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1.
Ann Vasc Surg ; 68: 569.e9-569.e11, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32278874

RESUMO

BACKGROUND: Vascular malformations of the hand are rare vascular malformations that are challenging to treat. METHODS: We present a case of a large vascular malformation with left hand pain and decreased sensation of the small and ring fingers. The lesion was treated operatively with surgical excision. RESULTS: The malformation was successfully removed surgically, and pain resolved and numbness recovered by 2 weeks after surgery. CONCLUSIONS: This is a rare case of large vascular malformation in the hand with compromised neurologic status. Surgical treatment provided complete relief of the disease, and the patient returned to normal daily activities.


Assuntos
Mãos/irrigação sanguínea , Mãos/inervação , Síndromes de Compressão Nervosa/etiologia , Nervo Ulnar/fisiopatologia , Malformações Vasculares/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Recuperação de Função Fisiológica , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/cirurgia
2.
Neurourol Urodyn ; 39(3): 890-897, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32022321

RESUMO

BACKGROUND: There is a gap between pudendal neuralgia (PN) due to pudendal entrapment syndrome and PN without pudendal entrapment syndrome. The latter could have atypical symptoms. AIM: Defining a rate of atypical PN from a clinical series of female patients with chronic pelvic-perineal pain. METHODS: The atypical PN was defined as a pain not meeting clinical criteria for pudendal entrapment syndrome. The effect size was the rate of atypical PN. Such a rate was expected to be found among patients screened for enrollment in clinical series on pudendal neuropathic pain. A systematic search was performed looking for clinical series on PN. Studies must report information on female patients, pelvic-perineal pain, at least a clinical criterion for diagnosing the pudendal neurogenic origin of pain, the proportion of patients with pain not meeting the clinical criterion/a for diagnosing the pudendal entrapment pain. RESULTS: From 2637 references, nine studies were included for qualitative analysis. Three of them were not suitable for data synthesis: one assessed the rate of PN after hip arthroscopy; second enrolled miscellaneous patients, a third investigated patients with gynecological diseases. Six studies involved patients with suspicion of pudendal entrapment symptoms (205 patients observed), allowing data synthesis. One of these series was judged as being of good quality. The overall rate of atypical PN is 0.013 (95% confidence interval, 0.008-0.021), I2 0%. Further analysis suggests the risk of bias for all studies. CONCLUSIONS: Atypical PN in females is low when clinical criteria for pudendal entrapment syndrome are applied.


Assuntos
Dor Crônica/fisiopatologia , Síndromes de Compressão Nervosa/fisiopatologia , Neuralgia/fisiopatologia , Dor Pélvica/fisiopatologia , Neuralgia do Pudendo/diagnóstico , Feminino , Humanos , Pelve , Períneo , Nervo Pudendo , Neuralgia do Pudendo/fisiopatologia
3.
Radiol Med ; 125(5): 481-490, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32020529

RESUMO

OBJECTIVES: To systematically review the current literature concerning the role of superb microvascular imaging (SMI), a novel Doppler technique that enables detection of fine vessels and slow blood flow, in the evaluation of musculoskeletal disorders. METHODS: An online search of the literature was conducted for the period 2013 to April 2019 and included original articles written in English language. A data analysis was performed at the end of the literature search. RESULTS: Eight original articles with prospective design and one with retrospective design were included in this review: 4 studies focused on rheumatoid arthritis, 2 on rheumatoid and other arthritides, 1 on lateral epicondylosis and 2 on carpal tunnel syndrome. Sample size ranged from 26 to 83 patients. Despite some methodological differences, all studies compared the performance of SMI with that of a conventional Doppler technique such as power and color Doppler and found an improvement in vascularity detection with SMI. The main variations were in sample size, evaluated parameters and vascularity interpretation methods. Inter-observer agreement for SMI ranged from moderate to excellent. CONCLUSIONS: SMI is a promising tool for the diagnosis and treatment planning of different musculoskeletal disorders. Future investigations should include larger samples of patients with long-term follow-up.


