1/5. 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.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/5. 'Neurographic' palmaris brevis sign in type II degrees ulnar neuropathy at wrist.OBJECTIVE: To investigate the source of an unusual and previously unreported volume conducted potential on motor nerve conduction studies. In a case of subacute ulnar neuropathy at wrist (UNW) selectively involving the deep motor branch, we recorded from the hypothenar eminence a large positive wave (2.5 ms-2 mV) preceding the negative takeoff of the delayed distal ulnar motor response. methods: We performed multiple channels motor and sensory ulnar nerve (UN) conduction studies; these included selective electrical stimulation and anaesthetic block of UN branches and also selective recording of motor responses by single fibre needles; data were confirmed by an intraoperative neurophysiological study and correlated with MRI and surgical findings. RESULTS: Detailed neurophysiological investigation demonstrated the generation of this waveform from the palmaris brevis (PB) muscle. MRI and surgical exploration documented a hypertrophy of this muscle. CONCLUSIONS: In type II degrees UNW, depolarization of a spared palmaris brevis muscle may be recorded as a positive wave preceding the delayed abductor digiti minimi motor response. SIGNIFICANCE: We underline the peculiar localizing value of this volume conducted 'meaningful artefact' in that particular setting. It actually represented an early neurographic analogue of what is known as the clinical 'Palmaris Brevis Sign' in long standing type II degrees UNW.- - - - - - - - - - ranking = 1.2keywords = palm (Clic here for more details about this article) |
3/5. Distal ulnar neuropathy in a golf player.A 51-year-old right-handed amateur golfer has developed fasciculations in the left first dorsal interosseous muscle for 3 weeks. He did not have any pain or motor or sensory deficit. The nerve conduction study and electromyography showed that he had mononeuropathy of the deep palmar branch of the ulnar nerve in his left palm. The forceful grasp of golf club handle in the left palm contributes to this rare focal neuropathy. He was advised to change his grip on the golf club, and the symptom resolved almost immediately.- - - - - - - - - - ranking = 0.6keywords = palm (Clic here for more details about this article) |
4/5. Nodular fasciitis of the ulnar nerve at the palm.A 42-year-old woman complained of progressive induration in the right palm. As the mass was impossible to separate from the ulnar nerve, we excised the mass together with the digital nerve and grafted 4cm of the sural nerve. The final diagnosis was nodular fasciitis.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
5/5. Flexor pollicis brevis adductorplasty: an alternative method in ulnar nerve paralysis.Loss of pinch power associated with loss of coordinated movement of thumb and index fingers is the major disability in patients with ulnar nerve paralysis. Several tendon transfer methods utilizing different donor muscles have been used to restore adductor pollicis muscle function in ulnar nerve paralysis. In this paper, we discuss the transfer of flexor digitorum brevis muscle to the tendon of adductor pollicis muscle as an alternative method to restore key pinch in ulnar nerve paralysis. The technique was applied to 4 patients with ulnar nerve paralysis. Before clinical application, an anatomic study was carried out in 6 cadaver hands. In cadavers, radial and ulnar arteries were injected with latex and arterial pedicles of flexor pollicis brevis muscle were dissected under 4x magnification. Also, motor branches from the median nerve were shown at the entrance point to the muscle. In surgical practice, the superficial head of the muscle is detached from its insertion and the minor pedicle of the muscle is cut. Muscle is dissected proximally up to two thirds of its length. The dominant pedicle of the muscle originating from superficial palmar arcus is preserved, and the muscle is sutured to the tendon of the adductor pollicis muscle close to its insertion. patients were evaluated in terms of key pinch strength preoperatively and at the postoperative sixth month using a pinch meter (Chattanooga Group, Inc). Key pinch strengths were recorded and expressed as percentage of the strength of the contralateral uninvolved hand. Mean key pinch strength of our patients was 29.7%.In conclusion, we believe in that flexor pollicis brevis adductorplasty may be an alternative method for restoration of adductor pollicis muscle function in ulnar nerve paralysis.- - - - - - - - - - ranking = 0.2keywords = palm (Clic here for more details about this article) |