1/15. Multiple constrictions of the radial nerve without external compression.We report a patient with multiple constrictions within the main trunk of the radial nerve that was found after epineurectomy and speculate that the etiology is an inflammatory response. (J hand Surg 2000; 25A:134-137.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
2/15. Severe, traumatic soft-tissue loss in the antecubital fossa and proximal forearm associated with radial and/or median nerve palsy: nerve recovery after coverage with a pedicled latissimus dorsi muscle flap.A total of 6 patients with complex, traumatic wounds of the antecubital fossa and proximal forearm were included in this study. All patients presented with radial and/or median nerve palsies in addition to their soft-tissue defect. Except for 1 patient with a 15-cm defect of the radial nerve, all other traumatized nerves appeared in-continuity at the time of surgery. However, the nerve injury was severe enough to induce wallerian degeneration (i.e., axonotmesis in traumatized nerves in-continuity). Three patients required brachial artery reconstruction with a reverse saphenous vein graft. Wound coverage was accomplished using a pedicled latissimus dorsi muscle flap, which was covered with a split-thickness skin graft. Successful reconstruction was obtained in all patients. Follow-up ranged from 2 to 6 years. The range of motion at the elbow and forearm was considered excellent in 5 patients and good in the remaining patient who had an intra-articular fracture. Motor recovery of traumatized nerves in-continuity was observed in all but 1 patient who had persistent partial anterior interosseous nerve palsy. The grip strength of the injured hand measured 70% to 85% of the contralateral uninjured hand. median nerve sensory recovery was excellent in all patients. The versatility of the pedicled latissimus dorsi muscle flap for coverage of these complex wounds with traumatized neurovascular bundles around the elbow is discussed.- - - - - - - - - - ranking = 0.053539242849694keywords = fracture (Clic here for more details about this article) |
3/15. Bilateral transient radial nerve palsies in an infant after cardiac surgery.PURPOSE: To describe the case of an infant who suffered bilateral transient radial nerve palsies after cardiac surgery. CLINICAL FEATURES: A one-month-old baby was found to have bilateral wrist and finger drop after the removal of splints that has been applied to the right hand for 14 days and to the right hand for six days during perioperative management of Blalock-Taussig shunt surgery. The hand splints had been applied to the forearms with adhesive silky tape to keep peripheral vascular lines in place. The patient also suffered from several episodes of cardiogenic shock, hypoxemia and generalized edema relating to cardiac dysfunction during this fine period. Given the findings of no impairment of median or ulnar nerves and brachioradial muscle, it was suspected that bandaging with adhesive tapes caused peripheral radial nerve damage at the level of posterior interosseus nerve on forearm. Diminished oxygen delivery and edema may additionally have contributed to peripheral nerve ischemia. The aforementioned neurologic symptoms resolved spontaneously after several days. CONCLUSION: Prolonged compression by bandaging of splints on forearm may have resulted in ischemic damage to the posterior interosseus nerve branch combined with extensor carpi radialis longus nerve branch of the radial nerve. We should attempt to reduce the frequency and duration of splinting of the extremities, especially in sedated, paralyzed babies, given the potential risk of compression neuropathy.- - - - - - - - - - ranking = 0.5keywords = compression (Clic here for more details about this article) |
4/15. Aggressive keloid scarring of the Caucasian wrist and palm.keloid scarring of the distal upper extremity is very rare. We report a Caucasian woman who presented with aggressive keloids of the hand and wrist causing De Quervain's syndrome, superficial radial-nerve entrapment and ulnar-nerve compression at the wrist. Multiple operations were required to alleviate her symptoms. A number of management conundrums arose, requiring defensive planning to pre-empt the possible complications of recurrent keloid scarring as a result of the surgical procedures.- - - - - - - - - - ranking = 0.25keywords = compression (Clic here for more details about this article) |
5/15. Radial tunnel syndrome in an elite power athlete: a case of direct compressive neuropathy.Radial tunnel syndrome (RTS) is thought to result from intermittent and dynamic compression of the posterior interosseous nerve (PIN) in the proximal part of the forearm associated with repeated supination and pronation. The diagnostic criteria encompassing RTS are purely clinical and the term "radial tunnel syndrome" has become controversial because of the lack of focal motor weakness in the majority of patients diagnosed with RTS. Retrospective cadaveric and surgical studies have revealed several areas within the forearm in which the PIN may become entrapped. Recent studies have suggested that the PIN is "fixed" in the supinator muscle and that wrist pronation is the actual movement that places the most stress on the PIN. The patients most often afflicted with RTS appear to be those who perform repetitive manual tasks involving rotation of the forearm and athletes involved in racket sports. Surgical exploration with decompression of the PIN is often required in patients with RTS. We present the first case of RTS occurring in an elite power athlete and believe this case represents a direct compressive sensory neuropathy. The optimum nonsurgical treatment plan for the elite athlete in training for competition and the cause of this compressive neuropathy in power athletes will be discussed.- - - - - - - - - - ranking = 0.5keywords = compression (Clic here for more details about this article) |
