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The case is described of a patient with a squamous cell carcinoma of the skin of a finger which spread in an unusual manner, caused median nerve compression at the wrist, and infiltrated the median nerve in the forearm. [ABSTRACT FROM AUTHOR] more...

Clinical and electrophysiological assessment of recovery of function are reported on 20 patients with median or ulnar nerve sections up to 53 months after surgical repair. Maximum improvement of sensory function was apparent by both methods of assessment at 15 months after suture, and thereafter conduction velocities in sensory fibres averaged 80% of normal in median nerves and 70% of normal in ulnar nerves. Similarly, the mean amplitude of the sensory action potential at the wrist remained depressed at 15% of control values. The clinical recovery of motor function pursued a similar time course with, however, some evidence to indicate a continuing improvement in the neurophysiological maturation of the motor nerve fibres up to 47 months after repair. The results are discussed in relation to previous electrophysiological studies on animals. [ABSTRACT FROM AUTHOR] more...

We report a rare case in which a peripherally inserted central catheter (PICC) asymptomatically penetrated the median nerve. The patient was a 71-year-old man who displayed no neurological symptoms until 4 days after PICC placement. An ultrasound scan revealed that the PICC had penetrated the median nerve. He underwent surgery to remove the catheter and had no sequelae. When placing a PICC, selecting the brachial vein as a puncture site is associated with a high risk of nerve injury. Furthermore, circumspect observation is needed until withdrawal as neurological symptoms may be absent even when the catheter has punctured a nerve., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 International Anesthesia Research Society.) more...

There is a risk of injury to the palmar cutaneous branch of the median nerve (PCBMN) during a volar approach to the carpus or the distal radius. Anatomic variations of the PCBMN increase this risk. We report an anatomic variant of the PCBMN that coursed superficial and radial to the flexor carpi radialis (FCR), reinforcing the need for meticulous subcutaneous dissection to protect the nerve during a volar approach to the distal radius. In this case, identification of the PCBMN variant warranted a modified surgical approach, ulnar to the FCR instead of radial in order to avoid iatrogenic injury. Level of Evidence: Level V (Therapeutic). more...

Background: Severe peripheral nerve injury, especially the long-distance peripheral nerve defect, causes severe functional disability in patients. There is always a lack of effective repair methods for clinic, and those in practice are associated with side effects. A case study was performed to observe the regenerative outcomes of the surgical repair of long-distance peripheral nerve defects in the upper arm with chitosan-poly(glycolide-co-lactide) (PGLA) nerve grafts combined with bone marrow mononuclear cells (BMMCs)., Methods: The right upper arm of a 29-year-old woman was injured, leaving a 50-mm-long median nerve defect, an 80-mm-long ulnar nerve defect, and muscle and blood vessel disruptions. The nerve defects were repaired by implanting BMMC-containing chitosan-PGLA nerve grafts on the 40th day after injury. A series of functional assessments were carried out from 2 weeks to 66 months after surgical repair. Sensory function was assessed by the pinprick test, two-point discrimination test and Semmes-Weinstein monofilament test. Motor function was evaluated by the range of motion of the wrist joint and muscle power. Autonomic function was monitored by laser-Doppler perfusion imaging (LDPI). Tissue morphology was observed through ultrasonic investigations., Results: No adverse events, such as infection, allergy, or rejection, caused by the treatment were detected during the follow-up period. Sensory and pinprick nociception in the affected thumb, index, and middle fingers gradually restored at 6th month after surgery. The monofilament tactile sensation was 0.4 g in the terminal finger pulp of the thumb and index finger, 2.0 g in the middle finger, and greater than 300 g in the ring finger and little finger at the 66th month. Motor function recovery was detected at the 5th month after surgery, when the muscle strength of the affected forearm flexors began to recover. At the 66th month after surgery, the patient's forearm flexor strength was grade 4, with 80° of palmar flexion, 85° of dorsal extension, 8° of radial deviation, 40° of ulnar deviation, 40° of anterior rotation, and 85° of posterior rotation of the affected wrist. The patient could perform holding, picking up, and some other daily activities with the affected hand. The patient's sweating function of the affected hand was close to the level of the healthy hand. LDPI showed that the skin blood flow perfusion was significantly increased, with perfusion similar to on the normal side in some areas. Neuromusculoskeletal ultrasonography showed the presence of nerve structures., Conclusion: These results suggest that chitosan-PGLA nerve grafts combined with BMMCs could effectively repair long-distance nerve defects and achieve good clinical results., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.) more...

