1/12. Ulnar conduction block at the wrist.Two cases of ulnar nerve lesions at the wrist are reported. The lesions had an acute onset and exclusively impaired the ulnar motor deep branch. The coexistence of carpal tunnel syndrome in each case allowed an early diagnosis but was somewhat misleading. In both cases, the use of classic motor and sensory conduction studies did not provide clear abnormalities that would have precisely determined the site of the nerve lesion. In both cases, only palmar stimulation of the ulnar motor deep branch showed an important conduction block. This electrodiagnostic finding showed definitively the site of the ulnar nerve lesion at the wrist and excluded proximal ulnar nerve lesions or C8-T1 radiculopathy. In both cases recovery occurred without surgery.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/12. ulnar nerve compression by an anomalous muscle following carpal tunnel release: a case report.We describe the acute development of ulnar nerve compression following carpal tunnel release in a patient with an accessory palmaris longus muscle. Although anomalous muscles in the wrist are relatively common and may produce ulnar nerve compression, this particular occurrence following carpal tunnel release has not been previously described in the literature. We theorize that the compression of the ulnar nerve proximal to Guyon's canal was caused by increased tension along the long axis of the anomalous accessory palmaris longus muscle as a consequence of transverse carpal ligament division.- - - - - - - - - - ranking = 2keywords = palm (Clic here for more details about this article) |
3/12. 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 = 4keywords = palm (Clic here for more details about this article) |
4/12. ulnar nerve entrapment in Guyon's tunnel by an anomalous palmaris longus muscle with a persisting median artery.A case of ulnar nerve entrapment in Guyon's tunnel caused by an aberrant palmaris muscle, associated with a patent median artery and duplication of the median nerve, is reported.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
5/12. Handlebar palsy--a compression syndrome of the deep terminal (motor) branch of the ulnar nerve in biking.We describe 3 patients who developed a severe palsy of the intrinsic ulnar supplied hand muscles after bicycle riding. Clinically and electrophysiologically all showed an isolated lesion of the deep terminal motor branch of the ulnar nerve leaving the hypothenar muscle and the distal sensory branch intact. This type of lesion at the canal of Guyon is quite unusual, caused in the majority of cases by chronic external pressure over the ulnar palm. In earlier reports describing this lesion in bicycle riders, most patients experienced this lesion after a long distance ride. Due to the change of riding position and shape of handlebars (horn handle) in recent years, however, even a single bicycle ride may be sufficient to cause a lesion of this ulnar branch. Especially in downhill riding, a large part of the body weight is supported by the hand on the corner of the handlebar leading to a high load at Guyon's canal. As no sensory fibres are affected, the patients are not aware of the ongoing nerve compression until a severe lesion develops. Individual adaptation of the handlebar and riding position seems to be crucial for prevention of this type of nerve lesion.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
6/12. Anomalous flexor digiti minimi brevis in Guyon's canal.In an adult male cadaver, the flexor digiti minimi brevis, a muscle of the hypothenar eminence, was found to arise from the superficial transverse septum (between the superficially placed flexor carpi ulnaris, palmaris longus, and flexor carpi radialis muscles, and the deeply placed flexor digitorum superficialis muscle) in the distal fourth of the flexor aspect of the left forearm. The muscle exhibited two strata of muscle fibers at its origin. The superficial stratum was a thin layer of transversely running fibers confined to the forearm, which has not been previously reported. The deep stratum, a thick layer of longitudinally running fibers, formed the bulk of the muscle. It traversed Guyon's canal superficial to the ulnar nerve and vessels to reach the hypothenar eminence. Its course through Guyon's canal could be a cause for ulnar tunnel syndrome. The ulnar nerve trunk innervated not only the anomalous flexor digiti minimi brevis muscle, but also abductor digiti minimi and palmaris brevis. This may be due to the common phylogeny of these three muscles from the same muscle mass.- - - - - - - - - - ranking = 2keywords = palm (Clic here for more details about this article) |
