Supernumerary muscles in the posterior leg compartment: a case report / Músculos supernumerarios en el compartimento posterior de la pierna: reporte de un caso

SUMMARY: The leg muscles are organized in anterior, lateral and posterior compartments. The posterior compartment is usually divided in two layers: superficial and deep. The deep muscles of the posterior compartment of the leg are known to mainly plantar flexion and toes flexion. In comparison to the other leg compartments, variations of the posterior one are rare. These variants often involve the presence or absence of one or more muscles, and they have differences among origin and insertion, which leads to confusion between anatomists. We aim to describe a case of a male cadaver that possessed three supernumerary muscles in the lateral and posterior compartments of both legs: the peroneus quartus muscle and two accessory bellies of the flexor digitorum longus. This presentation seems to be very rare and scarcely reported in the literature. These variants have the potential of causing nervous or vascular compression, thus leading to tarsal tunnel syndrome or a symptomatic peroneus quartus. The clinical and surgical implications of this abnormal presentation is discussed.

RESUMEN: Los músculos de la pierna están organizados en compartimentos anterior, lateral y posterior. El compartimento posterior por lo general es dividido en dos capas: superficial y profunda. Se sabe que los músculos profundos del compartimento posterior de la pierna se caracterizan principalmente por participar de la flexión plantar y la flexión de los dedos de los pies. En comparación con los otros compartimentos de la pierna, las variaciones musculares en el compartimiento posterior son raras. Estas variantes suelen implicar la presencia o ausencia de uno o más músculos y presentan diferencias en el origen y en la inserción, lo que conduce a confusión entre los anatomistas. Nuestro objetivo fue describir el caso de un cadáver masculino que poseía tres músculos supernumerarios en los compartimentos lateral y posterior de ambas piernas: el músculo fibular cuarto y dos vientres accesorios del músculo flexor largo de los dedos. Esta presentación parece ser muy rara y escasamente reportada en la literatura. Estas variantes musculares tienen el potencial de causar compresión nerviosa o vascular, lo que conduce al síndrome del túnel del tarso o un cuarto músculo fibular sintomático. Se discuten las implicaciones clínicas y quirúrgicas de esta presentación anormal.

Abdominal Cutaneous Nerve Entrapment Syndrome, Case Report and Diagnostic Evaluation

Abdominal cutaneous nerve entrapment is a rarely diagnosed condition that leads to intense neuropathic pain in the anterolateral wall of the abdomen. Generally, it is triggered by some factor implied in the increase of the pressure on the nerve in its passage by the abdominal wall. Its most important differential diagnosis is pain of visceral origin. We present a case in which the clinical findings confirmed on ultrasound and other imaging tests established the diagnosis and in which the noninvasive treatment was effective.

Characteristics of Low Back Pain due to Superior Cluneal Nerve Entrapment Neuropathy

STUDY DESIGN: Retrospective analysis. PURPOSE: The present study aimed to investigate the features of low back pain (LBP) due to superior cluneal nerve (SCN) entrapment neuropathy (SCN-EN) using the Roland Morris Disability Questionnaire (RMDQ), and to analyze the differences between LBP due to SCN-EN and lumbar spinal canal stenosis (LSS). OVERVIEW OF LITERATURE: The SCN is derived from the cutaneous branches of the dorsal rami of T11–L5 and passes through the thoracolumbar fascia. LBP due to SCN-EN is exacerbated by various types of lumbar movement, and its features remain to be fully elucidated, often resulting in the misdiagnosis of lumbar spine disorder. METHODS: The present study included 35 consecutive patients with SCN-EN treated via nerve blocks or surgical release between April 2016 and August 2017 (SCN-EN group; 16 men, 19 women; mean age, 65.5±17.0 years; age range, 19–89 years). During the same period, 33 patients were surgically treated with LSS (LSS group; 19 men, 14 women; mean age, 65.3±12.0 years; age range, 35–84 years). The characteristics of LBP were then compared between patients with SCN-EN and those with LSS using the RMDQ. RESULTS: The duration of disease was significantly longer in the SCN-EN group than in the LSS group (26.0 vs. 16.0 months, p=0.012). Median RMDQ scores were significantly higher in the SCN-EN group (13 points; interquartile range, 8–15 points) than in the LSS group (7 points; interquartile range, 4–9 points; p<0.001). For seven items (question number 1, 8, 11, and 20–23), the ratio of positive responses was higher in the SCN-EN group than in the LSS group. CONCLUSIONS: Patients with SCN-EN exhibit significantly higher RMDQ scores and greater levels of disability due to LBP than patients with LSS. The findings further demonstrate that SCN-EN may affect physical and psychological function.