Peripheral nerve injuries in children can result in devastating lifelong deficits. Because of the time-sensitive nature of muscle viability and the limited speed of nerve regeneration, early recognition and treatment of nerve injuries are essential to restore function. Innovative surgical techniques have been developed to combat the regenerative length and speed; these include nerve transfers. Nerve transfers involve transferring a healthy, expendable donor nerve to an injured nerve to restore movement and sensation. Nerve transfers are frequently used to treat children affected by conditions, including UE trauma, brachial plexus birth injury, and acute flaccid myelitis. Pediatricians play an important role in the outcomes of children with these conditions through early diagnosis and timely referrals. With this review, we aim to provide awareness of state-of-the-art surgical treatment options that significantly improve the function of children with traumatic nerve injuries, brachial plexus birth injury, and acute flaccid myelitis., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.) more...

Ghrelin is a circulating peptide hormone released by enteroendocrine cells of the gastrointestinal tract as two forms, acylated and unacylated. Acylated ghrelin (AG) binds to the growth hormone secretagogue receptor 1a (GHSR1a), thus stimulating food intake, growth hormone release, and gastrointestinal motility. Conversely, unacylated GHR (UnAG), through binding to a yet unidentified receptor, protects the skeletal muscle from atrophy, stimulates muscle regeneration, and protects cardiomyocytes from ischemic damage. Recently, interest about ghrelin has raised also among neuroscientists because of its effect on the nervous system, especially the stimulation of neurogenesis in spinal cord, brain stem, and hippocampus. However, few information is still available about its effectiveness on peripheral nerve regeneration. To partially fill this gap, the aim of this study was to assess the effect of UnAG on peripheral nerve regeneration after median nerve crush injury and after nerve transection immediately repaired by means of an end-to-end suture. To this end, we exploited FVB1 Myh6/Ghrl transgenic mice in which overexpression of the ghrelin gene (Ghrl) results in selective up-regulation of circulating UnAG levels, but not of AG. Regeneration was assessed by both functional evaluation (grasping test) and morphometrical analysis of regenerated myelinated axons. Results obtained lead to conclude that UnAG could have a role in development of peripheral nerves and during more severe lesions. more...

Background: There is a pressing need to identify alternative mesenchymal stem cell sources for Schwann cell cellular replacement therapy, to improve peripheral nerve regeneration. This study assessed the efficacy of Schwann cell-like cells (induced muscle-derived stem cells) differentiated from muscle-derived stem cells (MDSCs) in augmenting nerve regeneration and improving muscle function after nerve trauma., Methods: The Schwann cell-like nature of induced MDSCs was characterized in vitro using immunofluorescence, flow cytometry, microarray, and reverse-transcription polymerase chain reaction. In vivo, four groups (n = 5 per group) of rats with median nerve injuries were examined: group 1 animals were treated with intraneural phosphate-buffered saline after cold and crush axonotmesis (negative control); group 2 animals were no-injury controls; group 3 animals were treated with intraneural green fluorescent protein-positive MDSCs; and group 4 animals were treated with green fluorescent protein-positive induced MDSCs. All animals underwent weekly upper extremity functional testing. Rats were euthanized 5 weeks after treatment. The median nerve and extrinsic finger flexors were harvested for nerve histomorphometry, myelination, muscle weight, and atrophy analyses., Results: In vitro, induced MDSCs recapitulated native Schwann cell gene expression patterns and up-regulated pathways involved in neuronal growth/signaling. In vivo, green fluorescent protein-positive induced MDSCs remained stably transformed 5 weeks after injection. Induced MDSC therapy decreased muscle atrophy after median nerve injury (p = 0.0143). Induced MDSC- and MDSC-treated animals demonstrated greater functional muscle recovery when compared to untreated controls (hand grip after induced MDSC treatment: group 1, 0.91 N; group 4, 3.38 N); p < 0.0001) at 5 weeks after treatment. This may demonstrate the potential beneficial effects of MDSC therapy, regardless of differentiation stage., Conclusion: Both MDSCs and induced MDSCs decrease denervation muscle atrophy and improve subsequent functional outcomes after upper extremity nerve trauma in rodents., (Copyright © 2021 by the American Society of Plastic Surgeons.) more...

