1/11. Pacinian corpuscle neuroma of digital nerves.Symptoms and incapacitation due to abnormal aggregations of pacinian corpuscles are uncommon. Indeed, only three reports have been found in the scientific literature. A case is presented in which the patient's chief complaint was pain and localized tenderness in the hand which interfered with normal activity. Surgical exploration of the palm showed abnormalities of pacinian corpuscles attached to the median digital nerve in the form of a grape-like cluster and a single enlarged corpuscle beneath the epineurium; the abnormality attached to the ulnar digital nerve appeared as an offshoot of hyperplastic corpuscles lying in tandem. The abnormal corpuscles were excised. The symptoms have not recurred to date. These abnormalities in size, position, and number of pacinian corpuscles are compared to the findings of the few other reports in the literature. The neuroma formation found attached to this ulnar nerve has not been cited previously.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/11. Recurrent neuroma formation after lateral arm free flap coverage with neurorraphy to the posteroantebrachial nerve.We report a patient with previous wrist trauma and development of a symptomatic neuroma of the palmar cutaneous branch of the median nerve. The patient had previously been successfully treated with lateral arm free flap coverage with neurorrhaphy to a segment of the posteroantebrachial cutaneous nerve carried with the flap. Two years following this procedure the patient experienced re-onset of symptoms prompting surgical exploration of the area. At the time of operation a recurrent neuroma was found at the free distal terminus of the transferred posteroantebrachial cutaneous nerve. The neuroma was repositioned into the distal radius via a burr hole with relief of symptoms.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
3/11. Flexor tendon rupture 55 years following a wrist laceration.Flexor tendon rupture at the wrist or palm is rare. We present a case of index flexor digitorum profundus rupture at the level of the wrist associated with the site of a laceration 55 years earlier. Associated pathology included a large neuroma-in-continuity of the median nerve and adhesions involving the flexor digitorum superficialis tendons. The rupture was treated by tenodesis to the relatively unaffected flexor digitorum profundus to the adjacent long finger.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
4/11. Mucocutaneous neuromas: an underrecognized manifestation of PTEN hamartoma-tumor syndrome.BACKGROUND: The spectrum of clinical findings associated with PTEN tumor suppressor gene germline mutations, referred to as PTEN hamartoma-tumor syndrome (PHTS), includes Cowden and Bannayan-Riley-Ruvalcaba syndromes. Although the skin is the ectodermal structure most often affected by these autosomal dominant genodermatoses, abnormalities of neural tissues are frequently observed. OBSERVATIONS: We describe a 5-year-old boy with macrocephaly, prominent corneal nerves, and progressive development of multiple painful, dome-shaped, translucent pink to skin-colored papules on the vermilion portion of the upper lip, fingers, palms, and shins. Histologic evaluation demonstrated dermal proliferation of well-demarcated nerve bundles associated with abundant mucin and surrounded by a distinct perineural sheath, findings diagnostic of a nonencapsulated neuroma. Genetic analysis revealed a novel heterozygous germline nonsense mutation in PTEN, predicted to result in a truncated PTEN protein. To our knowledge, this represents the first report of multiple neuromas as the sole mucocutaneous manifestation of PHTS. CONCLUSIONS: This article highlights neuromas as a cutaneous sign of PHTS, drawing attention to manifestations of PHTS in neural tissues of the skin, eye, gastrointestinal tract, and brain. Along with multiple endocrine neoplasia type 2B, PHTS should be considered in the differential diagnosis of multiple mucocutaneous neuromas, particularly those involving extrafacial sites.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
5/11. Innervated lateral middle phalangeal finger flap for a large pulp defect by bilateral neurorrhaphy.BACKGROUND: The dorsal middle phalangeal finger flap is a reliable flap. However, it requires skin grafting on the whole surface of the dorsum of the middle phalanx of the donor finger for an exposed extensor tendon and leaves a conspicuous contour deformity at the donor site. In an effort to overcome this problem, the authors have been using a heterodigital innervated lateral middle phalangeal finger flap for resurfacing sizable defects of the pulp. methods: Flaps were designed on the lateral ulnar side of the middle finger for five thumb defects and the ring finger for two little finger defects. To provide sensation to the flap, one nerve fascicle from the direct small branches of the proper digital nerve after interfascicular dissection (palmar aspect of the flap) and the dorsal branch of the proper digital nerve (dorsal aspect) were identified and sectioned proximally, leaving a 1-cm nerve tail attached to the flap. RESULTS: These flaps provided sensate coverage with static two-point discrimination values of approximately 6 mm. Donor finger morbidity was minimal, and pulp sensation in donor fingers was normal in all cases. No donor finger cold intolerance was reported in this series. CONCLUSIONS: This described flap supplies glabrous skin of nearly normal sensibility. One nerve fascicle from the direct small branches of the proper digital nerve and the dorsal branch of the proper digital nerve were used for maximal sensation. Donor fingers are cosmetically better than those of dorsal middle phalangeal finger flaps because the grafted skin is hidden by an adjacent finger.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
6/11. Treatment of painful nerve lesions in the palm by "rerouting" of the digital nerve.An effective way to treat painful "neuromas in continuity" in the palm is to reroute the nerve under the lumbrical muscle. In two patients this has completely cured their symptoms.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
7/11. Complications of carpal tunnel surgery.During a 12-year period, the authors treated 25 patients with 26 complications of previous carpal tunnel surgery. Twenty-four of these patients were referred following initial surgery elsewhere. The most frequent complication identified was neuroma of the palmar cutaneous branch of the median nerve in 14 of the cases. Other complications were hypertrophic scars, dysesthesias after multiple procedures to release the carpal tunnel, joint stiffness, failure to relieve symptoms, and neuromas of the dorsal sensory branch of the radial nerve. All of these complications are potentially preventable. With a properly placed incision, exposure carried out under magnification, and surgery under direct vision the majority of these complications may be prevented. It is further noted that the technique of transverse incision at the wrist for release of the carpal tunnel is potentially dangerous and should be abandoned.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
8/11. Ulnar neuropathy at the wrist: case report and review of literature.We present a case of pure motor ulnar neuropathy with sparing of the hypothenar muscles and a review of 55 published cases of ulnar neuropathy at the wrist in which the clinicoanatomic correlation was clearly delineated. We propose a classification of ulnar neuropathies at the wrist divided into five types based on clinical findings, electrophysiologic studies, and clinicoanatomic correlations. Type I: a mixed motor and sensory neuropathy, occurring just outside or within the proximal end of Guyon's canal. II: a pure sensory neuropathy, where the lesion involves the superficial branch of the ulnar nerve (UN) at the wrist but distal to the branch to the m. palmaris brevis. III: a pure motor neuropathy due to a lesion of the deep branch of the UN just distal to the superficial branch but proximal to the branch to the hypothenars. IV: a pure motor ulnar neuropathy with sparing of hypothenars; this lesion occurs on the deep branch of the UN distal to the origin of the superficial branch and distal to the branch going to the hypothenars. V: a distal motor neuropathy in which the lesion occurs just proximal to the branches going to the first dorsal interosseus and adductor pollicis muscles.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
9/11. The abductor digiti minimi muscle flap: a salvage technique for palmar wrist pain.In a series of 12 patients incapacitated by persistent or recurrent pain in the palmar aspect of the hand and wrist, successful rehabilitation was aided by employing an abductor digit minimi muscle flap. It is emphasized that this muscle flap was utilized as an adjunct to microsurgical internal neurolysis and neuroma resection. Eleven of the 12 patients (92 percent) achieved good to excellent results in terms of relief of pain, plus either return to their previous job or vocational rehabilitation. The "salvage" nature, donor-site morbidity, and technical demands of the procedure are emphasized.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
10/11. Major neurovascular complications of endoscopic carpal tunnel release.Endoscopic carpal tunnel release is becoming an increasingly popular method of surgically correcting median nerve compression. Several complications have been suggested as possibilities following the technique; however, to date, there have been only isolated reports of iatrogenic injury to major neurovascular structures in the hand. We report both a case of transection of the median nerve and a pseudoaneurysm of the superficial palmar arch following endoscopic carpal tunnel release.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
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