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1.
Med Probl Perform Art ; 35(3): 138-144, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32870965

RESUMO

AIMS: Musicians spend numerous hours perfecting their skills and art, often leading to overuse injuries of the hand; of specific concern to musicians is carpal tunnel syndrome (CTS). This study evaluated the median nerve cross-sectional area and hand function of musicians and made comparisons to non-musicians. METHODS: Seventy-six participants took part in the study, 38 music students and professors in the musician group and 38 participants in the control group. Participants completed patient-reported questionnaires to assess the level of pain and hand function. Ultrasound images were collected at the carpal tunnel inlet and outlet. The median nerve cross-sectional area and the depth of the carpal tunnel were measured on ultrasound images using software imbedded in the ultrasound unit. RESULTS: Musicians showed higher levels of hand dysfunction and CTS symptoms than the non-musicians. The median nerve cross-sectional area was greater in musicians than in the non-musician group on both the right (mean difference 1.5 mm2, p=0.002) and left sides (mean difference 0.9 mm2, p=0.036). The depth of the carpal tunnel at the carpal tunnel inlet and outlet did not differ between the groups (p>0.05). CONCLUSION: The current research identified between-group differences in median nerve cross-sectional area and the level of hand dysfunction. Understanding the interaction between the anatomy of the wrist and wrist and hand dysfunction will benefit clinicians when evaluating and treating musicians.


Assuntos
Síndrome do Túnel Carpal , Nervo Mediano , Música , Síndrome do Túnel Carpal/etiologia , Humanos , Nervo Mediano/anatomia & histologia , Nervo Mediano/patologia , Ultrassonografia , Punho
2.
Muscle Nerve ; 62(5): 601-610, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32779757

RESUMO

Ultrasound has revealed cross-sectional nerve area (CSA) reduction in amyotrophic lateral sclerosis (ALS), but little is known about the sonographic nerve texture beyond CSA alterations. In a large cohort of 177 ALS patients and 57 control subjects, we investigated the covariance and disease-specific signature of several sonographic texture features of the median and ulnar nerves and their relationship to the patients' clinical characteristics. ALS patients showed atrophic nerves, a loss of the intranerve structures' echoic contrast, elevated coarseness, and a trend toward lower cluster shading compared with controls. A reduction in intranerve echoic contrast was related to longer disease duration and poorer functional status in ALS. Sonographic texture markers point toward a significant reorganization of the deep nerve microstructure in ALS. Future studies will be needed to further substantiate the markers' potential to assess peripheral nerve alterations in ALS.


Assuntos
Esclerose Amiotrófica Lateral/diagnóstico por imagem , Esclerose Amiotrófica Lateral/patologia , Nervo Mediano/patologia , Nervo Ulnar/patologia , Ultrassonografia , Idoso , Feminino , Antebraço/inervação , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Pessoa de Meia-Idade , Nervo Ulnar/diagnóstico por imagem , Senso de Humor e Humor como Assunto
3.
Yonsei Med J ; 61(6): 547-552, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32469179

RESUMO

Fascicular involvement of the median nerve trunk in the upper arm is uncommon in cases of peripheral neuropathy, and its symptoms are consistent with those of anterior interosseous nerve (AIN) syndrome. We report three cases of focal anterior interosseous fascicular involvement in the median nerve trunk presenting as AIN palsy. Our report emphasizes the unique ultrasonographic and magnetic resonance imaging (MRI) features of swelling, hourglass-like constriction and torsion, and entwinement of the nerve fascicle of the dorsal region of the median nerve, which were confirmed surgically. On MRI, all patients showed denervation changes in the AIN territory, as well as in the median nerve territory, without compressing structures.