Assuntos
Microvasos/diagnóstico por imagem , Doenças Musculoesqueléticas/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Artrite/diagnóstico por imagem , Artrite/fisiopatologia , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/fisiopatologia , Velocidade do Fluxo Sanguíneo , Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/fisiopatologia , Humanos , Microvasos/fisiopatologia , Doenças Musculoesqueléticas/fisiopatologia , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/fisiopatologia , Estudos Prospectivos , Estudos Retrospectivos , Tendinopatia/diagnóstico por imagem , Tendinopatia/fisiopatologia , Cotovelo de Tenista/diagnóstico por imagem , Cotovelo de Tenista/fisiopatologia , Ultrassonografia Doppler em Cores/métodos
4.
Neuromodulation ; 23(2): 167-176, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32103594

RESUMO

OBJECTIVE: The role of the nucleus accumbens (NAc) in chronic neuropathic pain has been suggested, but the role of the NAc in dorsal root ganglion (DRG) neuropathic pain remains unclear. The objective of this study was to determine whether optogenetic stimulation of the NAc influences DRG compression-induced neuropathic pain. MATERIALS AND METHODS: We established sham or DRG lesions in female Sprague-Dawley rats by L4-5 DRG root compression, and the animals received unilateral injections of optogenetic virus in the NAc core. We employed reflexive pain tests to assess the alterations between the groups at the light on/off states. To determine thalamic firing, we performed single-unit in vivo extracellular recording. For statistical analysis, we used one- or two-way repeated-measures analysis of variance. RESULTS: Compared to sham-operated rats, chronic compressed DRG rats showed elevated behavioral sensitivity and sustained neuronal hyperexcitability in the thalamus. NAc optic stimulation improved pain behaviors and lowered thalamic discharge from ventral posterolateral thalamic nuclei. CONCLUSIONS: The NAc core impacts the reward and motivational aspects of chronic neuropathic pain influenced by limbic behaviors to thalamic discharge. Increased thalamic firing activity may result in chronic compressed DRG-induced neuropathic pain, and optogenetic neuromodulation of the NAc can ease chronic pain and thalamic discharge.


Assuntos
Gânglios Espinais/lesões , Terapia a Laser/métodos , Síndromes de Compressão Nervosa/terapia , Neuralgia/terapia , Núcleo Accumbens/fisiologia , Fibras Ópticas , Animais , Modelos Animais de Doenças , Feminino , Gânglios Espinais/fisiopatologia , Síndromes de Compressão Nervosa/fisiopatologia , Neuralgia/fisiopatologia , Manejo da Dor/métodos , Ratos , Ratos Sprague-Dawley
5.
J Stroke Cerebrovasc Dis ; 29(2): 104459, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31839548

RESUMO

A 51-year-old Japanese woman was admitted to our hospital because of speech difficulty following severe headache. Neurological examination showed dysarthria and tongue weakness on the right side, indicating right hypoglossal nerve palsy. Needle electromyography of the right side of the tongue showed fibrillation potentials. Magnetic resonance angiography and computed tomography angiography revealed a right, persistent, primitive hypoglossal artery (PPHA) that met Lie's diagnostic criteria. Digital subtraction angiography showed an extended PPHA with irregular caliber in the portion running through the right hypoglossal canal. We diagnosed compression neuropathy of the hypoglossal nerve due to PPHA enlargement based on the findings of ipsilateral hypoglossal nerve palsy, fibrillation that indicated peripheral nerve palsy, and the enlarged diameter of the portion of the PPHA running through the right hypoglossal canal. We prescribed antihypertensive therapy. At 1 year after onset, her tongue weakness was alleviated. Clinicians should consider compression neuropathy due to a PPHA as one of the possibilities in the differential diagnosis of hypoglossal nerve palsy.


