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Anesthesiology and Pain Medicine Dec 2020Ulnar nerve entrapment is a relatively common entrapment syndrome second only in prevalence to carpal tunnel syndrome. The potential anatomic locations for entrapment... (Review)
Review
CONTEXT
Ulnar nerve entrapment is a relatively common entrapment syndrome second only in prevalence to carpal tunnel syndrome. The potential anatomic locations for entrapment include the brachial plexus, cubital tunnel, and Guyon's canal. Ulnar nerve entrapment is more so prevalent in pregnancy, diabetes, rheumatoid arthritis, and patients with occupations involving periods of prolonged elbow flexion and/or wrist dorsiflexion. Cyclists are particularly at risk of Guyon's canal neuropathy. Patients typically present with sensory deficits of the palmar aspect of the fourth and fifth digits, followed by motor symptoms, including decreased pinch strength and difficulty fastening shirt buttons or opening bottles.
EVIDENCE ACQUISITION
Literature searches were performed using the below MeSH Terms using Mendeley version 1.19.4. Search fields were varied until further searches revealed no new articles. All articles were screened by title and abstract. Decision was made to include an article based on its relevance and the list of final articles was approved three of the authors. This included reading the entirety of the artice. Any question regarding the inclusion of an article was discussed by all authors until an agreement was reached.
RESULTS
X-ray and CT play a role in diagnosis when a bony injury is thought to be related to the pathogenesis (i.e., fracture of the hook of the hamate.) MRI plays a role where soft tissue is thought to be related to the pathogenesis (i.e., tumor or swelling.) Electromyography and nerve conduction also play a role in diagnosis. Medical management, in conjunction with physical therapy, shows limited promise. However, minimally invasive techniques, including peripheral percutaneous electrode placement and ultrasound-guided electrode placement, have all been recently studied and show great promise. When these techniques fail, clinicians should resort to decompression, which can be done endoscopically or through an open incision. Endoscopic ulnar decompression shows great promise as a surgical option with minimal incisions.
CONCLUSIONS
Clinical diagnosis of ulnar nerve entrapment can often be delayed and requires the suspicion as well as a thorough neurological exam. Early recognition and diagnois are important for early institution of treatment. A wide array of diagnostic imaging can be useful in ruling out bony, soft tissue, or vascular etiologies, respectively. However, clinicians should resort to electrodiagnostic testing when a definitive diagnois is needed. Many new minimally invasive techniques are in the literature and show great promise; however, further large scale trials are needed to validate these techniques. Surgical options remains as a gold standard when adequate symptom relief is not achieved through minimally invasive means.
PubMed: 34150581
DOI: 10.5812/aapm.112070 -
Current Reviews in Musculoskeletal... Jan 2023Impaction syndromes are frequently a source of ulnar-sided wrist pain and patient disability. Differentiating between these entities can be difficult due to significant... (Review)
Review
PURPOSE OF REVIEW
Impaction syndromes are frequently a source of ulnar-sided wrist pain and patient disability. Differentiating between these entities can be difficult due to significant overlap in their clinical presentations. This manuscript reviews the diagnosis and treatment of three different impaction syndromes: (1) ulnar impaction syndrome, (2) hamate arthrosis lunotriquetral ligament syndrome, and (3) triquetrohamate impaction syndrome.
RECENT FINDINGS
While non-operative treatment is always recommended upon initial presentation, the duration and extent of treatment are poorly defined. Diagnostic wrist arthroscopy usually confirms the clinical diagnosis and facilitates appropriate surgical management. Pain from ulnar impaction syndrome can be effectively treated with an ulnar shortening osteotomy, which unloads the ulnar aspect of the carpus, but complications have been reported secondary to hardware prominence and nonunion at the osteotomy site. Hamate arthrosis lunotriquetral ligament syndrome can be addressed by arthroscopically or openly excising the proximal pole of the hamate, while triquetrohamate impaction syndrome demands a debridement procedure with partial excision of the impinging triquetrum or hamate. In summary, impaction syndromes are underappreciated clinical entities but are known causes of ulnar-sided wrist pain. Maintaining a high index of suspicion will help to expedite appropriate non-operative and operative treatment. Surgical intervention-if needed-is often curative.
PubMed: 36435859
DOI: 10.1007/s12178-022-09809-9 -
Anales Del Sistema Sanitario de Navarra Dec 2016Osteoblastoma is an infrequent primary osseous tumour. Its presentation in the upper extremities and more specifically in the carpal bones is unusual. We present a case...
Osteoblastoma is an infrequent primary osseous tumour. Its presentation in the upper extremities and more specifically in the carpal bones is unusual. We present a case of osteoblastoma localized in the hamate bone and review the treatment realized in this infrequent localization. A young male patient with pain and swelling in the back of his hand of one year’s evolution, resistant to medical treatment. Complementary tests showed lytic tumefaction in the hamate bone with non-aggressive characteristics. It was treated by curettage and filling the iliac crest with autologous graft. The pathological anatomical study diagnosed that it was a case of osteoblastoma. The result was satisfactory, with total disappearance of the pain and a radiological image of complete restitution of the osseous defect, with no signs of recurrence after 4 years. The treatment should be curettage plus autologous graft. Conversely, resection of the affected bone can be considered in cases with aggressive data.
Topics: Adult; Bone Neoplasms; Hamate Bone; Humans; Male; Osteoblastoma
PubMed: 28032879
DOI: 10.23938/ASSN.0246