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1.
Br J Anaesth ; 124(1): 92-100, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31711605

RESUMO

BACKGROUND: Intravenous dexamethasone is thought to prolong the duration of peripheral nerve block, but the dose-response relationship remains unclear. The aim of this volunteer study was to evaluate the dose-response effect of i.v. dexamethasone on the prolongation of median nerve block. METHODS: In a double-blind, randomised controlled study, 18 volunteer subjects received two median nerve blocks separated by a washout period. One block was conducted alongside an infusion of saline and the other alongside i.v. dexamethasone 2, 4, or 8 mg. The primary outcome was time to return of normal pinprick sensation. Secondary outcomes included thermal quantitative sensory testing (QST) for the time to return of cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), area under QST curves, grip strength, and the incidence of adverse effects. RESULTS: The primary outcome, time to recovery of pinprick sensation, was similar between volunteers receiving saline or i.v. dexamethasone, regardless of dose (P=0.99). The time to recovery of QST milestones was similar between groups, although area under QST curves indicated prolongation of CDT (0 vs 8 mg, P=0.002) and WDT (0 vs 2 mg, P=0.008; 0 vs 4 mg, P=0.001; 0 vs 8 mg, P<0.001). There was no difference in motor recovery or adverse effects. CONCLUSIONS: Intravenous dexamethasone failed to significantly prolong the duration of pinprick anaesthesia regardless of dose. However, area under QST curve analysis indicated a dose-independent prolongation of CDT and WDT, the clinical significance of which is unclear. CLINICAL TRIAL REGISTRATION: NCT02864602 (clinicaltrials.gov).


Assuntos
Adjuvantes Anestésicos , Dexametasona , Bloqueio Nervoso/métodos , Nervos Periféricos , Adjuvantes Anestésicos/administração & dosagem , Adjuvantes Anestésicos/efeitos adversos , Administração Intravenosa , Adulto , Estudos Cross-Over , Dexametasona/administração & dosagem , Dexametasona/efeitos adversos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Força da Mão , Voluntários Saudáveis , Humanos , Masculino , Nervo Mediano , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Limiar da Dor/efeitos dos fármacos , Sensação/efeitos dos fármacos , Sensação Térmica/efeitos dos fármacos , Adulto Jovem
2.
Pan Afr Med J ; 34: 50, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762916

RESUMO

This study aims to evaluate the advantages of ultrasound in the diagnosis of carpal tunnel syndrome by comparing it with electroneuromyography (ENMG). We conducted a cross-sectional study over a period of 6 months. All patients underwent ultrasound with measurement of the surface of the median nerve at the entrance of the carpal tunnel and electroneuromyographic examination of both wrists. The sensitivity and specificity of ultrasound was compared to those of ENMG. The average age of patients was 49.6 years with a clear female predominance (98%). The majority of patients were housewives. Paresthesias were the most common reason for consultation in 86%. Bilateral clinical manifestation occurred in 78% of cases. ENMG showed pathological result in 89 wrists (89%). Ultrasound was abnormal in 63 wrists (63%) with a median surface area of the median nerve of 11 mm2. This study highlights an ultrasound sensitivity of 70%, a specificity of 100% with a positive predictive value (PPV) of 100% and a negative predictive value (VPN) of 29.7%. It was concluded that ultrasound has sensitivity only to carpel tunnel with severe involvement on ENMG.


Assuntos
Síndrome do Túnel Carpal/diagnóstico , Eletromiografia/métodos , Ultrassonografia/métodos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Pessoa de Meia-Idade , Parestesia/etiologia , Valor Preditivo dos Testes , Punho/diagnóstico por imagem
5.
Eklem Hastalik Cerrahisi ; 30(3): 212-6, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650916

