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1.
Plast Reconstr Surg ; 146(1): 128-132, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32590654

RESUMO

Supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer is commonly performed in the authors' institution to augment intrinsic hand function. Following observations of recovery patterns, the authors hypothesized that despite its more distal innervation, the first dorsal interosseous muscle recovers to a greater extent than the abductor digiti minimi muscle. The objective of this work was to evaluate the clinical and electrodiagnostic pattern of reinnervation of intrinsic hand musculature following supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer. A retrospective cohort of prospectively collected data included all patients who underwent a supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer. Two independent reviewers performed data collection. Reinnervation was assessed with two primary outcome measures: (1) clinically, with serial Medical Research Council strength assessments; and (2) electrodiagnostically, with serial motor amplitude measurements. Statistical analysis was performed using nonparametric statistics. Seventeen patients (65 percent male; mean age, 56.9 ± 13.3 years) were included with a mean follow-up of 16.7 ± 8.5 months. Preoperatively, all patients demonstrated clinically significant weakness and electrodiagnostic evidence of denervation. Postoperatively, strength and motor amplitude increased significantly for both the first dorsal interosseous muscle (p = 0.002 and p = 0.016) and the abductor digiti minimi muscle (p = 0.044 and p = 0.015). Despite comparable preoperative strength (p = 0.098), postoperatively, the first dorsal interosseous muscle achieved significantly greater strength when compared to the abductor digiti minimi muscle (p = 0.023). Following supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer, recovery of intrinsic muscle function differs between the abductor digiti minimi and the first dorsal interosseous muscles, with better recovery observed in the more distally innervated first dorsal interosseous muscle. Further work to elucidate the underlying physiologic and anatomical basis for this discrepancy is indicated. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Mãos/inervação , Músculo Esquelético/inervação , Transferência de Nervo/métodos , Nervo Ulnar , Adulto , Idoso , Animais , Feminino , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Nervo Ulnar/lesões , Nervo Ulnar/cirurgia
2.
Clin Sports Med ; 39(3): 597-621, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446578

RESUMO

Sports-related peripheral neuropathies account for 6% of all peripheral neuropathies and most commonly involve the upper extremity. The routes of the median, radial, and ulnar nerves are positioned in arrangements of pulleys and sheaths to glide smoothly around the elbow. However, this anatomic relationship exposes each nerve to risk of compression. The underlying mechanisms of the athletic nerve injury are compression, ischemia, traction, and friction. Chronic athletic nerve compression may cause damage with moderate or low pressure for long or intermittent periods of time.


Assuntos
Traumatismos em Atletas , Cotovelo/inervação , Nervo Mediano/lesões , Nervo Radial/lesões , Nervo Ulnar/lesões , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/terapia , Cotovelo/lesões , Humanos , Nervo Mediano/anatomia & histologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Doenças do Sistema Nervoso Periférico/terapia , Nervo Radial/anatomia & histologia , Nervo Ulnar/anatomia & histologia
3.
Niger J Clin Pract ; 23(5): 647-653, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32367871

RESUMO

Background: Supracondylar humerus (SCH) fractures are serious injuries due to the neighborhood of critical neural and vascular structures. One of the most devastating complications of SCH fractures is neurological damage, since it may cause permanent disability. The aim of this study is to categorize neurological complications, to report long-term functional outcomes, and to determine risk factors associated with childhood SCH fractures. Methods: The records of 375 children were reviewed retrospectively. Data about amount and direction of displacement, the shape of the fracture, age at the time of fracture, gender, time from impaction to surgery, time of surgery, type of neurological injury, and recovery time were recorded. Results: Neurological complications were seen in 37 (9.85%) children. Thirteen (35.1%) of the children had an iatrogenic nerve injury. All iatrogenic injuries were fully recovered in this study. However, 2 children who had combined neurological injury of radial, ulnar, and median nerves did not recover. Nearly 95% of all children who had neurological injury recovered fully. An anterior long and sharp bone fragment (spike) was observed in most of the children with neurological injury, and this spike was seen in 14 (58.3%) patients who had a trauma-related injury (n = 24). Conclusion: The prognosis of these nerve injuries is excellent, especially the iatrogenic ones. A long and sharp bone fragment (spike) may be responsible for nerve injuries in some children. Surgical exploration is not necessary after an iatrogenic nerve injury when there is no neurotmesis. Patience and care are utmost needed to handle neurological complications.


