An Osteological Study Of Morphometric Variations Of Suprascapular Notch In South Gujarat Region

Background:The suprascapular notch is a depression in the lateral part of superior border of scapula. The suprascapular ligament bridges the notch. Thesuprascapular nerve passes below the ligament and corresponding artery above the ligament. Variation in size and shape of suprascapular notch is identified as one of the causes of suprascapular nerve entrapment.Aim Of Study:To study morphological variations of suprascapular notch in dry scapulae of South Gujarat (Indian) population and compare data with studies in other ethnic populations. Materials And Methods:Total 200 dry human scapulae were obtained from Anatomy departments of three medical collegesof south Gujarat. Three dimensions were defined and measured for each suprascapular notch (SSN) using classical osteometry: maximal depth (MD), superior transverse diameter (STD) and middle transverse diameter (MTD). Based on Micha? Polguj’s classification SSN was classified into five types. The results of the present study were compared with previous studies in different populations.Results:The proportion of Type III SSN is highest (46.5 %) followed by Type V (26 %), Type I (16 %), Type IV (6 %) and Type II (5.5 %). For Type III SSN, proportion of subtype III c is highest (36.5 %), followed by subtype III b (6 %) and subtype III a (4 %). For Type I SSN, proportion of subtype I c is highest (8.5 %), followed by subtype I a (4 %) and Subtype I b (3.5 %).Conclusion:The suprascapular nerve entrapment syndrome, in most cases is due to morphological variations of suprascapular notch particularly complete ossification of suprascapular ligament. So the knowledge of such variations is essential for clinicians,to make a proper diagnosis of shoulder pain and to plan the most suitable surgical intervention.

Constrictive entrapment neuropathies of a limb secondary to restraint strapping: A case report

@#<p style="text-align: justify;"><strong>Rationale:</strong> Entrapment neuropathies are peripheral nerve disorders at specific anatomical locations. They may be caused by trauma in a manner of sprains or bone fracture, but it is often caused by repetitive insults or compression of nerves as they travel through a narrow anatomic space. Pregnancy and pre-existing comorbidities such as diabetes, obesity, cancer, or autoimmune diseases may also cause nerve entrapment.</p><p style="text-align: justify;"><strong>Objective:</strong> To highlight the case of a 52-yearold female developing right foot dysesthesia and weakness after continuous restraint strapping from her previous hospitalization.</p><p style="text-align: justify;"><strong>Case:</strong> Here we have the case of a 52-year-old Filipino female consulted because of right foot dysesthesia, allodynia, and mild weakness. She had a history of bipolar disorder and recent onset of acute psychosis and overdosing with her irregularly taken maintenance olanzapine tablets. She was put on restraint strapping of the right lower limb in her one-week hospital stay. This resulted in developing restraint marks on her right ankle accompanied by difficulty walking on heels and toes, spontaneous dysesthesia, and touch allodynia of her entire right foot. An electrodiagnosis yielded right lower limb focal neuropathies involving the right fibular nerve, right tibial nerve, right superficial fibular, and right sural nerves. The prescribed amitriptyline and gabapentin for 6 months led to gradual improvement of neuropathic pain.</p><p style="text-align: justify;"><strong>Discussion and Summary:</strong> Our case exemplifies focal limb neuropathies from entrapment due to restraint strapping. Electrodiagnostic confirmation of neuropathies of the same limb sensory and motor nerves was mandated to corroborate clinical neuropathic pain and after ruling out other causes of entrapment neuropathies. Prolonged use of neuropathic pain medications were needed to attain relief in this present case. Restrictive strapping is an iatrogenic cause of entrapment neuropathy that is preventable, had there been proper medical attention applied.</p>

Frequency of Complete Absence of Suprascapular Notch in Dry Scapulae - An Osteological Study with Clinical Significance