RESUMO

OBJECTIVES: This study aims to compare endoscopic carpal tunnel release versus mini-open carpal tunnel release regarding volume changes in the carpal tunnel and median nerve by magnetic resonance imaging (MRI). PATIENTS AND METHODS: The study included 17 wrists of 13 patients (1 male, 12 females; mean age 55 years; range, 51 to 64 years) who were diagnosed with carpal syndrome. Ten wrists underwent mini-open carpal tunnel release, while seven wrists underwent uni-portal endoscopic carpal tunnel release. Carpal tunnel and median nerve volumetric changes were evaluated by MRI pre- and postoperatively. RESULTS: Surgical section of transverse carpal ligament significantly increased the postoperative volume of the carpal tunnel and median nerve compared to preoperative (p<0.05). However, the endoscopic and mini-open carpal tunnel techniques had no superiority over one another regarding volume expansion (p>0.05). CONCLUSION: Both methods can be preferred to release the transverse carpal ligament in patients with idiopathic carpal tunnel syndrome. The surgeon should decide on which method to use considering the advantages and disadvantages reported in the literature.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Endoscopia , Nervo Mediano/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Feminino , Humanos , Ligamentos Articulares/cirurgia , Imagem por Ressonância Magnética , Masculino , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Articulação do Punho/cirurgia
6.
Medicine (Baltimore) ; 98(38): e17227, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567983

RESUMO

RATIONALE: Autologous peripheral nerve injury caused by crush syndrome due to alcohol intoxication is relatively rare, and to our knowledge, the compression of 3 upper limb nerves at the same time has not been reported previously. If a compressive peripheral nerve injury is not treated in a timely manner, it is difficult to recover neurological function, and the prognosis is poor. PATIENT CONCERNS: Here, we present a case of a 50-year-old man with ipsilateral radial nerve, median nerve, and ulnar nerve injuries caused by autogenous compression after drunkenness. DIAGNOSIS: Electromyography and nerve conduction studies suggested peripheral nerve injury in the left upper limb. The diagnosis was injury to the radial nerve, median nerve, and ulnar nerve in the left upper arm. INTERVENTIONS: Exploratory neurolysis surgery of the radial nerve, median nerve, and ulnar nerve was performed in the left upper arm. Postoperative oral neurotrophic drugs were administered, and functional exercise was performed. OUTCOMES: After timely diagnosis and treatment, the strength of the left upper arm muscle recovered, and the prognosis of neurological function was satisfactory during 3 years of follow-up sessions. LESSONS: In the treatment of such patients, a comprehensive understanding of their medical history and a strict physical examination should be performed. Combined with neuroelectrophysiological and imaging examination, the diagnosis can be confirmed. After timely diagnosis and treatment, the prognosis is mostly excellent.


Assuntos
Intoxicação Alcoólica/complicações , Síndrome de Esmagamento/etiologia , Nervo Mediano/lesões , Nervo Radial/lesões , Nervo Ulnar/lesões , Intoxicação Alcoólica/patologia , Síndrome de Esmagamento/patologia , Síndrome de Esmagamento/terapia , Humanos , Masculino , Nervo Mediano/patologia , Pessoa de Meia-Idade , Nervo Radial/patologia , Nervo Ulnar/patologia
7.
Medicine (Baltimore) ; 98(41): e17522, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593124

RESUMO

BACKGROUND: Corticosteroid injection is beneficial in treating carpal tunnel syndrome (CTS) due to its anti-inflammatory effects. However, its side effects limit widespread usage. Recently, several studies have found that polydeoxyribonucleotide offers anti-inflammatory capabilities with fewer side effects, making it an ideal alternative. Nevertheless, there has been no study on its effectiveness in patients with CTS. Therefore, we evaluate the effectiveness of polydeoxyribonucleotide in patients with CTS. Based on the criteria, 30 patients with CTS who received two-consecutive polydeoxyribonucleotide injections (with a week interval) were initially included. METHOD: Patients with CTS were investigated retrospectively. To evaluate the effectiveness of polydeoxyribonucleotide in patients with CTS, numeric rating scale (NRS), cross-sectional area (CSA) of the median nerve, and severity and functional status scores of CTS based on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) were assessed. RESULTS: There was a significant improvement in the NRS, CSA, and functional and severity scores of BCTQ after two-consecutive polydeoxyribonucleotide injections (P < .05). CONCLUSION: In conclusion, although more research is needed to evaluate the effectiveness of polydeoxyribonucleotide in patients with CTS, the findings here suggest that polydeoxyribonucleotide may be a viable alternative to corticosteroids in patients with CTS.