Assuntos
Fraturas do Úmero/complicações , Luxações Articulares/cirurgia , Traumatismos dos Nervos Periféricos/diagnóstico , Neuropatias Ulnares/etiologia , Criança , Pré-Escolar , Feminino , Fixação de Fratura/métodos , Humanos , Fraturas do Úmero/cirurgia , Úmero/lesões , Úmero/cirurgia , Doença Iatrogênica , Luxações Articulares/diagnóstico por imagem , Masculino , Nervo Mediano/lesões , Prognóstico , Nervo Radial/lesões , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Nervo Ulnar/lesões
4.
Muscle Nerve ; 62(2): 239-246, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32415858

RESUMO

BACKGROUND: Compound muscle action potential (CMAP) scan and MScanFit have been used to understand the consequences of denervation and reinnervation. This study aimed to monitor these parameters during Wallerian degeneration (WD) after acute nerve transections (ANT). METHODS: Beginning after urgent surgery, CMAP scans were recorded at 1-2 day intervals in 12 patients with ANT of the ulnar or median nerves, by stimulating the distal stump (DS). Stimulus intensities (SI), steps, returners, and MScanFit were calculated. Studies were grouped according to the examination time after ANT. Results were compared with those of 27 controls. RESULTS: CMAP amplitudes and MScanFit progressively declined, revealing a positive correlation with one another. SIs were higher in WD groups than controls. Steps appeared or disappeared in follow-up scans. The late WD group had higher returner% than the early WD and control groups. CONCLUSIONS: MScanFit can monitor neuromuscular dysfunction during WD. SIs revealed excitability changes in DS.


Assuntos
Potenciais de Ação/fisiologia , Nervo Mediano/fisiopatologia , Neurônios Motores/fisiologia , Condução Nervosa/fisiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Nervo Ulnar/fisiopatologia , Degeneração Walleriana/fisiopatologia , Adolescente , Adulto , Progressão da Doença , Eletrodiagnóstico , Eletromiografia , Feminino , Humanos , Masculino , Nervo Mediano/lesões , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/cirurgia , Nervo Ulnar/lesões , Nervo Ulnar/cirurgia , Adulto Jovem
5.
Am J Case Rep ; 21: e921293, 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32080162

RESUMO

BACKGROUND Supracondylar humeral fracture is a common fracture in the pediatric population. Although extension-type is the most common fracture pattern (97% to 98%), flexion-type supracondylar fractures are rarely encountered (2% to 3%). The combination of a flexion-type supracondylar humeral fracture with an ulnar nerve injury represents a real challenge for an orthopaedic surgeon. CASE REPORT We report 2 cases of flexion-type supracondylar humeral fracture with ulnar nerve injury that open reduction and fixation was necessary because closed reduction could not achieve an acceptable result. An anterior approach to the elbow joint was chosen to explore whether any neurovascular structures were entrapped between the fragments. The ulnar nerve was not found to be compressed in the fracture site. After anatomic reduction, cross K-wire fixation of the fracture was performed. At 6-month follow-up, ulnar nerve injuries (in both patients) were resolved. CONCLUSIONS These case reports enhance the existing literature that flexion-type supracondylar fractures with ulnar nerve injury are associated with higher rates of open reduction. Orthopaedic surgeons should be aware, and family members of those patients should be informed, that the likelihood of an open reduction in these types of injuries is extremely high. Open reduction is needed not only to achieve an anatomic reduction of the fracture but to make sure that the ulnar nerve is not entrapped between the proximal and distal fragment.


