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Annals of Plastic Surgery Aug 2023Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome. No previous studies have compared preoperative and follow-up sonoelastography results or... (Comparative Study)
Comparative Study
Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome. No previous studies have compared preoperative and follow-up sonoelastography results or investigated the correlation of median nerve stiffness with the subjective/objective outcomes. Therefore, the aim of this study was to compare the preoperative and postoperative elastography after carpal tunnel release and find the correlation with associated subjective/objective outcomes.From May 2017 to March 2020, 32 patients (6 males, 26 females; 34 hands) with carpal tunnel syndrome were enrolled in this prospective study. Demographic data, QuickDASH score (Chinese version), Boston Carpal Tunnel Questionnaire (Chinese version), nerve conduction velocity/electromyography, and median nerve stiffness by sonoelastography were recorded.Comparisons of preoperative and average sonoelastography findings 1.5 years postoperatively showed a significant decrease in stiffness presented by velocity (Vs) (preoperative Vs, 4.63 ± 1.27 m/s, vs postoperative Vs, 3.39 ± 0.59 m/s; P < 0.001). Changes in subjective functional outcomes also showed the same significant trend. Based on the neurophysiologic study, the improvement of nerve conduction study and elastography have the significant correlation.The same trend of preoperative and postoperative changes in median nerve stiffness and subjective questionnaires/objective neurophysiologic studies may imply that sonoelastography can be used to assess the response to surgery in patients with carpal tunnel syndrome.
Topics: Female; Humans; Male; Asian People; Carpal Tunnel Syndrome; Elasticity Imaging Techniques; Median Nerve; Prospective Studies
PubMed: 37489968
DOI: 10.1097/SAP.0000000000003601 -
The Journal of Hand Surgery Nov 2023The dermatomal distributions of the ulnar and median nerves on the palmar skin of the hand have been studied thoroughly. However, the anatomic course of the median and...
PURPOSE
The dermatomal distributions of the ulnar and median nerves on the palmar skin of the hand have been studied thoroughly. However, the anatomic course of the median and ulnar cutaneous nerve branches and how they supply the skin of the palm is not well understood.
METHODS
The cutaneous branches of the median and ulnar nerves were dissected bilaterally in 9 fresh cadavers injected arterially with green latex.
RESULTS
We observed 3 groups of cutaneous nerve branches in the palm of the hand: a proximal row group consisting of long branches that originated proximal to the superficial palmar arch and reached the distal palm, first web space, or hypothenar region; a distal row group consisting of branches originating between the superficial palmar arch and the transverse fibers of the palmar aponeurosis (these nerves had a longitudinal trajectory and were shorter than the branches originating proximal to the palmar arch); and a metacarpophalangeal group, composed of short perpendicular branches originating on the palmar surface of the proper palmar digital nerves at the web space. The radial and ulnar borders of the hand distal to the palmar arch were innervated by short transverse branches arising from the proper digital nerves of the index and little finger. Nerve branches did not perforate the palmar aponeurosis in 16 of 18 cases.
CONCLUSIONS
The palm of the hand was consistently innervated by 20-35 mm long cutaneous branches originating proximal to the palmar arch and shorter branches originating distal to the palmar arch. These distal branches were either perpendicular or parallel to the proper palmar digital nerves.
CLINICAL RELEVANCE
Transfer of long proximal row branches may present an opportunity to restore sensibility in nerve injuries.
Topics: Humans; Ulnar Nerve; Hand; Fingers; Peripheral Nerves; Median Nerve; Ulnar Artery; Cadaver
PubMed: 35641387
DOI: 10.1016/j.jhsa.2022.03.021 -
Journal of Visualized Experiments : JoVE Oct 2022The use of neuromuscular ultrasound greatly enhances the evaluation of carpal tunnel syndrome as an adjunct diagnostic tool as it provides dynamic and structural...