Median nerve injury is rarely associated with the humeral shaft fracture. Sixty two year old woman with a displaced humeral shaft fracture, developed a symptomatic carpal tunnel syndrome after plating with a screw protruding medially. 16 months later, the implants were removed and the symptoms gradually improved without carpal tunnel release surgery. A double crush syndrome resulted due to the proximal compression by the medially protruding screw and the distal compression by carpal tunnel. The proximal decompression produced by removal of the screw led to relief of the symptoms. [ABSTRACT FROM AUTHOR] more...

Neurofibrolipoma is a very rare benign oral tumor with other synonyms such as neural fibrolipoma, perineural lipoma and intraneural lipoma. A 50 years old female presented with a massive swelling of the tongue of 6 years duration. The tumor was attached to the mucosa of the tip of the tongue, disturbing mastication and speech. On excision, histopathology revealed neurofibrolipoma. This case report shows the atypical presentation of neurofibrolipoma and the challenges of its management. [ABSTRACT FROM AUTHOR] more...

Summary: A number of tendon transfers have been described for opponensplasty. Transfer of the palmaris longus (PL) tendon with a palmar fascial extension was initially described by Camitz. This technique has mostly been combined with carpal tunnel release in patients with long standing median neuropathy with atrophy of the thenar muscles. However, the Camitz transfer has not been previously described in the setting of pediatric median nerve injury. We report 4 cases of Camitz transfer in pediatric patients with median nerve injuries. Four children (all female; age range 3–15 yrs) underwent PL tendon transfer following median nerve injury. The causes of injury included trauma, iatrogenic injury, and neuritis of the brachial plexus. The Camitz procedure was performed at the time of median nerve decompression and/or reconstruction. All patients had excellent early return of function. Transfer of the palmaris longus tendon reliably restores palmar abduction, with minimal to no additional morbidity, in carefully selected pediatric patients with median nerve injury undergoing release of the carpal tunnel. [Copyright &y& Elsevier] more...

Introduction: Peripheral nerves are injured commonly by mechanical trauma, the terms applied to the timing of the nerve repair include primary repair (immediately after injury, or within 6 to 12 hours), delayed primary repair (usually within the first 2 to 2.5 weeks), and secondary repair (after 2.5 to 3 weeks). This study was conducted to analyze the clinical outcome of median and ulnar nerve repair at wrist. Material and Method: This Prospective observational study was conducted at Liaquat University of medical & Health Sciences, Jamshoro. Twenty five patients, (37 nerves), with age range between 25 to 50 years, were included in the study and followed on average 24 months. Common cause of injury was sharp laceration as result of knife injury or sharp glass injury. Delayed primary repair (epineurialneurorrhaphy) was performed in all patients. The associated injuries to tendons were dealt at the same time. Informed consent was taken from all patients before their inclusion in study. Results: The results of unlar nerve repair: motor function recovery was fair in 8/19, (42.10%) nerves and good in 4/19(21.05%), and unsuccessful in 7/19 (36.8%) nerves. The sensory recovery was fair in 5/19 (26.31%) nerves and good in 7/19 (36.84%) nerves and unsuccessful in 7/19 (36.8%) repaired nerves. The results of Median Nerve repair: Motor function recovery was fair in 6/18(33.33%) and good in 4/18 (22.22%), and unsuccessful in 8/18 (44.44%) repaired median nerves. The sensory recovery was fair in 4/18 (22.22%) and good in 6/18 (33.33%), and unsuccessful in 8/18 (44.44%) repaired median nerves. Post operative wound infection was seen in 7/25 patients (28%). The infection was treated with drainage debridement and appropriate antibiotics. Conclusion: The results of median and ulnar nerve delayed primary repair may be adversely affected by infection, use of thick thread, and operating without magnification. [ABSTRACT FROM AUTHOR] more...