Assuntos
Fraturas do Úmero/cirurgia , Traumatismos dos Nervos Periféricos/cirurgia , Nervo Ulnar/lesões , Acidentes por Quedas , Fios Ortopédicos , Criança , Feminino , Fixação Interna de Fraturas , Humanos , Masculino
6.
J Pediatr Orthop ; 40(7): e603-e608, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31904615

RESUMO

BACKGROUND: A flexion deformity caused by a congenital anomaly of the flexor digitorum profundus (FDP) of the middle, ring, and small fingers is extremely rare, and it has previously been described only in isolated case reports. Hence, there has been no consensus with regard to the clinical presentation, etiology, and treatment. METHODS: We retrospectively analyzed our 10 cases (5 male individuals and 5 female individuals) for congenital FDP abnormalities. We obtained radiography, computed tomography, and magnetic resonance imaging on our patients. Nerve studies were performed in 7 of 10 patients, except for 3 patients below 5 years of age who were unable to co-operate. We used the grading criteria (Wang classification) to evaluate the restricted extension of the affected fingers and the active flexion function. An abnormal fibrous cord was seen intraoperatively in the proximal part of the belly of the FDP that was destined for the affected fingers. It originated from a bony prominence on the proximal part of the ulna. On resection of the aberrant cord, extension of the affected fingers was immediately improved. Pathologic examination of the removed aberrant cord revealed dense fibrous connective tissue. RESULTS: Nerve conduction studies and electromyography revealed that there was no substantial damage to the median and/or ulnar nerves. Plain radiography revealed no bone or joint anomalies. Computed tomography showed a slight bony prominence at the proximal part of the ulna. However, magnetic resonance imaging indicated a demonstrably abnormal fibrous cord in the FDP that originated from a bony prominence at the proximal part of the ulna and extended toward the middle, ring, and small fingers. On the basis of the Wang classification criteria for functional evaluation, 7 were moderate, and 3 were severe. Patients were followed-up for 2 to 36 months with a mean follow-up of 16 months. The postoperative outcomes were excellent in 8 cases and fair in 2 cases. The flexion and extension functions were regained, and there was no relapse of deformity. CONCLUSION: On the basis of its pathologic features, we recommend that this condition be treated by resection of the abnormal cord. LEVEL OF EVIDENCE: Level IV.


Assuntos
Contratura , Dedos , Deformidades Congênitas da Mão , Complicações Intraoperatórias/prevenção & controle , Traumatismos dos Nervos Periféricos , Tenotomia , Criança , Contratura/etiologia , Contratura/fisiopatologia , Contratura/cirurgia , Progressão da Doença , Eletromiografia/métodos , Feminino , Dedos/anormalidades , Dedos/fisiopatologia , Dedos/cirurgia , Deformidades Congênitas da Mão/diagnóstico , Deformidades Congênitas da Mão/cirurgia , Humanos , Masculino , Músculo Esquelético/anormalidades , Músculo Esquelético/diagnóstico por imagem , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Amplitude de Movimento Articular , Estudos Retrospectivos , Tenotomia/efeitos adversos , Tenotomia/métodos , Nervo Ulnar/lesões
7.
Hand Surg Rehabil ; 38(6): 381-385, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31589935

RESUMO

The ulnar-sided approach for arthroscopic peripheral triangular fibrocartilage complex (TFCC) repair may be associated with injury to the dorsal branch of the ulnar nerve (DBUN). The goal of this study was to develop a small incision to help minimize DBUN injury. Ten cadaveric upper limbs were used to measure the anatomic parameters of the DBUN. Based on these measured anatomical relationships, a 20 mm longitudinal incision with the ulnar styloid process as the midpoint was designed to explore and protect the DBUN. Three additional cadaveric upper limbs were used to test the feasibility of this method. Then this method was applied in 15 patients with TFCC injury (IB type). In 10 cadavers, the DBUN was located volar to the ulnar styloid process. The mean linear distance between the DBUN and the ulnar styloid process was 8.04 mm (range: 7.02-8.82mm) in the transverse-volar direction and 13.78 mm (range: 11.06-16.02mm) in the longitudinal-distal volar direction. In three additional cadavers, the DBUN was successfully explored and retracted with this incision, creating a safer space for passing sutures and tying knots. This modified method was used successfully in 15 patients, and the DBUN was protected during surgery. There were no complications, and most importantly, no injuries to the DBUN at the 6-month follow-up visit. Therefore, we recommend that a 20 mm longitudinal incision with the ulnar styloid process as the midpoint be made prior to passing sutures during the arthroscopic repair of TFCC tears to avoid injuring the various branches of the DBUN.


