1/78. Meralgia paresthetica secondary to limb length discrepancy: case report.Meralgia paresthetica consists of pain and dysthesia in the lateral thigh caused by entrapment of the lateral femoral cutaneous nerve (L2-L3) underneath the inguinal ligament. Abdominal distension, tight clothing, and hip hyperextension are all described causes of this condition. To our knowledge this has never been attributed to a limb length discrepancy. We present a 51-year-old man with a long-standing history of right sided meralgia paresthetica. history and physical and radiological examination were unrewarding except that his left leg was shorter than the right by 2 cm. Nerve conduction studies of the lateral femoral cutaneous nerve on the left had a normal latency and amplitude but were absent on the right. To prove the hpothesis that the limb length discrepancy was responsible for the condition, a single subject study was performed. The presence or absence of pain and dysesthesia in the right thigh was the observed behavior. Intervention consisted of wearing a 1.5-cm lift in the left or right shoe for 2 weeks each with an intervening 2-week lift-free period. Pain was recorded on a numeric scale and numbness as being present or absent. There was continuing pain without and with the lift in the right shoe but no pain or numbness with the lift in left shoe. It was concluded that the limb length discrepancy was responsible for the meralgia paresthetica. Pertinent literature and possible pathomechanics are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/78. Salon sink radiculopathy: a case series.Cervical radiculopathy can be diagnosed on physical examination with the Spurling test, which narrows neural foramina via neck extension along with coupled rotation and side-bending. In the presence of cervical radiculopathy, this test can reproduce radicular symptoms by transmitting compressive forces to affected nerve roots as they traverse the neural foramina. Treatment of cervical radiculopathy includes patient education to avoid obvious postures that exacerbate radicular symptoms and to assume positions that centralize discomfort. A potentially harmful position to which many patients are unwittingly subjected at least several times per year occurs when their hair is being shampooed in a salon sink before a haircut. This posture causes neck extension and is combined with rotation and side-bending as the patient's head is being manipulated during the shampooing. When the stylist then also applies a mild compressive force while shampooing the patient's hair, hyperextension of the neck is produced. We present two patients with cervical radiculopathy that was significantly exacerbated after the patient's hair had been shampooed in a salon sink; subsequently, these patients required oral administration of steroids. These cases illustrate that patients with suspected or known cervical radiculopathy should be forewarned to avoid this otherwise seemingly innocuous activity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/78. Endoscopic supraorbital nerve neurolysis.Endoscopic surgery, performed through small incisions, yields therapeutic results equivalent or superior to those obtained using the conventional approach. The technique has been established in laparoscopic cholecystectomic surgery. In plastic surgery, endoscopic techniques were first developed in aesthetic procedures and have been reported to be useful in face-lift operations, breast reconstruction, muscle flap harvesting and subcutaneous surgery. Endobrow lift has become a more and more popular aesthetic procedure. The endoscope provides an excellent magnification and, through a high power light source, a very good illumination of the operative field. It explains why the endoscope is more and more used in reconstructive procedures. We report the case of a patient suffering from a posttraumatic entrapment of the right supraorbital nerve which was released by an endoscopic approach.- - - - - - - - - - ranking = 0.52098579642648keywords = suffering (Clic here for more details about this article) |
4/78. Bilateral peroneal nerve palsy induced by prolonged squatting.External or internal pressures on peripheral nerves may result in compression neuropathies. Although compressive common peroneal nerve palsy is well known, to date very few cases with bilateral palsies have been reported. The clinical and electrophysiological manifestations of three patients with bilateral peroneal nerve palsies are reported, and their clinical outcomes are discussed. The first patient's transient bilateral palsy was corrected by conservative means. The second patient, with a more severe axonal lesion, did not improve within 3 months, and nearly complete recovery occurred after operative decompression. For the third patient, who had been suffering for a long time, no improvement could be hoped for. Prolonged squatting was the etiological factor in all three cases. Bilateral compression neuropathies of the peroneal nerve, like unilateral lesions, may recover spontaneously. Surgical intervention is recommended for patients with predominantly axonal lesions and for those who do not improve within 3 months.- - - - - - - - - - ranking = 0.52098579642648keywords = suffering (Clic here for more details about this article) |
5/78. Microvascular decompression for trigeminal neuralgia in charcot-marie-tooth disease.The authors report on three patients suffering from coexistent trigeminal neuralgia (TGN) and charcot-marie-tooth disease who, based on preoperative magnetic resonance tomographic angiography findings, underwent microvascular decompression. All patients had demonstrable neural compression and all experienced immediate postoperative pain relief. Symptoms recurred in one patient and required a second procedure in the form of a neurotomy. Two patients suffered from bilateral TGN. When a patient with TGN suffers coexistent neurological disease and experiences bilateral symptoms, preoperative imaging and subsequent decompressive surgery may avoid the unacceptable risk of morbidity associated with bilateral ablative procedures.- - - - - - - - - - ranking = 0.52098579642648keywords = suffering (Clic here for more details about this article) |