The use of neuromuscular ultrasound greatly enhances the evaluation of carpal tunnel syndrome as an adjunct diagnostic tool as it provides dynamic and structural information about the median nerve and its surrounding anatomy. Neuromuscular ultrasound aids in diagnostic accuracy (when used with electrodiagnostic testing) and offers etiologic information as a non-invasive, painless, cost-effective, and radiation-free imaging technology that can be easily carried out at the bedside for immediate interpretation. Neuromuscular ultrasound has the limitation of subjectivity, and the need for training and experience will affect the interpretation of results. This article describes a basic practical guide to visualizing the median nerve using neuromuscular ultrasound in a step-by-step manner to aid in the evaluation of carpal tunnel syndrome. Even though the use of ultrasound in the assessment of median nerve entrapment has been long established, there has been no recognized standard protocol. The present protocol aims to provide clear and concise instructions to describe a standard technique to visualize the median nerve through diagnostic ultrasound.
Topics: Humans; Median Nerve; Carpal Tunnel Syndrome; Wrist; Ultrasonography
PubMed: 36342145
DOI: 10.3791/63982 -
Median Nerve Recovery and Morphological Change on MRI at 24 Months after Open Carpal Tunnel Release.The Journal of Hand Surgery... Apr 2023This study aimed to investigate the relationship between postoperative clinical results and long-term morphological changes in patients with carpal tunnel syndrome...
This study aimed to investigate the relationship between postoperative clinical results and long-term morphological changes in patients with carpal tunnel syndrome (CTS) as observed on magnetic resonance imaging (MRI) before and after open carpal tunnel release (OCTR). We retrospectively analysed data for 28 hands that had undergone OCTR with at least 24 months of follow-up data. Two-point discrimination (2PD) test results were examined for the first three fingers, as were the distal motor latency (DML) and sensory conduction velocity (SCV) of the median nerve. We also calculated the cross-sectional area (CSA) of the carpal tunnel and the distance from the median nerve to the volar carpal bone at the hamate and the pisiform levels using MRI images. Variables were compared before and 24 months after OCTR. Significant improvements in all variables were observed, including average 2PD scores (Finger I: 13.1 ± 6.2 vs. 7.7 ± 4.3, < 0.01, Finger II: 11.9 ± 6.6 vs. 7.0 ± 3.5, < 0.01, Finger III: 13.6 ± 6.1 vs. 7.8 ± 4.5, < 0.01), average DML (8.3 ± 3.3 vs. 4.3 ± 0.6 m/s, < 0.01), average SCV (30.8 ± 11.0 vs. 41.3 ± 5.3 m/s, < 0.01), CSA of the carpal tunnel (hamate level: 194.9 ± 30.6 vs. 254.2 ± 47.6 mm, < 0.01, pisiform level: 244.2 ± 46.5 vs. 274.7 ± 75.1 mm, = 0.01) and the distance between the median nerve and volar carpal bone (hamate level: 8.7 ± 1.4 vs. 11.2 ± 1.6 mm, < 0.01, pisiform level: 11.8 ± 1.7 vs. 13.8 ± 2.5 mm, < 0.01). Our results demonstrate that OCTR is successful in achieving long-term decompression and recovery of the median nerve in patients with CTS. Level III (Therapeutic).
Topics: Humans; Carpal Tunnel Syndrome; Magnetic Resonance Imaging; Median Nerve; Retrospective Studies; Wrist
PubMed: 37120302
DOI: 10.1142/S2424835523500212 -
The Journal of the American Academy of... Sep 2017Annually, carpal tunnel release is one of the most commonly executed orthopaedic procedures. Despite the frequency of the procedure, complications may occur as a result... (Review)
Review
Annually, carpal tunnel release is one of the most commonly executed orthopaedic procedures. Despite the frequency of the procedure, complications may occur as a result of anatomic variations. Understanding both normal and variant anatomy, including anomalies in neural, vascular, tendinous, and muscular structures about the carpal tunnel, is fundamental to achieving both safe and efficacious surgery. Reviewing and aggregating this information reveals certain principles that may lead to the safest possible surgical approach. Although it is likely that no true internervous plane or so-called safe zone exists during the approach for carpal tunnel release, the long-ring web space axis does appear to pose the lowest risk to important structures.