Suprascapular notch is a depression located in the superior border of the scapula near its lateral part, close to the root of the coracoid process. It is bridged by the superior transverse scapular ligament & serves as a path for the suprascapular nerve. The notch is commonly seen in all the scapulae with variable morphology. Sometimes, it is associated with ossified transverse scapular ligament which plays an important role for the suprascapular neuropathies which has been suggested in many previous literatures. But, its absence can also be a reason for nerve entrapment which has been mentioned less frequently. The purpose of this study was to find out the incidence of completely absent suprascapular notch among dry scapulae of north India, especially Gurugram region along with a morphometric evaluation of superior border of scapular where the notch is situated.METHODSOne hundred & ten adult dry scapulae of unknown sex from the osteology museum of SGT Medical College, Gurugram, were obtained for evaluation of absence of suprascapular notch in the superior border of the scapulae near the root of the coracoid process by subjective evaluation (visual inspection). We have also done a morphometric evaluation (length) of the superior border of all the scapulae irrespective of the suprascapular notch. Our observations were compared with other osteological studies performed on other population groups.RESULTSOf the 110 scapulae studied, 43 belonged to right side & 67 scapulae of left side. By visual inspection, 13 scapulae (11.8%) were devoid of suprascapular notch on the upper border & rest 88 scapulae (88.81%) had different variety of suprascapular notch. Among the 13 scapulae without suprascapular notch, 8 scapulae (61.5%) were of right side and 5 scapulae (38.46%) were of left sided bone. Apart from this, the average length of the superior border of the scapulae was 42.73 mm.CONCLUSIONSIncidence of completely absent suprascapular notch in our study is 11.8% which will act as a reference point among Gurugram population in north India. Clinicians should keep in mind about complete absence of suprascapular notch which can be a probable reason for the suprascapular nerve entrapment.

Carpal Tunnel Syndrome in Pregnancy : Is There Really Oedema in the Carpal Tunnel?

@#Compression of the median nerve in pregnancy is thought to be due to fluid retention within the carpal tunnel space. We aim to discover the cause of carpal tunnel syndrome (CTS) in pregnancy using high resonance ultrasonography. Methods: This is a cross-sectional study where obstetric patients were screened for CTS and subjected to a non invasive ultrasonic imaging. Results: A total of 63 patients were seen with 25 diagnosed to have CTS (39.7%) and 38 patients had none (60.3%) based on a screening tool. Age ranged from 20-42 years old with the highest range in the 28-30 year old group (34.9%). In patients with CTS, the cross sectional area of the median nerve inside the tunnel was a mean of 0.908 cm² ie larger, while non-CTS patients had a mean of 0.797 cm² inside the tunnel. The transverse carpal ligament (TCL) measured a mean of 0.0988 cm in the CTS group (ie thinner) and 0.1058 cm in the non-CTS group. Median nerve mobility at equal to or less than one tendon width was 80% in pregnant women with CTS and 92.1% for those without. No fluid was present within the carpal tunnel of all patients. The results were statistically not significant. Conclusion: Ultrasonographic evidence in pregnant women with CTS shows a larger median nerve, a more mobile median nerve and a less thick transverse carpal ligament. There is absence of fluid retention and synovitis ruling out extrinsic compression of the median nerve as cause of CTS in pregnancy.

Evaluation Of The Origin Variability Of The Lateral Femoral Cutaneous Nerve With Clinical Significance

Background and Objectives: The lateral femoral cutaneous nerve (LFCN) of the thigh arises from the dorsalbranches of the second and third lumbar ventral rami. Several variations in the formation, course and branchesof this nerve have been reported. The regional anatomy of the lateral femoral cutaneous nerve is highly variedand may account for its susceptibility to local trauma. Knowledge of these variations is important for surgeonsto avoid injury to the nerve. The aim of this study was to evaluate the variations in the formation of LFCN of thethigh and to discuss its clinical implications.Materials And Methods: The study was conducted on 25(50 sides) adult human cadavers in the Department ofAnatomy, Sri Siddhartha Medical College, Tumkur, Karnataka, India by dissection method. The LFCN was lookedfor, bilaterally, and its formation studied. The specimens were numbered and photographed.Results: In the present study, the lateral femoral cutaneous nerve of thigh arising from dorsal divisions of L2 L3was observed in 34(68%) specimens. Variations in LFCN were observed in 16 specimens. The variationsencountered were the absence of LFCN (2%), the origin of LFCN from ventral ramus of L1 spinal nerve (2%), theorigin of LFCN from ventral rami of L1 L2 spinal nerves (8%), the origin of LFCN as a branch of femoral nerve (20%).Conclusion: The present study highlights the necessity for a thorough knowledge of the topographical features ofthe LFCN so as to increase the efficacy of diagnosis, reduce complications and increase patient comfort.