Assuntos
Artérias/anormalidades , Doenças do Nervo Hipoglosso/etiologia , Nervo Hipoglosso/fisiopatologia , Síndromes de Compressão Nervosa/etiologia , Língua/irrigação sanguínea , Língua/inervação , Malformações Vasculares/complicações , Anti-Hipertensivos/uso terapêutico , Artérias/diagnóstico por imagem , Artérias/fisiopatologia , Feminino , Humanos , Doenças do Nervo Hipoglosso/diagnóstico , Doenças do Nervo Hipoglosso/fisiopatologia , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Recuperação de Função Fisiológica , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/tratamento farmacológico , Malformações Vasculares/fisiopatologia
6.
World Neurosurg ; 133: e62-e67, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31442648

RESUMO

OBJECTIVE: Microvascular decompression (MVD) has been widely accepted for treating hemifacial spasm (HFS) and glossopharyngeal neuralgia (GN); an effective surgical treatment of coexistent HFS and GN still remains to be determined, however. In this paper we discuss the operative strategy of MVD for patients with coexistent HFS and GN. METHODS: This was a retrospective study. All cases of HFS with or without GN at China-Japan Friendship Hospital from January 2014 to June 2016 have been included. All patients underwent MVD and have been followed up for an average of 1.5 years. RESULTS: A total of 5375 cases of HFS were included, wherein 8 cases coexist with GN. Eight patients had same offending vessel(s) compressing the root entry zone of glossopharyngeal nerve and facial nerve. Posterior inferior cerebellar artery was identified as at least 1 of the offending arteries in all 8 patients. After MVD, spasm ceased in all 8 cases, with 7 cases ceasing immediately and 1 within 2 months. Pain disappeared also in all cases, with 7 cases immediately and 1 case after 4 days. No recurrence or complication was observed during the follow-ups. CONCLUSIONS: HFS combined with ipsilateral GN was rare. MVD could be performed to effectively relieve nerve root compression and associated symptoms for coexistent HFS and GN. Sufficient exposure of root entry zones of both nerves and fully decompression of offending blood vessels and exploratory sequences of different nerve roots are critical points for improving operative effect and reducing complications.


Assuntos
Doenças do Nervo Glossofaríngeo/cirurgia , Espasmo Hemifacial/cirurgia , Cirurgia de Descompressão Microvascular , Síndromes de Compressão Nervosa/cirurgia , Adulto , Nervo Facial/fisiopatologia , Feminino , Seguimentos , Nervo Glossofaríngeo/fisiopatologia , Doenças do Nervo Glossofaríngeo/fisiopatologia , Espasmo Hemifacial/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
7.
Muscle Nerve ; 60(3): 250-253, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31294855

RESUMO

INTRODUCTION: Suprascapular neuropathy (SSN) is rare, with an estimated prevalence of 4.3% in patients with shoulder pain. METHODS: This retrospective chart review included patients with SSN seen during a 16-year period. Demographics and clinical information were recorded. Descriptive statistics, including percentages, means, and standard deviations, were computed for the variables of interest for all patients. RESULTS: Of 87 patients included in this study, trauma (n = 27) was the most common cause of SSN, followed by neuralgic amyotrophy (n = 21). Fifty-seven patients had isolated SSN. Others had SSN associated with axillary neuropathy (23 patients), brachial plexopathy (3 patients), and long thoracic, radial, or spinal accessory neuropathy (1 patient each). DISCUSSION: SSN is commonly associated with axillary neuropathy. Trauma remains the most common cause of SSN. Electrodiagnostic findings aid in the initial diagnosis and may indicate the need for close clinical follow-up based on the severity of the axonal injury.


Assuntos
Axila/fisiopatologia , Neuropatias do Plexo Braquial/fisiopatologia , Síndromes de Compressão Nervosa/fisiopatologia , Dor de Ombro/etiologia , Adulto , Neurite do Plexo Braquial/complicações , Neurite do Plexo Braquial/fisiopatologia , Neuropatias do Plexo Braquial/complicações , Neuropatias do Plexo Braquial/diagnóstico , Eletromiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico , Dor de Ombro/diagnóstico , Dor de Ombro/fisiopatologia , Adulto Jovem
9.
Prog Retin Eye Res ; 73: 100765, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31202890

RESUMO

Compression of the optic chiasm causes an optic neuropathy that may be associated with reversible visual loss often immediately following surgical decompression. While the precise pathogenesis of retinal ganglion cell impairment and eventual death remains poorly understood, a number of putative mechanisms may play a role. In this article we review the evidence supporting various stages of visual loss and recovery in chiasmal compression. These include conduction block, demyelination, ischemic insult, and retrograde and anterograde degeneration. We also describe novel advances in magnetic resonance imaging with specialized modalities such as diffusion tensor imaging have provided further information to explain the underlying mechanism of visual loss. Functional measures including electrophysiology are time-consuming but have shown moderate prognostic ability. Optical coherence tomography has provided novel new biomarkers for predicting outcome following surgical decompression. Both retinal nerve fiber layer thickness and ganglion cell complex thicknesses have shown to have excellent predictive power. Such advances serve to inform patients and clinicians of pre-operative factors that predict the extent of visual recovery following medical or surgical treatment of para-chiasmal lesions.