Meralgia paresthetica following hemorrhoidectomy in the jack-knife position: A case report

Meralgia paresthetica (MP) is a neuropathic pain caused by the entrapment of the lateral femoral cutaneous nerve (LFCN). There have been reports of MP following various surgeries; however, it has not yet been reported after hemorrhoid surgery. We report a case of bilateral MP after hemorrhoid surgery in a jack-knife position. The patient presented with pain, tightness, and a tingling sensation in the anterolateral aspect of both thighs. Ultrasonography-guided LFCN block was used for diagnosis and treatment, along with conservative management for 20 days with oral medication. One month later, the patient's symptoms had resolved completely. MP due to the jack-knife position may occur postoperatively in patients with predisposing risk factors such as obesity and diabetes mellitus, despite adequate padding and a shorter operating time.

Thoracic Outlet Syndrome Induced by Huge Lipoma: A Case Report / 대한신경손상학회지

Thoracic outlet syndrome is a relatively well known disease. Other than trauma, this disease is mostly caused by anatomical structures that cause vascular or neural compression. The cause of thoracic outlet syndrome is diverse; however, there are only few reports of thoracic outlet syndrome caused by lipoma in the pectoralis minor space. We report a case of compression of the lower trunk of brachial plexus in which a large lipoma that developed in the pectoral minor space grew into the subclavicular space, along with a review of literature.

Anterior interosseous nerve: anatomical study and clinical implications / Nervo interósseo anterior: estudo anatômico e implicações clínicas

ABSTRACT Objective: The goal of this study was to describe anatomical variations and clinical implications of anterior interosseous nerve. In complete anterior interosseous nerve palsy, the patient is unable to flex the distal phalanx of the thumb and index finger; in incomplete anterior interosseous nerve palsy, there is less axonal damage, and either the thumb or the index finger are affected. Methods: This study was based on the dissection of 50 limbs of 25 cadavers, 22 were male and three, female. Age ranged from 28 to 77 years, 14 were white and 11 were non-white; 18 were prepared by intra-arterial injection of a solution of 10% glycerol and formaldehyde, and seven were freshly dissected cadavers. Results: The anterior interosseous nerve arose from the median nerve, an average of 5.2 cm distal to the intercondylar line. In 29 limbs, it originated from the nerve fascicles of the posterior region of the median nerve and in 21 limbs, of the posterolateral fascicles. In 41 limbs, the anterior interosseous nerve positioned between the humeral and ulnar head of the pronator teres muscle. In two limbs, anterior interosseous nerve duplication was observed. In all members, it was observed that the anterior interosseous nerve arose from the median nerve proximal to the arch of the flexor digitorum superficialis muscle. In 24 limbs, the branches of the anterior interosseous nerve occurred proximal to the arch and in 26, distal to it. Conclusion: The fibrous arches formed by the humeral and ulnar heads of the pronator teres muscle, the fibrous arch of the flexor digitorum superficialis muscle, and the Gantzer muscle (when hypertrophied and positioned anterior to the anterior interosseous nerve), can compress the nerve against deep structures, altering its normal course, by narrowing its space, causing alterations longus and flexor digitorum profundus muscles.

