• Archives of Plastic Surgery
• /
• v.37 no.6
• /
• pp.815-818
• /
• 2010

Purpose: Soft tissue chondroma is a rare benign tumor, found mainly on the palm and sole and grows slowly. Typically, mature hyaline cartilage is the dominant pathological feature. There are reports that assert soft tissue chondromas to be a cause of median nerve entrapment syndrome. However, this is the first case report showing soft tissue chondroma to be a cause of simultaneous median and ulnar neuropathy. Methods: A 62 year-old woman presented with chief complaints of numbness and hypoesthesia of her right palm for 4 to 5 years, and a palpable mass on her right palm that had been increasing in size slowly for 3 years. Physical examination revealed a firm, mobile, non-tender and about $3{\times}3\;cm^2$ sized mass in the center of the right palm. Electromyography showed entrapment neuropathy of the median and ulnar nerve. Ultrasonography showed an approximately $5.7\;cm^2$ mass below the flexor tendon of ring finger. Upon surgical excision, a $3{\times}3\;cm^2$ mass attached to the flexor digitorum profundus of ring finger and redness and hypertrophy of both the median and ulnar nerve were discovered. Mass excision was performed gently and the specimen was referred for histopathologic study. Mass excision resulted in median and ulnar nerve release. Results: The pathology report confirmed the mass to be a soft tissue chondroma with mature hyaline cartilage. The patient exhibited post-operative improvement of her symptoms and did not show any complications. Conclusion: This is the first case report showing soft tissue chondroma to be a cause of simultaneous median and ulnar neuropathy.

• Archives of Plastic Surgery
• /
• v.37 no.1
• /
• pp.95-98
• /
• 2010

Purpose: One of the most common cause of upper extremity lymphedema is breast cancer surgery. We experienced the nerve entrapment syndrome which was associated with postmastectomy lymphedema. To the best of our knowledge, this is the first case report of lymphedema induced nerve entrapment syndrome on upper extremity in Korea. Methods: A 54-year-old woman presented with a tingling sensation on her right hand, which had been present for 1 year. On her history, she had a postmastectomy lymphedema on her right upper extremity for 20 years. Initial electromyography (EMG) showed that the ampulitude of the median, ulnar, and dorsal ulnar cutaneous nerve were decreased, and conduction block was also seen in median nerve across the wrist. In needle EMG, incomplete interference patterns were observed in the muscles innervated by median and ulnar nerves. In conclusion, electrophysiologic study and clinical findings suggested right median and ulnar neuropathy below the elbow. Therefore, we performed surgical procedures, which were release of carpal tunnel, Guyon's canal, and cubital tunnel. Results: The postoperative course was uneventful until the first two years. The tingling sensation and claw hand deformity were improved, however, the motor function decreased progressively. In 7 years after the operation, patient could not flex her wrist and thumb sufficiently. EMG which was performed recently showed that ulnar motor response was of low ampulitude. Moreover, median, ulnar, dorsal ulnar cutaneous, lateral antecubital cutaneous and median antebrachial cutaneous sensory response were unobtainable. Abnormal spontaneous activities were observed in upper arm muscles. In conclusion, multiple neuropathies were eventually developed at above elbow level. Conclusion: On treating nerve entrapments associated with lymphedema, medical professionals should be fully aware of the possibility of unpredictable results after the surgery, because of the pathophysiologic traits of chronic lymphedema.

• Journal of Korean Neurosurgical Society
• /
• v.55 no.3
• /
• pp.148-151
• /
• 2014