Assuntos
Cegueira/fisiopatologia , Síndromes de Compressão Nervosa/fisiopatologia , Quiasma Óptico/fisiopatologia , Doenças do Nervo Óptico/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Animais , Humanos , Fibras Nervosas/fisiologia , Células Ganglionares da Retina/fisiologia , Tomografia de Coerência Óptica , Vias Visuais/fisiologia
10.
Clin Plast Surg ; 46(3): 285-293, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31103073

RESUMO

Nerve compression occurs in fibro-osseous tunnels as the nerves cross joints. The pathology involves traction and adhesion, aside from compression. This can occur at multiple sites along the course of the nerve. Regardless of level, clinical assessment is standard and a systematic approach to uncover all sites of compression is advised. Evolution of management for carpal tunnel and cubital tunnel syndrome is reviewed with an emphasis on natural history and nonsurgical treatment, which are not commonly discussed. Treatment is multimodal and the systemic factors that contribute to nerve dysfunction should also be addressed.


Assuntos
Síndromes de Compressão Nervosa , Síndrome do Túnel Carpal/terapia , Síndrome do Túnel Ulnar/terapia , Humanos , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Síndromes de Compressão Nervosa/terapia
11.
Auris Nasus Larynx ; 46(6): 876-881, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30979639

RESUMO

OBJECTIVE: To compare postoperative changes in visual acuity between the transnasal endoscopic approach and the transcaruncular approach when comparison of preoperative values used for medial orbital wall decompression in patients with dysthyroid optic neuropathy. METHODS: We included 14 patients (23 sides) and divided them into a transnasal group (11 sides, 8 patients) and a transcaruncular group (12 sides, 6 patients). Visual acuity was examined preoperatively, on postoperative days 1, 3, and 7, and at a final follow-up visit. The differences in postoperative improvement of the logarithm of the minimum angle of resolution (logMAR) visual acuity and critical flicker frequency (CFF) between the two surgical groups at each time point were analyzed using the Mann-Whitney U test. RESULTS: Postoperative improvement in logMAR visual acuity on postoperative days 1 and 3 and that in CFF on postoperative day 1 were greater in the endonasal group than in the transcaruncular group (P < 0.050). Vision was improved or maintained in all patients in the transnasal group at the final follow-up. One patient in the transcaruncular group had loss of vision on one side and decreased vision on the other side after surgery. CONCLUSION: Medial orbital decompression appears to provide better postoperative vision when performed by the transnasal approach than by the transcaruncular approach in patients with dysthyroid optic neuropathy.


Assuntos
Descompressão Cirúrgica/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Síndromes de Compressão Nervosa/cirurgia , Doenças do Nervo Óptico/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Endoscopia , Feminino , Oftalmopatia de Graves/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/fisiopatologia , Doenças do Nervo Óptico/etiologia , Doenças do Nervo Óptico/fisiopatologia , Resultado do Tratamento
12.
J Bone Joint Surg Am ; 101(6): 523-530, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30893233

