy in patients with piriformis syndrome.Materials and methods. A prospective, controlled, randomized study was conducted in 2019 at the Department of Sports Medicine and Medical Rehabilitation of I. M. Sechenov First Moscow Medical State University. In accordance with the inclusion criteria, 40 patients participated in the study. All participants, depending on the used treatment methodology, were divided by the method of simple randomization using envelopes into two equal groups. In the main group (group I), an integrated approach to treatment was tested: manual therapy in combination with visual color-impulse therapy (CIT); and in the other group (group II) only manual therapy was used.Results. The combined use of manual therapy and CIT in patients with piriformis syndrome leads to a significantly more pronounced decrease in the pain degree and normalization of impaired muscle tone. Also, an integrated approach helps to eliminate existing angiospastic disorders of the lower extremities.Conclusion. The study shows a clear positive dynamics in the integrated use of manual therapy methods in combination with visual color-impulse therapy in the treatment of patients with piriformis syndrome. It is planned to continue the study and assess the possibilities of using the combined technique in different groups of patients (athletes, pregnant women) with this syndrome.
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Poonai, Naveen, Rodrick Lim, and Tim Lynch. "Pseudoaneurysm formation following a traumatic wrist laceration." CJEM 13, no. 01 (2011): 48–52. http://dx.doi.org/10.2310/8000.2011.101038.
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ABSTRACT Pseudoaneurysms occur secondary to partial disruption of the arterial wall. They are a commonly described complication of arterial injury, with penetrating injury and iatrogenic arterial catheterization being the most common etiologies in children. Many present weeks to months after the injury, and the initial vascular injury is often missed. The complications of pseudoaneurysm, which include thromboembolism, neurapraxia, and compartment syndrome, underscore the importance of early recognition and management. Definitive therapy consists of ultrasound-guided compression or resection and possible graft interposition. We describe a case of pseudoaneurysm formation in the radial artery of an adolescent girl 6weeks following a penetrating injury. The patient’s injury was complicated by sensory and motor deficits consistent with ulnar nerve compression. This case attests to the importance of adequately ruling out arterial injury in penetrating injury and close followup if the history is suggestive. In addition, a high index of suspicion is warranted to facilitate imaging of a pulsatile mass to avoid confusion of a thrombosed artery with an abscess.
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Das, Pallab, Mohit Kataruka, and Rathindranath Haldar. "Electrophysiological Improvement Pattern in Patients with Carpal Tunnel Syndrome by Ultrasonic Therapy." Indian Journal of Physical Medicine and Rehabilitation 28, no. 3 (2017): 106–9. http://dx.doi.org/10.5005/jp-journals-10066-0012.
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ABSTRACT Introduction Carpal tunnel syndrome (CTS) was effectively treated by lots of conservative management that includes splints, exercise, different types of heat modality like ultrasonic therapy (UST), etc. This is our humble attempt to explore and find out electrophysiological improvement pattern after treatment with UST in CTS. This analytical study was conducted at the Department of Physical Medicine and Rehabilitation (PMR), Institute of Post Graduate Medical Education and Research (IPGMER), SSKM Hospital, Kolkata, West Bengal, India, from January 15, 2012 to July 15, 2013. Materials and methods After getting Institutional Ethical Committee clearance, patients with symptoms of nerve compression at wrist were included in the study group according to inclusion and exclusion criteria. Ultrasound treatment was administered 15 minutes per session for 15 days to the palmar carpal tunnel area at a frequency of 1 MHz and intensity of 1.0 W/cm2, pulsed mode, with a transducer of 5 cm2. The patients were examined after intervals of 2, 4, and 8 weeks postintervention. Results The results of our study suggest that there was marked improvement in all the clinical parameters. The same significant improvement was also found in electrophysiological parameter. Conclusion Ultrasonic therapy is one of the effective modalities of treatment for CTS. How to cite this article Kataruka M, Pramanik R, Das P, Haldar R. Electrophysiological Improvement Pattern in Patients with Carpal Tunnel Syndrome by Ultrasonic Therapy. Indian J Phy Med Rehab 2017;28(3):106-109.