Assuntos
Síndrome do Túnel Carpal/tratamento farmacológico , Nervo Mediano/efeitos dos fármacos , Polidesoxirribonucleotídeos/uso terapêutico , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Idoso , Feminino , Humanos , Injeções , Masculino , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Polidesoxirribonucleotídeos/administração & dosagem , Polinucleotídeos/uso terapêutico , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia/métodos
8.
Muscle Nerve ; 60(6): 757-761, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31520475

RESUMO

BACKGROUND: The objective of the study was to determine the reference values for cross-sectional area (CSA) of the nerves in healthy subjects between the age of 2 and 30 years. METHODS: High-resolution ultrasonography (HRU) of the median, ulnar, tibial, sural, peroneal and spinal nerves C5-C7 was performed in 72 healthy subjects. RESULTS: The CSA of peripheral nerves demonstrated an age-dependent increase in size at all measurement sites in children up to around 14 years of age. This was most pronounced for large lower limb nerves and least for small nerves. Intra-nerve and inter-nerve variability of nerve CSA did not change with age. CONCLUSIONS: This study provides normative values for HRU of peripheral nerves in children and young adults. Adult reference values should not be used for children under the age of 14 years.


Assuntos
Nervos Periféricos/diagnóstico por imagem , Ultrassonografia , Adolescente , Adulto , Fatores Etários , Vértebras Cervicais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Nervo Mediano/anatomia & histologia , Nervo Mediano/diagnóstico por imagem , Tamanho do Órgão , Nervos Periféricos/anatomia & histologia , Nervo Fibular/anatomia & histologia , Nervo Fibular/diagnóstico por imagem , Valores de Referência , Nervos Espinhais/anatomia & histologia , Nervos Espinhais/diagnóstico por imagem , Nervo Sural/anatomia & histologia , Nervo Sural/diagnóstico por imagem , Nervo Tibial/anatomia & histologia , Nervo Tibial/diagnóstico por imagem , Nervo Ulnar/anatomia & histologia , Nervo Ulnar/diagnóstico por imagem , Adulto Jovem
9.
Muscle Nerve ; 60(6): 658-661, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531870

RESUMO

Repetitive nerve stimulation (RNS) of the median nerve is rarely studied in myasthenia gravis (MG). We performed a retrospective analysis of RNS studies performed on 448 patients at our center between 2010 and 2016. Among 95 patients with MG, an abnormal decrement of the compound muscle action potential amplitude was seen in 40.7% of median, 38.4% of spinal accessory, and 57.1% of facial nerve RNS studies. Median nerve RNS was abnormal in 10 patients with normal spinal accessory and 5 patients with normal facial nerve RNS. MG patients with abnormal median nerve RNS were more likely to be seropositive and have limb weakness. No differences were observed in the incidence of abnormal median nerve RNS in patients with and without a median neuropathy at the wrist. Median nerve RNS is easy to perform, reproducible, and should be considered in the electrodiagnostic evaluation of MG.


Assuntos
Nervo Mediano/fisiopatologia , Debilidade Muscular/fisiopatologia , Miastenia Gravis/diagnóstico , Adulto , Idoso , Estimulação Elétrica , Eletrodiagnóstico , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/fisiopatologia , Sensibilidade e Especificidade
10.
Medicine (Baltimore) ; 98(36): e17066, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490404

RESUMO

Despite the high prevalence and clinical importance of soft-tissue disorders, objective methods for evaluation of the biomechanical properties of soft tissues are lacking. This study aimed to quantitatively evaluate stiffness, an important biomechanical characteristic of soft tissue, using acoustic radiation force impulse (ARFI) elastography. The shear wave velocity (SWV, m/s) values of soft tissue structures within the carpal tunnel (CT) were measured in various combinations of wrist and finger positions.Twenty-six healthy adults were enrolled in this study. We measured the cross-sectional area of the median nerve (MN) and the SWV values of several structures within the CT at the CT inlet level. Measurement of SWV of the MN, flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP), and transverse carpal ligament (TCL) were conducted in six wrist/finger motion combinations.When the wrist and fingers were in neutral positions (position A), the mean SWV was lowest for the MN (mean ±â€Šstandard deviation, 2.3 ±â€Š0.5 m/s), followed by the FDS (2.9 ±â€Š0.2), FDP (3.2 ±â€Š0.3), and TCL (3.3 ±â€Š0.4). The SWV was significantly different among the six different wrist/finger positions for all structures (P < .001). However, the MN cross-sectional area was not significantly different (P = .527). The SWV values for the MN, FDS, and FDP increased significantly as the wrist/finger positions the stress on the tendons increased (from position B to F) compared with a neutral position, while the SWV of the TCL was significantly higher for in all positions compared with neutral, except for wrist neutral, finger extension. The SWV values for the MN, FDS, and TCL gradually increased as stress increased.The intra-CT structures are under increased stress during wrist and finger motions than when the hand is in a neutral position. We have used ARFI elastography to gain insight into the pathophysiology of CTS.


