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A 78-year-old woman complained of severe pain in the left costal region. Her body mass index was 23.1 kg/m2. Lateral cutaneous nerve entrapment syndrome (LACNES) was the suspected diagnosis because the affected area was 2×2 cm and positive for pinch sign. Seventeen days later, the patient again presented with complaints of lower back pain accompanied by back pain upon extending the spine. Magnetic resonance imaging of the spine showed a fracture of the vertebral body of T11. We herein discuss our errors in the diagnostic process and critical tactics for avoiding such errors in the future.

BACKGROUND: Posterior interosseous nerve (PIN) entrapment syndrome is a rare condition and is predisposed by anatomical factors such as narrow passages through fibrous arcades; whereas, the Arcade of Frohse (AF) is the most common entrapment point. The aim of this study was to evaluate the entrance and exit points of the PIN into the supinator in detail. MATERIALS AND METHODS: One hundred unpaired upper extremities underwent dissection. The PIN’s entrance and exit points from the supinator were depicted. The distances between the tip of the radial head (RH) and the AF and the exit point of the PIN from the supinator were measured. Further, it was checked if the borders of the AF and the exit point were muscular, tendinous or a combination of these. RESULTS: The interval between the PIN’s entry into the supinator and the tip of the RH was at a mean of 28.9 mm. Concerning the border of the AF, in 54 cases a muscular and in 46 specimens a tendinous version could be observed. The interval between the exit point of the PIN and the tip of the RH proved to be at a mean of 64.2 mm. Further, the exit’s border was muscular in 65 specimens and tendinous in 35 cases. CONCLUSION: During surgical treatment of the PIN syndrome, it needs to be kept in mind that approximately one-third of all patients might also suffer from entrapment at the exit point of the PIN.

Cystic adventitial disease is an uncommon cause of lower extremity claudication resulting from accumulation of mucinous fluid in an arterial subadventitial layer, typically of the popliteal artery. A popliteal bruit and/or reduced distal pulses with knee flexion may be seen on examination. Alternatively, popliteal artery entrapment syndrome triggers claudication via an aberrant arterial pathway or muscular hypertrophy. Decreased distal pressures with plantar or dorsiflexion is a key finding. This report details the case of a middle-aged male with cystic adventitial disease whose diagnosis was complicated by concurrent features of popliteal artery entrapment syndrome. Treatment consisted of venous interposition grafting, which yielded excellent results.

Publisher Copyright: © 2020 The Author(s) Objective: We aim to describe the supraclavicular nerve's vascular entrapment by the external jugular vein as an unreported anatomical finding. Case description: In a routine cadaveric dissection, the superficial emergence of the first division of the left supraclavicular nerve emerged along a duct formed through the external jugular vein. No other vascular or neural anatomical abnormalities were found in the surrounding structures. Conclusion: This unreported vascular entrapment of the supraclavicular nerve by the external jugular may harbour clinical implications for surgical and endovascular procedures on the external jugular vein and in refractory thoracic and scapular waist pain.

Introduction Entrapment syndromes can occur in extremities like the genitalia, the penis, toes and fingres and mostly due to hair shed by the mother mostly in young children but may be other materials are involved specially in adults. Penile hair Entrapment syndrome is an uncommon health problem that leads to devastating injuries to the urethra and penis including urethral fistula up to urethral complete transaction and penile injury up to penile amputation. We are going to discuss our experience with the problem. Materials and Methods All 15 patients between 2018 and 2020 had been operated upon for various degrees of Penile hair Entrapment syndrome from simple single urethral fistula, and complete urethral transection, their ages ranged between 1.5 years to 4.6 years. Follow up ranged between 6 months to 1.4 years. Each patient was invstigated and examined at the emergency room for other entrapment syndromes and the causative agent was removed and the patients were admitted for managing their urethral and penile injuries. Results All 15 patient but 1 had complete healing with fistula healing and normal voiding with no meatal stenosis or urethral divritculum. One patient had incomplete urethral Closure wit redo operation and fistula closure. Discussion There are multiple reports and literature that address the problem yet nobody took into account how to prevent it. There should be public awarence about the problem, the mother should examine her child for any entrapment syndrome and if any suspicious finding she sholud seek medical advice. Conclusion Penile entrapment syndromes are uncommon urological health problems that can face the urologist but he should be aware of the problem that can affect young children and he should put in mind the problem to manage it as early as possible to prevent further damage of the valuable urethra and penis.

