11/38. [Proximal neuropathy of the median nerve] In a 77 year old man the rare clinical picture of a complete lesion of the median nerve at the upper arm is described. During removal of a "neurinoma" at the upper arm, inadvertedly the general surgeon had also transsected the median nerve. However diagnosis was delayed due to electrodiagnostic tests, which erronously interpreted the volume conduction of the neigbouring nerves as partial function, and later even as improvement of the median nerve function.Clinically he presented with "orators" hand. He was unable to pinch thumb and index finger, Sensory loss was noted at the fingertip 2 and 3, atrophy of the abductor pollicis brevis muscle and trophic skin changes with an ulcer at the tip of the index finger.Nerve revision confirmed the median nerve transsection. Intraoperative nerve stimulation could not elicit distal muscle stimulation. sural nerve transplant was performed and within one year a positive Tinel sign progressing 20 cm distally to the operation site, without distal motor or sensory changes was observed. ( info) |
12/38. Neuropathy of motor branch of median or ulnar nerve induced by midpalm ganglion. Two cases of neuropathy of a motor branch caused by a midpalmal ganglion are presented. In the first case the ganglion originated from the midcarpal joint, protruded into the thenar muscle, and compressed the motor branch of the median nerve. In the second case the ganglion, distal to the fibrous arch of the hypothenar muscles, originated from the third carpometacarpal joint and compressed the motor branch of the ulnar nerve. In both cases muscle weakness and finger deformity recovered well after resection of the ganglion. This clinical condition is rare compared with carpal tunnel syndrome and Guyon's tunnel syndrome, which are caused by a ganglion in the wrist. ( info) |
13/38. Inflammatory pseudotumor of the median nerve. Case report and review of the literature. The authors report the presence of an inflammatory pseudotumor of the median nerve in a young woman who presented with a sensorimotor deficit in the median nerve area. Magnetic resonance (MR) images revealed a fusiform mass in the nerve, and the patient underwent surgery for a suspected peripheral nerve-sheath tumor. Her clinical condition improved slowly and notably. Histological study revealed a heterogeneous lymphoid infiltration with mononuclear cells, lymphocytes (mostly T cells), and plasmocytoid cells. Because of the unknown significance of this infiltration, the patient was examined to exclude the possible diagnosis of a systemic tumoral process. All the studies yielded negative results and no systemic disease was found. Later, control MR imaging revealed no tumoral remains, and electromyography demonstrated progressive improvement of median nerve function. The follow-up period has been 8 years. The cause of the lesion is unknown. The differential diagnosis includes benign and malignant peripheral nerve-sheath tumors, lymphoma, and all tumorlike lesions of peripheral nerves. ( info) |
14/38. Neurilemmona of the median nerve in a child. Case report. A case of neurilemmoma of the median nerve in a child is reported. The rarity, the contribution to the diagnosis of the newer imaging methods, especially MRI, as well as the good prognosis after a careful enucleation of the tumor, are emphasized. ( info) |
15/38. Entrapment and transection of the median nerve associated with minimally displaced fractures of the forearm: case report and review of the literature. Complete transection of the median nerve associated with minimally displaced fractures of forearm bones is described in a 20-year-old woman. An end-to-end epineural repair was performed. There was good sensory and motor recovery of the median nerve in the hand. ( info) |
16/38. Postoperative edema after vascular access causing nerve compression secondary to the presence of a perineuronal lipoma: case report. OBJECTIVE AND IMPORTANCE: median nerve neuropathy can be clinically devastating to a patient. It can be caused by compression of the median nerve anywhere along its course. We present the case of delayed median nerve neuropathy after the placement of a vascular graft in the arm. CLINICAL PRESENTATION: An arm shunt was placed in the nondominant upper extremity in a 60-year-old man with end-stage renal disease. Twelve hours postoperatively, the patient developed neurapraxia in the median nerve distribution in the hand. INTERVENTION: Exploration of the arm revealed a lipoma coursing along and deep to the median nerve. Resection of the lipoma decompressed the nerve. CONCLUSION: In this patient, median nerve neuropathy was caused by a lipoma and postoperative swelling from placement of the vascular graft. The swelling that occurred after the shunt placement unmasked subclinical compression of the nerve by a lipoma deep to the median nerve. To our knowledge, this report is unique in documenting damage to the median nerve after vascular graft placement as a result of an occult mass. ( info) |
17/38. Anterior interosseous nerve and multifocal motor neuropathy. We report the case of a 47-year-old woman with a left anterior interosseous nerve palsy. Surgical release of the anterior interosseous nerve was initially proposed, but electrodiagnostic evaluation demonstrated that the neuropathy was due not to compression or to neuralgic amyotrophy but to a proximal conduction block. At that time, the conduction block could be defined only by indirect electrodiagnostic criteria. A multifocal motor neuropathy with persistent conduction block was subsequently diagnosed, and the patient was treated with intravenous immunoglobulins. The efficacy of this treatment and the subsequent disclosure of conduction block in the right posterior interosseous and peroneal nerves definitively confirmed the multifocal motor neuropathy. ( info) |
18/38. Entrapment neuropathy of the palmar cutaneous branch of the median nerve concomitant with carpal tunnel syndrome: a case report. A case of the entrapment neuropathy of the palmar cutaneous branch of the median nerve, concomitant with carpal tunnel syndrome is presented. This report demonstrates that the Semmes-Weinstein monofilament test and nerve conduction studies can identify entrapment of the palmar cutaneous branch of the median nerve concomitant with carpal tunnel syndrome. ( info) |
19/38. Functional improvement after physiotherapy with a continuous infusion of local anaesthetics in patients with complex regional pain syndrome. Three patients were referred to our pain clinic with evidence of complex regional pain syndrome in their extremities. Two presented at the atrophic stage with joint contractures. Multiple analgesics had been prescribed without long-lasting relief. Physiotherapy was required to improve physical activity but was severely limited by pain. We instituted local anaesthetic infusion with the possibility of self-supplementation to facilitate physiotherapy; two via brachial plexus catheters for hand pain and one via epidural catheter for knee pain. Although their resultant pain scores were variable after cessation of local anaesthetic infusion, all the affected joints exhibited marked improvement in range of movement. We propose that this technique is a useful option for patients in all stages of complex regional pain syndrome where the emphasis is now directed toward functional improvement. ( info) |
20/38. Concomitant compression of median and ulnar nerves in a hemophiliac patient: a case report. A 15-year-old boy, with a diagnosis of hemophilia a, suffered bleeding into his left forearm 5 months before being admitted to our medical center. His neurological examination revealed a pronounced median neuropathy and a minor ulnar neuropathy on the left side. There was marked muscle atrophy on the thenar side and, to a lesser degree, on the hypothenar side and in the forearm. Electromyographic findings demonstrated an evident, nearly complete, sensorimotor axonal loss in the median nerve. magnetic resonance imaging studies showed atrophy in muscles of the left forearm and median nerve. The patient was diagnosed as having median nerve axonotmesis and ulnar nerve neuropraxia due to compartment syndrome. In hemophiliac patients, frequent single nerve compressions (often involving the femoral nerve) can be seen. However, concomitant median and ulnar nerve injuries with differing severity are rare. ( info) |