Assuntos
Fáscia/patologia , Imagem por Ressonância Magnética , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/patologia , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/patologia , Ultrassonografia , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome , Adulto Jovem
5.
BMC Neurol ; 20(1): 55, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32054523

RESUMO

BACKGROUND: Perineuriomas are rare benign peripheral nerve sheath tumours of perineurial cell origin and can be classified into intraneural and extraneural perineuriomas. They most commonly present a mononeuropathy of gradual onset and slow progression, resulting in progressive neurological deficits like hypoesthesia or motor weakness. Therapy is still variable. Aim of the study was to compare our surgical treatment and our follow-up regime including high-resolution nerve sonography with the current literature to evaluate best treatment of perineuriomas. METHODS: Retrospective analysis of our dataset "peripheral nerve lesion" to identify patients suffering from perineuriomas between 01.01.2012 until 31.12.2018. Surgical treatment and the follow-up examination of three patients were described. Additionally, a systematic review including PubMed, the Cochrane Collaboration Library, Scopus and Google Scholar was performed for literature published between January 1, 1990 and October 31, 2019 independently by 2 authors. RESULTS: In the first case, the left ulnar nerve was affected. In the second case, the left peroneal nerve and in the third case the right median nerve was affected. High-resolution nerve sonography was performed in each case. All patients underwent interfascicular neurolysis combined with a targeted fascicular biopsy under electrophysiological monitoring. Neurological deficits improved subsidized by rehabilitation. Surgical therapy and the neurological outcome were compared with literature. Systematic review revealed 22 articles, which met the inclusion criteria. Therefore, demographics, surgical treatment and neurological outcome of 77 patients were analysed. CONCLUSIONS: Perineuriomas are rare benign nerve sheath tumours with a slow progression, sometimes difficult to diagnose. Decompression and neurolysis may improve neurological deficits. High resolution nerve sonography might serve as a helpful additional diagnostic tool in this process.


Assuntos
Neoplasias da Bainha Neural/diagnóstico , Adolescente , Biópsia , Feminino , Humanos , Masculino , Nervo Mediano/patologia , Pessoa de Meia-Idade , Neoplasias da Bainha Neural/cirurgia , Estudos Retrospectivos , Nervo Ulnar/patologia
6.
Int J Occup Med Environ Health ; 33(2): 151-161, 2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-31950930

RESUMO

OBJECTIVES: To evaluate: a) the prevalence of bilateral idiopathic carpal tunnel syndrome (CTS) in manual workers; b) a correlation between the duration of unilateral and bilateral CTS symptoms; c) a correlation between the onset of CTS symptoms in the unilateral dominant/non-dominant hand and the time of developing bilateral CTS; and d) findings of the nerve conduction study (NCS) in symptomatic and asymptomatic hands of patients with unilateral CTS. MATERIAL AND METHODS: Clinical and neurophysiological examinations were conducted along with a detailed analysis of job exposure of 332 manual workers admitted to the Occupational Medicine Department, the Nofer Institute of Occupational Medicine, with suspected occupational CTS. Eventually, 258 patients were excluded from the study: 34 with associated neuropathies and 206 with other conditions potentially associated with CTS. Cases with work-related CTS (18) were also excluded. RESULTS: A total of 74 patients were diagnosed as idiopathic CTS. In idiopathic CTS, the right hand was affected in 15 (20.3%) patients, the left hand in 4 (5.4%) patients, and both hands in 55 (74.3%) patients. Symptoms duration was longer in the patients with bilateral CTS (4.01 years) than in those with a unilateral right (1.7 years, p = 0.002) or left hand condition (2.8 years, p = 0.313). Median nerve impairment at the wrist was revealed by NCS in 6 left and 2 right asymptomatic hands. CONCLUSIONS: The findings of the study indicate the need for "alerting" patients with unilateral CTS about the risk of the disease developing in the contralateral hand. Therefore, NCS should be routinely performed in the asymptomatic hands of patients with unilateral CTS, which is essential for the prevention of neuropathies, especially among manual workers performing repetitive manual tasks. Int J Occup Med Environ Health. 2020;33(2):151-61.