Internal jugular vein (IJV) thrombosis is mainly related to central venous catheter, malignancy, and ovarian hyperstimulation syndrome. We report a case of IJV thrombosis possibly related to IJV compression between the styloid process and the first cervical vertebra (C1) transverse process. To support this hypothesis, we perform radiological assessment of the IJV and examine its relationship with the styloid process and C1 transverse process in 34 controls. Our results showed a strong correlation between IJV diameter and styloid process–C1 transverse process distance. Compared to control subjects, our patient had a short styloid process–C1 transverse process distance, which suggests its involvement in IJV thrombosis.

We compared the preoperative quality of life (QOL) of patients with carpal tunnel syndrome, lower extremity-, and para-lumbar entrapment syndrome, and the effect of surgery on their QOL. We prospectively enrolled 66 consecutive patients who underwent surgery for carpal tunnel syndrome (group 1, n = 23), lower extremity entrapment syndrome (group 2, n = 22), and para-lumbar entrapment syndrome (group 3, n = 21). Their pre- and postoperative overall health status was assessed on the Medical Outcomes Study Short-Form 36 Health Survey, v2 (SF-36). Except for the mental component summary, the preoperative score for items rated on the SF-36 was significantly lower in group 3 than in groups 1 and 2 (p

Popliteal artery entrapment syndrome generally causes calf claudication in young active adult. It is resulting of the anatomical relationship between the popliteal artery and adjacent muscles or fibrous bands in the popliteal fossa. We present the case of a 36-year-old male with left calf claudication limb in whom popliteal artery entrapment syndrome was diagnosed, and successfully treated surgically.

Teaching point: The Kiloh-Nevin Syndrome is a rare entrapment syndrome of the median nerve, with a distinct muscle edema pattern of the forearm.

Resumo A claudicação intermitente é uma queixa geralmente relacionada com oclusão arterial secundária a doença aterosclerótica. Entretanto, em pacientes jovens com queixa de claudicação, outras causas devem ser pesquisadas, como a síndrome do aprisionamento da artéria poplítea, síndrome compartimental crônica, compressões ósseas e arterites. Os autores relatam o caso de um paciente com claudicação intermitente devido à compressão extrínseca da artéria tibial anterior pela membrana interóssea, diagnosticada através de angiorressonância durante manobras de dorsiflexão do pé. A paciente foi tratada com sucesso através da liberação do fator compressivo, evoluindo com melhora dos sintomas.

Introduction: Median nerve compression is the most common nerve entrapment syndrome. After carpal tunnel release, patients often complain about the scar cosmetic appearance. Objective: The aim of our study was to evaluate the clinical outcome, surgical technique and complications of mini-open carpal release. Methods: We reviewed data from 48 surgical procedures for Carpal Tunnel Syndrome in 32 patients at the Pinheiros Neurologicaland Neurosurgical Clinic in the period of 2000 and 2008. The mean age was 49 years-old. We used a 2 cm incision and microscopic technique to obtain meticulous access of the palmar hand anatomy with special attention to both the recurrent motor branch and palmar cutaneous nerve. Results: Twenty-two patients had total resolution of symptoms. Two patients had no change of neurological symptoms. During the follow up no infection or neurological deficits were observed. Conclusion: Mini-open is a safe and effective approach for carpal tunnel syndrome release. However detailed palmar hand anatomy is mandatory to prevent lesion of branching palmar nerve. The use of microscope is desirable to help identify important structures and avoid complications.