RESUMO Objetivo: Analisar as relações anatômicas e as variações do nervo interósseo anterior e suas implicações clínicas. A paralisia completa do nervo interósseo anterior resulta na incapacidade de fletir as falanges distal do polegar e indicador; na incompleta, ocorre menor dano axonal e apenas o polegar ou o indicador são afetados. Método: Este estudo baseou-se na dissecção de 50 membros de 25 cadáveres, 22 eram do sexo masculino e três do feminino. A idade variou entre 28 e 77 anos, 14 da etnia branca e 11 não branca; 18 foram preparados por injeção intra-arterial de uma solução de glicerina e formol a 10% e sete foram dissecados a fresco. Resultados: O nervo interósseo anterior originou-se do nervo mediano em média de 5,2 cm distal à linha intercondilar. Em 29 membros, originou-se dos fascículos nervosos da região posterior do nervo mediano e em 21 membros, dos fascículos posterolaterais. Em 41 membros, o nervo interósseo anterior posicionava-se entre as cabeças umeral e ulnar do músculo pronador redondo. Em dois membros, observou-se a duplicação do nervo interósseo anterior. Em todos os membros, registramos que o nervo interósseo anterior se desprendia do nervo mediano proximalmente à arcada do músculo flexor superficial dos dedos. Em 24 antebraços a ramificação do nervo interósseo anterior ocorreu proximalmente à arcada do músculo flexor superficial dos dedos em 26, distalmente. Conclusão: As bandas fibrosas formadas pelas cabeças umeral e ulnar do músculo pronador redondo, a arcada fibrosa do músculo flexor superficial dos dedos e o músculo de Gantzer, quando hipertrofiado e posicionado anteriormente ao nervo interósseo anterior, podem comprimir o nervo contra estruturas profundas, alterar seu curso normal, por estreitar o espaço de sua passagem, causar alterações no músculo flexor longo do polegar e no flexor profundo dos dedos da mão.

Bicipital aponeurosis. Anatomical study and clinical implications / Aponeurose bicipital. Estudo anatômico e implicações clínicas

ABSTRACT Objective: The aim of this study was to analyze the anatomic variations of the bicipital aponeurosis (BA) (lacertus fibrosus) and its implications for the compression of the median nerve, which is positioned medially to the brachial artery, passing under the bicipital aponeurosis. Methods: Sixty upper limbs of 30 cadavers were dissected, 26 of which were male and four, female; of the total, 15 had been previously preserved in formalin and glycerine and 15 were dissected fresh in the Laboratory of Anatomy. Results: In 55 limbs, short and long heads of the biceps muscle contributed to the formation of the BA, and the most significant contribution was always from the short head. In three limbs, only the short head contributed to the formation of the BA. In two limbs, the BA was absent. The length of the bicipital aponeurosis from its origin to its insertion ranged from 4.5 to 6.2 cm and its width, from 0.5 to 2.6 cm. In 42 limbs, the BA was thickened; of these, in 27 it was resting directly on the median nerve, and in 17 a high insertion of the humeral head of the pronator teres muscle was found, and the muscle was interposed between the BA and the median nerve. Conclusion: These results suggest that a thickened BA may be a potential factor for nerve compression, by narrowing the space through which the median nerve passes.

RESUMO Objetivo: Analisar as variações anatômicas da aponeurose bicipital (lacertus fibrosus) e suas implicações na compressão do nervo mediano, que passa sob a aponeurose bicipital (AB) e se posiciona medialmente à artéria braquial. Método: Foram dissecados 60 membros superiores de 30 cadáveres adultos, 26 do sexo masculino e quatro do feminino; 15 haviam sido previamente preservados em formol e glicerina e 15 foram dissecados a fresco no Laboratório de Anatomia. Resultados: Em 55 membros, a AB recebia contribuição das cabeças curta e longa do musculo bíceps braquial, a contribuição mais significativa foi sempre da cabeça curta. Em três membros recebia contribuição exclusiva da cabeça curta. Em dois membros, a AB estava ausente. O comprimento da AB desde sua origem até sua inserção variou entre 4,5 e 6,2 cm e sua largura entre 0,5 e 2,6 cm. Em 42 membros, a AB apresentava-se espessada, em 27 apoiava-se diretamente sobre o nervo mediano e em 17 havia inserção alta da cabeça umeral do músculo pronador redondo, de forma que o músculo ficava interposto entre a AB e o nervo mediano. Conclusão: Esses resultados sugerem que a AB espessada pode ser um dos fatores potenciais da compressão nervosa, por estreitar o espaço no qual passa o nervo mediano.

Undiagnosed Peripheral Nerve Disease in Patients with Failed Lumbar Disc Surgery

STUDY DESIGN: Retrospective study (level of evidence=3). PURPOSE: We examine the relationship between residual symptoms after discectomy for lumbar disc herniation and peripheral nerve (PN) neuropathy. OVERVIEW OF LITERATURE: Patients may report persistent or recurrent symptoms after lumbar disc herniation surgery; others fail to respond to a variety of treatments. Some PN neuropathies elicit symptoms similar to those of lumbar spine disease. METHODS: We retrospectively analyzed data for 13 patients treated for persistent (n=2) or recurrent (n=11) low back pain (LBP) and/or leg pain after primary lumbar discectomy. RESULTS: Lumbar re-operation was required for four patients (three with recurrent lumbar disc herniation and one with lumbar canal stenosis). Superior cluneal nerve (SCN) entrapment neuropathy (EN) was noted in 12 patients; SCN block improved the symptoms for eight of these patients. In total, nine patients underwent PN surgery (SCN-EN, n=4; peroneal nerve EN, n=3; tarsal tunnel syndrome, n=1). Their symptoms improved significantly. CONCLUSIONS: Concomitant PN disease should be considered for patients with failed back surgery syndrome manifesting as persistent or recurrent LBP.