RESUMO

BACKGROUND: Peripheral nerve compression and entrapment can be debilitating. Using a validated animal model of peripheral nerve compression, we examined the utility of 2 drugs approved for other uses in humans, 4-aminopyridine (4-AP) and erythropoietin (EPO), as treatments for surgically induced ischemia and as adjuvants to surgical decompression. METHODS: Peripheral nerve compression was induced in wild-type mice by placing an inert silicone sleeve around the sciatic nerve. Decompression surgery was performed at 6 weeks with mice receiving 4-AP, EPO, or saline solution either during and after compression or only after decompression. A nerve conduction study and morphometric analyses were performed to compare the extent of the injury and the efficacy of the therapies, and the findings were subjected to statistical analysis. RESULTS: During peripheral nerve compression, there was a progressive decline in nerve conduction velocity compared with that in sham-treatment animals, in which nerve conduction velocity remained normal (∼55 m/s). Mice treated with 4-AP or EPO during the compression phase had significantly smaller declines in nerve conduction velocity and increased plateau nerve conduction velocities compared with untreated controls (animals that received saline solution). Histomorphometric analyses of newly decompressed nerves (i.e., nerves that underwent decompression on the day that the mouse was sacrificed) revealed that both treated groups had significantly greater proportions of large (>5-µm) axons than the untreated controls. Following surgical decompression, all animals recovered to a normal baseline nerve conduction velocity by day 15; however, treatment significantly accelerated improvement (in both the 4-AP and the EPO group), even when it was only started after decompression. Histomorphometric analyses at 7 and 15 days following surgical decompression revealed significantly increased myelin thickness and significantly greater proportions of large axons among the treated animals. CONCLUSIONS: Both the 4-AP and the EPO-treated group demonstrated improvements in tissue architectural and electrodiagnostic measurements, both during and after peripheral nerve compression, compared with untreated mice. CLINICAL RELEVANCE: Peripheral nerve decompression is one of the most commonly performed procedures in orthopaedic surgery. We believe that there is reason for some optimism about the translation of our findings to the clinical setting. Our findings in this murine model suggest that 4-AP and EPO may lessen the effects of nerve entrapment and that the use of these agents after decompression may speed and perhaps otherwise optimize recovery after surgery.


Assuntos
4-Aminopiridina/uso terapêutico , Epoetina alfa/uso terapêutico , Hematínicos/uso terapêutico , Síndromes de Compressão Nervosa/terapia , Bloqueadores dos Canais de Potássio/uso terapêutico , Neuropatia Ciática/terapia , Animais , Descompressão Cirúrgica , Modelos Animais de Doenças , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Síndromes de Compressão Nervosa/fisiopatologia , Condução Nervosa/fisiologia , Neuropatia Ciática/fisiopatologia
13.
Ann Vasc Surg ; 57: 275.e9-275.e12, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30711499

RESUMO

We present the case of an 89-year-old man with 3-month history of hoarseness and no other significant clinical manifestations. Flexible laryngoscopy revealed a paralyzed left vocal cord, and contrast-enhanced computed tomography showed a thoracic dissecting aortic aneurysm of the distal aortic arch and proximal descending aorta. The aortic aneurysm was repaired through implantation of an endovascular stent graft, and the patient was discharged uneventfully after a week. The false lumen was completely thrombosed, and the patient had a partial resolution of hoarseness at the 1-year follow-up.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Rouquidão/etiologia , Síndromes de Compressão Nervosa/etiologia , Nervo Laríngeo Recorrente/fisiopatologia , Prega Vocal/inervação , Idoso de 80 Anos ou mais , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Rouquidão/fisiopatologia , Humanos , Laringoscopia , Masculino , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Desenho de Prótese , Recuperação de Função Fisiológica , Stents , Síndrome , Resultado do Tratamento , Voz
14.
Med Clin North Am ; 103(2): 357-370, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30704687

RESUMO

Upper extremity entrapment neuropathies are common and can cause pain, sensory loss, and muscle weakness that lead to functional disability. In this article, the authors review common entrapment neuropathies of the upper extremities, including median neuropathy at the wrist (carpal tunnel syndrome), ulnar neuropathy at the elbow, and radial neuropathy. The authors discuss the pathophysiology of nerve compression and typical etiologies, as well as strategies for differentiating between common mimics such as cervical radiculopathy and for selecting between various treatment modalities.