Objective : Posture-induced radial neuropathy, known as Saturday night palsy, occurs because of compression of the radial nerve. The clinical symptoms of radial neuropathy are similar to stroke or a herniated cervical disk, which makes it difficult to diagnose and sometimes leads to inappropriate evaluations. The purpose of our study was to establish the clinical characteristics and diagnostic assessment of compressive radial neuropathy. Methods : Retrospectively, we reviewed neurophysiologic studies on 25 patients diagnosed with radial nerve palsy, who experienced wrist drop after maintaining a certain posture for an extended period. The neurologic presentations, clinical prognosis, and electrophysiology of the patients were obtained from medical records. Results : Subjects were 19 males and 6 females. The median age at diagnosis was 46 years. The right arm was affected in 13 patients and the left arm in 12 patients. The condition was induced by sleeping with the arms hanging over the armrest of a chair because of drunkenness, sleeping while bending the arm under the pillow, during drinking, and unknown. The most common clinical presentation was a wrist drop and paresthesia on the dorsum of the 1st to 3rd fingers. Improvement began after a mean of 2.4 weeks. Electrophysiologic evaluation was performed after 2 weeks that revealed delayed nerve conduction velocity in all patients. Conclusion : Wrist drop is an entrapment syndrome that has a good prognosis within several weeks. Awareness of its clinical characteristics and diagnostic assessment methods may help clinicians make diagnosis of radial neuropathy and exclude irrelevant evaluations.

• The Journal of Korean Orthopaedic Ultrasound Society
• /
• v.1 no.2
• /
• pp.128-133
• /
• 2008

Nerve compression is caused by external force or internal pathology, which symptom develops along nerve distribution. There are median, ulnar and radial nerve compression neuropathies below elbow. Carpal tunnel syndrome at the flexor retinaculum is most common among all the entrapment neuropathies. Other causes of median nerve neuropathy include Struther's ligament, biceps aponeurosis, pronator teres, FDS aponeurosis and aberrant muscles, which induce pronator syndrome or anterior interosseous nerve syndrome. Ulnar nerve can be compressed at the elbow by arcade of Struther, medial epicondylar groove, FCU two heads, which develops cubital tunnel syndrome, at the wrist by ganglion, fracture of hamate hook and vascular problem, which develops Guyon's canal syndrome. Radial tunnel syndrome is caused by supinator muscle, which compresses its deep branch. Treatment is conservative at initial stage like NSAID, night splint or steroid injection. If symptom persists, operative treatment should be considered after electrodiagnostic or imaging studies.

• Archives of Hand and Microsurgery
• /
• v.23 no.4
• /
• pp.267-270
• /
• 2018

Recurrent motor branch entrapment syndrome is a compressive mononeuropathy of recurrent motor branch of median nerve. It is a rare condition as a cause of thenar muscle wasting and may have different pathogenesis. If such an anatomical variation is the cause, there is a possibility that thenar muscle atrophy remains if only the transcarpal ligament release is performed. We report a 25-year-old male patient with carpal tunnel syndrome with thenar muscle wasting 1 month ago.

• Archives of Plastic Surgery
• /
• v.38 no.1
• /
• pp.117-120
• /
• 2011

Purpose: Carpal tunnel syndrome is the most common peripheral compressive neuropathy. Most cases are idiopathic, but rarely carpal tunnel syndrome can be associated with a ganglionic mass. We report our recently encountered experience of surgical treatment of carpal tunnel syndrome caused by a simple ganglionic mass. Methods: A 53-year-old man presented with chief complaints of numbness and hypoesthesia of his left palm, thumb, index finger, long finger, and ring finger of one and half month duration. Physical examination revealed positive Tinnel's sign without previous trauma, infection or any other events. Electromyography showed entrapment neuropathy of the median nerve. Magnetic resonance imaging (MRI) showed an approximately 2.0 cm-sized mass below the transverse carpal ligament. Upon surgical excision, a $1{\times}1.5cm^2$ mass attached to the perineurium of the median nerve and synovial sheath of the flexor digitorum superficialis and redness and hypertrophy of the median nerve were discovered. With surgical intervention, we completely removed the ganglionic mass and performed surgical release of the transverse carpal ligament. Results: The pathology report confirmed the mass to be a ganglion. The patient exhibited post-operative improvement of his symptoms and did not show any complications. Conclusion: We present a review of our experience with this rare case of carpal tunnel syndrome caused by a ganglionic mass and give a detailed follow-up on the patient treated by surgical exploration with carpal tunnel release.

• Clinical Pain
• /
• v.20 no.1
• /
• pp.20-24
• /
• 2021

In this case report, we present a rare case of lipoma of the tendon sheath localized to the wrist which caused median entrapment neuropathy and was successfully treated with surgical excision. Dynamic examination using ultrasonography revealed the exact location of the lipoma. Electrodiagnostic study (EDX) was done before surgery to elucidate combined neuropathy, and surgery for ulnar neuropathy around elbow was also performed simultaneously. Diagnostic ultrasound can be used for dynamic examinations with real-time visualization.

