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Cureus Feb 2024Here, we present a 37-year-old right-handed female patient who presented with increasing paresthesia, tingling, and numbness in the radial palm and lateral three fingers...
Here, we present a 37-year-old right-handed female patient who presented with increasing paresthesia, tingling, and numbness in the radial palm and lateral three fingers of her right hand for six months. Because of the intense wrist discomfort and unilateral involvement, ultrasonography was used to evaluate the patient in addition to a nerve conduction study to exclude secondary causes of carpal tunnel syndrome.
PubMed: 38516461
DOI: 10.7759/cureus.54551 -
Radiology Case Reports Jun 2024Posterior interosseous nerve syndrome (PINs) is a rare nerve compression syndrome that affects the deep branch of the radial nerve in the supinator muscle region. In...
Posterior interosseous nerve syndrome (PINs) is a rare nerve compression syndrome that affects the deep branch of the radial nerve in the supinator muscle region. In this article, we aimed to report a case of a 58-year-old male who had clinical symptoms, electromyographic, ultrasound, and MRI features suggestive of PINs due to compressing the arcade of Frohse. He subsequently underwent surgical correlation at our hospital, and the clinical symptoms were improved significantly.
PubMed: 38515775
DOI: 10.1016/j.radcr.2024.02.090 -
Cureus Feb 2024There are various causes of unilateral finger palsy. Its potential etiologies include peripheral neuropathy, carpal tunnel syndrome, and nerve root disorder due to...
There are various causes of unilateral finger palsy. Its potential etiologies include peripheral neuropathy, carpal tunnel syndrome, and nerve root disorder due to myelopathy. In addition to them, similar paralysis has been reported in localized lesions of the cerebrum, classically referred to as pseudoperipheral palsy. In this report, we describe a case of an 80-year-old man who developed sudden clumsiness of the right fingers. Neurological examination showed muscle weakness mainly in the 1st and 2nd fingers (Medical Research Council grade 1-4) and normal reflexes in the extremities. The affected muscles were innervated by the median nerve, ulnar nerve, and radial nerve, and their nerve root levels ranged from C6 to T1. All the Phalen's, Tinel's, and flick signs were negative. Diffusion-weighted brain magnetic resonance imaging showed hyperintensity limited in the precentral knob on the left precentral gyrus. The etiology was diagnosed as cardiogenic embolism due to atrial fibrillation. In this report, we provide key findings for diagnosing pure motor isolated finger palsy by cerebral infarction through neurological examination.
PubMed: 38505443
DOI: 10.7759/cureus.54390 -
International Journal of Surgery Case... Apr 2024Lipomas are slow growing benign soft tissue tumors that arise from mesenchymal preadipocytes. Histologically they are composed of mature adipocytes. They typically have...
INTRODUCTION & IMPORTANCE
Lipomas are slow growing benign soft tissue tumors that arise from mesenchymal preadipocytes. Histologically they are composed of mature adipocytes. They typically have a shawl like distribution in the body, anywhere from the subcutaneous space to bone, but are seen only rarely in the hand. When >5 cm, they are referred to as 'giant lipoma' and can be symptomatic due to neurovascular compression and impaired hand function.
CASE PRESENTATION
A 51-year-old forensic analyst presented with a progressively enlarging lump over the thenar eminence and palm of his dominant right hand for 2 years duration. Although initially asymptomatic, he developed progressive numbness over the radial 21/2 fingers and impaired hand function due to its size resulting in occupational impairment. Examination revealed a 5x5cm painless lobulated lump over palm. NCS showed evidence of median nerve compression. MR imaging revealed a giant lipoma involving the thenar and midpalmar space. Enbloc surgical excision was performed and histology was confirmatory.
CLINICAL DISCUSSION
Lipomas of the hand could be superficial or deep space. They are slow growing and asymptomatic initially and are brought to attention due to cosmetic concerns, nerve compression or mechanical hand impairment with enlargement. Giant lipomas must be treated with suspicion due to denovo liposarcoma and risk of sarcomatous change.
CONCLUSION
Giant multi-compartment lipomas of the hand are rare. Surgical excision is advocated for suspicion of malignancy, nerve compression and functional limitation. Enbloc resection without fragmentation has minimal risk of recurrence and complications.