Assuntos
Artroscopia/métodos , Complicações Intraoperatórias/prevenção & controle , Traumatismos dos Nervos Periféricos/prevenção & controle , Fibrocartilagem Triangular/lesões , Fibrocartilagem Triangular/cirurgia , Nervo Ulnar/lesões , Idoso , Idoso de 80 Anos ou mais , Cadáver , Humanos , Pessoa de Meia-Idade
8.
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
9.
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
10.
J Hand Surg Asian Pac Vol ; 24(3): 323-328, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31438805

RESUMO

Background: Shoulder and elbow motions can affect ulnar nerve strain. However, there is no evidence that links this kind of strain to specific activities. The purpose of this study was to examine ulnar nerve strain at the elbow resulting from normal daily activities. Methods: This study was conducted using thirty fresh frozen cadaveric elbows from subjects who had no deformities or history of previous upper extremity surgery. Strain was calculated based on nerve elongation. Ulnar nerve strain at the elbow from motion related to common daily activities was measured in both normal nerves and nerves in which gliding motion was restricted. The results of these measurement were then compared. Results: Activities related to extreme elbow and shoulder motions, such as cellular phone use, yielded an average strain of 6.3%. In addition, we found that nerve strain increased significantly in conditions in which gliding motion was restricted. Nerve strain due to motion associated with cellular phone use, for example, rose by 69.1%. Conclusions: Elbow flexion and shoulder abduction in daily activities are associated with increases in ulnar nerve strain, but this may not cause permanent damage to the nerve. After nerve gliding motion had been restricted, nerves that normally exhibited less strain often had even increased higher levels of strain than those nerves that normally exhibited high strain.


Assuntos
Articulação do Cotovelo/fisiologia , Amplitude de Movimento Articular/fisiologia , Entorses e Distensões/etiologia , Nervo Ulnar/lesões , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Articulação do Ombro/fisiologia
11.
Exp Brain Res ; 237(9): 2297-2304, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31273391

RESUMO

Incomplete recovery of sensory function is common after peripheral nerve injury (PNI). Despite reinnervation following injury, disorganized cortical representations persist and may contribute to functional deficits. There is a dearth of literature characterizing cortical responses after PNI in rodent models. Here we develop a quantitative electrophysiological method for mapping forepaw digit responses in primary somatosensory cortex (S1) of rats. We tested the hypothesis that PNI in the forelimb would generate significant, long lasting sensory deficits, and corresponding disorganization in S1. Rats underwent a transection of the proximal segment of the median and ulnar nerves in the forelimb followed by tubular repair. 4-12 months after nerve injury, we tested mechanosensory withdrawal thresholds and mapped S1 responses to mechanical stimulation of the digits. PNI produces persistent elevation of mechanical withdrawal thresholds, consistent with an impairment in sensory function. Assessment of cortical neurophysiology reveals a substantial disorganization of S1 somatotopy. Additionally, we document degraded timing and digit specificity of cortical responses. This quantitative measurement of long-term changes in S1 digit representations after forelimb nerve injury in rodents provides a framework for further studies focused on the development of therapeutic strategies to restore cortical and sensory function.


Assuntos
Membro Anterior/fisiopatologia , Nervo Mediano/fisiopatologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Limiar Sensorial/fisiologia , Córtex Somatossensorial/fisiopatologia , Dedos do Pé/fisiopatologia , Percepção do Tato/fisiologia , Nervo Ulnar/fisiopatologia , Animais , Modelos Animais de Doenças , Eletroencefalografia , Feminino , Nervo Mediano/lesões , Estimulação Física , Ratos , Ratos Sprague-Dawley , Nervo Ulnar/lesões
12.
Eur J Orthop Surg Traumatol ; 29(6): 1169-1175, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31037406