Topics: Arteries; Carpal Tunnel Syndrome; Decompression, Surgical; Hand; Humans; Median Nerve; Postoperative Complications; Tendons; Wrist
PubMed: 28837460
DOI: 10.5435/JAAOS-D-16-00038 -
Clinical Rheumatology Apr 2015Lipofibromatous hamartoma is an uncommon benign tumor, usually unknown or misdiagnosed. We report the case of a 61-year-old patient presenting an acquired painful...
Lipofibromatous hamartoma is an uncommon benign tumor, usually unknown or misdiagnosed. We report the case of a 61-year-old patient presenting an acquired painful macrodactyly of the left thumb with paresthesia in the median nerve territory. Clinical examination reveals a tumefaction of the volar side of the wrist. She had a medical history of amputation of the forefinger for macrodactyly without any diagnosis. Paraclinical exploration guided us to the correct diagnosis; hypertrophic bone structures of the affected finger were detected on radiographs. The left median nerve appeared hypertrophic, with a fatty infiltration on the ultrasound exploration. These pathological findings revealed a late discovered lipofibromatous hamartoma of the median nerve, a rare entity often associated with macrodactyly and diagnosed in childhood. Therefore, we retrospectively made the same diagnosis for the amputated index finger with the analysis of her ancient paraclinical exams. Lipofibromatous hamartoma remains an obscure pathology and its treatment stays controversial.
Topics: Amputation, Surgical; Female; Fingers; Hamartoma; Humans; Limb Deformities, Congenital; Median Nerve; Middle Aged; Peripheral Nervous System Neoplasms; Radiography; Recurrence; Ultrasonography
PubMed: 24687379
DOI: 10.1007/s10067-014-2580-8 -
Journal of Visualized Experiments : JoVE Apr 2020The main goal of this investigation is to show how to create and repair different types of median nerve (MN) lesions in the rat. Moreover, different methods of...
The main goal of this investigation is to show how to create and repair different types of median nerve (MN) lesions in the rat. Moreover, different methods of simulating postoperative physiotherapy are presented. Multiple standardized strategies are used to assess motor and sensory recovery using an MN model of peripheral nerve lesion and repair, thus permitting easy comparison of the results. Several options are included for providing a postoperative physiotherapy-like environment to rats that have undergone MN injuries. Finally, the paper provides a method to evaluate the recovery of the MN using several noninvasive tests (i.e., grasping test, pin prick test, ladder rung walking test, rope climbing test, and walking track analysis), and physiological measurements (infrared thermography, electroneuromyography, flexion strength evaluation, and flexor carpi radialis muscle weight determination). Hence, this model seems particularly appropriate to replicate a clinical scenario, facilitating extrapolation of results to the human species. Although the sciatic nerve is the most studied nerve in peripheral nerve research, analysis of the rat MN presents various advantages. For example, there is a reduced incidence of joint contractures and automutilation of the affected limb in MN lesion studies. Furthermore, the MN is not covered by muscle masses, making its dissection easier than that of the sciatic nerve. In addition, MN recovery is observed sooner, because the MN is shorter than the sciatic nerve. Also, the MN has a parallel path to the ulnar nerve in the arm. Hence, the ulnar nerve can be easily used as the nerve graft for repairing MN injuries. Finally, the MN in rats is located in the forelimb, akin to the human upper limb; in humans, the upper limb is the site of most peripheral nerve lesions.
Topics: Action Potentials; Animals; Forelimb; Hand Strength; Median Nerve; Motor Activity; Muscles; Myography; Nerve Regeneration; Nociception; Physiology; Rats, Wistar; Recovery of Function; Temperature; Thermography; Walking
PubMed: 32364547
DOI: 10.3791/59767 -
Folia Morphologica 2018Communications between the median, ulnar and musculocutaneous nerves in the arm, forearm and hand were reported in adult cadaveric and electrophysiological studies....
BACKGROUND
Communications between the median, ulnar and musculocutaneous nerves in the arm, forearm and hand were reported in adult cadaveric and electrophysiological studies. These communicant branches may lead conflicting clinical and electrodiagnostic outcomes. While there are many studies on adult patients or cadavers, there is poor regarding foetuses. The present study was conducted to examine the frequencies of these communications and their coexistences in human foetuses.
MATERIALS AND METHODS
Anterior aspect of the forearms of 50 foetuses (29 females, 20 males, and 1 unknown) were dissected bilaterally (totally 100 sides) for this purpose.