• Korean Journal of Clinical Laboratory Science
• /
• v.37 no.3
• /
• pp.212-215
• /
• 2005

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in clinical practice, with a 0.1% life time risk in the general population. Conventional neurophysiological studies have been useful in the diagnosis of this condition, as have a number of more specialized procedures. Therefore, we evaluated the diagnostic sensitivities of several parameters in nerve conduction technique for CTS patients. We analyzed 100 patients (159 hands) who were diagnosed with CTS clinically and electrophysiolosically. Median motor and sensory nerve conduction velocities (MCV and SCV) with wrist, palm, and finger stimulation were performed in traditional methods. Sensitivities of each test were calculated and compared to normal control data. The sensitivities of existing nerve conduction method were noted in terminal latency on median nerve, 2nd finger-wrist segment, 3rd finger-wrist segment, palm-wrist segment and distoproximal ratio, as 72.96%, 92.45%, 94.34%, 94.97%, and 97.48%, respectively. In the early course of CTS, sensory nerve conductions in the median nerve are more valuable than motor nerve conduction. Sensory nerve conductions are usually affected before motor nerve conductions in CTS. In this study, we detected that slowing of median SCV was the most frequent in the distoproximal ratio.

• Journal of Medicine and Life Science
• /
• v.15 no.2
• /
• pp.101-104
• /
• 2018

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by focal compression of the median nerve in the carpal tunnel. However, many patients with CTS, who are diagnosed clinically and confirmed with electrophysiological studies, complain of the sensory symptoms extends to the ulnar nerve territory. The aim of this study was to evaluate whether a dysfunction in sensory fibers of the ulnar nerve was present or not in hands with CTS patients who had extramedian spread of sensory symptoms over the hand. We retrospectively analyzed the recording of the subjects who were diagnosed with CTS within a one-year-period of time. After exclusions, 136 hands recordings of 87 patient were included. We compared the results of median and ulnar nerve sensory conduction studies between normal hands and hands with CTS. We did not detect statistically significant difference on all parameters of ulnar nerve sensory conduction studies between the normal hands and the hands with CTS. The parameters of the obtained in median nerve sensory conduction studies were statistically different between the healthy control and CTS patients. The hands with CTS showed similar rate of ulnar sensory conduction abnormalities compared with the normal hands. In conclusion, our study showed that none of the parameters in ulnar sensory nerve conduction studies differ between two groups. Accordingly, our study revealed that ulnar nerve involvement does not contribute in CTS patients underlying the spread of paresthesia extends to the ulnar nerve territory.

• Annals of Clinical Neurophysiology
• /
• v.3 no.1
• /
• pp.15-20
• /
• 2001

Background : Carpal tunnel syndrome(CTS) is the most common entrapment neuropathy that refers to a group of signs and symptoms resulting from compression of the median nerve at the wrist. The course of CTS in older patients is different from the younger patients. This difference may be the result of different underlying mechanisms. The different nerve conduction studies of CTS may signify different approaches in management. This study was done to assess the differences in nerve conduction study of CTS in younger and older patients. Methods : This study involved 224 patients who visited Gachon Medical School, Gil Medical Center and was diagnosed by nerve conduction study from October 1997 to October 1999. We compared the results of nerve conduction study to age, especially in between those under 60 years and those 60 years or over CTS patients. Nerve conduction study consists of motor studies of both median nerves(terminal latency, compound action potential) and sensory studies(nerve conduction velocity, nerve action potential). And we also evaluated the variables between younger and older patients group. Those variables include sex, symptom period, laterality, abnormal physical findings and radiculopathy. Results : We found that a significant increase of terminal latency(p<0.1), but a decrease in compound motor action potential(p<0.05) in older patient's group. There was no significant differences in sensory nerve conduction velocity and action potential between those under 60 years and those 60 years or even patients. And also there was no significant difference in sex, symptom period, laterality, abnormal physical findings, radiculopathy between older and younger patients. Conclusions : This study showed a significant increase in the terminal latency and a decrease in compound action potential in older patients. The different nerve conduction studies of CTS by age effect may need different approaches in management.