RESUMO

Aim of this review article is to evaluate the percentage of ulnar nerve lesion during cross-pinning considering the patient's position (supine or prone) on the surgical bed. Comprehensive research was performed by searching in PUBMED, Cochrane Library, ISI Web of Science, SCOPUS and Clinicaltrials.gov from 2005. Children with extension type supracondylar humeral fractures without clinical signs of ulnar nerve lesion at presentation were included. A total of 28 papers were examined including 2147 patients; 1541 underwent a closed reduction and cross-pinning in supine position and 606 in prone position. Among 1541 patients in supine position, 69 (4.5%) suffered from a ulnar nerve injury while among the 606 patients treated in prone position none ulnar nerve lesions were reported. Despite the apparent safety of prone position, further larger studies, comparing the patient's position on the surgical bed, need to be carried out in order to confirm this likelihood.


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Fraturas do Úmero/cirurgia , Complicações Intraoperatórias/prevenção & controle , Posicionamento do Paciente/métodos , Traumatismos dos Nervos Periféricos , Nervo Ulnar/lesões , Criança , Fixação Interna de Fraturas/métodos , Humanos , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Risco Ajustado
13.
J Pak Med Assoc ; 69(5): 672-676, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31105286

RESUMO

OBJECTIVE: To explore the pattern of electrodiagnostic findings in cases of wrist drop and compare gender, involved side of the body, and military versus civilian population for the aetiology of wrist drop. METHODS: This cross-sectional study was conducted at Armed Forces Institute of Rehabilitation Medicine Rawalpindi, Pakistan, from August 2013 to December 2014, and comprised wrist drop cases regardless of age or gender. Evaluation was done using XLTEK Neuromax 1004 EMG unit in line with the recommended protocol for electrodiagnostic evaluation of a suspected radial nerve injury(RNI). SPSS 20 was used for data analysis. RESULTS: Of the 119 patients, 97(81.5%) were males, 66(55.5%) were in the 16-30 years' age group, and 96(80.7%) were military personnel. RNI at the mid-arm level was the commonest cause in 88(73.9%) cases. The frequent inciting event was trauma with fracture of the humerus in 39(32.8%) cases. Eighty-four (70.6%) lesions were axonal. Ninety-four (79%) individuals had no associated injury to other nerves. Injuries due to trauma were more frequent in males (p<0.001), on the right side (p=0.046), and in the military population (p=0.05). CONCLUSIONS: RNI at the mid arm level was the commonest cause of wrist drop in our sample and fracture of the humerus was the main inciting event..


Assuntos
Fraturas Ósseas/complicações , Úmero/lesões , Doença Iatrogênica , Traumatismos dos Nervos Periféricos/etiologia , Nervo Radial/lesões , Neuropatia Radial/etiologia , Adolescente , Adulto , Eletrodiagnóstico , Eletromiografia , Feminino , Hospitais Militares , Humanos , Masculino , Nervo Mediano/lesões , Pessoa de Meia-Idade , Militares/estatística & dados numéricos , Condução Nervosa , Traumatismos dos Nervos Periféricos/diagnóstico , Neuropatia Radial/diagnóstico , Raízes Nervosas Espinhais/lesões , Nervo Ulnar/lesões , Adulto Jovem
14.
Arch Orthop Trauma Surg ; 139(7): 1021-1023, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31011794

RESUMO

Nerve injuries, mostly to the median nerve, are common following distal radius fractures. Ulnar nerve injuries are rarely encountered, with only few case reports of motor or motor and sensory loss described in the literature. In this paper, we report two consecutive cases of young patients with a distal radius fracture and a pure sensory ulnar neuropathy. Both patients had a radially displaced fracture and presented with sensory loss and paresthesia in the distribution of the dorsal cutaneous branch of the ulnar nerve (DCBUN), which resolved after fracture reduction. We believe this clinical scenario is the result of traction or compressive neuropraxia of the DCBUN in the subcutaneous tissue around the ulnar styloid-a neurologic injury which had not yet been described for distal radius fractures.