RESULTS
Communications between the median and the musculocutaneous nerves in the arm were found unilaterally in 4%. Communications from the median to the ulnar nerve in the forearm were encountered unilaterally in 22%, and bilaterally in 12%; from the ulnar to the median nerve in the hand unilaterally in 28%, and bilaterally in 12%. Coexistence of all these variations was not encountered in any foetus. But coexistence of two different types of communicant branch was encountered in 4%.
CONCLUSIONS
Precise knowledge of nerve communications, variations and rate of coexistences in foetuses may have significance for clinicians and researchers dealing with subjects in foetal period.
Topics: Female; Fetus; Humans; Male; Median Nerve; Musculocutaneous Nerve; Ulnar Nerve
PubMed: 29131277
DOI: 10.5603/FM.a2017.0107 -
Anaesthesia, Critical Care & Pain... Apr 2021Radial artery is a common site of cannulation in acute care setting. There are conflicting reports as to which nerve, radial or median or both supplies the radial...
BACKGROUND AND AIMS
Radial artery is a common site of cannulation in acute care setting. There are conflicting reports as to which nerve, radial or median or both supplies the radial artery. We did this prospective study in patients undergoing minor procedures under peripheral nerve blocks to ascertain which nerve block, radial or median increases the cross sectional area and blood flow in the radial artery.
METHODS
Ninety ASA I/II patients undergoing upper limb minor surgeries under various blocks (radial or median or radial + median nerve) were enrolled in this study. Patients in group R were those who received Ultrasound-guided (USG) radial nerve block, group M median nerve block while group MR received both the nerve blocks. The primary objective was to assess the increase in cross sectional area (CSA) of radial artery in the groups after the block. Secondary objectives included assessment of time average maximum velocity (TAMAX) and blood volume (BV) after the block.
RESULTS
The CSA, TAMAX and BV of radial artery increased in all the three groups. Within each group the difference between the preblock and postblock parameters were highly significant. However, the differences are greater in groups M and M + R than in group R; (P < 0.001).
CONCLUSION
Ultrasound-guided median nerve block causes arterial vasodilation, and an increase in radial artery blood flow velocity. There was no added benefit of radial block along with median block in increasing the blood flow further.
Topics: Humans; Median Nerve; Nerve Block; Peripheral Nerves; Prospective Studies; Radial Artery; Ultrasonography, Interventional
PubMed: 33744492
DOI: 10.1016/j.accpm.2021.100831 -
Surgical and Radiologic Anatomy : SRA Nov 2022The purpose of this study is to characterize the division of the median nerve by the persistent median artery (PMA) and highlight the associated clinical implications....
PURPOSE
The purpose of this study is to characterize the division of the median nerve by the persistent median artery (PMA) and highlight the associated clinical implications. Penetration of the median nerve by the PMA is believed to cause compression of the median nerve and affect nerve conduction velocity. This paper explored whether the origin and the pattern of PMA dictate its ability to divide the median nerve.
METHODS
Origin, and relationship of the PMA to the median nerve were documented in 60 cadavers donated to the Human Anatomy Program at UT Health San Antonio. Entire path of this artery was followed in the forearm and the hand.
RESULTS
Twenty-five cases of a persistent median artery (PMA) were found in the upper limbs (20.83%; 25/120) of these donated cadavers. Most of the persistent median arteries originated from the ulnar artery (48%; 12/25) and the others originated either from the anterior interosseous artery (36%; 9/25) or from the common interosseous artery (16%; 4/25). Sixty percent (15/25) of the persistent median arteries penetrated and divided the median nerve in the forearm. Interestingly, all the persistent median arteries that originated from the ulnar artery (100%; 12/12) divided the median nerve in the forearm and a palmar type of PMA was found to be more likely to divide the median nerve.
CONCLUSION
Clinicians performing surgeries in the forearm and hand need to be aware of this anomaly and should screen patients for the presence of this artery prior to surgical intervention.
Topics: Humans; Median Nerve; Forearm; Ulnar Artery; Hand; Cadaver
PubMed: 36280597
DOI: 10.1007/s00276-022-03035-1