The Fate of Anterior Interosseous Nerve Syndrome

PURPOSE: We report the causes and prognosis of anterior interosseous nerve syndrome (AIN) according to the treatment. METHODS: From March 2009 to December 2015, the 20 patients with the clinical symptom of AIN syndrome were enrolled in the study and electromyography (EMG) of AIN was performed. We retrospectively reviewed hand function test, active range of motion, the disabilities of the arm, shoulder and hand (DASH) score and EMG during the recovery from disease. We further surveyed the time of recovery and residual symptoms. RESULTS: The patients with unknown cause of the disease (12 cases), heavy work or trauma (6 cases) and infection (2 cases) were investigated in the study. Thirteen out of 15 cases with conservative treatment and 2 out of 5 cases with a surgical treatment at an average of 8 months from disease were recovered. In addition, 8 cases with fine motor disturbance and 3 cases with tingling residual symptom were observed. CONCLUSION: Due to the low possibility of entrapment neuropathy, conservative treatment for 7 months is the first choice rather than surgical treatment. If there is no improvement from the conservative treatment, surgical exploration of AIN is the indication of treatment. After recovery, patients may have the symptoms of fine motor disturbance and tingling.

Frecuencia de algunos signos de provocación para el nervio cubital en el codo en una población sana / Fréquence de quelques signes de provocation du nerf ulnaire au coude dans une population saine / Frequency of some signs of challenge to the ulnar nerve at the elbow in a healthy population

Introducción: el síndrome del túnel cubital en el codo es a menudo subdiagnosticado y confundido con la epicondilitis medial. Presenta, con frecuencia, variabilidad en las pruebas del codo contra gravedad; se determinó la proporción de signos positivos sobre el total de codos examinados. Objetivo: determinar en una población sana asintomática la frecuencia de los signos del síndrome del túnel cubital en el codo. Métodos: en 380 codos de una población voluntaria, se realizaron las pruebas de Tinel, de flexión del codo, de rotación interna y flexión del codo, el scratch-collapse y test de flexión del codo contra gravedad; se determinó la proporción de signos positivos sobre el total de codos examinados. Resultados: en total, 66 personas (34,7 por ciento) tuvieron al menos un test positivo en uno o ambos codos. El 45,4 por ciento de las mujeres y el 20,7 por ciento de los hombres tuvieron al menos un test positivo (p=0,001). La prueba de flexión del codo con estimulo de presión tuvo la mayor frecuencia (13,4 por ciento), luego la prueba de Tinel (8,9 por ciento). El test de flexión del codo contra gravedad (4,2 por ciento) y la prueba scratch-collapse (3,4 por ciento) obtuvieron bajas frecuencias. Conclusiones: el 34,7 por ciento de individuos tuvieron al menos un test positivo en uno o ambos codos, cifra alta que sugeriría una alta tasa de falsos positivos en pacientes con síndrome del túnel cubital. En las mujeres, que tenían el doble que los hombres de positividad, sugiere que algunos factores anatómicos, hormonales y otros desconocidos podrían influenciar en esto. El test de flexión del codo contra gravedad tiene en cuenta el flujo contra gravedad de la circulación arterial del nervio cubital, que sumado a la flexión del codo, reproduciría más rápido los síntomas en un paciente con síndrome del túnel cubital. En población sana se encontró una frecuencia baja (4,2 por ciento), lo cual se sugiere como un nuevo signo para apoyar el diagnóstico clínico. No obstante se requiere de otros estudios en pacientes con esta afección para determinar la sensibilidad y especificidad(AU)

