Epidemiological Profile of Surgically-Treated Peripheral-Nerve Diseases

Objective To outline the epidemiological profile of surgical patients treated at the peripheral-nerve outpatient clinic of a public hospital in the state of Pernambuco, Brazil, from 2008 (the year this service was implemented in the hospital ) to 2016. Material and Methods A cross-sectional study with data collection from the medical records. A descriptive analysis was performed with the qualitative variables presented as relative and absolute frequencies, and the quantitative variables, as means and standard deviations. The studied variables were gender, age, diagnosis, and surgical techniques. Results In total, 506 medical records were analyzed. Of these, 269 were of male patients (53%), and 238 were of female patients (46%). The age of the sample ranged from 5 to 84 years (41 14 years). The most prevalent diagnoses were: carpal tunnel syndrome (38.9%) followed by traumatic brachial plexus injury (33.2%). The first diagnosis was more frequent among women, while the second, among men. This collaborates with the predominant findings of upper-limb lesions (91%), in which men accounted for 52,75% (244) and women, for 47,25% (217). Conclusion The present study provided relevant information regarding the reality of peripheral-nerve surgeries performed at a public hospital in the state of Pernambuco, Brazil. Public health issues increasingly require the continuity of public policies and government incentive.

An accessory abductor digiti minimi as possible risk factor of the median and ulnar nerves compression / Músculo abductor digiti minimi accesorio como posible factor de riesgo de la compresión de los nervios mediano y ulnar

SUMMARY: During routine dissection of a left upper limb of a 68-year-old male human cadaver, an unusual muscle was observed originating from the radius and flexor retinaculum, and continued in the hypothenar region with the muscle belly of the abductor digiti minimi. We checked that it was an accessory abductor digiti minimi (ADM). Its muscular belly was in close relation to the median and ulnar nerves. We review the literature regarding such muscle variations and discuss the potential for compression of the median and ulnar nerves. Although the accessory ADM is usually asymptomatic and only rarely results in nerve compression, it should be taken into account by surgeons when establishing a differential diagnosis in the compression neuropathies of the median and ulnar nerves. An ultrasound scanning can help establish the differential diagnosis.

RESUMEN: Durante la disección de rutina de un miembro superior izquierdo de un cadáver humano masculino de 68 años, se observó un músculo inusual que se originaba en el radio y el retináculo flexor del carpo, y continuuaba en la región hipotenar con el vientre muscular del abductor digiti minimi manus. Verificamos que se trataba del músculo abductor digiti minimi accessorius (ADMA). Su vientre muscular se encontraba en estrecha relación con los nervios mediano y ulnar. Revisamos la literatura sobre variaciones musculares y discutimos la potencial compresión de los nervios mediano y ulnar. Aunque el ADMA suele ser asintomático y rara vez produce compresión nerviosa, los cirujanos deben tenerlo en cuenta al establecer un diagnóstico diferencial en las neuropatías de compresión de los nervios mediano y ulnar. Una ecografía puede ayudar a establecer el diagnóstico diferencial.

Compressive Neuropathy of the Ulnar Nerve in the Hypothenar Region by Lipoma: Case Report

Lipomas are well-defined tumors of the adipose tissue that often occur in the torso or the extremities of adult patients. These tumors usually develop painlessly and insidiously, but theymay compress adjacent structures. The objective of the present study is to describe the case of a 68-year-old female patient with a giant lipoma located at the hypothenar region, with manifestation of compression of the common palmar digital nerves, the ulnar nerve, andthe abductormuscle of theVfinger. Regarding the symptoms, the patient feltmoderate pain in the hypothenar region, with no Tinel sign, and no changes in the motor function or sensibility of the digits innervated by the ulnar nerve. Lipomasmay present a varied range of histological characteristics, and malignant tumors may be a differential diagnosis. An imaging exammay aid in the diagnosis, which is confirmed by a histopathological study. For the present case, as recommended in the literature, a surgical procedure was performed for the resection of the tumor, which resulted in the control of the symptoms.