Assuntos
Técnicas de Imagem por Elasticidade , Nervo Mediano/diagnóstico por imagem , Tendões/diagnóstico por imagem , Punho/diagnóstico por imagem , Adulto , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Valores de Referência , Punho/fisiologia , Adulto Jovem
11.
Acta Orthop Traumatol Turc ; 53(4): 310-312, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31500812

RESUMO

Angioleiomyoma is a solitary form of leiomyoma which is typically encountered in the subcutis. They are mostly seen in lower extremities, and the upper extremity is the second most common location for these lesions. There are only a few reports about the presence of an angioleiomyoma within a peripheral nerve in the upper extremity. Here we report a 56-year-old male patient who was referred to our clinic after an attempt was made for removal of a forearm mass at another institution. The lesion was encased within the median nerve and there was an unusual hypervascularity around the tumor with numerous vessels entering the lesion. Removal of the tumor without apparent damage to nerve fascicles was possible. Histopathological examination of the excision material revealed an intraneural angioleiomyoma. Following surgery, the patient was free of any functional deficits and no evidence of recurrence was observed at one year follow-up. There is no data regarding recurrence in intraneural lesions due to the lack of a large series. It would not be wrong to recommend spare grossly uninvolved fascicles if the nerve in question is not expendable.


Assuntos
Angiomioma/diagnóstico , Antebraço/patologia , Imagem por Ressonância Magnética/métodos , Nervo Mediano , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade
12.
J Pediatr Orthop ; 39(9): e652-e656, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503220

RESUMO

BACKGROUND: Nerve injuries occur in approximately 11% of pediatric extension supracondylar humerus fractures (SCHF), yet there is scarce literature to guide clinicians on management. The primary goal of this study was to report the presentation, treatment, and outcome of motor nerve injuries associated with extension SCHF. Our secondary goal was to determine which injury and treatment factors were associated with prolonged motor nerve recovery. METHODS: Two hundred forty-four traumatic nerve injuries associated with extension SCHF treated at a single institution between 1996 and 2012 were reviewed. Patients with iatrogenic nerve injuries or subjective paresthesias without motor deficit were excluded. Univariable and multivariable general linear modeling were used to compare recovery times across nerve injury types and to determine the effect of injury and treatment characteristics on recovery time. RESULTS: Patients were a mean age of 6.7 years, with 89% presenting with a single nerve injury and 29% of the cohort experiencing a concurrent vascular injury. The majority of injuries (62%) were to the median nerve. Forty-three (18%) cases had acute nerve decompression at the time of fracture fixation. Five cases required subsequent surgery for poor nerve recovery; none of which underwent initial nerve decompression. Thirty-one patients were lost to follow-up after injury. Median time to nerve recovery was 2.3 months (IQR 1.4 to 3.7 mo); 60% of injuries had nerve recovery by 3 months and 196 (92%) patients had complete nerve recovery at final follow-up. A greater percentage of isolated median nerve (70%) injuries recovered within 3 months compared with radial nerve (42%) injuries (P=0.01). Multivariable analysis demonstrated that multiple nerve injuries took 54% longer to recover than single median nerve injuries (P=0.01), and single radial nerve injuries took 30% longer to recover than single median nerve injuries (P=0.04). CONCLUSIONS: The majority of nerve injuries associated with pediatric extension SCHF recover within 6 months without acute nerve decompression. The presence of either an isolated radial nerve injury or multiple nerve injuries is associated with prolonged motor recovery. LEVEL OF EVIDENCE: Level IV.


Assuntos
Fraturas do Úmero/complicações , Nervo Mediano/lesões , Traumatismos dos Nervos Periféricos/etiologia , Nervo Radial/lesões , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Fixação de Fratura , Humanos , Fraturas do Úmero/cirurgia , Úmero/lesões , Traumatismo Múltiplo , Estudos Retrospectivos , Traumatismos do Sistema Nervoso , Lesões do Sistema Vascular
13.
Neurochem Res ; 44(9): 2230-2236, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31486011

