[Vasomotor disorders of the hand and carpal tunnel syndrome]. / Troubles vasomoteurs des mains et syndrome du canal carpien.

Clinical electrophysiological and chronothermodynamic examinations were performed on 71 patients with paresthesiae and pain of the hands. In 35 patients, the electromyographic examination confirmed the diagnosis of carpal tunnel syndrome on the basis of clear signs of chronic compression of the median nerve at the carpal tunnel. In the other 36 patients, the electro-physiological findings were normal. Twenty-nine patients with bilateral (n = 24) or unilateral (n = 5) carpal tunnel syndrome, and 29 patients without, this syndrome had chronothermodynamic abnormalities demonstrating the vascular origin of the disorders of the hands; in 18 patients, a Raynaud's syndrome was suspected on the basis of severe dysthermia. In 7 patients, the origin of pain and paresthesiae remained unknown. This study shows that (i) vascular disorders of the hand are very frequent in patients with paresthesiae and pain of the hands and may mimic a carpal tunnel syndrome, and (ii) clinical examination is insufficient to assess the diagnosis of carpal tunnel syndrome. Before deciding on any kind of therapy, this diagnosis has to be assessed on electrophysiological and chronothermodynamic examinations performed according to precise protocols.

[Cervical myelopathy disclosing dissection of the extracranial vertebral artery]. / Myélopathie cervicale symptomatique d'une dissection de l'artère vertébrale extracrânienne.

A case of medullary ischaemic accident in C5 symptomatic of extracranial vertebral artery dissection is reported. The facilitating factors of vertebral artery dissection are discussed.

[Carpal tunnel syndrome. Can it still be a controversial topic?]. / Le canal carpien. Peut-il être encore sujet de controverse?

The authors studied two aspects of the carpal tunnel syndrome. As far as the diagnosis is concerned, clinical signs and provocative manoeuvres compared to the accepted standard of electrophysiological studies proved to be insufficient to settle a surgical indication in 85 carpal tunnel syndromes. When surgery is needed, post-operative course is frequently bothered by pillar pain and decreased strength postponing return to manual activities. The authors performed a prospective randomized study of 3 techniques in 251 carpal tunnel releases: classical technique, Agee endoscopic technique and anterior ligamentoplasty. Strength was only improved by the last technique. The only advantage for the endoscopic technique was greater post-operative comfort.

[Role of the electrophysiologic examination in the diagnosis of Bassen-Kornzweig syndrome]. / Apport de l'examen électrologique au diagnostic de maladie de Bassen-Kornzweig. A propos de deux observations.

An autosomal recessive disorder, abetalipoproteinemia or Bassen-Kornzweig disease, concerning two sisters are described. This disorder, clinically similar to Friedreich ataxia, should be examined by electrophysiological and laboratory procedures because of the possibility of treatment by high doses of vitamin A and E. The routine electrophysiological examination of the two sisters revealed a degenerative spinocerebellar and peripheral nervous process which confirmed the damage of large myelinated fibers, as reported in the literature: neurogenic muscular atrophy of distal muscles, polyphasic motor unit potentials, moderately decrease of lower motor and sensory nerve conduction rates, and reduced amplitude of evoked responses in sensory nerves and muscles. We stress out the diagnostic value of the heterogenous conduction decrease in the distal motor fibers, signs of processes of demyelination or distal regeneration.

[Meningoradiculitis after a tick bite. Study of 31 cases]. / Les méningo-radiculites après morsure de tique. Etude de 31 cas.

A retrospective study covering a period of 20 years identified reports on 31 cases of meningoradiculitis of the Garin-Bujadoux-Bannwarth type (MRGBB). Clinical, biological, electromyographic characteristics and course of the disease were studied. The most recent cases (n = 8) in 1984 and 1985 had serological tests for Borrelia Burgdorferi and half of the cases had negative results. Conversely, in some patients with meningoradiculitis, even in the absence of a tick bite or of migrating chronic erythema, serology was positive for Borrelia Burgdorferi antigen. The efficacy of antibiotic therapy against pain and on the quality and time of functional recovery justifies the use of this therapy under these two circumstances.

[A multidisciplinary approach to algodystrophy of the hand]. / L'approche pluridisciplinaire de l'algodystrophie de la main.

A multidisciplinary approach for the management of reflex sympathetic dystrophy at SOS Main of Strasbourg has been progressively adopted due to the severe functional sequelae of this disease. The TC99 bone scan in three phases has allowed us after a one week duration of the symptoms to make an early diagnosis and to start dynamic splinting in flexion. Our study compares two groups of patients, one with an early treatment and the other with delayed treatment. It shows a correlation between the stiffness of the affected hand and the isotopic findings. The benefit from an early dynamic splinting in flexion as evidenced by a clinical improvement is corroborated by the bone scan.

[Carpal tunnel syndrome: clinical and electrologic forms. Results after neurolysis (88 cases)]. / Syndromes du canal carpien: formes cliniques et électrologiques. Résultats après neurolyse (88 cas).

Eighty-eight neurolyses of the median nerve in the carpal tunnel were performed. Clinical, anatomical and electrological characteristics allowed to classify the carpal tunnel syndromes in painful and dysesthesial type, in types with progressive (electromyographical, clinical, complete, incomplete) or acute hand muscle atrophy. After neurolysis, clinical and electrological results were analysed and correlated with initial severity of the chronic median nerve entrapment in the carpal tunnel.

Lumbo-sacral spinal cord injuries.

Thirty-three cases of spinal cord complications in thoraco-lumbar junction injuries were studied, classified in four groups according to the gravity of the lesion and the clinical and electromyographic neurological signs. An original system of graphic representation was used. The spinal lesion was probably secondary to the interruption of arterial vascularisation in the lumbo-sacral spinal cord in two groups and symptomatic of previous contusions in the others. Finally some correlations were established between types of spinal lesions and functional vesico-recto-sphincter and sexual repercussions.

[Contribution of electromyography to the diagnosis of acute radicular or medullary cervical disc palsies (author's transl)]. / Apport de l'électromyographie au diagnostic des paralysies aiguës radiculaires ou médullaires cervicales d'origine discale.

Operative treatment was employed in 38 patients with cervical disc lesions. These had produced either compression of spinal cord nerves, especially C6 or C7 (22 cases), or cervical ischemic lesions (16 cases) of the centromedullary region, either isolated or associated with symmetrical, bilateral cord lesions. A study of pre- and post-operative clinical and electromyographic correlations enabled differentiation of acute cervical radioculopathies from myelopathies and definition of their progression as a function of the surgical treatment employed.

[Contribution of EMG to the diagnosis of facial nerve and muscle involvement in neurinoma of the VIIIth nerve]. / Apport de l'EMG au diagnostic des atteintes faciales par neurinome du VIII.

An examination of 5 cases of acoustic nerve neurinoma, and 3 cases where the diagnosis was suspected, showed that EMG signs of a possible facial nerve compression in the ponto-cerebellar angle were represented by abnormal activity at rest, sub-clinical signs of progressive neurogenic atrophy in the hemi-facial muscles, and a significant increase in the latency of the oligosynaptic R1 reflex response.