Assuntos
Síndrome do Túnel Carpal/patologia , Doenças Profissionais/patologia , Síndrome do Túnel Carpal/epidemiologia , Progressão da Doença , Feminino , Humanos , Masculino , Nervo Mediano/patologia , Pessoa de Meia-Idade , Condução Nervosa , Doenças Profissionais/epidemiologia , Prevalência
7.
Muscle Nerve ; 61(3): 301-310, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31773766

RESUMO

INTRODUCTION: In this study we tested the hypothesis that fascicular constrictions (FCs) of the median nerve proximal to the elbow joint characterize anterior interosseous nerve syndrome (AINS). METHODS: Magnetic resonance neurography (MRN) and ultrasound (US) examinations were evaluated in 45 patients with clinically suspected AINS. All 22 patients at site 1 underwent MRN and 8 underwent US; all 23 patients at site 2 underwent US. RESULTS: Median nerve FCs were identified in all MRN cases; FCs and/or fascicular enlargements were identified in 88% of US cases. Most FCs were in the mediannerve posterior/posteromedial region and were proximal to the elbow joint line (mean distance: MRN, 5.4 cm; US, 7.5 cm), with the exception of a single FC (located 1 cm distal). No extrinsic compression of median or anterior interosseous nerves was identified in the arm or forearm. DISCUSSION: AINS is a noncompressive neuropathy characterized by median nerve FCs in the arm.


Assuntos
Nervo Mediano/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/patologia , Constrição Patológica/diagnóstico por imagem , Articulação do Cotovelo/inervação , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Nervo Mediano/patologia , Síndrome , Ultrassonografia
9.
Mod Rheumatol ; 30(3): 481-488, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30947583

RESUMO

Objectives: This study aimed to compare median nerve stiffness measured by ultrasound real-time tissue elastography in patients with and without rheumatoid arthritis (RA and non-RA groups, respectively).Methods: Altogether, 402 hands of 201 RA group and 222 hands of 111 non-RA group were included in the study. Ultrasonography was performed to evaluate the circumference, cross-sectional area (CSA) and strain ratio as an elasticity of the median nerve at the inlet level of the carpal tunnel and the proximal portion of the carpal tunnel inlet. Using propensity score matching, the difference between RA and non-RA group were analyzed.Results: After propensity score matching, 135 hands in 104 RA group and 70 non-RA group were finally analyzed. There were no significant differences in the circumference and CSA of the median nerve between the two groups. The strain ratio of the median nerve was significantly higher in RA group than in non-RA group only at the inlet of the carpal tunnel level.Conclusions: The nerve stiffness in patients with RA measured by ultrasound real-time tissue elastography was higher than without RA. Inflammatory condition of the flexor tendon and wrist joint in patients with RA may generate fibrotic changes in the median nerve.Trial registration: University Hospital Medical Information Network Clinical Trials Registry: UMIN000015314.


Assuntos
Artrite Reumatoide/complicações , Síndrome do Túnel Carpal/complicações , Nervo Mediano/diagnóstico por imagem , Adulto , Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/patologia , Técnicas de Imagem por Elasticidade , Feminino , Humanos , Masculino , Nervo Mediano/patologia , Pessoa de Meia-Idade
11.
Turk Neurosurg ; 29(6): 927-932, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573064