Introduction: cubital tunnel syndrome in the elbow is often sub-diagnosed and confused with medial epicondylitis. Variability has often provocative tests. Objective: determine frequency of signs of cubital tunnel syndrome in the elbow in a healthy asymptomatic population. Methods: 380 elbows in a voluntary population were tested by Tinel tests, elbow flexion, internal rotation and elbow flexion, the scratch test-collapse and elbow flexion against gravity; the proportion of positive signs on total elbows examined was determined. Results: in total, 66 persons (34.7 percent) had at least one positive test on one or both elbows. 45.4 percent women and 20.7 men had at least one positivest (p = 0.001). The elbow flexion test with pressure stimulus had the highest rate (13.4 percent e test (p = 0.001). The elbow flexion test with pressure stimulus had the highest rate (13.4 percent), then Tinel test (8.9 percent). The test of elbow flexion against gravity (4.2 percent) and the scratch-collapse (3.4 percent) had low test frequencies. Conclusions: 34.7 percent of subjects had at least one positive test on one or both elbows. This high number would suggest high rate of false positives in patients with cubital tunnel syndrome. In women, they were positive twice as men, suggesting that some anatomical, hormonal and other unknown factors could influence. The test of elbow flexion against gravity takes into account the gravity flow against the arterial circulation of the ulnar nerve, which added to the elbow flexion reproduce faster symptoms in a patient with cubital tunnel syndrome. In the healthy population low frequency (4.2 percent) was found, which is suggested as a new sign to support the clinical diagnosis. However it requires further studies in patients with this condition to determine sensitivity and specificity(AU)

Introduction: le syndrome du tunnel cubital au coude est souvent mal diagnostiqué et confondu avec l'épicondylite médiale. D'habitude, les tests de provocation ont des résultats variables. Objectif: le but de ce travail est de déterminer la fréquence des signes du syndrome du tunnel cubital au coude dans une population saine asymptomatique. Méthodes: dans une population volontaire (380 coudes), on a effectué des tests cliniques tels que le test de Tinel, le test de flexion du coude, le test de rotation interne et flexion du coude, le test de scratch-collapse, et le test de flexion active du coude contre la gravité. On a déterminé la proportion de signes positifs sur le total de coudes examinés. Résultats: au total, soixante-six personnes (34.7 pourcent) ont eu au moins un test positif d'un ou de tous les deux bras. Il y a eu au moins un test positif (p=0.001) dans 45.4 pourcent des femmes et dans 20.7 pourcent des hommes. Le test de flexion du coude à stimulus de pression a été le plus fréquent (13.4 pourcent), suivi par le test de Tinel (8.9 pourcent). Le test de flexion du coude contre la gravité (4.2 pourcent) et le test de scratch-collapse (3.4 pourcent) n'ont pas été assez fréquents. Conclusions: dans 34.7 pourcent des cas, il y a eu au moins un test positif d'un ou de tous les deux coudes. Cette chiffre considérée haute suggère un haut taux de faux positifs chez les patients atteints de syndrome du tunnel cubital. Chez les femmes ayant une positivité deux fois plus haute que chez les hommes, elle suggère que des facteurs anatomiques, hormonaux et d'autres encore inconnus peuvent influer. Le test de flexion du coude contre la gravité tient en compte le flux contra la gravité de la circulation artérielle du nerf cubital qui, conjointement avec la flexion du coude, reproduit plus rapidement les symptômes du syndrome du tunnel cubital chez un patient. Dans une population saine, on a trouvé une basse fréquence (4.2 pourcent), ce qui indique un nouveau signe soutenant le diagnostic clinique. Toutefois, il faut faire de nouvelles études pour déterminer la sensibilité et la spécificité(AU)

Ultrasonographic Findings of the Normal Nerves in Common Entrapment Site; Cross-Sectional Area Reference Value and Normal Variant