RESUMO

Upper limb nerve injuries are common, and their treatment poses a challenge for physicians and surgeons. Experimental models help in minimum exploration of the functional characteristics of peripheral nerve injuries of forelimbs. This study was conducted to characterize the functional recovery (1, 3, 7, 10, 14, and 21 days) after median and ulnar nerve crush in mice and analyze the histological and biochemical markers of nerve regeneration (after 21 days). Sensory-functional impairments appeared after 1 day. The peripheral nerve morphology, the nerve structure, and the density of myelin proteins [myelin protein zero (P0) and peripheral myelin protein 22 (PMP22)] were analyzed after 21 days. Cold allodynia and fine motor coordination recovery occurred on the 10th day, and grip strength recovery was observed on the 14th day after injury. After 21 days, there was partial myelin sheath recovery. PMP22 recovery was complete, whereas P0 recovery was not. Results suggest that there is complete functional recovery even with partial remyelination of median and ulnar nerves in mice.


Assuntos
Nervo Mediano/fisiopatologia , Recuperação de Função Fisiológica , Remielinização , Nervo Ulnar/fisiopatologia , Animais , Masculino , Nervo Mediano/lesões , Nervo Mediano/metabolismo , Camundongos , Proteína P0 da Mielina/metabolismo , Proteínas da Mielina/metabolismo , Compressão Nervosa , Nervo Ulnar/lesões , Nervo Ulnar/metabolismo
14.
Med Lav ; 110(4): 271-277, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31475688

RESUMO

BACKGROUND: Occupational tasks characterized by repetitive, awkward and forceful movements of the hand and wrist may heighten the risk of carpal tunnel syndrome (CTS) among dairy parlor workers. Median nerve impairment can be investigated with ultrasonography (US) and nerve conduction studies (NCS) but a structured questionnaire may help identify early symptoms. OBJECTIVES: Our objectives were to: a) compare the sensitivity of US investigations and NCS to detect early signs of CTS; b) explore the correlation of the results of these two tests with CTS symptoms obtained from the administration of a targeted questionnaire. METHODS: Forty male milking parlor workers were recruited. The study protocol included: 1) the identification of characteristic CTS symptoms through a targeted questionnaire; 2) US imaging of the carpal tunnel inlet (using a portable ultrasound device; 3) NCS of the distal median nerve. RESULTS: The symptom questionnaire was considered positive if at least one CTS symptom was present within two weeks prior to the examination. The symptom questionnaire showed a high level of specificity (92,6%) and sensitivity (61%) when compared with NCS results. Ultrasound results revealed a prevalence of median neuropathy of 55%, but when compared to NCS, the ultrasound showed quite low predictive values (NPV of 37% and PPV of 38%). DISCUSSION: The symptom questionnaire was associated with the median nerve pathology often seen in CTS. Moreover, the study results have shown the questionnaire to be the most effective screening method when compared to ultrasound.


Assuntos
Síndrome do Túnel Carpal , Indústria de Laticínios , Doenças Profissionais , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/etiologia , Humanos , Itália , Masculino , Nervo Mediano , Condução Nervosa , Doenças Profissionais/etiologia , Sensibilidade e Especificidade
17.
J Physiol Anthropol ; 38(1): 9, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395098

RESUMO

BACKGROUND: High-resolution ultrasound is being widely used in carpal tunnel examination to understand morphological and biomechanical characteristics of the median nerve and surrounding anatomy structures. MAIN BODY: Healthy young and elderly men were recruited. The median nerve at proximal wrist region was examined by ultrasound imaging technique. A total of seven wrist angle was examined. Generally, the median nerve cross-sectional area of the elderly group is significantly larger than the young group. SHORT CONCLUSION: Wrist posture in greater flexion or extension caused a larger decrease in the median nerve cross-sectional area across both groups.


Assuntos
Envelhecimento/fisiologia , Mãos/diagnóstico por imagem , Nervo Mediano/diagnóstico por imagem , Postura/fisiologia , Adulto , Idoso , Humanos , Masculino , Ultrassonografia , Punho/diagnóstico por imagem , Adulto Jovem
18.
Curr Pain Headache Rep ; 23(10): 70, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31372847