Entrapment neuropathies of the peripheral nervous system are frequently encountered due to anatomical variations. Median nerve is the most vulnerable nerve to undergo entrapment neuropathies. The clinical complications are mostly manifested by median nerve impingement in forearm and wrist areas. Median nerve entrapment could also occur at the arm, due to the presence of ligament of Struthers. Here we report a rare case of proximal entrapment of median nerve and brachial artery in the arm by an abnormally formed musculo-fascial tunnel. The tunnel was formed by the muscle fibers of brachialis and medial intermuscular septum in the lower part of arm. Due to this, the median nerve coursed deep, below the tunnel and continued distally into the forearm, underneath the pronator teres muscle and hence did not appear as a content of cubital fossa. The present entrapment of neurovascular structures in the tunnel might lead to pronator syndromes or other neurovascular compression syndromes.

An 18-year-old woman with no remarkable medical history presented with sudden onset of left-sided abdominal pain that manifested after she bent forward in her chair to pick something up. The pain intensified whenever she rotated her trunk. The day before visiting my centre, she visited another

Introduction: Flexor digitorum profundus (FDP) muscle is the muscles of anterior compartments of the forearm with the most frequent anatomical variations. Macalister reported the variations in FDP. The incidences of variation are observed mainly in the number of heads of proximal attachment, though the variation in the tendon of distal attachment is comparatively rare. Methods: A 48-year-old male formalin preserved cadaver, finely dissected at dissection hall. Results: Normally the FDP muscle insert with four tendons. In this present case, the origin of FDP muscle was normal, but its insertion was by five separate tendons variate musculo-tendon which was found arises from FDP muscle in the mid of the 2nd and 3rd tendon with its fibers again dividing and going with them. Macalister reported many variations regarding this muscle but this type of variation is less commonly found. Conclusion: This particular variation is important for a clinical perspective as this extra musculo tendon may cause entrapment syndrome of the median nerve and also for the surgeon to be careful while performing tenoplasty.

A 75-year-old man presenting with intermittent discolouration of his left toes was referred to vascular surgery with suspicion of embolic vascular disease. A contrast-enhanced MR angiogram was performed which revealed bilateral dominant peroneal arteries (PRAs). There was evidence of short atherosclerotic stenosis directly at the point where the left PRA passes through the tibiofibular interosseous membrane which we postulate to be the source of the emboli. We present what is believed to be the first reported case of PRA entrapment complicated by distal toe emboli.

This case presents the utility of ultrasound examination in diagnostics, providing accurate therapy and follow-up of entrapment syndrome of the ulnar nerve, caused by heterotopic ossification. The heterotopic ossifications were in this case presumably linked to a long-term working with a vibration sander.

Peripheral neuropathies of the shoulder are common and could be related to traumatic injury, shoulder surgery, infection or tumour but usually they result from an entrapment syndrome. Imaging plays an important role to detect the underlying causes, to assess the precise topography and the severity of nerve damage. The key points concerning the imaging of nerve entrapment syndrome are the knowledge of the particular topography of the injured nerve, and the morphology as well signal modifications of the corresponding muscles. Magnetic Resonance Imaging best shows these findings, although Ultrasounds and Computed Tomography sometimes allow the diagnosis of neuropathy.

Posterior interosseous nerve entrapment is a potential cause of upper extremity muscle weakness and pain. The diagnosis may be difficult to make clinically, and electrodiagnostic tests may not identify the exact site of nerve compression. We report a case of posterior interosseous nerve entrapment in which electrodiagnostic studies suggested radial neuropathy at the level of the spiral groove, but the sonographic evaluation pinpointed the arcade of Frohse as the level of compression. The patient’s symptoms improved dramatically following surgical release of the nerve. Sonography may be a valuable, non-invasive diagnostic tool in evaluating patients with posterior interosseous nerve entrapment.