Assuntos
Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/terapia , Exame Neurológico , Síndrome do Túnel Carpal/diagnóstico , Diagnóstico Diferencial , Eletrodiagnóstico , Humanos , Síndromes de Compressão Nervosa/fisiopatologia , Paralisia/diagnóstico , Paralisia/terapia , Extremidade Superior
15.
Ann Anat ; 221: 173-178, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30248401

RESUMO

BACKGROUND: The variable of the suprascapular notch (SSN) is a common cause in suprascapular nerve (SN) entrapment. Hence, knowledge of SSN variations may be predictive valuable for the predisposition to compression of SN. The aim of this study was to propose the classification of SSN in Chinese population and took this complex morphology into account. MATERIAL AND METHODS: 308 human dry scapulae were analyzed thoroughly and systematically in this study. Morphological variations of the SSN were observed by visual inspection and the classification of SSN was determined by geometrical measurements. Then measurement results were averaged and recorded. RESULTS: Chinese dry scapulae were measured, we found seven types of SSN. Type Ⅰ (√, 44.8%) was the most common, followed by type Ⅱ (U, 41.9%) to Ⅶ (double O, 0.6%). Right scapulae were larger in depth of SSN and thickness of A and C. Type Ⅶ (double O) had the deepest SSN and type Ⅰ (√) was widest among five types. For BC, type Ⅰ (√) was shorter than type Ⅲ (V). For thickness of A, type Ⅶ (double O) was greater than type Ⅰ (√). For thickness of C, type Ⅰ (√) and type Ⅱ (U) were shorter than type Ⅲ (V). There were no significant differences in other measurements between types and sides of body. Seven types of SSN in Chinese population were defined in our study. CONCLUSION: These anatomical variations of the SSN may improve the diagnostic rate and success rate of the surgical for the suprascapular nerve entrapment.


Assuntos
Síndromes de Compressão Nervosa/fisiopatologia , Escápula/anatomia & histologia , Articulação do Ombro/anatomia & histologia , Grupo com Ancestrais do Continente Asiático , China , Feminino , Humanos , Masculino , Síndromes de Compressão Nervosa/genética , Escápula/inervação , Articulação do Ombro/inervação
16.
J Vasc Access ; 20(2): 226-228, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30073904

RESUMO

INTRODUCTION:: Insertion of central catheters in peripheral vessels is a common procedure performed for a variety of indications, including parenteral nutrition. Hyperemesis gravidarum may require parenteral nutrition in exceptional situations. Although globally safe, insertion of peripherally inserted central catheters (PICCs) can lead to complications. CASE REPORT:: We describe a case of a pregnant woman who required parenteral nutrition and underwent an unsuccessful PICC insertion attempt resulting in arterial puncture, and who 34 days later presented with right upper limb paresthesia. A pseudoaneurysm with nerve compression was diagnosed and treated by open surgery, without maternal or fetal complications. CONCLUSION:: We recommend active surveillance ultrasound (e.g. in the first 24-48 h) of unsuccessful PICC insertion attempts, because late complications may occur and require invasive procedures for treatment.


Assuntos
Artéria Braquial/lesões , Neuropatias do Plexo Braquial/etiologia , Cateterismo Periférico/efeitos adversos , Hiperêmese Gravídica/terapia , Síndromes de Compressão Nervosa/etiologia , Nutrição Parenteral , Lesões do Sistema Vascular/etiologia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Artéria Braquial/diagnóstico por imagem , Neuropatias do Plexo Braquial/diagnóstico , Neuropatias do Plexo Braquial/fisiopatologia , Feminino , Humanos , Hiperêmese Gravídica/diagnóstico , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Gravidez , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal/métodos , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Adulto Jovem
17.
Laryngoscope ; 129(9): 2105-2111, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30582168