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Umure, Jolanta, Ināra Logina, and Marija Mihailova. "OUR EXPERIENCE IN CARPAL TUNNEL SYNDROME THERAPEUTIC EFFECTIVENESS EVALUATION." CBU International Conference Proceedings 7 (September 30, 2019): 833–38. http://dx.doi.org/10.12955/cbup.v7.1463.
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Objectives: Analyze the literature data on the incidence and manifestation of carpal tunnel syndrome (CTS), as well as the pathogenesis and treatment options. Perform a specially designed, validated test - Pain Detection. Evaluate the objective state of patients with CTS - sensory impairment, compression test. Assess patients’ neurologic and neurophysiologic data before and after the blockade and evaluate its effectiveness. Perform a specially designed, validated test - Patients` Global Impression of Change scale (PGIC) one month after corticosteroid injection (CSI).Methods and Materials: The study includes an analysis of 55 arms of patients of different age with mild and moderate CTS who came for a neurological examination at the Neurology Outpatient Department of the Pauls Stradiņš Clinical University Hospital during the period of 01.08.2018 – 01.01.2019. All patients were analyzed clinically and neurophysiologically before CSI and one month after CSI. A Pain Detect scale, PGIC scale, compression tests and sensory tests were used for the evaluation of clinical symptom. A median nerve sensory and motor nerve conduction study was performed.Results: According to the Pain Detect scale, 60% of patients showed neuropathic pain before CSI, and 78% of patients presented clinical effectiveness after CSI. 98% of patients present clinical effectiveness after CSI in the PGIC scale. 85% of patients had improvement in neurophysiological studies – motor distal latency decreased after CSI. Before CSI, the average motor distal latency was 5.7ms (range 4.5-12.9ms SD±1.5), which was on average 130% from the maximal norm (range 102- 293 SD±36). After the CSI, the average motor distal latency was 5.2ms (range 3.8-10.7ms SD±1.3), which was on average 120% from the maximal norm (range 88-243 SD±30). We didn’t find any significant correlation between the improvement of the patient's clinical condition and the improvement of electrophysiological outcomes.Conclusions: The study concludes that the Pain Detect sensitivity for neuropathic pain evaluation of patients with CTS is 60%. Patients show clinical and neurophysiological improvement after CSI, but there is no correlation between neurophysiological and clinical improvement. The study concludes that the PGIC scale can be used to quickly assess the effectiveness of therapy.
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Pratiwi, Jihan Nur, and Khoirun Nisa. "Terapi Komplementer Akupuntur Terhadap Penderita Sindroma Terowongan Karpal." Jurnal Penelitian Perawat Profesional 1, no. 1 (2019): 95–102. http://dx.doi.org/10.37287/jppp.v1i1.28.
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Sindroma Terowongan Karpal (Carpal Tunnel Syndrome atau CTS) adalah kondisi kompresi saraf medianus pada terowongan karpal sehingga muncul gejala klinis berupa kekakuan, paresthesia, dan nyeri. Beberapa intervensi perawatan baik konservatif dan bedah diusulkan untuk pengobatan CTS. Intervensi konservatif termasuk bebat, injeksi steroid lokal, carpal tunnel release, steroid oral atau ketoprofen phonophoresis, efektif pada pasien dengan gejala ringan sampai sedang. Sementara pembedahan disarankan jika intervensi konservatif gagal. Di antara intervensi tersebut, akupuntur telah mendapat perhatian khusus. Akupuntur adalah terapi komplementer yang telah lama digunakan pada perawatan medis di Cina. Literature review ini bertujuan untuk menjelaskan efektifitas akupuntur dalam pengelolaan CTS mulai dari gejala ringan hingga sedang. Metode yang digunakan dalam artikel ini adalah penelusuran artikel melalui database NCBI. Tahun penerbitan pustaka adalah dari tahun 2004 hingga 2017 dengan 22 sumber pustaka. Artikel yang dikumpulkan terkait dengan stimulasi terapi akupuntur terhadap perubahan dalam pemrosesan otak pada respon limbik yang terkoordinasi, efek anti-inflamasi, dan modulator imun. Hasil dari sintesa 14 artikel yang telah ditemukan, terdapat pengaruh terapi komplementer akupuntur pada peningkatan regenerasi saraf dan kinerja fungsional pada penderita Sindroma Terowongan Karpal.
