Nerve entrapment syndromes in dermatology: Review and practical approach to treatment.

A good understanding of cutaneous nerve entrapment syndromes is important for physicians to provide early and accurate diagnosis and treatment. These syndromes have traditionally been managed with analgesics, antidepressants or antiepileptic medication but this approach is often inadequate and causes frequent adverse medication effects. With early diagnosis and treatment, many nerve entrapment syndromes can be successfully managed with physical, non-pharmacological approaches including stretches, exercises and physiotherapy.

Meralgia paresthetica: 3-Tesla magnetic resonance neurography.

OBJECTIVE: To assess the diagnostic accuracy and observer performance of 3-Tesla magnetic resonance neurography (MRN) in the evaluation of meralgia paresthetica (MP). MATERIALS AND METHODS: Two independent readers were blinded to the clinical diagnosis and evaluated the MRN studies of the pelvis of 11 patients with MP and 28 control participants. In each study, the lateral femoral cutaneous nerves were assessed for signal alteration and/or neuroma formation, indicating lateral femoral cutaneous neuropathy, at various levels along their course. Intra- and inter-observer reliability was evaluated. RESULTS: Both readers exhibited substantial intraobserver agreement in detecting signal alterations and neuroma formation of the lateral femoral cutaneous nerve (LFCN). The readers demonstrated moderate interobserver agreement in detecting signal alteration of the LFCN and poor interobserver agreement in diagnosing neuroma formation. Sensitivity, specificity, positive predictive value, and negative predictive value of LFCN neuropathy diagnosis were ≥ 71 % and ≥ 94 % for both readers respectively. The diagnostic test accuracy was ≥ 90 % for both readers. CONCLUSION: 3-Tesla MRN provides reliable and accurate diagnostic evaluation of meralgia paresthetica.

A case report on accessory brachialis muscle.

Supernumerary heads or slips of brachialis (anticus) muscle is one among the most striking variations, described and encountered in the dissection routine. Very few studies are quoted in the list of its anomalies. We present a unique occurrence of an accessory brachialis muscle (acBr) that formed a fibro-muscular tunnel after blending with the medial intermuscular septum in the lower part of the arm. This tunnel contained the median nerve, the brachial artery and few additional twigs that innervated the neighboring muscles. Because of its intimate topographical relation with the neurovascular bundle, there is no doubt about its role, in the etiogenesis of various compression syndromes. Also, the brachial flexors received innervation from the median nerve, due to the absence of the musculo-cutaneous nerve. We discuss in this report the possible embryogenesis and the clinical application of this variation that can aid the physicians in their approach and required treatment.

Newborn radial nerve palsy: report of four cases and review of published reports.

Four newborns presented with isolated radial nerve palsy during the first 2 days of life. In three, there was a history of failure of progression of labor, which may have resulted in prolonged radial nerve compression. Furthermore, three infants had fat necrosis of the upper arm above the elbow, suggestive of compression of the radial nerve in the region of the spiral groove. Significant recovery of function was evident within 1 month in all four infants. The authors review published reports about the rare condition of isolated radial nerve palsy in the newborn.

Neonatal ductus arteriosus aneurysm causing nerve palsies and airway compression: surgical treatment by decompression without excision.

A 4-kg male child, born at 34 weeks to a gestational diabetic mother, had a large ductus arteriosus aneurysm causing phrenic and recurrent laryngeal nerve palsies and large airway compression. The right and left atrial appendages and distal descending aorta were cannulated, allowing left heart partial or complete cardiopulmonary bypass as necessary. On bypass the ductus was ligated, decompressed, and oversewn but not excised. Examination 1 month later suggested resolution of the recurrent laryngeal palsy and echocardiography showed regression of the aneurysm. Ductus ligation and decompression was an effective surgical treatment, which is less likely to cause complications than resection.

"Congenital" common peroneal nerve compression.

Common peroneal nerve palsies may arise from numerous causes. We report an unusual case of common peroneal nerve palsy secondary to a previously unreported congenital band crossing the nerve at the level of the fibular head.

[Bilateral reversed palmaris longus muscle--a rare cause of peripheral median nerve compression syndrome. Case report]. / Bilateraler reverser Musculus palmaris longus--seltene Ursache eines peripheren N.-medianus-Kompressionssyndroms. Fallbericht.

A rare case of median nerve compression syndrome outside the carpal tunnel in the distal forearm is reported. A 21-year-old man suffered while working from symptoms of temporary median nerve compression in both forearms; this was caused by hypertrophy of reversed palmaris longus muscles. Resection of the abnormal muscle bellies relieved the symptoms immediately. Only ten similar cases have been reported in the literature, and this is the first case with bilateral symptoms.

Conjoined lumbosacral nerve roots.

Conjoined lumbosacral nerve roots is a congenital anomaly that may produce lumbosciatic pain. When symptomatic and undiagnosed, it may be one of the causes of failed back syndrome. Diagnosis with water-soluble contrast myelography has a frequency of 4%. Anatomical studies have shown to have an incidence of 14%. High quality Magnetic Resonance Imaging (MRI) with coronal views may reveal this condition without recurring to computed tomography (CT)-myelography. In this paper we describe our recent experience with five consecutive cases observed during a one year period.

Congenital compression of the radial nerve.

Congenital dysfunction of a major peripheral nerve is unusual. Most cases are the result of amniotic banding or abnormal uterine activity during labor. When this problem is associated with constricting bands the results of treatment are not well reported in the literature and seem somewhat unpredictable. We report a case of congenital compression of the radial nerve and review the literature.

The tethered spinal cord syndrome.

The results of surgical treatment of the tethered spinal cord syndrome in twenty-five children in the age range six weeks to nineteen years are reported. After a description of the symptomatology, the importance of neuroradiologic investigations including myelography and CT-scanning as well as urodynamic studies are explained. The operative techniques are described in cases of tight filum terminale, lipoma of the filum terminale, diastematomyelia, lipomyelomeningocele and meningocele. Early operation is essential to avoid the neurological damage which results from awaiting the onset of symptoms. The aim of the operation is to free the conus medullaris and cauda equina before mechanical traction or compression damages function in lumbosacral cord.

Congenital ring constrictions with entrapment neuropathies.

An eight year old boy with multiple simple congenital ring constrictions is described with peripheral nerve palsies caused by entrapment in the constrictions. It is suggested that ring constrictions should be considered in the differential diagnosis of entrapment neuropathy.