Assuntos
Redução Fechada/métodos , Fratura-Luxação , Traumatismos dos Nervos Periféricos , Fraturas do Rádio , Transtornos das Sensações , Nervo Ulnar/lesões , Punho/diagnóstico por imagem , Adulto , Fratura-Luxação/complicações , Fratura-Luxação/diagnóstico , Fratura-Luxação/fisiopatologia , Fratura-Luxação/cirurgia , Fixação de Fratura/métodos , Humanos , Masculino , Exame Neurológico , Parestesia/diagnóstico , Parestesia/etiologia , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Traumatismos dos Nervos Periféricos/terapia , Radiografia/métodos , Fraturas do Rádio/complicações , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/fisiopatologia , Fraturas do Rádio/cirurgia , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/etiologia , Pele/inervação , Tato , Resultado do Tratamento
15.
Injury ; 50 Suppl 1: S2-S9, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30955872

RESUMO

In the pediatric population supracondylar humerus fracture (SHF) is one of the most common injuries. Diagnosis is based on inspection and conventional radiography. SHFs should be classified according to the modified Gartland classification, which guides treatment. Non-displaced or minimally displaced fractures (Gartland type-I) should be treated non-operatively, completely displaced type III fractures require closed reduction and K-wire fixation. In type-II fractures, important landmarks, such as the anterior humeral line (Roger´s line), the shaft-physeal angle (Baumann´s angle) and the shaft condylar angle should be considered to guide treatment. Special attention has to be paid for potential rotational dislocation, which is indicated by a ventral spur. In such cases surgery is necessary. The degree of acceptable extension malpositioning depends on patient´s age. In 10-year-old children fractures with a shaft condylar angle of more than 15° are still suitable for non-operative therapy. Timing for surgery is controversially discussed. Postponing surgery to the next day seems reasonable if absence of pain, intact soft tissue and normal neurovascular status are present. Neurovascular complications are not uncommon, especially in Gartland type-III fractures and in cases with additional forearm injuries. A white hand without palpable pulse needs emergency surgery, the management of the pulseless pink hand is still controversially discussed. Different operative techniques exist for surgical treatment. The golden standard is closed reduction and percutaneous K-wire pinning. Crossed pinning seems to achieve best biomechanical stability. Since ulnar nerve injuries are reported to occur in 6% after medially inserting K-wires, lateral divergent insertion of two K-wires has been compared to crossed pinning fixation in several randomized controlled trials. Meta-analyses demonstrated a higher risk for ulnar nerve injury for the crossed pinning technique while risk for loss of fixation was higher in lateral only pinning. In both cases, K-wires should be removed 3-6 weeks after surgery with consolidation of the fracture. Clinical and radiological follow-up should be carried out at 3 weeks post fracture fixation to rule out loss of reduction. If this should occur, early revision surgery has been demonstrated beneficial.


Assuntos
Tratamento Conservador/estatística & dados numéricos , Fixação Interna de Fraturas , Fixação Intramedular de Fraturas/instrumentação , Fraturas do Úmero/terapia , Doença Iatrogênica/prevenção & controle , Reoperação/estatística & dados numéricos , Nervo Ulnar/lesões , Fenômenos Biomecânicos , Fios Ortopédicos , Criança , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/estatística & dados numéricos , Fixação Intramedular de Fraturas/métodos , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/fisiopatologia , Radiografia
16.
J Am Acad Orthop Surg ; 27(19): 717-725, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30939566

RESUMO

Tardy ulnar nerve palsy is a chronic clinical condition characterized by a delayed onset ulnar neuropathy after an injury to the elbow. Typically, tardy ulnar nerve palsy occurs as a consequence of nonunion of pediatric lateral condyle fractures at the elbow, which eventually lead to a cubitus valgus deformity. While the child grows, the deformity worsens and the ulnar nerve is gradually stretched until classic symptoms of ulnar nerve neuropathy appear. Other childhood elbow trauma has also been associated with tardy ulnar nerve palsy, including supracondylar fractures resulting in cubitus varus, fractures of the medial condyle and of the olecranon, as well as radial head or Monteggia fractures/dislocation, with or without deformity. The clinical assessment includes obtaining a complete history, physical examination, nerve conduction tests, and elbow imaging studies. Treatment consists of ulnar nerve decompression, with or without corrective osteotomy, with overall successful results usually achieved.