Anatomical Variants of “Short Head of Biceps Femoris Muscle” Associated with Common Peroneal Neuropathy in Korean Populations : An MRI Based Study

OBJECTIVE: In Asians, kneeling and squatting are the postures that are most often induce common peroneal neuropathy. However, we could not identify a compatible compression site of the common peroneal nerve (CPN) during hyper-flexion of knees. To evaluate the course of the CPN at the popliteal area related with compressive neuropathy using magnetic resonance imaging (MRI) scans of healthy Koreans.METHODS: 1.5-Tesla knee MRI scans were obtained from enrolled patients and were retrospectively reviewed. The normal populations were divided into two groups according to the anatomical course of the CPN. Type I included subjects with the CPN situated superficial to the lateral gastocnemius muscle (LGCM). Type II included subjects with the CPN between the short head of biceps femoris muscle (SHBFM) and the LGCM. We calculated the thickness of the SHBFM and posterior elongation of this muscle, and the LGCM at the level of femoral condyles. In type II, the length of popliteal tunnel where the CPN passes was measured.RESULTS: The 93 normal subjects were included in this study. The CPN passed through the “popliteal tunnel” formed between the SHBFM and the LGCM in 36 subjects (38.7% type II). The thicknesses of SHBFM and posterior portions of this muscle were statistically significantly increased in type II subjects. The LGCM thickness was comparable in both groups. In 78.8% of the “popliteal tunnel”, a length of 21 mm to < 40 mm was measured.CONCLUSION: In Korean population, the course of the CPN through the “popliteal tunnel” was about 40%, which is higher than the Western results. This anatomical characteristic may be helpful for understanding the mechanism of the CPNe by posture.

Anatomical Variants of “Short Head of Biceps Femoris Muscle” Associated with Common Peroneal Neuropathy in Korean Populations : An MRI Based Study

OBJECTIVE: In Asians, kneeling and squatting are the postures that are most often induce common peroneal neuropathy. However, we could not identify a compatible compression site of the common peroneal nerve (CPN) during hyper-flexion of knees. To evaluate the course of the CPN at the popliteal area related with compressive neuropathy using magnetic resonance imaging (MRI) scans of healthy Koreans. METHODS: 1.5-Tesla knee MRI scans were obtained from enrolled patients and were retrospectively reviewed. The normal populations were divided into two groups according to the anatomical course of the CPN. Type I included subjects with the CPN situated superficial to the lateral gastocnemius muscle (LGCM). Type II included subjects with the CPN between the short head of biceps femoris muscle (SHBFM) and the LGCM. We calculated the thickness of the SHBFM and posterior elongation of this muscle, and the LGCM at the level of femoral condyles. In type II, the length of popliteal tunnel where the CPN passes was measured. RESULTS: The 93 normal subjects were included in this study. The CPN passed through the “popliteal tunnel” formed between the SHBFM and the LGCM in 36 subjects (38.7% type II). The thicknesses of SHBFM and posterior portions of this muscle were statistically significantly increased in type II subjects. The LGCM thickness was comparable in both groups. In 78.8% of the “popliteal tunnel”, a length of 21 mm to < 40 mm was measured. CONCLUSION: In Korean population, the course of the CPN through the “popliteal tunnel” was about 40%, which is higher than the Western results. This anatomical characteristic may be helpful for understanding the mechanism of the CPNe by posture.