6/78. Synovial osteochondromatosis at the elbow producing ulnar and median nerve palsy. Case report and review of the literature.The authors present the case of a 53-year-old woman suffering from synovial osteochondromatosis of her right elbow responsible for ulnar and median nerve entrapment neuropathy. This condition is characterised by the formation of multiple cartilaginous nodules in the metaplastic synovium of otherwise normal joints, bursae or tendon sheaths. Treatment consisted of partial synovectomy, removal of loose bodies and microscopic nerve release. Synovial osteochondromatosis complicated by nerve compression syndromes has been rarely reported, usually with ulnar tunnel syndrome at the elbow. The literature on this subject is reviewed.- - - - - - - - - - ranking = 0.52098579642648keywords = suffering (Clic here for more details about this article) |
7/78. Chronic calf pain in athletes due to sural nerve entrapment. A report of 18 cases.We retrospectively analyzed the charts of 13 athletes (18 limbs) who had sural nerve entrapment localized in the passage of the nerve through the superficial sural aponeurosis. There were 11 men and 2 women (average age, 43 years; range, 31 to 59). All patients reported chronic calf pain that was exacerbated during physical exertion. Delay to diagnosis averaged 9 months (range, 5 to 24). Tenderness in the calf was identified along the course of the sural nerve in all cases. In 10 patients (15 limbs) electrodiagnostic testing before surgery was positive. After failure of nonoperative treatment, surgery was conducted under local anesthesia. Neurolysis was performed by incising the superficial sural aponeurosis and the fibrous band in it through which the nerve passes. The results of the operation were evaluated in terms of residual symptoms, ability to return to the former sport, and degree of patient satisfaction. A final follow-up examination was performed an average of 14 months (range, 6 to 30) after the operation. The final result was excellent in 9 limbs (2 bilateral), good in 8 limbs (2 bilateral), and fair in 1 case. The differential diagnosis of sural nerve entrapment in athletes is discussed. Increase in sural muscle mass or development of local fibrous scar tissue compromised the sural nerve in its course through the unyielding and inextensible superficial sural aponeurosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/78. Superior cluneal nerve entrapment.BACKGROUND AND OBJECTIVES: Pain due to superior cluneal nerve entrapment is an infrequent cause of unilateral low back pain. Here we present a case of acute unilateral low back pain treated by superior cluneal nerve (SCN) block. CASE REPORT: A 55-year-old woman presented to the outpatient clinic suffering from unilateral low back pain localized to right iliac crest and radiating to the right buttock. Her history was taken, physical examination was performed, and a thorough radiologic evaluation was performed to minimize radiculopathy and facet syndromes as causative. After transient pain relief with a diagnostic trigger point injection, entrapment of SCN was diagnosed and therapeutic nerve block with local anesthetic and steroid combination was performed. CONCLUSION: SCN is prone to entrapment where it passes through the fascia near the posterior iliac crest. Unilateral low back pain and deep tenderness radiating to the ipsilateral buttock are the clinical findings accompanying SCN entrapment. The case presented emphasizes the relief of possible SCN after limiting other etiologic causes of low back pain.- - - - - - - - - - ranking = 1.5209857964265keywords = physical, suffering (Clic here for more details about this article) |
9/78. blood pressure cuff compression injury of the radial nerve.We describe a 19-year-old man who underwent emergency laparotomy for perforated peptic ulcer. He was otherwise healthy before this admission with no history of diabetes mellitus or neuropathy. A standard-size adult blood pressure cuff connected to a Dinamap monitor, set to cycle automatically every 3 minutes was affixed to his left upper extremity during surgery. One day after the operation he complained of numbness over the dorsum of the left hand and wrist drop. physical examination revealed 0/5 muscle power of the left wrist and finger extensor muscles with reduced sensation on the radial aspect of the dorsum of the same hand. A diagnosis of acute radial nerve injury was made and rehabilitation was started. The wrist numbness and sensation improved with physical therapy, and he was discharged 9 days after the operation with an active wrist splint. He continued with rehabilitation on an out-patient basis. The muscle power of the wrist extensors gradually improved after three months of physical therapy and reverted to completely normal one month later. Locating the cuff higher on the arm, away from the elbow joint, to avoid the most superficial portion of radial nerve, may prevent this type of compression injury especially in asthenic patients.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
10/78. Superior oblique myokymia: magnetic resonance imaging support for the neurovascular compression hypothesis.Superior oblique myokymia is a rare movement disorder thought to be caused by vascular compression of the trochlear nerve. Direct display of such neurovascular compression by magnetic resonance imaging has been lacking. The goal of this study was to assess the presence of neurovascular contacts in patients with superior oblique myokymia, using a specific magnetic resonance imaging protocol. A total of 6 patients suffering from right superior oblique myokymia underwent detailed neuro-ophthalmological examination, which showed tonic or phasic eye movement. All patients underwent magnetic resonance imaging, using a magnetic resonance imaging Fourier transform constructive interference in steady-state sequence in combination with magnetic resonance imaging time of flight magnetic resonance arteriography both before and after the administration of Gd-DTPA. With this protocol, the trochlear nerve could be visualized on 11 of 12 sides (92%). Arterial contact was detected at the root exit zone of the symptomatic right trochlear nerve in all 6 patients (100%). No arterial contact was identified at the root exit zone of the asymptomatic left trochlear nerve in any of the 5 left nerves visualized. In conclusion, superior oblique myokymia can result from neurovascular contact at the root exit zone of trochlear nerve, and therefore should be considered among the neurovascular compression syndromes.- - - - - - - - - - ranking = 0.52098579642648keywords = suffering (Clic here for more details about this article) |
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