RESUMO

PURPOSE OF REVIEW: Carpal tunnel syndrome (CTS) is an entrapment neuropathy that involves the compression of the median nerve at the wrist and is considered the most common of all focal entrapment mononeuropathies. CTS makes up 90% of all entrapment neuropathies diagnosed in the USA and affects millions of Americans. RECENT FINDINGS: Age and gender likely play a role in the development of CTS, but additional studies may further elucidate these associations. Of known associated risk factors, diabetes mellitus seems to have the greatest association with CTS. One of the most commonly reported symptoms in CTS is a "pins-and-needles" sensation in the first three fingers and nocturnal burning pain that is relieved with activity upon waking. Treatment for CTS is variable depending on the severity of symptoms. Conservative management of CTS is usually considered first-line therapy. In cases of severe sensory or motor deficit, injection therapy or ultimately surgery may then be considered. Still CTS is often difficult to treat and may be reoccurring. Novel treatment modalities such as laser and shockwave therapy have demonstrated variable efficacy though further studies are needed to assess for safety and effect. Given the unknown and potentially complex etiology of CTS, further studies are needed to explore combinations of diagnostic and therapeutic modalities.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Nervo Mediano/cirurgia , Dor/cirurgia , Punho/cirurgia , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/fisiopatologia , Humanos , Nervo Mediano/fisiopatologia , Síndromes de Compressão Nervosa/complicações , Síndromes de Compressão Nervosa/cirurgia , Dor/complicações , Fatores de Risco , Punho/inervação
19.
Muscle Nerve ; 60(5): 582-585, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31443126

RESUMO

INTRODUCTION: Our aim in this work was to determine the safety and accuracy of the volar approach to the pronator quadratus (PQ) through cadaver dissection. METHODS: Twenty upper limbs from 10 fresh cadavers were investigated. At the level 3 cm proximal to the ulnar styloid process (USP), a needle was inserted just medial to the palmaris longus (PL) tendon. Distances of the median nerve (MN) and ulnar artery (UA) from the needle insertion point (IP) were measured using ultrasonography and cadaver dissection. RESULTS: The PQ was located at a depth of 10.8-19.9 mm from the skin and had a median thickness of 9.1 mm, measured 3 cm proximal to the USP. The median distances of the MN and UA from the IP were 7.6 and 13.4 mm, respectively. DISCUSSION: A needle insertion for the volar approach to the PQ was safe at 3 cm proximal to the USP, just medial to the PL tendon.


Assuntos
Pontos de Referência Anatômicos , Antebraço/anatomia & histologia , Nervo Mediano/anatomia & histologia , Músculo Esquelético/anatomia & histologia , Artéria Ulnar/anatomia & histologia , Cadáver , Dissecação , Eletromiografia/métodos , Feminino , Antebraço/diagnóstico por imagem , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Tendões , Artéria Ulnar/diagnóstico por imagem , Ultrassonografia
20.
Muscle Nerve ; 60(6): 744-748, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31469427

RESUMO

INTRODUCTION: Nerve cross-sectional area (CSA) is larger than normal in Charcot-Marie-Tooth disease 1A (CMT1A), although to a variable extent. We explored whether CSA is correlated with CMT clinical severity measured with neuropathy score version 2 (CMTNS2) and its examination subscore (CMTES2) in CMT1A. METHODS: We assessed 56 patients with CMT1A (42 families). They underwent nerve conduction study (NCS) and nerve high-resolution ultrasound (HRUS) of the left median, ulnar, and fibular nerves. RESULTS: Univariate analysis showed NCS and HRUS variables to be significantly correlated with CMTNS2 and CMTES2 and with each other. Multivariate analysis showed that ulnar motor nerve conduction velocity (ß: -0.19) and fibular compound muscle action potential amplitude (-1.50) significantly influenced CMTNS2 and that median forearm CSA significantly influenced CMTNS2 (ß: 5.29) and CMTES2 (4.28). DISCUSSION: Nerve size is significantly associated with clinical scores in CMT1A, which suggests that it might represent a potential biomarker of CMT damage and progression.


Assuntos
Doença de Charcot-Marie-Tooth/fisiopatologia , Nervo Mediano/fisiopatologia , Condução Nervosa/fisiologia , Nervo Fibular/fisiopatologia , Nervo Ulnar/fisiopatologia , Adulto , Doença de Charcot-Marie-Tooth/diagnóstico por imagem , Doença de Charcot-Marie-Tooth/patologia , Feminino , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/patologia , Pessoa de Meia-Idade , Tamanho do Órgão , Nervo Fibular/diagnóstico por imagem , Nervo Fibular/patologia , Índice de Gravidade de Doença , Nervo Ulnar/diagnóstico por imagem , Nervo Ulnar/patologia , Ultrassonografia
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