Search Results (78)

In recent decades, information technology has grown. Computers have become a daily activity, facilitating access to information, faster communication and faster work. If used responsibly, it has many advantages. Objectives: To explore the potential link between prolonged use of computer input devices—such as keyboards and mice—and the development of compressive neuropathies, including carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CuTS), in individuals whose daily routines are heavily reliant on computer-based activities. Methods: A comprehensive review of the literature was undertaken to assess the correlation between the use of computer input devices and the incidence of compressive neuropathies in the upper limbs, with particular attention to repetitive strain, ergonomic posture deviations, and personal risk factors. Results: Current evidence indicates a potential association between prolonged computer use and the development of upper limb compressive neuropathies; however, a definitive consensus within the scientific literature remains elusive. Repetitive movements and non-neutral postures appear to be significant contributing factors, particularly among individuals with predisposing risk factors. Despite increasing awareness of this issue, standardized, evidence-based clinical guidelines for the evaluation and management of work-related nerve disorders remain lacking. Conclusions: While the relationship between computer use and compressive neuropathies remains debated, healthcare professionals should be aware of the risks, particularly in individuals exposed to repetitive strain and ergonomic stress. Further research and the development of clinical guidelines are needed to better understand and manage these work-related conditions. Full article

Background/Objectives: The co-existence of multiple compression sites on the same nerve can pose a clinical and diagnostic challenge, warranting a different treatment strategy. This so-called double crush syndrome (DCS) has mainly been investigated in the upper limb. Only a few studies have investigated DCS for the lower limb. In this article, a single-center illustrative clinical case series is presented, and current literature on L5 nerve root (NR) and concomitant common peroneal nerve (CPN) is reviewed. Methods: All patients presenting between 2019 and 2022 with L5 nerve root (NR) compression and, along their clinical courses, concomitant compression of the common peroneal nerve (CPN) at the fibular head were included. Information on clinical features, diagnostics and surgeries was obtained. The outcome was assessed at the last outpatient follow-up appointment. In addition, an extensive literature review has been conducted. Results: Fourteen patients were included with a mean follow-up of 6.8 months. The majority had pain (71%) or motor deficits (71%). Seven patients were referred for clinical and radiological L5 NR compression but were also found to have CPN compression; the other seven patients had persisting or recurrent symptoms after surgically or conservatively treated L5 NR compression, suggestive of additional peroneal neuropathy. All patients had CPN decompression at the fibular head, with successful results obtained in 93% of the patients. Pain of the lower leg improved in all patients, and dorsiflexion function improved in 78%. Conclusions: Concomitant L5 NR and CPN appear to occur more frequently than expected. Peroneal neuropathy can present simultaneously with L5 nerve radiculopathy or after surgically or conservatively treated L5 NR compression. Overlapping symptoms and variation in clinical presentations make it difficult to diagnose and, therefore, underrecognized. More awareness among treating physicians of this specific double crush syndrome is important to prevent any delay in treatment, in this case, a less invasive common peroneal nerve release at the fibular head, and to avoid unnecessary (additional) spinal surgery. Full article

Background: Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb, and it is characterized by ulnar nerve compression at the elbow. Traditional surgical options, including simple decompression and anterior transposition, have limitations in addressing ulnar nerve instability. This study introduces and evaluates the short-term outcomes of a novel surgical technique, the fascio-aponeurotic epicondylar flap (FAEF), for stabilizing the ulnar nerve and managing its instability. Materials and methods: A retrospective study was conducted on ten patients with longstanding cubital tunnel syndrome and confirmed ulnar nerve dislocation or instability. All patients underwent surgical intervention using the FAEF technique, which involves creating a quadrangular fascial flap from the epicondylar fascia to stabilize the ulnar nerve within the retrocondylar groove. Outcomes were assessed using clinical follow-ups, the Michigan Hand Outcomes Questionnaire (MHQ), VAS, and qDASH scores over a 90-day postoperative period. Results: All ten patients experienced complete resolution of neurological symptoms, including paresthesia, pain, and nerve clicking, by the final follow-up. Postoperative recovery was uneventful, with no complications such as infections or hematomas. Grip strength and hand functionality were fully restored, with significant improvements in MHQ scores (mean: 94). Dynamic elbow mobilization initiated on the first postoperative day resulted in full recovery of elbow range of motion. No recurrence of ulnar nerve dislocation was observed. Discussion: The FAEF technique effectively stabilizes the ulnar nerve, alleviates symptoms, and restores function while minimizing risks associated with traditional procedures, such as nerve trauma and elbow instability. By preserving the anatomical integrity of the medial epicondyle and enhancing nerve mobility, this approach represents a less invasive alternative to anterior transposition and medial epicondylectomy. Conclusions: The FAEF technique is a viable and effective surgical option for managing ulnar nerve instability in cubital tunnel syndrome. It offers a less invasive solution with excellent short-term outcomes, making it a promising addition to the surgical armamentarium for this condition. Further studies are warranted to evaluate long-term efficacy and broader applicability. Full article