We report a case of a median nerve schwannoma, a rare type of a benign tumor of Schwann cells that presents as a palpable and painful mass on the flexor aspect of the forearm. Schwannomas of the median nerve make up 0.1–0.3% of all hand tumors. Symptoms are caused by an entrapment syndrome resulting from the growing tumor. Pain is the most common complaint of schwannomas. Imaging studies include computed tomography and magnetic resonance imaging and ultrasound. It is difficult to differentiate schwanommas from neurofibromas solely on the basis of a radiological investigation. Tumors of the median nerve are diagnostically challenging and median nerve schwannomas are rare. Diagnostic pearls are described to facilitate a more accurate and timely diagnosis. These characteristics include mobility, Tinel’s sign, S-100 histological staining, and Antoni patterns. With a correct diagnosis, the tumor can be extirpated with preservation of nerve function and a low risk of recurrence.

Bildgebende Untersuchungen gewinnen bei der Diagnostik von/Erkrankungen peripherer Nerven zunehmend an Bedeutung. Die hochauflosende Sonografie und das MRT liefern dabei wichtige morphologische Informationen uber Nervenstamme, Nervenwurzeln und den Plexus brachialis. Im Gegensatz zur elektrophysiologischen Untersuchung ermoglichen sie die millimetergenaue Lokalisation der Lasion und geben in vielen Fallen auch Auskunft uber deren Atiologie. Wahrend der letzten Jahre wurden zahlreiche Artikel uber die Anwendung des hochauflosenden Ultraschalls bei der Diagnostik von Engpasssyndromen, traumatischen Nervenverletzungen, Raumforderungen am peripheren Nerven und Polyneuropathien veroffentlicht. Diese Arbeit versucht unter Berucksichtigung der personlichen Erfahrungen des Autors einen Uberblick uber die wichtigsten Entwicklungen auf diesem Feld zu geben.

Medial supracondylar spur from the humerus is a rare cause of neurovascular pain of the upper extremity. The spur typically entraps the brachial artery and median nerve, resulting in compression-related symptoms. In advance stages, compression could lead to endothelial damage and thrombotic occlusion of brachial artery. Spur is also associated with an anomalous higher insertion of the pronator teres muscle, which could result in multilevel entrapment of the brachial artery. We report a patient with acute upper limb ischemia secondary to brachial artery compression and distal embolization from a medial supracondylar spur and anomalous attachment of the pronator teres. The entrapped brachial artery and median nerve were released by resection of the spur and of the anomalous belly of the pronator teres with thrombectomy of brachial artery.

The brachialis muscle is one of the chief flexors of the upper arm, and its variation can affect the movements of the elbow joint. This case report presents a rare case of a large accessory brachialis muscle in the right arm that comes with an abnormal aponeurosis. The aponeurosis from the distal part of the aberrant muscle arches over the radial artery and is attached to the deep fascia of the right forearm. While rare, the presence of an accessory brachialis muscle coupled with the unusual aponeurosis can lead to compression of the radial artery, causing radial artery entrapment syndrome and creating potential difficulties in the catheterisation of the radial artery.