The presence of anatomical variations of the peripheral nervous system often accounts for unexpected clinical signs and symptoms. We report unusual variations of the lateral and posterior cords of the brachial plexus in a female cadaver. Such variations are attributed to a faulty union of divisions of the brachial plexus during the embryonic period. The median nerve lay medial to the axillary artery (AA) on both sides. On the right, the lateral root of the median nerve crossing the AA and the median nerve in relation to the medial side of the AA was likely the result of a faulty development of the seventh intersegmental artery. We discuss these variations and compare them with the findings of other researchers. Knowledge of such rare variations is clinically important, aiding radiologists, anaesthesiologists and surgeons to avoid inadvertent damage to nerves and the AA during blocks and surgical interventions. [ABSTRACT FROM AUTHOR] more...

The article focuses on the use of a modified Jebsen Taylor Hand Function Test to gather normative data on Indian population. It comments on modifications to the test to allow for testing of uneducated people and for cultural differences. It mentions that an analysis of the data found gross motor functions were less affected when compared to fine motor functions in the majority of patients who sustained Ulnar and or Median nerve injuries or clawing of the hand due to any reason. more...

In this report, two cases presenting with CTS including a fracture of the silicone implant for Kienböck's disease after replacement over 20 years postoperatively where CTR ceased the symptoms of CTS. The major symptom characteristic was the median nerve impairment with less emphasis on the limited range of motion of the wrist or wrist pain due to a fracture of the silicone implant. There was an unlikely association between the fracture of the implant and CTS, which was confirmed by the operative findings of tenosynovitis and thickness of the degenerated transverse ligament without a significant protrusion of the silicone implant. [ABSTRACT FROM AUTHOR] more...

The article discusses a communication between the musculocutaneous and median nerves in the left arm. The musculocutaneous nerve emerged from the lateral cord of the brachial plexus and supplied the coracobrachialis muscle before piercing. The author claims that the fibres of the musculocutaneous and median nerves proximal to the entrance of the musculocutaneous into coracobrachialis. more...

Patients affected by carpal tunnel syndrome (CTS) often report finding themselves “dropping objects”. This symptom is perceived as a severe and frustrating problem. We investigated the occurrence of “dropping objects” in a sample of 532 patients affected by CTS, studied with a multidimensional protocol (clinical, neurophysiological, and patient-oriented). To ensure that the definition of “dropping objects” was index of abnormality, we evaluated a control group interviewing 200 subjects. In order to evaluate if “dropping objects” was an index of more severe CTS impairment, we compared the severity measures between the patients with and without this condition. Severity of CTS multidimensionally assessed was significantly greater in patients with a history of dropped objects than those without. Moreover, “dropping objects” was more frequent in females, older patients, and in those patients with more functional impairment. The occurrence of “dropping objects” in CTS patients seems to be an index of CTS severity. [ABSTRACT FROM AUTHOR] more...

To our knowledge, the combination of a palmar subluxation of the thumb carpometacarpal (CMC) joint with low median nerve deficit followed by the recurrent branch injury is extremely rare. We present a case of the subluxation of the thumb CMC joint with low median nerve deficit. [ABSTRACT FROM AUTHOR] more...

This report describes a rare case of secondary carpal tunnel syndrome due to a lipofibromatous hamartoma of the median nerve. Excision of the fibrofatty tissue between the nerve fascicles without risking damage to the fascicles was impossible. The transverse carpal ligament was incised and an epineurotomy was performed. Within six months, the 25-year-old female patient's symptoms were much improved. [ABSTRACT FROM AUTHOR] more...

A volar dislocation of the lunate is a severe injury associated with rupture of the palmar capsule usually occurring as a triad with radial styloid and transcaphoid fractures. Associated median nerve palsy can occur due to palmar rotation of the dislocated lunate into the carpal tunnel, but ulnar nerve dysfunction is rare. We present the second reported case of ulnar nerve paresis secondary to lunate dislocation resulting from a wrist hyperextension injury. Early open reduction and screw fixation lead to rapid resolution of symptoms. [ABSTRACT FROM AUTHOR] more...

A nurse-led carpal tunnel service was started in Leicester in 1999. Many developments in the service have been patient-driven. A large proportion of our patients are not salaried and many had expressed concerns about the amount of time taken off work after surgery. This therefore prompted us to encourage immediate hand function after surgery. Subsequently, in 494 patients studied prospectively, we have seen 93% of patients return to work by 2 weeks and 99% by 4 weeks. This has obvious benefits in terms of reducing loss of income. Furthermore there is potential for considerable economic savings. [ABSTRACT FROM AUTHOR] more...