Assuntos
Traumatismos do Braço/complicações , Cotovelo/lesões , Fraturas Ósseas/complicações , Traumatismos dos Nervos Periféricos/terapia , Síndromes de Compressão do Nervo Ulnar/terapia , Nervo Ulnar/lesões , Neuropatias Ulnares/terapia , Doença Crônica , Humanos , Traumatismos dos Nervos Periféricos/classificação , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Fatores de Tempo , Nervo Ulnar/cirurgia , Síndromes de Compressão do Nervo Ulnar/classificação , Síndromes de Compressão do Nervo Ulnar/diagnóstico , Síndromes de Compressão do Nervo Ulnar/etiologia , Neuropatias Ulnares/classificação , Neuropatias Ulnares/diagnóstico , Neuropatias Ulnares/etiologia
17.
Am J Sports Med ; 47(5): 1124-1129, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30883185

RESUMO

BACKGROUND: Isolated ulnar nerve decompression/transposition is an uncommon surgical procedure among professional baseball players. PURPOSE/HYPOTHESIS: To determine performance and rate of return to sport (RTS) among professional baseball players after isolated ulnar nerve decompression/transposition, including those who required decompression/transposition after ulnar collateral ligament reconstruction (UCLR), and to compare outcomes between cases and matched controls. The authors hypothesized a high rate of RTS among professional baseball players undergoing isolated ulnar nerve decompression/transposition with no difference in RTS rate or performance between cases and controls as related to earned run average, WHIP ([walks + hits]/innings pitched), wins above replacement, and on base + slugging percentage. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Utilizing the injury database of Major League Baseball, we identified all professional baseball players who underwent isolated ulnar nerve decompression/transposition between 2010 and 2016. De-identified demographic and performance data (before and after surgery) for each player were recorded from Major League Baseball records. Performance metrics were then compared between cases and matched controls. RESULTS: The study included 52 players; 83% were pitchers; and 14 underwent prior UCLR. Most surgical procedures (92%) were anterior subcutaneous transpositions. Overall, 62% of players were able to successfully RTS, and 56% returned to the same or higher level. There was no significant difference between cases and controls in the majority of pre- and postoperative performance metrics-specifically, earned run average, WHIP, wins above replacement, and on base + slugging percentage. When players who had UCLR before ulnar nerve decompression/transposition were compared with controls with a history of UCLR but no subsequent ulnar nerve decompression/transposition, the only performance difference of all the recorded metrics was that cases allowed more walks per 9 innings (4.4 vs 2.8, P = .011). CONCLUSION: Anterior subcutaneous transposition is the most common surgical procedure among professional baseball players to address ulnar neuropathy at the elbow. Players have a 62% rate of RTS, which is lower than expected for this nonreconstruction or repair procedure. For players who successfully RTS, performance metrics versus matched controls remained the same except for allowing significantly more walks per 9 innings. Postoperatively, pitchers with UCLR before ulnar nerve decompression/transposition who had a successful RTS performed the same as matched controls with prior UCLR without subsequent ulnar nerve decompression/transposition.


Assuntos
Beisebol/lesões , Descompressão Cirúrgica/métodos , Articulação do Cotovelo/lesões , Desempenho Físico Funcional , Volta ao Esporte , Síndromes de Compressão do Nervo Ulnar/cirurgia , Nervo Ulnar/cirurgia , Adulto , Articulação do Cotovelo/inervação , Articulação do Cotovelo/fisiopatologia , Seguimentos , Humanos , Masculino , Período Pós-Operatório , Nervo Ulnar/lesões , Síndromes de Compressão do Nervo Ulnar/fisiopatologia
18.
Bone Joint J ; 101-B(2): 124-131, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30700118

RESUMO

Nerve transfer has become a common and often effective reconstructive strategy for proximal and complex peripheral nerve injuries of the upper limb. This case-based discussion explores the principles and potential benefits of nerve transfer surgery and offers in-depth discussion of several established and valuable techniques including: motor transfer for elbow flexion after musculocutaneous nerve injury, deltoid reanimation for axillary nerve palsy, intrinsic re-innervation following proximal ulnar nerve repair, and critical sensory recovery despite non-reconstructable median nerve lesions.