RESUMO

AIM: To evaluate the feasibility of the mini-open incision method in patients who underwent median nerve decompression in the carpal tunnel with a mini incision made proximal to the distal wrist crease. MATERIAL AND METHODS: A total of 80 patients (84 hands) operated by a single surgeon with a mini incision were included. The patients were evaluated postoperatively for the presence of pillar pain, pain on the incision scar, and scar sensitivity in addition to preoperative findings. The Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) questionnaire was used for clinical scoring. To evaluate the effectiveness of the method, the findings were recorded at and compared between at 12 and 24 months follow-ups. RESULTS: No complications were observed at the wound site in the early postoperative period. Ten patients reported numbness, 5 experienced weakness, and 4 revealed positive Tinel's sign. Keloid formation without pain and scar sensitivity was detected in 2 patients at 6 months. No patient reported night pain, pain on pillar or incision scar, scar sensitivity, recent sensory loss, and disease recurrence. Numbness was present in 7 patients at 12 months and in 3 at 24 months; 3 and 2 patients reported weakness at 12 and 24 months, respectively. The mean Quick DASH score was 72.7 preoperatively, 10.2 at 12 months, and 9.1 at 24 months. CONCLUSION: The median nerve decompression in the carpal tunnel may be performed with a mini incision made proximal to the distal wrist crease is effective and safe method, and provides less complications and higher patient comfort.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Nervo Mediano/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Ferida Cirúrgica , Articulação do Punho/cirurgia , Adulto , Idoso , Síndrome do Túnel Carpal/diagnóstico , Feminino , Humanos , Masculino , Nervo Mediano/patologia , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/cirurgia , Medição da Dor/métodos , Ferida Cirúrgica/patologia , Inquéritos e Questionários , Resultado do Tratamento , Articulação do Punho/patologia
12.
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
13.
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
14.
Khirurgiia (Mosk) ; (6): 94-100, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317947

RESUMO

Carpal tunnel syndrome (CTS) requires special attention due to its different reasons and course. Knowledge about the variability of median nerve (MN) topography in carpal canal region, features of diagnosis and treatment extends outlooks on this pathology. Aggregating rare clinical cases from the Medline and Pubmed databases is useful to form personified approach. There are 3 types of topographic variations which should be considered to prevent false-positive diagnosis of pathology: recurrent branch location, early bi- and trifurcations of MN, anastomoses. Since acute CTS is treated only by surgery, every surgical approach is aimed at minimally invasiveness and fast recovery. Endoscopic decompression (ED) is more favorable regarding these aspects. However, this method cannot be considered as perfect due to available data about incomplete decompression and certain incidence of recurrences. The last ones are absent after microsurgical decompression as a rule. It can be concluded that only individual approach is advisable for complete release of CTS without iatrogenic damage and recurrences.


Assuntos
Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/cirurgia , Nervo Mediano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Doença Aguda , Síndrome do Túnel Carpal/etiologia , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Humanos , Doença Iatrogênica/prevenção & controle , Nervo Mediano/anatomia & histologia , Nervo Mediano/patologia , Microcirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Neurocirúrgicos/efeitos adversos , Recidiva
15.
J Clin Neurophysiol ; 36(6): 468-470, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31274708

RESUMO

A 55-year-old woman presented with an 18-month history of intermittent left-hand paresthesias affecting her first, second, and third digits. A small, immobile, nontender midline mass on the volar aspect of the left wrist was also present. Evaluation included normal routine nerve conduction studies and needle electromyography. An ultrasound was performed in the electromyography laboratory, verifying median nerve involvement of the mass within the proximal carpal tunnel. This finding guided the electromyographer to perform the unconventional technique of sensory nerve short segmental stimulation across the carpal tunnel, which confirmed focal slowing across the lesion, achieving electrodiagnostic confirmation of median nerve impairment. This case of atypical carpal tunnel syndrome due to a median nerve schwannoma demonstrates both the utility and specificity of short segmental sensory stimulation in some cases of median neuropathy at the wrist and the value of sonography in the electromyography laboratory.


