Posterior interosseous nerve palsy by synovial cyst of proximal radioulnar joint: our experience after 5 years.

AIM: The posterior interosseous nerve palsy is a neuropathy of radial nerve interesting its deep motor branch. The neuropathy can appear with a hollow in the proximal half of the forearm without significant swelling, a complete loss of extension of the fingers with radial deviation of the wrist during extension. In some cases, PIN compression may simulate tendon rupture in rheumatologic diseases, because the pain and the paralysis occur suddenly, so often can be difficult to make a diagnosis. The palsy is caused by compression of the posterior interosseous nerve from soft tissue tumours or tumour-like masses: ganglions, lipomas, rheumatoid synovitis, synovial chondromatosis, fibromas, neurofibromas, bursitis, synovial cysts of the elbow and radioulnar proximal joints. The aim of our research was to individuate the better treatment for the posterior interosseous nerve palsy. METHODS: From 2002 to 2007 we examined 8 patients: 2 female and 6 male. Median age was 43 years. The diagnosis was made by clinical examination, ultrasound, nerve conduction studies and magnetic resonance imaging (MRI). Patients underwent to decompressing posterior interosseous nerve surgery. RESULTS: After the surgical exploration in 8 cases a globular mass of around 2.5 cm to 4.5 cm diameter was discovered. At the histological examination, a synovial cyst of the elbow joint was found in 7 out of 8 patients and an hemangioma tumor in the one remaining patient. 12 months was the median time for a complete recovery after the operation, confirmed by EMG. CONCLUSION: The surgical treatment offers a complete resolution in all cases.

[Surgical treatment of Morton's neuroma: our experience and literature review]. / Il trattamento chirurgico del neuroma di Morton: la nostra esperienza alla luce della letteratura.

OBJECTIVE: Morton's neuroma is a common foot problem associated with pain. MATERIALS AND METHODS: In 52 patients intermetatarsal spaces were operated on for Morton's neuralgia Gautier surgical treatment. The procedure included dorsal incision, division of the deep intermetatarsal ligament, and resection of the common digital nerve including the neuroma. Results. The outcome of the operation was excellent in 47 patients. CONCLUSIONS: The results show the efficacy of the surgical treatment of Morton's neuralgia with a dorsal incision, over a long follow-up period.

[Dupuytren's disease simulated by epithelioid sarcoma with atypical perineural invasion of the median nerve. Case report]. / Malattia di Dupuytren simulata da un sarcoma epitelioide con atipica invasione perineurale del nervo mediano. Caso clinico.

Epithelioid sarcoma is an infrequent tumour, especially in upper limb, which nerve spread is not common. We describe the case of a 27 years old caucasian male with initial diagnosis of Dupuytren's disease. He underwent palmar fascia surgery, but the surgical treatment was followed by recurrence of the deformity in retraction of 4th and 5th finger of the left hand. When he presented himself at our attention, the patient underwent surgical biopsy and new histological examination was made with diagnosis of epithelioid sarcoma. We highlight essentially two aspects of this case: the diagnostic delay of tumour caused by simulation of the Dupuytren's disease and the atypical perineural spread along the median nerve.

The pillar pain in the carpal tunnel's surgery. Neurogenic inflammation? A new therapeutic approach with local anaesthetic.

AIM: After the surgical decompression of the transverse carpal ligament as treatment of the tunnel carpal syndrome, pillar pain manifestation is possible. This is a painful and temporary invaliding syndrome with unknown aetiology. Aim of the study is to demonstrate that pillar pain is based on autonomic irritation that disappears with simple infiltration of local anaesthetic (LA), or rather by neuromodulation. METHODS: Eighty-four patients were enrolled for this study and underwent an open release technique surgery. They were then asked for regular postoperative follow-ups. RESULTS: Thirty-two out of 84 patients (38%) developed pillar pain. Accordingly, injection of LA as pain treatment has since been studied and results compared with the conventional protocol for this painful syndrome. CONCLUSION: Even if the number of the patients considered is not great, there is evidence of a decrement of pillar pain by means of LA injections. Excellent functional outcomes and satisfaction were achieved using LA infiltrations for pillar pain after carpal tunnel decompression. The minimally invasive technique offers a quick, easy, effective, and inexpensive method useful to minimize and cure in a few days the pillar pain.