Kata Kunci: akupuntur, terapi komplementer, sindroma terowongan karpal
ACUPUNCTURE COMPLEMENTARY THERAPY FOR PEOPLE WITH CARPAL TUNNEL SYNDROME
ABSTRACT
Carpal Tunnel Syndrome (CTS) is a condition of median nerve compression in the carpal tunnel so that clinical symptoms appear in the form of stiffness, paresthesia, and pain. Several conservative and surgical treatment interventions are proposed for the treatment of CTS. Conservative interventions including bebat, local steroid injection, carpal tunnel release, oral steroids or ketoprofen phonophoresis, are effective in patients with mild to moderate symptoms. While surgery is recommended if conservative intervention fails. Among these interventions, acupuncture has received special attention. Acupuncture is a complementary therapy that has long been used in medical care in China. This literature review aims to explain the effectiveness of acupuncture in the management of CTS ranging from mild to moderate symptoms. The method used in this article is article searching through the NCBI database. Library publication year is from 2004 to 2017 with 22 library sources. The articles collected are related to the stimulation of acupuncture therapy for changes in brain processing in coordinated limbic responses, anti-inflammatory effects, and immune modulators. The results of the synthesis of 14 articles that have been found, there is the effect of acupuncture complementary therapy on increased nerve regeneration and functional performance in patients with carpal tunnel syndrome.
Keywords: acupuncture, complementer therapy, carpal tunnel syndrome
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REMPEL, DAVID, LARS DAHLIN, and GÖRAN LUNDBORG. "Pathophysiology of Nerve Compression Syndromes." Journal of Bone & Joint Surgery 81, no. 11 (1999): 1600–10. http://dx.doi.org/10.2106/00004623-199911000-00013.
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Gevirtz, Clifford. "Lower Extremity Nerve Compression Syndromes." Topics in Pain Management 30, no. 5 (2014): 1–9. http://dx.doi.org/10.1097/01.tpm.0000458783.81549.2d.
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Gevirtz, Clifford. "Lower Extremity Nerve Compression Syndromes." Topics in Pain Management 30, no. 6 (2015): 1–9. http://dx.doi.org/10.1097/01.tpm.0000459764.07815.b5.
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O'Shaughnessy, Brian A., Christopher C. Getch, Bernard R. Bendok, and H. Hunt Batjer. "Surgical management of unruptured posterior carotid artery wall aneurysms." Neurosurgical Focus 15, no. 1 (2003): 1–8. http://dx.doi.org/10.3171/foc.2003.15.1.9.
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Intracranial aneurysms arising from the posterior wall of the supraclinoid carotid artery are extremely common lesions. The aneurysm dilation typically occurs in immediate proximity to the origin of the posterior communicating artery and, less commonly, the anterior choroidal artery (AChA). Because of the increasingly widespread use of non-invasive neuroimaging methods to evaluate patients believed to harbor cerebral lesions, many of these carotid artery aneurysms are now documented in their unruptured state, prior to occurrence of subarachnoid hemorrhage. Based on these factors, the management of unruptured posterior carotid artery (PCA) wall aneurysms is an important element of any neurosurgical practice. Despite impressive recent advances in endovascular therapy, the placement of microsurgical clips to exclude aneurysms with preservation of all afferent and efferent vasculature remains the most efficacious and durable therapy. To date, an optimal outcome is only achieved when the neurosurgeon is able to combine systematic preoperative neurovascular assessment with meticulous operative technique. In this report, the authors review their surgical approach to PCA wall aneurysms, which is greatly based on the extensive neurovascular experience of the senior author. Focus is placed on their methods of preoperative evaluation and operative technique, with emphasis on neurovascular anatomy and the significance of oculomotor nerve compression. They conclude by discussing surgery-related complications, with a particular focus on intraoperative rupture of aneurysms and their management, and the postoperative ischemic AChA syndrome.