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1/64. 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. ( info)

2/64. The double-crush phenomenon--an unusual presentation and literature review.

    The double-crush syndrome was initially described by Upton and McComas in 1973. They postulated that nonsymptomatic impairment of axoplasmic flow at more than one site along a nerve might summate to cause a symptomatic neuropathy. This was suggested by their clinical observation that the majority of their patients had a median or ulnar neuropathy associated with evidence of cervicothoracic root lesions. They also hypothesized that one of the constraints on axoplasmic flow could be a metabolic neuropathy, and this is supported by the high association of diabetes and carpal tunnel syndrome. Other researchers have since reported series of patients supporting the frequent association of a proximal and distal nerve compression syndrome, including carpal tunnel syndrome associated with cervical radiculopathy, brachial plexus compression, and diabetic neuropathy. Subsequently, MacKinnon and Dellon have expanded the description of this syndrome to include a) multiple anatomic regions along a peripheral nerve, b) multiple anatomic structures across a peripheral nerve within an anatomic region, c) superimposed on a neuropathy, and d) combinations of the above. We present an unusual case of symptomatic nerve compression caused by two nonanatomic structures within an anatomic region. ( info)

3/64. Defending negligence claims.

    When a surgical patient suffers injury away from the operative site, an inference is raised that care has fallen below a reasonable standard in the operating room. This was the central issue in Robertson v Hospital Corporation of America, a 'positioning' case heard in 1995 that should interest perioperative nurses and place further expert opinion in the operating room arena. The previous year, a united states court accepted expert evidence that the 'ultimate' responsibility for protection against ulnar nerve injury during a bilateral mastectomy lay with the anaesthetist. ( info)

4/64. Tardy ulnar tunnel syndrome caused by Galeazzi fracture-dislocation: a neuropathy with a new pathomechanism.

    We present a case of late-onset ulnar tunnel syndrome following a Colles fracture. The nerve palsy was caused by a vascular branch that stretched over the ulnar head, compressing the nerve and generating friction against the ulnar head when the forearm was rotated. This is the first report of such a pathomechanism. ( info)

5/64. Compression of the ulnar nerve in Guyon's canal by uremic tumoral calcinosis.

    We describe the case of a 70-year-old woman with chronic renal failure on haemodialysis presenting with an ulnar nerve compression in Guyon's canal secondary to uremic tumoral calcinosis. Excision of calcium deposits and external neurolysis of the ulnar nerve were successfully performed. Simultaneously, the hyperphosphatemia and hypercalcemia were corrected. The pathogenesis of this condition is different from primary tumoral calcinosis. Clinical and radiological features and therapy are discussed. Uremic tumoral calcinosis is an unusual etiology of ulnar nerve compression in Guyon's canal not previously reported in dialysis patients. ( info)

6/64. ulnar nerve compression at the wrist by a synovial cyst successfully treated with percutaneous puncture and corticosteroid injection.

    A case of ulnar nerve palsy due to a conduction block in the deep motor branch at the wrist is reported. The cause was a rapidly growing synovial cyst. ultrasonography and computed tomography were performed to determine the exact location of the cyst, which was punctured and injected with corticosteroid. Function promptly returned to normal after this procedure. ( info)

7/64. 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. ( info)

8/64. ulnar nerve compression secondary to ulnar artery true aneurysm at Guyon's canal.

    This article presents a case of ulnar nerve compression at the Guyon's canal caused by a true aneurysm of the ulnar artery secondary to blunt trauma. The duration of follow-up was one year. SETTING: Hospitalized care. A 27-year-old man who worked in an office fell on to a gravel path landing on his out-stretched right hand. decompression of the ulnar nerve was made by simple ligation of the damaged artery and resection of aneurysm. MEASURES: Histological examination. The sensory symptoms disappeared two days after the operation. At one year after surgery, the patient was completely asymptomatic. There was no residual cold intolerance. Simple ligation of the damaged artery and resection of aneurysm resulted satisfactory. It seemed to be a safe method in this case. ulnar nerve compression due to a true aneurysm of the ulnar artery in the Guyon's canal is rarely described in the literature. ( info)

9/64. Ulnar neuropathy caused by a lipoma in Guyon's canal--case report.

    A 74-year-old female presented with a 3-month history of compression neuropathy of the right ulnar nerve in Guyon's canal. magnetic resonance imaging and ultrasonography revealed the location of the mass lesion. Surgical exploration discovered a lipoma pressing against both the ulnar nerve and the ulnar artery. The mass was extirpated. The postoperative course was uneventful with good function recovery. ( info)

10/64. Atypical compression of the deep branch of the ulnar nerve in Guyon's canal by a ganglion. Case report.

    A 61-year-old woman with an ulnar claw-finger deformity but no sensory loss had a cystic lesion excised from Guyon's canal. The ganglion was in zone 1 of the canal, which is associated with both motor and sensory deficit, but on this occasion it caused motor dysfunction alone. ( info)
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