Cubital Tunnel Syndrome by a Ganglion Cyst in an Amateur Tennis Player / 대한스포츠의학회지

Ganglion cyst is considered to be a usual cause of peripheral nerve compression. In this report, we present a rare case of ulnar nerve compression by a multi-septated ganglion cyst in the cubital tunnel. A 33-year-old left-handed male amateur tennis player developed progressive numbness and weakness in his right elbow, forearm, and hand for 1 year. Decrease of grip power was apparent in left hand. Clinical examination revealed a cystic mass at the posterior side of the elbow. Magnetic resonance imaging identified a ganglion cyst at the elbow. During surgery about 3 cm diameter epineural ganglion was observed compressing the ulnar nerve and was excised using microsurgery techniques. Three months postoperatively, the clinical recovery of the patient was very satisfactory and he restored his original performance in tennis match.

Distal Humerus Fracture: How to Choose the Approach, Implant, Fixation and Rehabilitation

Distal humerus fractures require stable fixation and early joint motion, similar to other intra-articular fractures, but are difficult to treat adequately because of the anatomical complexity, severe comminution, and accompanying osteoporosis. In most cases, surgical treatment is performed using two supporting plates. Plate fixation can be divided into right angle plate fixation and parallel plate fixation. In addition, depending on the type of fracture, surgical procedures can be performed differently, and autologous bone grafting can be required in the case of severe bone loss. The elbow joint is vulnerable to stiffness, so it is important to start joint movement early after surgery. Postoperative complications, such as nonunion, ulnar nerve compression, and heterotopic ossification, can occur. Therefore, accurate and rigid fixation and meticulous manipulation of soft tissues are required during surgery.

Diagnosis of Pure Ulnar Sensory Neuropathy Around the Hypothenar Area Using Orthodromic Inching Sensory Nerve Conduction Study: A Case Report

Ulnar neuropathy at the wrist is an uncommon disease and pure ulnar sensory neuropathy at the wrist is even rarer. It is difficult to diagnose pure ulnar sensory neuropathy at the wrist by conventional methods. We report a case of pure ulnar sensory neuropathy at the hypothenar area. The lesion was localized between 3 cm and 5 cm distal to pisiform using orthodromic inching test of ulnar sensory nerve to stimulate at three points around the hypothenar area. Ultrasonographic examination confirmed compression of superficial sensory branch of the ulnar nerve. Further, surgical exploration reconfirmed compression of the ulnar nerve. This case report demonstrates the utility of orthodromic ulnar sensory inching test.

Anconeus Epitrochlearis Muscle as a Cause of Ulnar Nerve Compression at the Elbow

Ulnar nerve entrapment is the second most common compressive neuropathy in the upper limb, after carpal tunnel syndrome (Dellon, 1986). One of the causes that must be considered is the accessory anconeus epitrochlearis muscle, which is present in 4% to 34% of the general population (Husarik et al, 2010; Vanderpool et al, 1968; Nellans et al, 2014). We describe a patient with symptoms of compression of the left ulnar nerve at the elbow and the result of the surgical treatment. The patient presented with hypoesthesia in the fourth and fifth fingers of the left hand, and reduction of strength in the fifth finger abduction. No alterations were found in the thumb adduction. Initially, the treatment was conservative (splint, physiotherapy, analgesics); surgical treatment was indicated due to the continuity of the symptoms. The ulnar nerve was surgically released and transposed, with complete recovery after 6 months of follow-up. Ulnar nerve entrapment at the elbow by the anconeus epitrochlearis muscle is not common, but it must not be ignored (Chalmers, 1978). Ultrasonography (Jung et al, 2013; Bargalló et al, 2010), elbow magnetic resonance imaging (MRI) (Jeon, 2005), and electromyography (Byun, 2011) can help establish the proper diagnosis.