Median nerve neuropathy

The median nerve is the most important nerve in the upper extremity, as it is responsible for most of the sensation of the hand, the fine motor functions of the thumb, and finger grasping. Median neuropathies most commonly occur as compressive neuropathy or entrapment neuropathy, but sometimes as neuritis without any compressive lesion. Carpal tunnel syndrome (CTS), anterior interosseous nerve syndrome, and pronator teres syndrome are the subtypes of median nerve neuropathies, of which CTS is the most common. Median neuropathies can be diagnosed clinically by careful history-taking and a physical examination. Typical symptoms of CTS include night pain (crying), a tingling sensation of the radial digits, numbness or paresthesia, clumsiness, and atrophy of the thenar muscles. Electrophysiologic testing can be used for confirmation of the diagnosis and for documentation before surgical treatment. Imaging modalities including ultrasonography or magnetic resonance imaging can be used to ensure diagnostic accuracy and to detect unusual causes of compression. Conservative treatments include rest, bracing, nerve stretching, non-steroidal anti-inflammatory drugs, and steroid injections. If nonsurgical approaches are unsatisfactory or the nerve damage is severe, surgical treatment should be considered. Carpal tunnel release for CTS is a relatively simple procedure that involves division of the transverse carpal ligament and decompression of the median nerve. Early diagnosis and proper management are important, as muscle atrophy and sensory loss may persist when surgical release is delayed in patients with advanced disease.

Radial nerve neuropathy

Radial nerve entrapment or compression in the upper extremity is relatively rare compared to medial nerve or ulnar nerve entrapment and compression. Various syndrome types are defined according to the location of radial nerve entrapment and the pattern of symptom expression. In the upper arm, Saturday night palsy or honeymoon palsy occurs. Around the elbow, posterior interosseous nerve entrapment syndrome, which involves pure motor symptoms, and radial tunnel syndrome, which mainly involves pain symptoms, can develop. Finally, superficial radial nerve entrapment occurs in the distal forearm and has the symptom of painful or abnormal sensory disturbances of the hand. Conservative treatment is usually the first choice for radial nerve neuropathy, unless there is motor paralysis. Surgical treatment can be considered if there is no improvement after adequate conservative treatment.

Diagnosis and Treatment of Tarsal Tunnel Syndrome / 대한정형외과학회잡지

Tarsal tunnel syndrome is an entrapment neuropathy of the tibial nerve and its branches within the tarsal tunnel, which usually occurs as a result of a space-occupying lesion, trauma or foot deformity. The typical symptoms are pain and paresthesia of the foot at the dermatome of involved nerve branches, and the diagnosis can be made through careful history taking and physical examination. Treatments include conservative management and surgery. Although the reported results of surgical treatment vary, surgical decompression can yield satisfactory outcomes in cases of tarsal tunnel syndrome with a space-occupying lesion.

Tratamiento quirúrgico del síndrome de túnel del carpo en adultos mayores / Surgical treatment of carpal tunnel syndrome in older adults / Traitement chirurgical du syndrome du canal carpien chez les personnes âgées

INTRODUCCIÓN: el síndrome del túnel del carpo constituye el diagnóstico más común para cirujanos de mano. Se han descrito diversos métodos quirúrgicos para su tratamiento, con reportes de buenos resultados. OBJETIVO: mostrar los resultados del tratamiento quirúrgico del síndrome del túnel del carpo, con empleo de anestesia local, incisión razonable y movilidad precoz en pacientes mayores de 65 años de edad. MÉTODO: estudio de intervención longitudinal prospectivo con pacientes mayores de 65 años de edad diagnosticados e intervenidos por síndrome del túnel del carpo entre el 1ro. de enero 2010 y el 1ro. de julio del 2014, y evaluados 1 año después de dicho tratamiento en el CITED. RESULTADOS: serie constituida por 194 pacientes, predominó el sexo femenino (81,44 %), se encontró asociación de síndrome del túnel del carpo con: realización de actividades manuales previas, posibilidad de afectación bilateral, antecedente de fractura de radio distal ipsilateral, comorbilidad con otras enfermedades como diabetes, artritis reumatoide y afecciones de tendones y sus vainas. La mejoría en síntomas, dolor y función al año fue superior al 98 %. CONCLUSIONES: el tratamiento quirúrgico del síndrome del túnel del carpo, con empleo de anestesia local, incisión de piel razonable y movilidad precoz, ocasiona significativa mejoría de los síntomas, del dolor y la función en adultos mayores de 65 años de edad.

