• Title/Summary/Keyword: Proximal median neuropathy

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Segmental Sensory Nerve Conduction Study in Vibration Exposed Subjects

  • Kim Mi-Jung;Yoon Cheol-In;Choi Hyun-Ju
    • Biomedical Science Letters
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    • v.11 no.2
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    • pp.193-199
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    • 2005
  • The present study was performed to assess peripheral neural involvement by exposure to hand-arm vibration. Segmental sensory nerve conduction in the median and ulnar nerves were measured in shipyard workers exposed to vibration. The subjects were 47 male adults exposed to hand-arm vibration and 7 healthy male controls. The subjects underwent an extensive bilateral neurophysiological examination. Sensory compound nerve action potential (SNAP) of the median and ulnar nerves in palm-finger and wrist-palm segments were measured by antidromic method. And SNAP of the median and ulnar nerves in wrist-proximal finger and wrist-distal finger segments were measured by orthodromic method. Result of sensory nerve conduction study was abnormal in 31 patients $(66\%)$ and normal in 16 patients $(34\%)$ of subjects. The pathological pattern in the hand-arm vibration exposed group was 13 patients $(28\%)$ of carpal tunnel syndrome, 18 patients $(38\%)$ of distal sensory neuropathy, 7 patients $(15\%)$ of multifocal and 1 patient $(2\%)$ of Guyon syndrome. The present study indicates that vibration-induced nerve impairments exist both in the finger-palm and palm-wrist segment of median and ulnar sensory nerves. The results suggest that segmental sensory nerve conduction study would be useful as objective indication of peripheral nerve impairment induced by the hand-arm vibration.

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Application of Proximal Stimulation for Somatosensory Evoked Potentials in Patients with Diabetic Polyneuropathy (당뇨병성 다발신경병증 환자에서 체감각유발전위검사 시 근위부 자극법의 적용)

  • Kwon, Hyung-Min;Nam, HyunWoo;Sung, Jung-Joon;Lee, Chang-Hee;Park, Young Joo;Moon, Min Kyong
    • Annals of Clinical Neurophysiology
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    • v.5 no.2
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    • pp.181-186
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    • 2003
  • Background: Somatosensory evoked potential (SSEP) is valuable for the evaluation of the central pathway. However, peripheral neuropathy sometimes renders the test useless by preventing the conduction from reaching the CNS. We postulated that the peripheral conduction problems could be overcome by proximal stimulation in SSEP and wanted to verify this in the study. Methods: Twenty patients with diabetic sensorimotor polyneuropathy were included. SSEP was elicited by stimulating the median and posterior tibial nerves. We compared the effect of distal and proximal stimulations in each SSEP in the aspect of presence/absence and various latencies of resultant waves. Results: Among the 40 cases, proximal stimulation caused reappearance of subsided waves in 10 cases (25%). In the median nerve SSEP, proximal stimulation made EN1 and CN2 visible which were not evident when distally stimulated. In the posterior tibial nerve SSEP, there was also improvement of forming waves when proximally stimulated. Conclusions: In the diabetic polyneuropathy, proximal stimulation of SSEP is more effective than the conventional distal stimulation in evaluating central pathway.

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Early Surgical Treatment of Pronator Teres Syndrome

  • Lee, Ho Jin;Kim, Ilsup;Hong, Jae Taek;Kim, Moon Suk
    • Journal of Korean Neurosurgical Society
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    • v.55 no.5
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    • pp.296-299
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    • 2014
  • We report a rare case of pronator teres syndrome in a young female patient. She reported that her right hand grip had weakened and development of tingling sensation in the first-third fingers two months previous. Thenar muscle atrophy was prominent, and hypoesthesia was also examined on median nerve territory. The pronation test and Tinel sign on the proximal forearm were positive. Severe pinch grip power weakness and production of a weak "OK" sign were also noted. Routine electromyography and nerve conduction velocity showed incomplete median neuropathy above the elbow level with severe axonal loss. Surgical treatment was performed because spontaneous recovery was not seen one month later.

Rare Tumors Causing Median Nerve Compression in Adults-A Narrative Review

  • Natroshvili, Tinatin;Peperkamp, Kirsten;Malyar, Masoud A.;Wijnberg, David;Heine, Erwin P.;Walbeehm, Erik T.
    • Archives of Plastic Surgery
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    • v.49 no.5
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    • pp.656-662
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    • 2022
  • The median nerve can be compressed due to a tumor along the course of the median nerve, causing typical compression symptoms or even persistence or recurrence after an operation. The aim of this review is to provide a comprehensive overview of rare tumors described in recent publications that cause median nerve compression and to evaluate treatment options. The PubMed, Embase, and Web of Science databases were searched for studies describing median nerve compression due to a tumor in adults, published from the year 2000 and written in English. From 94 studies, information of approximately 100 patients have been obtained. Results The rare tumors causing compression were in 32 patients located at the carpal tunnel, in 21 cases in the palm of the hand, and 28 proximal from the carpal tunnel. In the other cases the compression site extended over a longer trajectory. There were 37 different histological types of lesions. Complete resection of the tumor was possible in 58 cases. A total of 8 patients presented for the second time after receiving initial therapy. During follow-up, three cases of recurrence were reported with a mean follow-up period of 11 months. The most common published cause of median nerve compression is the lipofibromatous hamartoma. Besides the typical sensory and motor symptoms of median nerve compression, a thorough physical examination of the complete upper extremity is necessary to find any swelling or triggering that might raise suspicion of the presence of a tumor.

Ultrasonographic Examination of Compression Neuropathy in the Upper Extremity (상지의 압박성 신경병증의 초음파 검사)

  • Chung, Yang-Guk;Kim, Bae-Gyun
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.1 no.1
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    • pp.64-72
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    • 2008
  • Compression neuropathy around elbow and wrist are one of the common disturbing problems in the upper extremity. The understanding of normal nerve architectures and pathophysiologic changes in compression neuropathy is important to interpret the ultrasonographic images correctly. Compression neuropathies have characteristic ultrasonographic imaging features of flattened nerve at compression and hypoechoic swollen nerve with loss of fascicular patterns at proximal segments. Dynamic ultrasonographic imagings on motion can show dymanic subluxation of ulnar nerve and medial head of triceps muscle over the medial epicondyle in snapping triceps syndrome. Dynamic compression of median nerve also can be visualized in pronator teres syndrome by dynamic imaging studies. A quantitative measures of cross sectional area or compression ratio can be helpful to diagnose compression neuropathies, such as carpal tunnel syndrome or cubital tunnel syndrome. With the clinical features and electeophysiologic studies, the untrasonographic imagings are useful tool for evaluation of the compression neuropathies in the upper extremities.

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