Summary: This study assesses the impact on outcome of wearing a bulky dressing following carpal tunnel decompression. One hundred patients were randomised for having a bulky dressing removed at either 24h or 2 weeks postoperatively. A Levine score was measured preoperatively and postoperatively at 2 weeks. The surgery and other dressings used were standardised as per the protocol. Comparison was made between the symptom and functional severity scores for each group to assess the impact of duration of wearing the dressing on resolution of symptoms. The results indicate no difference in outcome between the 2 week and 24h groups. We therefore feel that patients should be given the choice as to when to remove their dressing. If they feel restricted, they are free to remove the bulky dressing without an increased risk of a worse outcome. If they feel secure in the dressing, they will not suffer leaving it in place for 2 weeks. [Copyright &y& Elsevier] more...

Anthropometric wrist measurement ratios were examined for an association with idiopathic carpal tunnel syndrome (CTS). Wrist measurements were recorded in 67 patients with CTS and in a matched control group of 67 healthy volunteers. The Wrist Ratio (WR) (wrist anterior to posterior dimension/wrist medial–lateral dimension) and the Wrist Palm Ratio (wrist anterior to posterior dimension/palm length) were calculated for each case. We found that a WR of ≥0.70 and a Wrist Palm Ratio of >0.342 were significantly associated with idiopathic CTS. [ABSTRACT FROM PUBLISHER] more...

We present a case in which the radial artery was found running within the carpal tunnel at the time of routine carpal tunnel decompression. It appears to be an anomalous superficial palmar branch of the radial artery that is substituting for the normal radial artery. [Copyright &y& Elsevier] more...

Summary: A persisting median artery associated with carpal tunnel syndrome in a patient with symbrachydactyly has not been previously described in the literature. It is unclear whether there may be a developmental association between persistence of a median artery and Symbrachydactyly. [Copyright &y& Elsevier] more...

Compression of median nerve at elbow secondary to loose body is very rare, only two cases have been reported in literature. Elbow swelling in this case led us to the cause of our patient’s median nerve dysfunction. A simple day case elbow arthroscopy procedure, and removal of loose body provided a cure for the elbow symptoms and the neuropathy. Compression neuropathy at the elbow, while rare, should be considered in the differential diagnosis of hand paraesthesia. [ABSTRACT FROM AUTHOR] more...

A cohort of 119 patients with carpal tunnel syndrome completed the questionnaire of the Dutch version of the DASH score pre-operatively and one year postoperatively. The mean DASH score decreased from 38.2 to 22.0. There was a significant correlation with the Boston carpal tunnel outcome score (). With an effect size of 0.87 and a standardized mean response of 0.69, the Dutch version of the DASH is highly responsive for the evaluation of the outcome of surgery for carpal tunnel syndrome. [Copyright &y& Elsevier] more...

Hemangioma of the median nerve presenting as acute carpal tunnel syndrome is unusual A-18- year old male presented with severe incapacitating pain of sudden onset of left forearm and hand after manual field work. There was swelling on volar aspect of forearm, with hyperalgesia in the median nerve distribution. The fingers and wrist were inmarked flexion and the patient did not allow wrist and finger extension. X-rays were within normal limits. An emergency volar carpal ligament release revealed, haematoma about 100 ml with numerous vessels encircling the median nerve. Histopathology of lesion turned out to be a cavernous hemangioma. Post operatively patient had full recovery. [ABSTRACT FROM AUTHOR] more...

During open carpal tunnel release in patients with severe idiopathic carpal tunnel syndrome, an area of constriction in the substance of the median nerve is frequently noted. In a prospective study of 30 patients, the central point of the constricted part of the nerve was determined intraoperatively and found to be, on average, 2.5 (range 2.2–2.8)cm from the distal wrist crease. This point always corresponded to the location of the hook of the hamate bone. These intraoperative findings were compared with the “narrowest” point of the carpal canal as determined by anatomical and radiological studies in the literature. [Copyright &y& Elsevier] more...

This is a case in which an anomalous tendon of the palmaris profundus was found running on the anterior surface of the median nerve, dividing the nerve into 2 branches at the wrist bilaterally. Excision of the tendon at the time of re-exploration of the carpal tunnel resulted in complete relief of carpal tunnel symptoms. [Copyright &y& Elsevier] more...