INTRODUCTION: Carpal tunnel syndrome is the most common diagnosis for hand surgeons. They described various surgical methods for treatment, with reports of good results. OBJECTIVE: Show the results of surgical treatment of carpal tunnel syndrome using local anesthesia, reasonable incision and early mobility in patients older than 65 years old. METHOD: Prospective longitudinal intervention study with patients older than 65 years of age diagnosed and surgically treated for carpal tunnel syndrome from January 2010 to July 2014 and they were evaluated one year after treatment at CITED. RESULTS: In the series consisting of 194 patients, women predominated (81.44%). Association of carpal tunnel syndrome was found with holding prior manual activities, the possibility of bilateral involvement, history of fracture of ipsilateral distal radius, comorbidity with other diseases such as diabetes, rheumatoid arthritis and diseases of tendons. The improvement of symptoms, pain and function after a year was higher than 98%. CONCLUSIONS: Surgical treatment of carpal tunnel syndrome using local anesthesia, reasonable skin incision and early mobility causes significant improvement in symptoms, pain and function in adults older than 65 years old.

INTRODUCTION: Le syndrome du canal carpien est le diagnostic le plus souvent trouvé par les chirurgiens spécialisés en main. Plusieurs techniques chirurgicales ont été décrites pour son traitement, avec de très bons résultats. OBJECTIFS: Ce travail a le but de montrer les résultats du traitement chirurgical du syndrome du canal carpien à l'aide de l'anesthésie locale, d'une incision raisonnable et d'une mobilité précoce chez les patients âgés de plus de 65 ans. MÉTHODE: Une étude interventionnelle, longitudinale et prospective de patients âgés de plus de 65 ans, diagnostiqués et traités pour syndrome de canal carpien entre le 1er janvier 2010 et le 1er juillet 2014, et évalués un an après, a été effectuée au CITED. RÉSULTATS: Dans une série de 194 patients, où le sexe féminin était en majorité (81,44 %), on a trouvé que le syndrome du canal carpien était associé aux activités manuelles, à un possible trouble bilatéral, à une histoire de fractures du radius distal ipsilatéral, et à une comorbidité avec d'autres maladies telles que le diabète, l'arthrite rhumatoïde et les atteintes des tendons et leurs gaines. Les symptômes, la douleur et la fonction ont amélioré un an après l'opération dans 98 % de cas. CONCLUSIONS: En utilisant de l'anesthésie locale, une incision raisonnable et une mobilité précoce, le traitement chirurgical du syndrome du canal carpien entraîne une significative amélioration des symptômes, de la douleur et de la fonction chez les personnes âgées de plus de 65 ans.

Ultrasound Guided Transversus Abdominis Plane Block for Anterior Cutaneous Nerve Entrapment Syndrome

Anterior cutaneous nerve entrapment syndrome (ACNES) is one the most common cause of chronic abdominal wall pain. The syndrome is mostly misdiagnosed, treated wrongly and inadequately. If diagnosed correctly by history, examination and a positive carnett test, the suffering of the patient can be relieved by addressing the cause i.e. local anaesthetic with steroid injection at the entrapment site. Conventionally, the injection is done by landmark technique. In this report, we have described 2 patients who were diagnosed with ACNES who were offered ultrasound guided transverses abdominis plane (TAP) injection who got significant pain relief for a long duration of time.

Bilateral Anterior Interosseous Nerve Syndrome: A Case Report

Anterior interosseous nerve is purely a motor nerve and supplies flexor pollicis longus, flexor digitorum profundus to the index finger, and pronator quadratus. The etiology and treatment option of anterior interosseous nerve syndrome remain controversial. Bilateral involvement of the anterior interosseous nerve have been described rarely; however, we found no reported case of nonsimultaneous bilateral anterior interosseous nerve palsy associated with the entrapment neuropathy. We present the unique case of delayed anterior interosseous nerve syndrome, 3 years 5 months following an identical event in the opposite extremity and literature review.