RESUMO

OBJECTIVE: We report an association between lower cranial nerve (CN IX/X) vascular compression at the brainstem with laryngeal symptoms utilizing a stepwise algorithm that systematically evaluates and eliminates all other common etiologies. Our experiences with retromastoid craniectomy with lower cranial nerve (LCN) decompression versus non-neurosurgical treatments are detailed. STUDY DESIGN: Retrospective chart review at a tertiary care academic medical center with follow-up telephone survey. METHODS: Baseline demographics, clinical characteristics, quality-of-life surveys, and treatment outcomes were recorded for patients with laryngeal symptoms associated with LCN compression at the brainstem. RESULTS: Forty-nine patients demonstrated LCN compression at the brainstem on imaging and presented with chief complaints of dysphonia (25 of 49, 51%), chronic cough (19 of 49, 39%), dysphoric breathing (3 of 49, 6%), and dysphagia (2 of 49, 4%). Poor initial scores were noted for Voice-Related Quality of Life (V-RQOL), Reflux Symptom Index, and Glottal Closure Index. Twenty-four patients underwent LCN decompression, of which 21 of 24 (88%) reported partial, near-complete, or complete improvement. Major perioperative complications occurred in four of 24 patients (17%). Patients who had undergone decompression were more likely to obtain complete/near-complete symptom resolution (10 of 24 patients, 42%) compared to those undergoing conservative treatments (2 of 25 patients, 8%) (P = 0.02). V-RQOL scores improved more in surgical patients [mean change score, 33.0 (standard deviation [SD], 31.2) than nonsurgical patients (mean change score 9.6, SD 20.9) (P = 0.03) (mean follow-up 3.0 years, SD 2.0). CONCLUSION: Lower cranial nerve compression at the brainstem should be considered when all other etiologies are excluded. Retromastoid craniectomy with LCN decompression demonstrates an acceptable safety profile. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:2105-2111, 2019.


Assuntos
Tronco Encefálico/irrigação sanguínea , Nervo Glossofaríngeo/fisiopatologia , Doenças da Laringe/fisiopatologia , Síndromes de Compressão Nervosa/fisiopatologia , Síndromes de Compressão Nervosa/cirurgia , Nervo Vago/fisiopatologia , Idoso , Tronco Encefálico/diagnóstico por imagem , Descompressão Cirúrgica , Feminino , Humanos , Doenças da Laringe/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico por imagem , Complicações Pós-Operatórias , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
18.
J Sport Rehabil ; 28(3): 219-228, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29364045

RESUMO

CONTEXT: Isolated infraspinatus atrophy (IIA) is a common condition among overhead activity athletes, which affects the hitting shoulder and is caused by suprascapular nerve injury. The loss of infraspinatus function could lead to altered activity of the glenohumeral and scapulothoracic (ST) muscles and compromise the optimal shoulder function. OBJECTIVE: To assess the surface electromyographic (sEMG) activity patterns, relationships, and response latencies of relevant shoulder girdle muscles in professional volleyball players with IIA and in healthy control players. DESIGN: Cross-sectional study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-four male professional volleyball players (12 players with diagnosed IIA and 12 healthy players) recruited from local volleyball teams. INTERVENTION(S): sEMG activity of anterior, middle, and posterior deltoid; upper, middle, and lower trapezius; and serratus anterior (SA) was recorded and evaluated during a movement of shoulder abduction in the scapular plane, monitored with an optoelectronic motion capture system. MAIN OUTCOME MEASURE(S): sEMG activity, relationships, and response latencies of the selected muscles were analyzed with analysis of variance models to highlight statistical differences within and between groups. RESULTS: Athletes with IIA demonstrated significant higher deltoid and trapezius muscles activity and lower SA activity compared with the contralateral shoulder and healthy athletes. The shoulder with IIA also showed a higher activity ratio between the upper trapezius and other ST muscles in addition to anticipated activation of the upper trapezius and delayed activation of the SA, with regard to the onset of shoulder movement. CONCLUSIONS: This study highlighted altered shoulder muscle activity levels, ST muscles imbalances, and abnormal ST recruitment patterns in the hitting shoulder of professional volleyball players with IIA, secondary to suprascapular nerve neuropathy. Such shoulder girdle muscles' impairments may compromise the optimal scapulohumeral rhythm and function, increasing the risk of acute and overuse shoulder injuries.