PubMed: 38503162
DOI: 10.1016/j.ijscr.2024.109527 -
The Journal of Physiological Sciences :... Mar 2024The purpose of this study was to clarify sex differences in the inhibition of sympathetic vasomotor outflow which is caused by the loading of cardiopulmonary...
The purpose of this study was to clarify sex differences in the inhibition of sympathetic vasomotor outflow which is caused by the loading of cardiopulmonary baroreceptors. Ten young males and ten age-matched females participated. The participants underwent a passive leg raising (PLR) test wherein they were positioned supine (baseline, 0º), and their lower limbs were lifted passively at 10º, 20º, 30º, and 40º. Each angle lasted for 3 min. Muscle sympathetic nerve activity (MSNA) was recorded via microneurography of the left radial nerve. Baseline MSNA was lower in females compared to males. MSNA burst frequency was decreased during the PLR in both males (- 6.2 ± 0.4 bursts/min at 40º) and females (- 6.5 ± 0.4 bursts/min at 40º), but no significant difference was detected between the two groups (P = 0.61). These results suggest that sex has minimal influence on the inhibition of sympathetic vasomotor outflow during the loading of cardiopulmonary baroreceptors in young individuals.
Topics: Humans; Male; Female; Leg; Muscle, Skeletal; Sympathetic Nervous System; Pressoreceptors; Lower Extremity; Blood Pressure; Baroreflex; Heart Rate
PubMed: 38500058
DOI: 10.1186/s12576-024-00909-4 -
Biomedical Optics Express Mar 2024Currently, deep learning-based methods have achieved success in glaucoma detection. However, most models focus on OCT images captured by a single scan pattern within a...
Currently, deep learning-based methods have achieved success in glaucoma detection. However, most models focus on OCT images captured by a single scan pattern within a given region, holding the high risk of the omission of valuable features in the remaining regions or scan patterns. Therefore, we proposed a multi-region and multi-scan-pattern fusion model to address this issue. Our proposed model exploits comprehensive OCT images from three fundus anatomical regions (macular, middle, and optic nerve head regions) being captured by four scan patterns (radial, volume, single-line, and circular scan patterns). Moreover, to enhance the efficacy of integrating features across various scan patterns within a region and multiple regional features, we employed an attention multi-scan fusion module and an attention multi-region fusion module that auto-assign contribution to distinct scan-pattern features and region features adapting to characters of different samples, respectively. To alleviate the absence of available datasets, we have collected a specific dataset (MRMSG-OCT) comprising OCT images captured by four scan patterns from three regions. The experimental results and visualized feature maps both demonstrate that our proposed model achieves superior performance against the single scan-pattern models and single region-based models. Moreover, compared with the average fusion strategy, our proposed fusion modules yield superior performance, particularly reversing the performance degradation observed in some models relying on fixed weights, validating the efficacy of the proposed dynamic region scores adapted to different samples. Moreover, the derived region contribution scores enhance the interpretability of the model and offer an overview of the model's decision-making process, assisting ophthalmologists in prioritizing regions with heightened scores and increasing efficiency in clinical practice.
PubMed: 38495692
DOI: 10.1364/BOE.512138 -
Journal of ISAKOS : Joint Disorders &... Jun 2024Radial nerve entrapment is an uncommon diagnosis. The entrapment can occur at any location within the course of the nerve distribution, but the most frequent location of... (Review)
Review
Radial nerve entrapment is an uncommon diagnosis. The entrapment can occur at any location within the course of the nerve distribution, but the most frequent location of entrapment occurs around the elbow and involves the posterior interosseous nerve. Several potential sites of radial nerve entrapment around the elbow are identified: the capsular tissue of the radiocapitellar joint; hypertrophic crossing branches of leash of henry; the leading proximal tendinous and medial edge of extensor carpi radialis brevis; the arcade of Frohse and distal border of the supinator between its two heads. The arcade of Frohse is the most common site of compression. The aim of this manuscript is to describe the common surgical methods to approach the radial nerve entrapments around the elbow and define the preferred surgical approach based on the site of compression.