7/12. ulnar nerve stimulation at the palm in diagnosing distal ulnar nerve entrapment.Distal entrapment of the ulnar nerve at the wrist and hand (Guyon's syndrome) is a relatively uncommon condition. It may present with a confusing permutation of sensory and motor symptoms, depending on which branches of the ulnar nerve are involved Electrodiagnostic test procedures are often helpful in sorting out this quandary. Electrophysiologic studies that include electrical stimulation of the nerve at the palm, in addition to stimulation of the ulnar nerve at other locations, are useful in demonstrating the focal nerve conduction abnormality that is involved in the entrapment. Sensory and motor recordings from palmar stimulation of the ulnar nerve are not technically difficult procedures, and can be performed routinely.- - - - - - - - - - ranking = 6keywords = palm (Clic here for more details about this article) |
8/12. Bilateral median and ulnar neuropathy at the wrist in a parquet floorer.Many cases of work related compression neuropathy of the ulnar and median nerves at the wrist have been described. This report presents a case of bilateral distal neuropathy of the median and ulnar nerves in a parquet floorer, who laid wooden block flooring by hand and used the palms and volar surface of both hands to hit the blocks into place. He also used an electric sander and polisher. Bilateral numbness and paraesthesias in all fingers had been present for about one year. Clinical examination was normal; the neurological assessment indicated slight impairment in response to tactile, heat, and pain stimuli in all 10 fingers. Electroneurography showed increased distal motor latencies of median and ulnar nerves at both wrists, although the lower limbs were normal. The results of blood, urine, and instrumental tests excluded systemic disease or local factors that could cause compression neuropathy. After stopping work for three months, the clinical picture and electroneurographic results improved. These data support the hypothesis that the damage to the median and ulnar nerves had been caused by the patient's way of working, which provoked repeated bilateral microtrauma to his wrists. To diagnose work related multiple neuropathy can be difficult and an accurate work history is necessary. Preventive measures and diligent health care are required for this category of worker.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
9/12. MR demonstration of an anomalous muscle in a patient with coexistent carpal and ulnar tunnel syndrome. Case report and literature summary.An aberrant muscle is demonstrated by magnetic resonance (MR) imaging in a patient presenting with focal wrist swelling and compression neuropathy of median and ulnar nerves following 4 months of carpentry work. The muscle originated from the palmaris longus tendon and ulnar antebrachial fascia at the lower half of the forearm as a single belly, then diverged medially from palmaris longus tendon and bifurcated. Both portions of the split muscle extended into the distal ulnar tunnel or Guyon's canal. One segment joined with the abductor digiti minimi muscle and the other with the flexor retinaculum. MR was able to clearly delineate this hypertrophied, symptomatic muscle anomaly. It may be helpful when mass effect is suspected in either tunnel, or in patients with atypical work-related carpal tunnel syndrome with evidence of significant ulnar neuropathy for evaluation of underlying anomalous musculature. Normal MR images of the wrist are included for comparison and the literature is reviewed.- - - - - - - - - - ranking = 2keywords = palm (Clic here for more details about this article) |
10/12. Lumbrical-interossei motor studies localize ulnar neuropathy at the wrist.ulnar nerve entrapment at the wrist (UNW) is uncommon and often difficult to localize electrophysiologically. The difference between the motor latencies to the median-innervated second lumbrical (2L) and ulnar-innervated palmar interosseous (Pl) (Diff 2L-Pl) has been shown to be of localizing value in patients with median neuropathy at the wrist. In the last year, we evaluated 2 patients with clinically definite ulnar neuropathy at the wrist. We performed motor studies to the 2L-Pl on the 2 patients and 12 disease controls with ulnar neuropathy at the elbow as follows: Using the same electrodes to record both the 2L and Pl, the median and ulnar nerves were each stimulated supramaximally above the wrist using identical distances. In the disease control subjects, the Diff 2L-Pl was essentially the same as normal controls (mean [0.13], range [(-0.3)-0.4]). In both patients with UNW, the Diff 2L-Pl clearly supported the routine electrophysiological studies in localizing the lesion (ulnar latencies were 1.1 and 1.8 ms longer than the median latencies). We conclude that the lumbrical-interosseous latency difference is useful in localizing ulnar nerve entrapment to the wrist.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
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