Lateral thoracic or abdominal cutaneous nerve entrapment syndrome (C.N.E.S.) refers to the pain originating from thoracic or abdominal wall. It is a common ailment which is often misdiagnosed as arising from a source inside the abdominal cavity mistakenly leading to inappropriate diagnostic investigations, unsatisfactory treatment, and considerable costs. The thoracoabdominal nerves terminate as the cutaneous nerves at a point from which accessory branches are given off in the rectus channel ending in the skin. Peripheral nerve entrapment occurs at anatomic sites where the nerve changes direction to enter a fibrous or osseofibrous tunnel because mechanically induced irritation is most likely to occur at these locations. Controlled investigations demonstrate that satisfactory alleviation is to be gained by immediate intervention by the most widely adopted technique of a fanning infiltration of the region of maximal point of tenderness with anesthetic and anti-inflammatory agents. Unfortunately, we observe that clinicians inexperienced performing this procedure are deterred from this technique owing to fears of inaccurate medication deposition or penetrating the abdominal cavity and perforating viscera. In this paper we describe a method to provide a safe and accurately targeted injection precisely at the necessary location without risking iatrogenic harm. This is easily achieved by raising a mound of the superficial soft tissue at the point of maximal tenderness and inserting the needle oriented Method Article Naimer; BJMMR, 7(8): 672-677, 2015; Article no.BJMMR.2015.375 673 parallel to the surface of the anterior body surface. Adoption of this method provides a simple, safe and effective solution for C.N.E.S. and will allow recruiting more physicians to join the circle of those actively treating this condition.

The biceps brachii is one of three muscles of the anterior compartment of arm. Variations of the biceps brachii are not rare. The most frequent is the existence of a third head called the humeral head by Le Double (1897) (Rodríguez-Vázquez et al., 1999). Our article is based on the unexpected result of a routine dissection class held for medical students. Dissection was performed according to the guidelines accepted by the anatomy department (Seichert, 1999). We describe a third (accessory) head of the biceps brachii. In addition of two regular heads, the third head originated together with the short head from the coracoid process and had three insertions on the humerus after enfolding the median nerve and the brachial artery. This particular variation is important from a clinical perspective as the third head may cause entrapment syndrome of the median nerve and hypoperfusion of the upper limb due to compression of the brachial artery.

Spinal accessory nerve entrapment is difficult to diagnose due to its overlapping clinical features with other common diseases and nerve entrapments. It severely affects the life of an individual as normal neuronal physiology of the nerve is important for proper functioning and stability of the shoulder girdle. The patient develops symptoms like pain over the shoulder and neck, drooping of the shoulder, and weakness of overhead abduction of the arm. Ultrasound-guided block of this nerve has been described in the literature, but hydro-dissection using ultrasound as treatment has not been described yet. We have reported a case of spinal accessory nerve entrapment following sebaceous cyst excision in the posterior neck which was diagnosed clinically and confirmed using ultrasound-guided block and managed simultaneously by hydro-dissection. A case of 56 years female who underwent sebaceous cyst excision in the posterior triangle of the neck on the right side in May 2016. After 6 weeks of surgery, the patient developed pain in the right shoulder and gradually developed weakness in the overhead abduction of the arm. She went from one hospital to another for her pain relief but her pain remained undiagnosed and untreated. She came to Daradia Pain Hospital with complaint of pain in her right shoulder.

Objective Popliteal artery entrapment syndrome is a rare cause of popliteal artery aneurysms. We present a rare case of a false aneurysm associated with popliteal artery entrapment syndrome that was treated with endovascular repair that initially failed. Case report A 60-year-old man with a false popliteal artery aneurysm and limb ischemia was treated with endovascular repair that initially failed. The popliteal artery was suspected to be compressed by an abnormal bundle of muscle according to the findings of a subsequent magnetic resonance imaging examination. The popliteal artery was entrapped by an abnormal slip of the medial gastrocnemius muscle head. Parts of the popliteus muscle were also involved in compression of the popliteal artery, which was not distinguished on preoperative magnetic resonance imaging. Thus, the patient was diagnosed with a mixed type of popliteal artery entrapment syndrome (types III and IV). Bypass with the small saphenous vein was then performed. The patient was finally discharged with satisfactory relief of his ischemic symptoms. Conclusion Popliteal artery entrapment syndrome should be considered before treating popliteal artery aneurysms, especially atypical pseudoaneurysms without significant atherosclerosis. Definitive surgical management rather than endoluminal treatment is required unless combined with open decompressive surgery to correct the musculotendinous anatomy.