Decompression of the Sciatic Nerve Entrapment Caused by Post-Inflammatory Scarring

A rare case of chronic pain of entrapment neuropathy of the sciatic nerve successfully relieved by surgical decompression is presented. A 71-year-old male suffered a chronic right buttock pain of duration of 7 years which radiating to the right distal leg and foot. His pain developed gradually over one year after underwenting drainage for the gluteal abscess seven years ago. A cramping buttock and intermittently radiating pain to his right foot on sitting, walking, and voiding did not respond to conventional treatment. An MRI suggested a post-inflammatory adhesion encroaching the proximal course of the sciatic nerve beneath the piriformis as it emerges from the sciatic notch. Upon exploration of the sciatic nerve, a fibrotic tendinous scar beneath the piriformis was found and released proximally to the sciatic notch. His chronic intractable pain was completely relieved within days after the decompression. However, thigh weakness and hypesthesia of the foot did not improve. This case suggest a need for of more prompt investigation and decompression of the chronic sciatic entrapment neuropathy which does not improve clinically or electrically over several months.

Variations of pronator teres muscle. A morphological study.

The muscles of shoulder girdle and elbow act together to position the hand accurately for manipulative functions. The superior extremity of man has undergone various modifications during evolution one of which is the lateral rotation of forelimbs at joints with pectoral girdle. The aim of the present study was to study the variations of pronator teres muscle. The present study was done on 60 upper limbs (56 Males and 4 Females) of embalmed adult human cadavers obtained from Deptt of Anatomy, Govt. Medical College Patiala. The humeral head of PT was found in all the cases, while Ulnar head was present in 52(86.7%) cases. The Humeral head was muscular in all the cases. The Ulnar origin was muscular in 15 cases (28.84%), tendinous in 7 cases (13.46%) & mixed in 30 cases (57.7%). In 2 (3%) cases there was double humeral head and the median nerve was passing between them. In 3cases (5%) there was high origin of humeral head of Pronator teres from medial intermuscular septum. Anatomy instructors and health professionals should be aware of the common variations in muscles and tendons of the forearm, not only for their academic interest but also for their clinical and functional implications.

Update on Management of Compressive Neuropathy: Tarsal Tunnel Syndrome / 대한정형외과학회잡지

The tarsal tunnel is located beneath the flexor retinaculum, which connects the medial malleolus and calacaneus. The tarsal tunnel contains the posterior tibialis tendon, flexor digitorum longus tendon, posterior tibial artery and vein, posterior tibial nerve, and flexor halluces longus tendon. Tarsal tunnel syndrome is a compressive neuropathy of posterior tibial nerve and its branches under the flexor retinaculum. The etiologies of tarsal tunnel syndrome are space-occupying lesion, hypertrophied flexor retinaculum, osteophytes, tarsal coalition, varicose vein, and trauma. The symptoms are foot pain and hypoesthesia or paresthesia at dermatome according to involving nerve branches. Clinical diagnosis can be obtained from a detailed history and physical examination such as compressive test at the tarsal tunnel area. Ultrasonography and magnetic resonance imaging can reveal the space-occupying lesion, such as ganglion, lipoma, and neuroma. The initial treatments of tarsal tunnel syndrome are conservative management, such as physical therapy, night splint, and steroid injection. Surgical decompression is indicated after failure of conservative managements. Variable results of surgical treatment have been reported. Favorable result after decompression could be obtained from young patients, early onset symptoms, and space-occupying lesion.

Overlapped multiple distal entrapment neuropathies hindering diagnosis of thoracic outlet syndrome: A case report

Thoracic outlet syndrome is caused by the compression of neurovascular structures at the thoracic outlet region. Diagnosis is difficult since thoracic outlet syndrome is often accompanied by distal entrapment neuropathies such as carpal tunnel syndrome or ulnar and radial neuropathies. In this article, the authors report a case regarding a patient with thoracic outlet syndrome whose diagnosis was delayed due to the overlapping of multiple distal entrapment neuropathies.