BACKGROUND: Neuromuscular ultrasound has emerged over the last decade as a useful tool for diagnosing peripheral neuropathy. Because nerve enlargement is the most important diagnostic marker of an abnormal nerve, quantification of nerve size is essential. METHODS: We included 80 healthy volunteers aged 21-60 years. The nerve cross-sectional area (CSA) was measured in all participants at the following common compressive sites: bilateral median nerve at the carpal tunnel and forearm, ulnar nerve at the wrist and medial epicondyle, radial nerve at the spiral groove, peroneal nerve at the fibular head and popliteal fossa, and tibial nerve at the popliteal fossa. Anatomical variants were also evaluated, including a bifid median nerve and persistent median artery. RESULTS: The CSAs were 9.58+/-1.55, 6.87+/-1.61, 4.72+/-0.91, 6.64+/-1.33, 6.48+/-1.68, 12.35+/-3.55, and 26.98+/-6.92 mm2 (mean+/-SD) for the median nerve at the carpal tunnel and forearm, ulnar nerve at the wrist and medial epicondyle, radial nerve at the spiral groove, peroneal nerve at the fibular head, and tibial nerve at the popliteal fossa, respectively. The nerve CSA was significantly larger in men than in women and was correlated with body mass index, weight, and height. A bifid median nerve and persistent median artery were seen in 12 (7.5%) and 4 (2.5%) of 160 hands, respectively. CONCLUSIONS: The information produced in this study can serve as reference data when evaluating these nerve sites using ultrasound.

Vestibular Paroxysmia in a 7-Year-Old Child / 대한평형의학회지

Neurovascular cross-compression of the eighth cranial nerve is characterized by brief attacks of vertigo, unilateral audiologic symptoms such as tinnitus, ear fullness and hearing disturbance and relatively rare disease, in particular, in children. We report a 7-year-old female patient who presented with recurrent spontaneous vertigo, lasting 15 seconds and occuring up to 40 times per day and often associated with physical activity. Her symptoms were developed by hyperventilation. Associated aural symptoms are not founded. Magnetic resonance image showed the eighth cranial nerve compression caused by the vascular loop. She was treated with oxcarbazepine and showed improving symptoms. Therefore we report our clinical experience with a brief review of literature.

A Case of Vestibular Paroxysmia Offended by Vertebral Artery / 대한이비인후과학회지

Vestibular paroxysmia, which is caused by neurovascular cross-compression of the eighth cranial nerve, is characterized by recurrent vertiginous spells and other audiologic symptoms such as tinnitus, aural fullness and hearing impairment. Magnetic resonance image may show the eighth cranial nerve compression by vessels in the posterior fossa such as the anterior-inferior cerebellar, posterior-inferior cerebellar, basilar, or vertebral arteries. Medical therapy including carbamazepine, phenytoin or gabapentin and microvascular decompression of the eighth cranial nerve can be contemplated. Here, we report of a 51 year-old man who presented with recurrent vertigo attacks and tinnitus. His symptoms were aggravated by positional change. Videonystagmography and auditory brainstem response showed abnormal results. Magnetic resonance image showed the eighth cranial nerve compression caused by the vascular loop. The offending vessel was revealed as vertebral artery. He was treated with carbamazepine and showed no recurrent symptoms. We report this rare case with a review of the relevant literatures.

Accessory muscle in the forearm: a clinical and embryological approach / 대한해부학회지

Muscular variations of the flexor compartment of forearm are usual and can result in multiple clinical conditions limiting the functions of forearm and hand. The variations of the muscles, especially accessory muscles may simulate soft tissue tumors and can result in nerve compressions. During a routine dissection of the anterior region of the forearm and hand, an unusual muscle was observed on the left side of a 65-year-old male cadaver. The anomalous muscle belly arose from the medial epicondyle approxiamately 1 cm posterolateral to origin of normal flexor carpi ulnaris muscle (FCU), and from proximal part of the flexor digitorum superficialis muscle. It inserted to the triquetral, hamate bones and flexor retinaculum. Passive traction on the tendon of accessory muscle resulted in flexion of radiocarpal junction. The FCU which had one head, inserted to the pisiform bone hook of hamate and palmar aponeurosis. Its contiguous muscles displayed normal morphology. Knowledge of the existence of muscle anomalies as well as the location of compression is useful in determining the pathology and appropriate treatment for compressive neuropathies. In this study, a rare accessory muscle has been described.