Abstract: Carpal tunnel injections are widely performed for diagnostic and therapeutic purposes. Injury to the median nerve is a serious and fairly common complication. There is no consensus regarding the safest injection site. The objective of this study was to determine the safest injection site based on anatomical data. During 124 endoscopic procedures for median nerve release at the carpal tunnel, we measured the distances separating the median nerve, palmaris longus (PL), flexor carpi radialis (FCR), and flexor carpi ulnaris 1 cm proximal to the wrist crease. The edge of the median nerve extended medially beyond the PL tendon in 82 (88%) hands. Thus, needle insertion within 1 cm of either edge of the PL tendon may cause median nerve injury; with injection sites located further toward the medial edge, the ulnar pedicle may be at risk. Consequently, we recommend that carpal tunnel injections be performed through the FCR tendon. [Copyright &y& Elsevier] more...

Abstract: Carpal tunnel syndrome presenting as a trophic disorder in the hand is unusual. We report the case of a 66 year old man in whom nerve conduction tests confirmed compression of the median nerve in the carpal tunnel, and vasospasm in the corresponding area was demonstrated by arteriography for, we believe, the first time. Simple decompression of the carpal tunnel brought about total recovery. The mechanism of the autonomic disorders found in carpal tunnel syndrome remains controversial. The clinical case that we report objectively demonstrates the vasospasm caused by the compression of the autonomic fibres of the median nerve. [Copyright &y& Elsevier] more...

We report a new case of pediatric carpal tunnel syndrome in a patient with juvenile rheumatoid arthritis. Symptoms were mainly motor weakness and severe atrophy of the thenar. [ABSTRACT FROM AUTHOR] more...

Carpal tunnel syndrome (CTS) is a nerve entrapment disorder, involving the median nerve when it passes the carpal tunnel at the wrist. Using a case-control methodology, 312 electrophysiologically confirmed CTS patients with mean age of 51.3 ± 9.4 (27–74) years (81.7% women) and 100 controls with mean age of 50.4 ± 9.2 (21–88) years (75% women) were examined utilising a questionnaire similar to the clinical diagnostic criteria of restless legs syndrome (RLS). Forty-four (14.1%) of the CTS patients have symptoms compatible with restless hand syndrome compared with none (0%) in the control group (p < 0.0001). The severity of CTS was not significantly associated with the motor restlessness. Our observations suggest that entrapment syndromes such as CTS can be associated with a form of restlessness in the hands, analogous to RLS. [ABSTRACT FROM AUTHOR] more...

Evaluates the possible carpal tunnel syndrome in dogs. Causes of entrapment neuropathies; Development of carpal tunnel syndrome; Diagnosis of the syndrome.

A rare case of complete division of the flexor pollicis longus tendon as a complication of open carpal tunnel using a short-incision is reported. The tendon was cut directly beneath the proximal edge of the transverse carpal ligament. Furthermore, the transverse carpal ligament was split incompletely. A few days after surgery, the patient noted that she was unable to flex the thumb interphalangeal joint. A re-operation completely releasing the transverse carpal ligament and suturing the lacerated tendon was performed 2 weeks later. [ABSTRACT FROM AUTHOR] more...

Introduction. Compression of the median nerve at the wrist by a persistent median artery is one of the uncommon reasons for carpal tunnel syndrome. Most of the studies in the literature deal with thrombosed persistent median artery. Materials and method. In this study, we present surgical treatment of four carpal tunnel syndromes, which had persistent median arteries. The mean age of the patients was 51 years. All four median arteries were patent and only transverse carpal ligament releases were performed using a standard anterior open approach for decompression of the carpal tunnel. Neither ligation nor transposition of the arteries was done. Results. All patients became symptom free after a few weeks. Only one patient had a slight recurrence 13 months postoperatively. Splint use and modification of her activities reduced her disturbance, and no further treatment was applied. Conclusion. If the patient has no additional anomaly, our clinical experiences lead us not to advise resection or transposition because simple release of the transverse carpal ligament can relieve symptoms. [ABSTRACT FROM AUTHOR] more...