Neurolysis for Megalgia Paresthetica

OBJECTIVE: Meralgia paresthetica (MP) is a syndrome of pain and/or dysesthesia in the anterolateral thigh that is caused by an entrapment of the lateral femoral cutaneous nerve (LFCN) at its pelvic exit. Despite early accounts of MP, there is still no consensus concerning the effectiveness of neurolysis or transaction treatments in the long-term relief for medically refractory patients with MP. We retrospectively analyzed available long-term results of LFCN neurolysis for medically refractory MP in an effort to clarify this issue. METHODS: During the last 7 years, 11 patients who had neurolysis for MP were enrolled in this study. Nerve entrapment was confirmed preoperatively by electrophysiological studies or a positive response to local anesthetic injection. Decompression of the LFCN was performed at the level of the iliac fascia, inguinal ligament, and fascia of the thigh distally. The outcome of surgery was assessed 8 weeks after the procedure followed at regular intervals if symptoms persisted. RESULTS: Twelve decompression procedures were performed in 11 patients over a 7-year period. The average duration of symptoms was 8.5 months (range, 4-15 months). The average follow-up period was 33 months (range, 12-60 months). Complete and partial symptom improvement were noted in nine (81.8%) and two (18.2%) cases, respectively. No recurrence was reported. CONCLUSION: Neurolysis of the LFCN can provide adequate pain relief with minimal complications for medically refractory MP. To achieve a good outcome in neurolysis for MP, an accurate diagnosis with careful examination and repeated blocks of the LFCN, along with electrodiagnosis seems to be essential. Possible variation in the course of the LFCN and thorough decompression along the course of the LFCN should be kept in mind in planning decompression surgery for MP.

Sural Nerve Entrapment by Fragments of Calcaneal Fracture (A Case Report) / 대한족부족관절학회지

Sural nerve is a sensory nerve that innervates the lateral side of ankle and foot, and the injury of this nerve can be usually caused by surgical approch of calaneal fracture or achilles tendon injury. Entrapment neuropahty of sural nerve caused by bony fragment after calcaneal fracture is not reported, yet. Authors experienced one case that sural nerve injury due to bony fragment after calcaneal fracture and we regard that it is a rare case, so we report this case after reviewing literatures.

Entrapment of the median nerves and brachial arteries in the lower arms bilaterally and additional origin of biceps brachii muscle: case report / Compresión bilateral del nervio mediano y de la arteria braquial en la parte distal del brazo y origen adicional del músculo bíceps braquial: reporte de caso

Neuro-vascular entrapments associated with variations observed in the origins of muscles in the arm are not uncommon. Though additional heads of biceps brachii muscle and extra fibres of brachialis muscles have been demonstrated earlier, bilateral additional heads of the biceps are rarely seen, especially with entrapment of the median nerve and the brachial arteries in both the arms. The present study reports conspicuous heads of the biceps brachii originating extensively from the medial inter-muscular septum, sharing its origin with the brachialis muscle. The extra origins of the muscle formed long musculo-aponeurotic tunnels. The tunnels measured eight centimeters in length extending from the lower arm to the cubital-fossa. Both the median nerve and the brachial arteries passed through the tunnel. The lower aspect of the left tunnel exhibited origins of fibres belonging to the superficial flexors of the forearm. The neuro-vascular structures did not give any branches in the tunnel. Awareness of such variations can aid clinicians in diagnosing and treating such neuropathies and vascular compromise.

No es infrecuente observar atrapamientos neuro-vasculares asociados con variaciones en el origen de los músculos del brazo. A pesar de haberse observado cabezas adicionales del músculo bíceps braquial y fibras extra del músculo braquial raramente estas cabezas adicionales bilaterales han sido causantes de la compresión del nervio mediano y de la arteria braquial. En este trabajo presentamos las cabezas del músculo bíceps braquial originándose en gran parte en el tabique intermuscular medial compartiendo su origen con el músculo braquial. Los orígenes adicionales del músculo forman largos túneles músculo fasciales. Los túneles miden 8 cm de longitud, y se extienden desde la parte inferior del brazo hasta la fosa cubital. Tanto el nervio mediano como la arteria braquial pasan por el túnel. La parte inferior del túnel izquierdo dio origen a fibras pertenecientes al músculo flexor superficial del antebrazo. Las estructuras neurovasculares no otorgaron colaterales en el túnel. El conocimiento de estas variaciones puede ayudar a los clínicos en el diagnóstico y el tratamiento de neuropatías y compromiso vascular.