Assuntos
Traumatismos em Atletas/fisiopatologia , Músculo Deltoide/fisiopatologia , Atrofia Muscular , Lesões do Ombro/fisiopatologia , Músculos Superficiais do Dorso/fisiopatologia , Adulto , Atletas , Estudos Transversais , Eletromiografia , Humanos , Masculino , Síndromes de Compressão Nervosa/fisiopatologia , Escápula , Voleibol , Adulto Jovem
19.
Disabil Rehabil ; 41(8): 991-993, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29216768

RESUMO

PURPOSE: To describe the clinical manifestation and the treatment of complex regional pain syndrome type II in childhood. METHODS: Using information on the symptoms, diagnosis, rehabilitation and outcome of a young patient with complex regional pain syndrome type II. RESULTS: A 9-year -old girl had severe pain in the region of the left foot, signs of a common fibular nerve entrapment, hyperalgesia not limited to the distribution of the injured nerve, weakness and temperature asymmetry unknown origin. She consulted few doctor's before she was given the right diagnosis of complex regional pain syndrome type II. Following the diagnosis the treatment started, it included intensive physiotherapy, electrical therapy and also supportive psychological therapy. Half a year later, the patient was free of the daily pain and returned to all physical activity without any restrictions. CONCLUSIONS: The case report illustrates that peripheral nerve compression or injuries specifically, complex regional pain syndrome type II, should be taken into consideration when evaluating children with weakness and pain of the lower or upper limb. Implication of rehabilitation Raising the awareness of complex regional pain syndrome in the childhood is essential for an early diagnosis and appropriate treatment. The treatment options include early and adequate pain management inclusive electrical therapy and physiotherapy. Psychological therapy helps to avoid psychological stress reaction and the disease negative impact on the child's education and sports and the family social life.


Assuntos
Síndromes da Dor Regional Complexa , Terapia por Estimulação Elétrica/métodos , , Modalidades de Fisioterapia , Técnicas Psicológicas , Criança , Síndromes da Dor Regional Complexa/diagnóstico , Síndromes da Dor Regional Complexa/fisiopatologia , Síndromes da Dor Regional Complexa/psicologia , Síndromes da Dor Regional Complexa/reabilitação , Exercício Físico , Feminino , Pé/inervação , Pé/fisiopatologia , Humanos , Hiperalgesia/diagnóstico , Hiperalgesia/etiologia , Hiperalgesia/terapia , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Síndromes de Compressão Nervosa/terapia , Medição da Dor/métodos , Resultado do Tratamento
20.
Neurosurgery ; 84(2): 404-412, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29529303

RESUMO

BACKGROUND: Several hypotheses have been proposed for the pathophysiology of suprascapular nerve (SSN) palsy, including compression, traction, and nerve inflammation. OBJECTIVE: To provide insight into the pathophysiology of isolated nontraumatic SSN palsy by performing critical reinterpretations of electrodiagnostic (EDX) studies and magnetic resonance (MR) images of patients with such diagnosis. METHODS: We retrospectively reviewed all patients referred to our institution for the past 20 yr with a diagnosis of nontraumatic isolated suprascapular neuropathy who had an upper extremity EDX study and a shoulder or brachial plexus MR scan. Patient charts were reviewed to analyze their initial clinical examination, and their original EDX study and MR images were reinterpreted by an experienced neurologist and a musculoskeletal radiologist, respectively, both blinded from the authors' hypothesis and from each other's findings. RESULTS: Fifty-nine patients were included. Fifty of them (85%) presented with at least 1 finding that was inconsistent with an isolated SSN palsy. Forty patients (68%) had signs on physical examination beyond the SSN distribution. Thirty-one patients (53%) had abnormalities on their EDX studies not related to the SSN. Twenty-two patients (37%) had denervation atrophy in other muscles than the spinati, or neural hyperintensity in other nerves than the SSN on their MR scans, without any evidence of SSN extrinsic compression. CONCLUSION: The great majority of patients with presumed isolated SSN palsy had clinical, electrophysiological, and/or imaging evidence of a more diffuse pattern of neuromuscular involvement. These data strongly support an inflammatory pathophysiology in many cases of "isolated" SSN palsy.


Assuntos
Neuropatias do Plexo Braquial/fisiopatologia , Paralisia/fisiopatologia , Adulto , Neuropatias do Plexo Braquial/etiologia , Eletrofisiologia , Feminino , Humanos , Inflamação/complicações , Inflamação/fisiopatologia , Imagem por Ressonância Magnética/métodos , Masculino , Síndromes de Compressão Nervosa/complicações , Síndromes de Compressão Nervosa/fisiopatologia , Paralisia/etiologia , Estudos Retrospectivos , Adulto Jovem
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