RESUMO
The ulnar nerve is the second most commonly entrapped nerve after the median nerve. Although clinical evaluation and electrodiagnostic studies remain widely used for the evaluation of ulnar neuropathy, advancements in imaging have led to increased utilization of these newer / better imaging techniques in the overall management of ulnar neuropathy. Specifically, high-resolution ultrasonography of peripheral nerves as well as MRI has become quite useful in evaluating the ulnar nerve in order to better guide treatment. The caliber and fascicular pattern identified in the normal ulnar nerves are important distinguishing features from ulnar nerve pathology. The cubital tunnel within the elbow and Guyon's canal within the wrist are important sites to evaluate with respect to ulnar nerve compression. Both acute and chronic conditions resulting in deformity, trauma as well as inflammatory conditions may predispose certain patients to ulnar neuropathy. Granulomatous diseases as well as both neurogenic and non-neurogenic tumors can also potentially result in ulnar neuropathy. Tumors around the ulnar nerve can also lead to mass effect on the nerve, particularly in tight spaces like the aforementioned canals. Although high-resolution ultrasonography is a useful modality initially, particularly as it can be helpful for dynamic evaluation, MRI remains most reliable due to its higher resolution. Newer imaging techniques like sonoelastography and microneurography, as well as nerve-specific contrast agents, are currently being investigated for their usefulness and are not routinely being used currently.
Assuntos
Neoplasias , Síndromes de Compressão do Nervo Ulnar , Neuropatias Ulnares , Humanos , Nervo Ulnar/diagnóstico por imagem , Nervo Ulnar/patologia , Punho/patologia , Síndromes de Compressão do Nervo Ulnar/diagnóstico por imagem , Síndromes de Compressão do Nervo Ulnar/patologia , Neuropatias Ulnares/diagnóstico por imagemAssuntos
Fraturas do Tornozelo/classificação , Educação Médica/métodos , Ortopedia/educação , Ensino , Punho , HumanosRESUMO
Mycobacterial hand infections are uncommon. These infections have an indolent course and are marked by variable and nonspecific presentations, often leading to diagnostic and treatment delays. The pathogens involved in mycobacterial hand infections include Mycobacterium tuberculosis complex, atypical mycobacteria, and M leprae. Initial treatment involves a combination of long-term antibiotics and surgical débridement to cure the infection. Reconstructive procedures aid in restoring hand function lost secondary to the disease.
Assuntos
Mãos/microbiologia , Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/terapia , Punho/microbiologia , Antibacterianos/uso terapêutico , Desbridamento , Mãos/cirurgia , Humanos , Punho/cirurgiaAssuntos
Traumatismos da Mão , Hanseníase , Entorses e Distensões , Traumatismos do Punho/cirurgia , Humanos , PunhoRESUMO
INTRODUCTION: Focal peripheral neuropathy of the median nerve is mainly caused by a traumatic event or pressure, but it may also be produced by systemic illnesses. Among the latter, leprosy is a rare cause. METHODS: Six cases of isolated median neuropathy as the first sign of leprosy were selected from patients with an exclusively neurological complaint as the initial symptom. The patients, evaluated at the National Leprosy Reference Center in Rio de Janeiro, Brazil, followed routine and specialized procedures. RESULTS: Three of the patients had pure neural leprosy, and 3 had skin lesions. Clinical median nerve function impairment was confirmed by neurophysiological testing and histopathology. Both mononeuritis and mononeuritis multiplex were observed. CONCLUSIONS: This case series demonstrates an additional form of presentation of leprosy, which, if not diagnosed and treated in time, may lead to permanent disability.
Assuntos
Hanseníase/fisiopatologia , Neuropatia Mediana/patologia , Neuropatia Mediana/fisiopatologia , Adulto , Eletromiografia , Potencial Evocado Motor/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Nervos Periféricos/patologia , Nervos Periféricos/fisiopatologia , Pele/patologia , Punho/inervação , Adulto JovemRESUMO
A total of 38 patients with leprosy and localised nerve damage (11 median at the wrist and 37 posterior tibial at the ankle) were treated by 48 freeze-thawed skeletal muscle autografts ranging between 2.5 cm and 14 cm in length. Sensory recovery was noted in 34 patients (89%) and was maintained during a mean period of follow-up of 12.6 years (4 to 14). After grafting the median nerve all patients remained free of ulcers and blisters, ten demonstrated perception of texture and eight recognised weighted pins. In the posterior tibial nerve group, 24 of 30 repairs (80%) resulted in improved healing of the ulcers and 26 (87%) demonstrated discrimination of texture. Quality of life and hand and foot questionnaires showed improvement; the activities of daily living scores improved in six of seven after operations on the hand, and in 14 of 22 after procedures on the foot. Another benefit was subjective improvement in the opposite limb, probably because of the protective effect of better function in the operated side. This study demonstrates that nerve/muscle interposition grafting in leprosy results in consistent sensory recovery and high levels of patient satisfaction. Ten of 11 patients with hand operations and 22 of 25 with procedures to the foot showed sensory recovery in at least one modality.
Assuntos
Tornozelo/cirurgia , Hanseníase/cirurgia , Músculo Esquelético/transplante , Regeneração Nervosa/fisiologia , Transplante Autólogo/métodos , Punho/cirurgia , Atividades Cotidianas/psicologia , Adolescente , Adulto , Feminino , Humanos , Hanseníase/patologia , Masculino , Qualidade de Vida/psicologia , Resultado do Tratamento , Úlcera/patologiaAssuntos
Hanseníase Tuberculoide/tratamento farmacológico , Hanseníase Tuberculoide/patologia , Prednisona/uso terapêutico , Biópsia por Agulha , Face , Seguimentos , Humanos , Imuno-Histoquímica , Hanseníase Tuberculoide/diagnóstico , Masculino , Pessoa de Meia-Idade , Pescoço , Medição da Dor , Índice de Gravidade de Doença , Resultado do Tratamento , PunhoRESUMO
Soft cystic swellings are noticed in leprosy patients during the course of disease and are seen all through the spectrum. The commonest site for these is the dorsum of wrist. At times these are seen over the dorsum and the lateral aspects of ankle as well. These contain straw colored sticky but clear fluid. On exploration these appear to arise from the synovial covering of the extensor tendons of wrist and fingers and have no communication with the wrist joint. Histology of the synovium suggests these swellings to be of inflammatory nature.
Assuntos
Hanseníase/complicações , Cisto Sinovial/patologia , Punho , Adolescente , Adulto , Feminino , Granuloma/patologia , Humanos , Hanseníase/patologia , Masculino , Pessoa de Meia-Idade , Cisto Sinovial/etiologia , Líquido Sinovial/análise , Membrana Sinovial/patologiaRESUMO
Abnormalities of division of the median nerve are exceptional. Several cases are found in the literature. The authors report a case of high bilateral division of the median nerve into two trunks of identical volume in a patient with Hansen's disease. The external trunk of the division supplies the thenar branch and the first commissure and the internal trunk supplies the second and third commissures.