The purpose of this study was to investigate the long-term prognosis of patients with carpal tunnel syndrome (CTS). We prospectively followed-up patients with CTS for 80 weeks. Thirty cases had been treated with a single injection of methylprednisolone acetate and another 30 with a 10-day course of prednisolone. At the end of the follow-up period, there were no significant differences in symptoms as measured by global symptom score and in the proportion of patients who progressed to decompressive surgery. Few patients who were not operated on (11.4%) remain asymptomatic. [ABSTRACT FROM AUTHOR] more...

Case studied. Median nerve entrapment is a rare, serious complication of elbow dislocation. We report a Type 4 median nerve entrapment after elbow dislocation in a 10-year-old boy. Radiologically Matev's sign and a new radiological finding—a sclerotic tunnel at the lateral side of the olecranon—were seen. Treatment. The patient was treated by excising the damaged segment and reanastomosing the nerve 13 months after the injury. [ABSTRACT FROM AUTHOR] more...

A study of 20 doctors in their first or second postgraduate year highlighted deficiencies in their knowledge of the nerve supply of the hand and forearm. The children’s game rock–paper–scissors (Figs. 1–3Fig. 1Rock: the pronated fist, median nerve.Fig. 2(a, b) Paper: the extended wrist and hand, radial nerve.Fig. 3Scissors: the ulnar nerve.) can be used as a simple aide-memoir for the nerve supply to the hand and forearm. The median nerve creates the “rock position” of the pronated fist (Fig. 1). The radial nerve extends the wrist and hand forming the “paper position” (Fig. 2a and b) and the ulnar nerve creates the “scissor position” (Fig. 3), by clawing the ring and little fingers and spreading the index and middle and adducting the thumb and flexing the interphalangeal joint. [Copyright &y& Elsevier] more...

We report a 28-month-old male child, known to have Maroteaux-Lamy syndrome (mucopolysaccharidosis type VI), who presented with inconsistent right hand discomfort. Clinical suspicion of right carpal tunnel syndrome was confirmed by nerve conduction and electromyographic studies, and a decompressive procedure was done with uneventful recovery. Carpal tunnel syndrome in mucopolysaccharidosis patients should be suspected, diagnosed and treated early for better outcome.Copyright © 2002 S. Karger AG, Basel [ABSTRACT FROM AUTHOR] more...

Case: A 41-year-old woman sustained a distal radius fracture with concomitant median nerve transection. The wound was consistent with an inside-to-outside mechanism with noted metaphyseal bone loss at the level of the median nerve injury. The median nerve was not amenable to primary repair, and given concern for inability to define the zone of the injury, the patient underwent delayed reconstruction of the nerve., Conclusion: A review of the literature highlights the rare incidence of this combined injury that can be undetected or misdiagnosed as an acute carpal tunnel syndrome or stretch injury to the median nerve., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B662)., (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.) more...

Carpal tunnel release is a routinely performed operation to relieve pressure caused by compression on the median nerve. In the majority of cases, the causation of the compression will be idiopathic. Among the secondary causes of median nerve compression is the palmaris profundus, a rare anatomical variant separate to the palmaris longus tendon. It has been suggested that it may cause carpal tunnel syndrome as it courses underneath the flexor retinaculum with the contents of the carpal tunnel reducing the space available to the median nerve. Several cases have found it intimately associated with the median nerve within the carpal tunnel. Raising awareness of this anatomical variant is therefore important for those undertaking carpal tunnel decompression in order to avoid unintended damage., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.) more...

The existence of familial carpal tunnel syndrome (FCTS) as a separate autonomic entity has been discussed during the last few years. In order to contribute with more data to the literature, we report here the results of clinical, electrophysiological, pathological and radiological studies performed in 5 patients belonging to the same Finnish pedigree. The disease appeared usually before the second decade with numbness and pain on the I–III digits. In most patients symptoms were unilateral but within 2 years they became bilateral. In all patients typical electrophysiological features of median nerve entrapment have been recorded. X-rays of the wrist showed narrow carpal tunnel in all patients. In all patients the possibility of having HNPP as well as familial amyloidosis has been excluded by molecular genetic and pathological studies. All patients underwent surgery and at postoperative stage symptoms were relieved or completely disappeared. Our study supports the theory that FCTS exists as a separate autonomic entity, therefore it is important in front of a sporadic case to investigate the family occurrence of CTS. [ABSTRACT FROM AUTHOR] more...