Assuntos
Síndrome do Túnel Carpal/diagnóstico , Eletromiografia/métodos , Nervo Mediano/patologia , Neurilemoma/diagnóstico , Síndrome do Túnel Carpal/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Neurilemoma/complicações , Ultrassonografia/métodos , Punho/inervação , Punho/patologia
16.
Muscle Nerve ; 60(4): 415-419, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31294858

RESUMO

INTRODUCTION: We present a case series of six treatment-naive patients with clinical phenotypes compatible with chronic inflammatory demyelinating polyneuropathy and multifocal motor neuropathy without electrodiagnostic features of demyelination but with abnormal peripheral ultrasound findings who responded to treatment. METHODS: All six patients underwent a complete set of ancillary investigations, including extensive nerve conduction studies. We also performed standardized nerve ultrasound of median nerves and brachial plexus as part of a larger effort to evaluate diagnostic value of sonography. RESULTS: Nerve conduction studies did not show conduction block or other signs of demyelination in any of the six patients. Sonographic nerve enlargement was present in all patients and was most prominent in proximal segments of the median nerve and brachial plexus. Treatment with intravenous immunoglobulin resulted in objective clinical improvement. DISCUSSION: Our study provides evidence that nerve ultrasound represents a useful complementary diagnostic tool for the identification of treatment-responsive inflammatory neuropathies.


Assuntos
Plexo Braquial/diagnóstico por imagem , Nervo Mediano/diagnóstico por imagem , Condução Nervosa/fisiologia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico por imagem , Idoso , Plexo Braquial/patologia , Plexo Braquial/fisiopatologia , Eletrodiagnóstico , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Masculino , Nervo Mediano/patologia , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Tamanho do Órgão , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/fisiopatologia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/terapia , Ultrassonografia
17.
Rev Med Interne ; 40(7): 453-456, 2019 Jul.
Artigo em Francês | MEDLINE | ID: mdl-31040049

RESUMO

Carpal tunnel syndrome is a common peripheral neuropathy, usually idiopathic or post-traumatic due to the compression of the median nerve. Numbness and paresthesias in the median nerve distribution are the most common symptoms associated with this condition. Persistent median artery is a rare anatomic variation, thrombosis of this additional artery can be responsible for an acute carpal tunnel syndrome, and patients frequently complain about coldness and acute hand swelling. These unusual features must lead clinicians to think of a vascular cause. The diagnosis can be easily confirmed by using ultrasound doppler, but CT-scan and MRI are sometimes helpful. We describe 2 cases of acute carpal tunnel syndrome due to thrombosed persistent median artery, including a case of thromboangiitis obliterans. These thrombosis might also be due to traumatic causes. No guidelines are currently available to help physicians for the management of carpal tunnel syndrome from thrombosed persistent median artery. Antiplatelet therapy, statin, anticoagulant might be helpful, and surgery has sometimes be reported as effective.


Assuntos
Artérias/patologia , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/etiologia , Nervo Mediano/irrigação sanguínea , Trombose/complicações , Trombose/diagnóstico , Doença Aguda , Adulto , Feminino , Humanos , Masculino , Nervo Mediano/patologia , Neuropatia Mediana/complicações , Neuropatia Mediana/patologia , Pessoa de Meia-Idade
18.
Biomed Res Int ; 2019: 6872948, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30949505

RESUMO

The previous anterior approach to the elbow provides a limited exposure of the coronoid process. The aim of this study was to identify the optimal exposure interval for coronoid fractures from the anterior aspect of elbow. We exposed the coronoid process on twelve fresh-frozen cadaveric elbows from the anteromedial aspect of the elbow. The dissection intervals used were the novel brachial artery-median nerve interval (B-M interval) and the previously reported biceps tendon-brachial artery interval (B-B interval). Access to key anatomic landmarks around the coronoid process was assessed and the exposed surface area of coronoid process was calculated in each specimen. The average exposed surface area of coronoid process was 2.26 times greater with the B-M interval (4.58 cm2) compared with the B-B interval (2.03 cm2) (p < 0.05). All key anatomic landmarks around the coronoid process were directly visualised via the B-M interval in each specimen. In conclusion, the anteromedial approach through the B-M interval provides a more extensive exposure of the coronoid process than the traditional B-B interval. This new approach can be useful for the fixation of coronoid fractures.