[Tenosynovial giant cell tumour of the hand and wrist: early diagnosis and surgical treatment]. / Tumore a cellule giganti tenosinoviale della mano e del polso: diagnosi precoce e trattamento chirurgico.

Fourty two patients with tenosynovial giant cell tumour, treated with radical excision, underwent detailed follow-up to evaluate the outcomes and to find early the possible recurrence of disease. Radical excision is the only way to have a complete recovery from disease and total recovery of function. Early diagnosis of recurrence is possible by careful clinical examination, ultrasonography and, in selected cases, magnetic resonance imaging.

[Surgical treatment of painful amputation neuromas with hyaluronic acid gel. Preliminary study of six patients]. / Trattamento chirurgico dei neuromi d'amputazione dolorosi con gel di acido ialuronico. Lavoro preliminare su 6 casi.

Amputation neuroma is the consequence of a traumatic event that interrupt the anatomic structure of a nerve. After the lesion, the nerve begin an plerosis attempt. This condition determines hyposensitivity on its innervation area and a painful syndrome. The pattern's resolution is possible with the neuroma's tissue exeresis and the sinking of proximal stump into closer tissue. This operation reduces or eliminates axonal nerve's flux. The hyaluronic acid (Hyaloglide 0.8-1 ml) use is based on the necessity of proximal stump preservation from mechanical and thermic stimuli that are responsible of typical neuroma's symptoms. In this study we used hyaluronic acid on six painful amputation neuroma patterns on sensitive nerves of upper and lower extremities.

[Complex Regional Pain (CRPS) Syndrome type II. Timing for surgery and therapeutic options: neuromodulation]. / La Sindrome Complessa Dolorosa Regionale (CRPS) tipo II. Timing chirurgico e strategie terapeutiche: la neuromodulazione.

OBJECTIVE: The object of this study is to evaluate the importance of a correct timing for surgery, the different strategies of therapy and the use of the neuromodulation in the Complex Regional Pain Syndrome (CRPS) type II. PATIENTS AND METHODS: The last 2 years we observed 8 patients with the clinical picture of a CPRS type II, due to previous peripheral nerve lesions of the upper extremity. All the patients followed a therapeutic protocol of neuromodulation and reconstructive surgical repair. RESULTS: Six patients out of eight had almost a complete recovery of the symptoms 6 months after the surgery. CONCLUSIONS: Our study demonstrates that the patients who underwent surgical repair followed by neuromodulation didn't present any recurrence of the symptoms.

[Double compression of the ulnar nerve at the elbow and at the wrist (double-crush syndrome). Case report and review of the literature]. / Doppia compressione del nervo ulnare alla doccia epitrocleo-olecranica ed al polso (double-crush syndrome). Descrizione di un caso e revisione della letteratura.

Double compression of a peripheral nerve is not rare in medical practice. This article describes an ulnar neuropathy along the elbow and the wrist segments with electro-diagnostic examination (EDX). The proximal compression was an ulnar entrapment at the olecranon-epitrochlear semi-canal; the distal one was after the canal of Guyon, due to an arthro-synovial cyst arising from the pisohamatum joint. There aren't analogous clinical reports in the literature.

[Neuritis of the sensory branch of the radial nerve: Wartemberg's syndrome. A case report]. / La neurite dei rami terminali del nervo radiale: la sindrome di Wartemberg. Descrizione di un caso e revisione della letteratura.

Wartembergs syndrome is an entrapment of the sensory branch of the radial nerve in the forearm. It is not mentioned with the other peripheral nerve entrapments and it is very rare. Wartemberg's syndrome is too often misdiagnosed as the De Quervain's disease or is not diagnosed at all. The Authors report their experience with a case surgically treated.