Topics: Humans; Radial Nerve; Radial Neuropathy; Nerve Compression Syndromes; Elbow Joint; Elbow; Decompression, Surgical
PubMed: 38453022
DOI: 10.1016/j.jisako.2024.03.001 -
Surgical and Radiologic Anatomy : SRA Apr 2024Anterior compartment muscles of the arm present high morphological variability, with possible clinical significance. The current cadaveric report aims to describe a...
PURPOSE
Anterior compartment muscles of the arm present high morphological variability, with possible clinical significance. The current cadaveric report aims to describe a bilateral four-headed brachialis muscle (BM) with aberrant innervation. Emphasis on the embryological background and possible clinical significance are also provided.
METHODS
Classical upper limb dissection was performed on an 84-year-old donated male cadaver. The cadaver was donated to the Anatomy Department of the National and Kapodistrian University of Athens.
RESULTS
On the left upper limb, the four-headed BM was supplied by the musculocutaneous and the median nerves after their interconnection. On the right upper limb, the four-headed BM received its innervation from the median nerve due to the musculocutaneous nerve absence. A bilateral muscular tunnel for the radial nerve passage was identified, between the BM accessory heads and the brachioradialis muscle.
CONCLUSION
BM has clinical significance, due to its proximity to important neurovascular structures and frequent surgeries at the humerus. Hence, knowledge of these variants should keep orthopedic surgeons alert when intervening in this area. Further dissection studies with a standardized protocol are needed to elucidate the prevalence of BM aberrations and concomitant variants.
Topics: Humans; Male; Aged, 80 and over; Arm; Radial Nerve; Musculocutaneous Nerve; Muscle, Skeletal; Median Nerve; Cadaver
PubMed: 38441620
DOI: 10.1007/s00276-024-03315-y -
The Archives of Bone and Joint Surgery 2024Posterior interosseous nerve (PIN) injury is an uncommon yet debilitating complication following distal bicep tendon repair. There are case reports of acute...
Posterior interosseous nerve (PIN) injury is an uncommon yet debilitating complication following distal bicep tendon repair. There are case reports of acute intraoperative PIN injury related to retractor placement, drill trajectory, and nerve incarceration. We report three cases of delayed PIN neuropathy in the setting of a loose cortical button. All patients had resolution of their pain with removal of the cortical button and decompression of the radial tunnel. The purpose of this case series is to: 1) highlight the possibility of a loose cortical bicep button as the cause of proximal forearm pain and PIN neuropathy in the early or late postoperative timeframe; and 2) emphasize the importance of proper surgical technique and use of intraoperative fluoroscopy to assure the cortical button is well-fixed and flush with the radial shaft. .
PubMed: 38420519
DOI: 10.22038/ABJS.2023.75292.3483 -
Cureus Jan 2024Introduction There is constant debate regarding the best surgical technique for the fixation of shaft humerus fractures. Intramedullary nailing and dynamic compression...
Introduction There is constant debate regarding the best surgical technique for the fixation of shaft humerus fractures. Intramedullary nailing and dynamic compression plating are the most popular surgical options. Materials and methods In our study, we retrospectively analyze the results of 27 patients with shaft humerus fractures managed with intramedullary nailing (10) and dynamic compression plating (17) at our institute from September 2021 to October 2022. Preoperative clinical assessment sheets, postoperative follow-up sheets, operative notes, anesthesia sheets, and preoperative and follow-up radiographs were analyzed. Reamed antegrade nailing was done in all cases, while dynamic compression plating was done through a posterior approach. Results The operative time of the nailing group was 82.1 ± 7.61 mins, which was significantly lesser (P value <0.05) than that of the plating group, which was 119.59 ± 10.16 mins. The intraoperative blood loss of the patients who were managed with nailing was 71 ± 7.38 mL, which was significantly lesser (P value <0.05) than that of the plating group, which was 130.59 ± 11.44 mL. The patients in both groups had a statistically nonsignificant difference in terms of functional results, which were assessed using Rodriguez-Merchan criteria. Complications were similar in both groups with infection (17.65%), and postoperative radial nerve palsy (11.76%) was more common among the patients undergoing plating, and shoulder impingement(20%) was common among those undergoing nailing. Conclusion This study concluded that both surgical options are similar in the case of functional results. The selection of the surgical method should be as per the surgeon's surgical familiarity and personalized to individual patients.
PubMed: 38406053
DOI: 10.7759/cureus.52883