Correlation between Anterior Inferior Cerebellar Artery Loop and Otologic Symptoms / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The correlation of anterior inferior cerebellar artery (AICA) vascular loop around cerebellopontine angle (CPA) and otologic symptoms remains controversial. The objective of this study was to evaluate the relationship of the anatomical type of AICA loop and otologic symptoms according to the findings of 3-dimensional Fourier transformation constructive interference in steady state (3DFT-CISS) MRI. SUBJECTS AND METHOD: 316 ears from 165 patients were included in this study. Otologic symptoms and the results of pure tone audiometry, auditory evoked potential, and electronystagmography were checked by retrospective chart review. AICA loops were classified by its configuration on 3DFT-CISS MRI. According to their extension depth in internal auditory canal (IAC), the loops were classified as type I (lying within CPA), type II (from porus acusticus to 50% of the length of IAC), and type III (extending beyond 50% of IAC). In addition, the loops were classified as S (small) and L (large) by comparing the thickness of the loop with adjacent facial nerve. RESULTS: The predominant type of AICA loop was type I (62.0%) and type S (72.8%). Ears with type III loop presented significantly higher rate of hearing impairment than those with type I or II. There were no significant differences in pure tone threshold, hearing loss in 3 consecutive frequencies, canal paresis, and AEP latencies among 3 AICA types classified with the depth of the loop. Ears with type S AICA loop showed significantly higher rate of hearing impairment, elevated threshold, hearing loss in 3 consecutive frequencies, and canal paresis than those with type L loop. CONCLUSION: The small diameter of AICA loop had significant association with hearing impairment and otologic test abnormalities. Impaired blood flow through the vascular loop and resultant hypoperfusion of inner ear may be the pathophysiologic mechanism of vestibulocochlear nerve compression syndrome.

Anatomical study on compression of tibial nerve and it's branches in ankle and foot / 吉林大学学报(医学版)

Objective To observe the branches and distribution of the tibial nerve and analyze the compressed position of it.Methods Twenty sides of adult cadavers were anatomized and the tibial nerve branches in ankle,foot,the internal and external plantar tunnel were observed.Correlated data was measured and recorded.Results ① The tendinous part of abductor hallucis muscle that was located under the muscle and consisted the surface of the internal and external plantar tunnel was(8.62?0.79)cm in length,(3.01?0.30)cm in width,and the thickness of it was about(0.24?0.02)cm.The internal and external nerves were located in the internal and external tunnel.The length of the internal tunnel was about(4.58?0.41)cm,and the diameter was(1.11?0.10)cm.The length of the external tunnel was about(2.58?0.23)cm,the diameter was about(0.96?0.08)cm.② Internal hell nerve was in an isolated tunnel interior the hell,which was the hell tunnel.The length of the hell tunnel was about(3.03?0.21)cm,the diameter was(1.07?0.09)cm.Conclusion The tibial nerve branches can be compressed at internal,external plantar tunnel or the heel tunnel.When making neurolysis of the tibial nerve for tarsal tunnel syndrome patients,except for the flexor retinaculum,the internal and external plantar tunnel and the hell tunnel should also be decompressed especially for the patients with the symptom of compressed single branch.

Effect of Relaxing Operation with Small Needle Knife and Compound Osteotide Injection for Suprascapular Nerve Compression Syndrome: An Observation of 120 Cases / 广州中医药大学学报

[ Objective ] To observe the effect of relaxing operation with small needle knife and acupoint injection of Compound Osteotide Injection (COI) for suprascapular nerve compression syndrome (SNCS) . [Methods] Two hundred and twenty cases of SNCS were randomized to three groups: group A ( re = 120) was treated with small needle knife for relaxation and acupoint injection of COI, group B ( n = 50) with small needle knife for relaxation and group C ( re = 50) with acupoint injection of COI. The short-term and long-term effects were compared in the three groups. [Results] Total effective rate was 98.3% in group A, 88.0% in group B and 74.0% in group C ( P

Nerve Compression Syndromes of the Upper Extremities / 대한정형외과학회잡지

Nerve compression syndromes can be caused by compression of the peripheral nerve from interior or exterior of the nerve. In the upper extremities, brachial plexus, ulnar nerve and median nerve can be compressed in thoracic outlet syndrome, cubital tunnel syndrome and carpal tunnel syndrome respectively. Because these syndromes are caused by compression, decompressive management can be expected to be the principle of treatment. From Jan. 1980 to Dec. 1988, 94 patients were admitted and treated for nerve compression syndromes of the upper extremities in Seoul National University Hospital. Among these, 52 patients suffered from carpal tunnel syndrome and operation was performed to 86 hands. Twelve patients suffered from thoracic outlet syndrome and 25 from cubital tunnel syndrome. Ten patients were treated with conservative method and 84 with decompressive surgery. Satisfactory results were obtained in 92.3% of carpal tunnel syndrome and 84% of cubital tunnel syndrome. Of 4 operated cases of thoracic outlet syndrome, 3 cases were satisfactory.