Assuntos
Transferência de Nervo/métodos , Traumatismos dos Nervos Periféricos/cirurgia , Extremidade Superior/inervação , Adulto , Axila/inervação , Feminino , Humanos , Masculino , Nervo Mediano/lesões , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Nervo Musculocutâneo/anatomia & histologia , Nervo Musculocutâneo/lesões , Nervo Musculocutâneo/cirurgia , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Nervos Periféricos/anatomia & histologia , Nervos Periféricos/cirurgia , Luxação do Ombro/etiologia , Nervo Ulnar/lesões , Nervo Ulnar/transplante , Extremidade Superior/lesões , Adulto Jovem
19.
Tech Hand Up Extrem Surg ; 23(3): 111-114, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30664066

RESUMO

INTRODUCTION: Many methods have been described to minimize the risk of ulnar nerve injury during the insertion of a medial pin for the percutaneous pinning of pediatric supracondylar humerus fractures (SCHF). The most recent AAOS Clinical Practice Guidelines suggests that physicians might want to avoid the use of medial-entry pins due to considerations of potential injury to the ulnar nerve. However, there are circumstances whereby a cross pin configuration is required. These include cases where there is medial wall comminution or due to the obliquity of the fracture. In this study, we present a group of patients with SCHF in which the medial pin was inserted using a new technique. MATERIALS AND METHODS: This is a retrospective case series approved by the local centralized institutional review board. The medical records of all patients who underwent closed reduction and percutaneous pinning for SCHF using a new technique-the sliding method-by a single pediatric orthopedic surgeon from August 2017 till January 2018 were reviewed. Patient demographics, fracture type, operative time, postoperative Baumann's angle, postoperative lateral capitellohumeral angle, and the rate of ulnar nerve palsy were recorded. RESULTS: This new technique was used in a total of 35 patients. Two patients were excluded as one had multiple same limb injuries, while another had a Gustilo 3A humerus supracondylar fracture. The average patient age at the time of surgery was 6.2 years (range: 2 to 12 y). There were 22 children with Gartland grade 3 fractures, 10 with grade 2b fractures, and 1 had a flexion type fracture. The average operative time was 21 minutes (range: 7 to 58 min). The average postoperative Baumann's angle was 73.9 degrees (range: 63.8 to 79.6 degrees) and the average postoperative lateral capitellohumeral angle was 44.6 degrees (range: 31.1 to 56.8 degrees). There were no cases of ulnar nerve palsy. CONCLUSIONS: The sliding method is a novel technique of protecting the ulnar nerve during closed reduction percutaneous pinning of SCHF. LEVEL OF EVIDENCE: Level IV.


Assuntos
Pinos Ortopédicos , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Criança , Pré-Escolar , Redução Fechada , Feminino , Humanos , Fraturas do Úmero/classificação , Masculino , Duração da Cirurgia , Traumatismos dos Nervos Periféricos/prevenção & controle , Estudos Retrospectivos , Nervo Ulnar/lesões , Neuropatias Ulnares/prevenção & controle
20.
J Hand Surg Eur Vol ; 44(3): 269-272, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30563413

RESUMO

Primary repair of a nerve is preferable over nerve grafting when a tension-free environment can be achieved. The purpose of this cadaveric study was to evaluate the facility of nerve-gap closure gained by removing the hamate hook, eliminating the circuitous path of the motor branch of the ulnar nerve in the hand. Six cadaveric specimens were dissected and the length of the motor branch coursing through Guyon's canal before and after hamate hook excision and nerve transposition was recorded. Average length was significantly shorter in specimens after transposition, with a mean 21% reduction relative to the nerve's original course. This knowledge may help guide surgeons on whether excision of the hamate hook will allow for primary repair of the nerve when a segmental defect or retraction and scarring of the nerve stumps is encountered.


Assuntos
Mãos/cirurgia , Transferência de Nervo/métodos , Nervo Ulnar/cirurgia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Descompressão Cirúrgica/métodos , Feminino , Hamato/cirurgia , Humanos , Masculino , Nervo Ulnar/lesões
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