A compressão do nervo ulnar é a segunda causa mais frequente de neuropatia compressiva no membro superior, após a síndrome do túnel do carpo (Dellon, 1986). Uma das causas que dever ser considerada é a presença do músculo anconeu epitroclear, que está presente em cerca de 4% a 34% da população (Husarik et al, 2010; Vanderpool et al, 1968; Nellans et al, 2014). Descrevemos uma paciente com sintomas de compressão do nervo ulnar esquerdo no cotovelo, e o resultado do tratamento cirúrgico. A paciente apresentava hipoestesia no IV e V dedos da mão esquerda, e diminuição de força na abdução do V dedo; não foram encontradas alterações na adução do polegar. Inicialmente, o tratamento foi conservador (uso de splint, fisioterapia e analgésicos); a cirurgia foi indicada pela persistência dos sintomas. O nervo ulnar foi cirurgicamente liberado e transposto, com melhora total dos sintomas após 6 meses de acompanhamento. A compressão do nervo ulnar no cotovelo não é comum, mas não deve ser ignorada (Chalmers, 1978). Ultrassonografia (Jung et al, 2013; Bargalló et al, 2010), ressonância magnética do cotovelo (Jeon, 2005) e eletromiografia (Byun, 2011) auxiliam no diagnóstico.

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.

Ulnar Neuropathy Caused by a Schwannoma in the Guyon's Cannal / 대한정형외과학회잡지

Guyon's canal syndrome is a compression neuropathy of the ulnar nerve entrapment at the wrist. Compression of the ulnar nerve at the wrist by a ganglion, lipomas, diseases of the ulnar artery, fractures of the hamate and trauma is a common etiological factor. We report on a rare case of ulnar neuropathy caused by a schwannoma at the level of Guyon's canal.

Postoperative Cubital Tunnel Syndrome due to Deep Flexor Pronator Aponeurosis / 대한정형외과학회잡지

Entrapment of the ulnar nerve around the elbow is the second most common compression neuropathy in the upper extremity. Many anatomical regions that possibly compress the ulnar nerve around the elbow joint have been described, however few cases below the flexor carpi ulnaris muscle have been reported. A case with ulnar nerve entrapment at the flexor pronator aponeurosis, secondary to surgery is reported in this study.

Misdiagnosed Handlebar Palsy: Giant Cell Tumor of the Tendon Sheath in Guyon's Canal / 대한스포츠의학회지

Ulnar tunnel syndrome (UTS) is a compressive neuropathy of the upper extremity that shows various clinical symptoms according to the anatomic region of the compression site. Numerous factors may cause UTS, and most publications are case reports describing various etiologies; thus, obtaining a correct diagnosis is often challenging. Giant cell tumor of the tendon sheath (GCTTS) is well described to be a common benign soft tissue tumor of the hand; however, it is rarely reported to cause UTS. We report a case of GCTTS in Guyon's canal causing UTS that was misdiagnosed as handlebar palsy.

Ulnar Artery Thrombosis in Guyon's Canal

Causes of ulnar nerve compression in Guyon's canal are various, but thrombosis of the ulnar artery due to a single trauma is rarely reported. We report a case of ulnar nerve compression caused by traumatic thrombosis of the ulnar artery in Guyon's canal. Surgical excision of the ulnar artery thrombus and end to end anastomosis resulted in complete relief of the patient's symptoms.

Type III Guyon Syndrome in 'B Boy' Break-Dancer: A Case Report / 대한신경손상학회지

Although the musculoskeletal injuries associated with break-dancing which is gaining more popularity among adolescent and young people has been reported, the report regarding a peripheral nerve injury associated with breakdance is scarce. We report a rare case of a young amateur break-dancer, 'b-boy' who suffered from a painful paresthesia in his left hand, later diagnosed as type III Guyon's canal syndrome. A 23-year-old, right handed college man presented with a tenderness over the left hypothenar eminence and painful paresthesia over the ring and little fingers of 3 months duration. He trained himself as an amateur 'b boy' break-dancer for the last 10 months. Conservative management under the diagnosis of wrist sprain before presentation did not improve his hand pain. An magnetic resonance imaging and electrodiagnostic study revealed that painful paresthesia was caused by type III Guyon's canal syndrome, and 4 weeks of corticosteroid treatment was given with resolution of pain and paresthesia.