6/15. radial nerve palsy in an elite bodybuilder.A case is reported of high radial nerve palsy in an elite bodybuilder caused by an extrinsic mass effect of muscular hypertrophy. Surgical decompression resulted in complete clinical resolution.- - - - - - - - - - ranking = 0.25keywords = compression (Clic here for more details about this article) |
7/15. radial nerve compression by a large cephalic vein aneurysm: case report.A 43-year-old man had weakness of the extensor muscles in the right forearm and could not extend the right wrist. The apparent disorder was caused by radial nerve compression by a large aneurysm in the cephalic vein in the antecubital fossa. Surgical resection of the aneurysm resolved the symptoms. This exceedingly rare complication of venous aneurysm is discussed. Venous aneurysm should be included in the differential diagnosis of a subcutaneous mass, and diagnosis is best made with Duplex ultrasound scanning. Surgical excision is the appropriate treatment.- - - - - - - - - - ranking = 1.25keywords = compression (Clic here for more details about this article) |
8/15. Bed footboard peroneal and tibial neuropathy. A further unusual type of Saturday night palsy.An uncommon cause of bilateral tibial and peroneal compression neuropathy is reported. After taking alcohol and drugs, a young heroin-addicted man lay unconscious overnight in supine position, with both legs crossing the wooden board at the end of the bed, the posterior aspect of the flexed knees pressing against its edge. The following day, he had weakness of foot flexion and extension and a sensory loss consistent with a bilateral tibial and peroneal neuropathy. Symptoms resolved rapidly in the left side; in the right side, a conduction block was still demonstrable 3 weeks later.- - - - - - - - - - ranking = 0.25keywords = compression (Clic here for more details about this article) |
9/15. Rapid nerve recovery following decompression--a case of post-traumatic axonamonosis.We report a humeral fracture associated with complete radial nerve palsy, where immediate nerve recovery followed decompression. This uncommon type of nerve lesion is referred to as axonamonosis and is not included in the traditional Seddon nerve injury classification.- - - - - - - - - - ranking = 1.3035392428497keywords = compression, fracture (Clic here for more details about this article) |
10/15. Thermal tissue damage caused by ultrasonic cement removal from the humerus.BACKGROUND: Ultrasound devices can selectively remove cement during revision arthroplasty. These instruments initially were designed for the hip and knee but also have been applied to the upper extremity. We describe a patient in whom a radial nerve palsy and a pathologic humeral fracture developed after ultrasonic cement removal was performed because of an infection at the site of a total elbow arthroplasty. Biopsies of the humerus, the triceps muscle, and the radial nerve showed widespread necrosis consistent with thermal injury. methods: A study involving six human cadaveric specimens was conducted to measure temperature elevations in bone and adjacent soft tissue during cement removal with use of an ultrasound device with and without irrigation. RESULTS: While temperature increased only minimally during cement polymerization, ultrasonic melting and removal of cement with use of constant energy delivery led to markedly elevated temperatures in the humeral cortex, the triceps muscle, and the radial nerve. These temperatures were above the known thresholds for thermal injury and necrosis. Subsequently, strategies designed to allow for safe ultrasonic cement removal from the humerus were applied, including intermittent delivery of energy and the use of cold irrigation between probe passes. These strategies resulted in markedly lower maximum temperatures in all tissues tested. CONCLUSIONS: Temperatures in the humerus, triceps, and, most importantly, the radial nerve can reach potentially dangerous levels when ultrasound technology is used to remove cement from the humerus. We suggest intermittent cold irrigation of the humeral canal, no tourniquet use, education of surgeons with regard to proper techniques designed to limit heat generation, and consideration of exposure and protection of the radial nerve when ultrasound devices are used.- - - - - - - - - - ranking = 0.053539242849694keywords = fracture (Clic here for more details about this article) |
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