Assuntos
Articulação do Cotovelo , Fraturas Ósseas , Cadáver , Articulação do Cotovelo/patologia , Articulação do Cotovelo/cirurgia , Feminino , Fraturas Ósseas/patologia , Fraturas Ósseas/cirurgia , Humanos , Masculino , Nervo Mediano/patologia , Nervo Mediano/cirurgia
19.
PLoS One ; 14(4): e0215750, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31013299

RESUMO

Essential tremor (ET) is a common movement disorder characterized by postural or kinetic tremor. We aimed to evaluate median nerve enlargement in patients with ET using ultrasonography (USG). Thirty-eight hands from 19 patients with ET and 24 hands from 13 controls underwent nerve conduction studies (NCS) and USG at the wrist. Tremor severity was measured using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). The median nerve cross sectional area (mCSA) in USG and NCS parameters were compared using ANCOVA. We evaluated the correlation between mCSA and NCS parameters or FTM-TRS scores using linear regression analysis. mCSA was significantly larger (p<0.001) and NCS parameters were different in two groups. Also, mCSA was negatively correlated with part B and C scores of FTM-TRS (p<0.001 and p = 0.039, respectively). In conclusion, median nerve enlargement with the changes of NCS parameters was observed and correlated with the severity of tremor in patients with ET.


Assuntos
Potenciais de Ação/fisiologia , Tremor Essencial/patologia , Nervo Mediano/patologia , Músculo Esquelético/fisiopatologia , Adulto , Idoso , Tremor Essencial/diagnóstico , Tremor Essencial/fisiopatologia , Feminino , Mãos , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Músculo Esquelético/inervação , Tamanho do Órgão , Estudos Prospectivos , Índice de Gravidade de Doença , Ultrassonografia
20.
Biomed Res Int ; 2019: 9498656, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30915366

RESUMO

Objectives: Carpal tunnel syndrome (CTS) is one of the most common nerve entrapment syndromes, which has a serious impact on patients' work and life. The most effective conservative treatment is steroid injection but its long-term efficacy is still not satisfactory. The aim of this study was to evaluate the effectiveness of steroid injection combined with miniscalpel-needle (MSN) release for treatment of CTS under ultrasound guidance versus steroid injection alone. We hypothesized that combined therapy could be more beneficial. Methods: Fifty-one patients with CTS were randomly allocated into two groups, namely, steroid injection combined with MSN release group and steroid injection group. The therapeutic effectiveness was evaluated using Boston Carpal Tunnel Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, and four electrophysiological parameters, including distal motor latency (DML), compound muscle action potential (CMAP), sensory nerve action potential (SNAP), and sensory nerve conduction velocity (SNCV) at baseline, 4 and 12 weeks after treatment. Results: Compared with baseline, all the parameters in both groups showed statistically significant improvement at week 4 and week 12 follow-up, respectively (P<0.05). When compared with steroid injection group, the outcomes including BCTQ, DML, CMAP, SNCV, and CSA of the median nerve were significantly better in steroid injection combined with MSN release group at week 12 after treatment (P<0.05). Conclusions: The effectiveness of steroid injection combined with MSN release for CTS is superior to that of steroid injection alone, which may have important implications for future clinical practice. This Chinese clinical trial is registered with ChiCTR1800014530.


Assuntos
Síndrome do Túnel Carpal/tratamento farmacológico , Terapia Combinada , Esteroides/administração & dosagem , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/fisiopatologia , Síndrome do Túnel Carpal/cirurgia , Terapia Combinada/métodos , Feminino , Humanos , Ligamentos/diagnóstico por imagem , Ligamentos/efeitos dos fármacos , Masculino , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/efeitos dos fármacos , Nervo Mediano/patologia , Pessoa de Meia-Idade , Agulhas , Condução Nervosa/efeitos dos fármacos , Resultado do Tratamento
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