Symptomatic Neural Loop of the Distal Ulnar Nerve / 대한정형외과학회잡지

We found a unique anatomical variant of the distal ulnar nerve, a neural loop encompassing the flexor carpi ulnaris during Guyon's canal exploration. Compression by the flexor carpi ulnaris during active wrist movement was suspected as the cause of ulnar neuropathy. The symptom was relieved after neurolysis and release of surrounding tissue. With regard to the ulnar side wrist pain, which is suspicious for ulnar compression syndrome at the wrist level, the surgeon should always suspect anomalous nerve branch as source of compressive neuropathic pain.

Neglected reverse Essex-Lopresti injury with ulnar nerve compression / 中华创伤杂志(英文版)

A 45 year old woman was diagnosed as having anteromedial radial head dislocation and distal radius fracture five months after her injury on right forearm. The radial head dislocation led to ulnar nerve compression. She had severe restriction of her elbow movements. She was treated with arthrolysis, decompression of the ulnar nerve and radial head resection. The reverse Essex Lopresti injury and radial head dislocation compressing the ulnar nerve has not been reported in English language literature to the best of our knowledge. A mechanism is proposed for the injury. In acute presentations, restoration of both the radioulnar joints should be done and neglected nature of such injury leads to suboptimal outcomes.

Validity of F-wave minimal latency of median and ulnar nerves for diagnosis and severity assessment of carpal tunnel syndrome in type II diabetes mellitus

Type II diabetes mellitus is a common problem and is sometimes associated with Carpal Tunnel Syndrome [CTS] due to compression of median nerve at wrist. Electrophysiological tests are frequently used for its diagnosis. In this work, F-wave minimal latency [FWML] difference between median and ulnar nerve and F-ratio is used to facilitate the diagnosis and severity of CTS in type II diabetes mellitus [T2DM]. Thirty control cases were selected who were physically fit for normal electrophysiological values. Thirty-two patients with a long history of type II diabetes mellitus were studied for electro-diagnostic tests. All patients had clinical evidence of CTS. Among all diabetics about 20 cases had poor glycaemic control [HbA1c>7.5]. F-wave minimal latency [FWML] were measured in median and ulnar nerves and F-ratio of median nerve were also noted. The mean values in different groups were compared using t-test and p

Ulnar Nerve Compression in Guyon's Canal by Ganglion Cyst

Compression of the ulnar nerve in Guyon's canal can result from repeated blunt trauma, fracture of the hamate's hook, and arterial thrombosis or aneurysm. In addition, conditions such as ganglia, rheumatoid arthritis and ulnar artery disease can rapidly compress the ulnar nerve in Guyon's canal. A ganglion cyst can acutely protrude or grow, which also might compress the ulnar nerve. So, clinicians should consider a ganglion cyst in Guyon's canal as a possible underlying cause of ulnar nerve compression in patients with a sudden decrease in hand strength. We believe that early decompression with removal of the ganglion is very important to promote complete recovery.

Neurólise ulnar sob anestesia localem pacientes com hanseníase / Ulnar nerve decompression with local anesthesia in patients with Hansen disease

Contexto: A hanseníase é uma doença endêmica em nosso meio e pode provocar deformidadesfísicas se não tratada adequadamente. A descompressão cirúrgica do nervo periférico acometido porvezes é necessária para prevenção dessas ocorrências. Objetivo: Relatar a técnica de descompressãode nervo ulnar, o mais frequentemente acometido na hanseníase, realizada ambulatorialmente emserviço de referência no estado da Bahia. Material e métodos: Os autores relatam a experiência com84 pacientes submetidos à cirurgia ambulatorial de neuropatia compressiva ulnar, entre fevereiro de 2008 e fevereiro de 2009. O quadro clínico mais encontrado foi dor de difícil manejo terapêutico e asincapacidades físicas. As cirurgias tiveram uma média de duração de 30 minutos. O procedimentoconsistiu em descompressão seguida de neurólise de nervo ulnar sob anestesia local sem utilização degarrote. Resultados: Os pacientes toleraram bem as cirurgias, e a dor, avaliada pela escala analógica,melhorou em praticamente todos os casos. Conclusão: A técnica ambulatorial de descompressãoulnar é um método eficaz, com baixo índice de complicações e adequada para manuseio de doençatão desafiadora como a hanseníase em países em desenvolvimento.

Background: Leprosy is endemic in our country leading often to physical deformities when not adequatelytreated. The surgical decompression of the peripheral nerve involved by the disease sometimes isthe best option in order to avoid these occurrences. Objective: To report the surgical technique ofulnar decompression with local anesthesia as an outpatient procedure at a Leprosy Institution inBahia, Brazil. Material and methods: Eighty-four outpatients were operated between February 2008and February 2009. Pain of difficult management and the physical disabilities were the predominantsymptoms. The procedure consisted of decompression followed by neurolyses under local anesthesiawithout tourniquet. The median surgical time was thirty minutes. Results: The patients tolerated wellthe procedure and significant pain relief was obtained in almost all cases. Conclusion: The outpatientsurgical decompression of ulnar nerve is efficacious and accompanied by minor complications and is adequate to manage ulnar compression by leprosy in developing countries.

Síndrome do canal de Guyon causada por cisto sinovial / Guyon's canal syndrome due to a synovial cyst

Apresentamos um caso de síndrome do canal de Guyon por um cisto sinovial no punho esquerdo de uma paciente do sexo feminino, de 48 anos. A paciente apresentava dor e parestesia na topografia do nervo ulnar, diminuição da força muscular e deformidade na mão esquerda. A eletroneuromiografia evidenciava compressão do nervo ulnar no nível do punho. Realizada a ressecção do cisto e descompressão do nervo no canal de Guyon. Após a cirurgia a paciente apresentou melhora da dor e da parestesia, além de aumento do trofismo muscular e correção da deformidade.

The authors present a case of Guyon's canal syndrome due to a synovial cyst within the left wrist of a 48-year-old female patient. The patient reported pain and paresthesia in the topography of the ulnar nerve, loss of muscular strength and left hand deformity. Electromyography showed a compression of the ulnar nerve at the wrist level. Surgical decompression at the Guyon canal with resection of the cyst was performed. After surgery, the patient presented with improvement of pain and paresthesia, as well as an increase in muscular trophism and correction of the deformity.

Ulnar Artery Obstruction in Guyon Canal Compression Syndrome

PURPOSE: There are many articles describing about Guyon canal compression syndrome. Until recently, most of these articles have been presented about the symptoms of ulnar nerve compression, but there have been no reports about ulnar artery compression. In this article, besides the nerve compression symptoms in the Guyon's canal, we represented the symptoms and treatments based on the ulnar artery obstruction. METHODS: Guyon canal is composed of the hamate and pisiform, and the ligaments which connect them. The course of the ulnar nerve and artery, which passes through this narrow canal, is affected by the anatomical structure of the base of the canal. Out of 14 patients (21 cases) were retrospectively reviewed in this study from 2006 to 2009. Of 14 patients, there were 5 men and 9 women with ages between 21 to 61 years old. The symptoms had volar sensory loss of ulnar sided digits, with muscular atrophy of hypothenar muscles. Prior to surgery, most of these patients had vascular disorders which was diagnosed definitively by angiography and electromyogram. RESULTS: The release of Guyon canal and interposition graft of the obstructed arteries was carried out to 11 patients (15 cases) who had artery (vascular) occlusive disorder, and. 12 cases had sympathectomy and interposition graft after resection of obstructed ulnar artery. Six cases had release of carpal tunnel performed simultaneously. There were no major complications after surgery. The circulation of the ulnar artery was improved along with the patients' symptoms. CONCLUSION: The pre-existing articles about Guyon canal compression syndrome were mainly focused on ulnar nerve compression. This study, which was carried out by our department, showed that most of these patients had ulnar artery obstruction or stenosis simultaneously with ulnar nerve compression. The vascular disorder was corrected by interposition graft after the resection of the site of ulnar artery occlusion. And to conclude, When we resolve the ulnar nerve compression, the proper diagnosis & treatment of impaired ulnar artery circulation should be carried out concomitantly.