Background: Suprascapular neuropathy is a known cause of shoulder pain. Although neurodynamic techniques are widely used to treat peripheral neuropathies, the mechanical behavior of the suprascapular nerve in the shoulder region remains poorly understood. Objectives: This study aimed to analyze the mechanical behavior of the suprascapular nerve during a contralateral cervical glide and an infraspinatus muscle contraction. Methods: The study was conducted in two phases. First, nerve movement was analyzed in 12 cryopreserved cadaveric shoulders using anatomical dissection. Second, suprascapular nerve displacement was assessed in 34 shoulders from 17 healthy volunteers using ultrasound imaging. Results: In cadaveric dissections, the contralateral cervical glide produced a proximal nerve displacement of 1.85 mm at the suprascapular notch. In the ultrasound study, this maneuver resulted in horizontal and vertical displacements of 1.18 mm and 0.39 mm, respectively. In contrast, infraspinatus muscle contraction caused a distal displacement of 3.21 mm in the cadaveric study, and ultrasound imaging showed horizontal and vertical displacements of 1.34 mm and 0.75 mm, respectively. All reported displacements were statistically significant (p < 0.05). Conclusions: The findings of both phases of the study contribute to a better understanding of suprascapular nerve biomechanics and may inform clinical neurodynamic interventions. Full article

Objective: Neurogenic thoracic outlet syndrome (nTOS) is a rare compression neuropathy, and establishing a firm diagnosis can be challenging. Interscalene nerve blocks with Ropivacaine and Dexamethasone have been proposed in cases with typical symptoms and without evident pathology of the thoracic outlet (i.e., disputed nTOS) to establish the diagnosis. The aim of this study was to evaluate the effectiveness of interscalene nerve block for long-term pain relief in patients with true and disputed nTOS. Methods: Patients between 18 and 90 years of age with either true or disputed nTOS were prospectively included in the study. All patients received an interscalene nerve block with Ropivacaine and Dexamethasone. At baseline, 2, 6, 12, and 24 weeks after infiltration, minimum and maximum pain levels were assessed using the numeric rating scale (NRS 0–10). Furthermore, arm function was assessed using the Quick-DASH, and health-related quality of life was assessed by means of the SF-12 questionnaire. Statistical analysis was performed with SPSS version 29.0 using the Wilcoxon signed rank test and t-test for paired samples. A p-value below 0.05 was considered statistically significant. Results: A total of 21 patients were included in the study. There was a significant decrease in the minimum (Pmin) and maximum (Pmax) mean pain levels at 2 and 6 weeks after the baseline. Thereafter, 12 patients dropped out of the study due to surgery. In the remaining nine patients, pain levels remained significantly lower than baseline at 12 and 24 weeks after infiltration. Quick-DASH scores as well as the physical domain of the SF-12 showed significant improvement compared to baseline. Conclusions: In patients with true and disputed nTOS, long-term pain relief can be achieved with the interscalene nerve block with Ropivacaine and Dexamethasone. Additionally, the study indicated an improvement in arm function and health-related quality of life. In patients with disputed nTOS, the interscalene nerve block may be a useful tool to establish the diagnosis of clinically relevant true nTOS. Key points: Question: Does a scalene nerve block with Ropivacaine and Dexamethasone lead to long-term pain relief in patients with a neurogenic thoracic outlet syndrome (nTOS)? Findings: A scalene nerve block with Ropivacaine and Dexamethasone leads to significant pain relief, as well as an improvement in arm function and health-related quality of life for patients with a neurogenic TOS. Meaning: This study provides new insights into the diagnostic of neurogenic TOS and may be used as a short- and long-term pain therapy. Full article

Objective: Various orbital conditions (trauma, autoimmune thyroid disease, tumors, infections, congenital malformations) may lead to a consecutive increase in orbital cavity pressure resulting in orbital compartment syndrome (OCS). OCS is associated with acute loss of visual function and a high risk of permanent damage to the optic nerve (compressive optic neuropathy). Orbital decompression surgery (ODS) is a time-critical procedure that reduces pressure on the optic nerve, thereby improving visual function. The surgical management protocol for orbital decompression is not standardized and varies. Surgical techniques differ in orbital fat decompression, lateral canthotomy, and decompression of the medial orbital wall and floor. This retrospective study aims to evaluate surgery procedures and the outcome of visual function after orbital decompression surgery. Methods: In this retrospective study, we evaluated 28 patients (17 male, 11 female) with orbital compartment syndrome from May 2016 to October 2024. All patients underwent orbital decompression surgery as first-line treatment. Visual acuity (VA), diplopia, and ocular motility were analyzed pre- and postoperatively. Recovery was defined as postoperative improvement of vision, diplopia, and ocular motility. Linear and logistic regression analyses were used to assess the associations between clinically relevant risk factors and primary outcomes. Results: Orbital decompression surgery was performed with a median of 8.40 h (Q1: 4.80, Q3: 24.00) upon occurrence of symptoms. The average preoperative measured VA (logMAR) of the affected eye was 1.0. A total of 46% of the patients were preoperatively categorized as ”blind“ according to the WHO visual impairment categories. A total of 96% of the patients showed preoperative ocular motility impairment. Diplopia was preoperatively present in 46% of the patients. After orbital decompression surgery, postoperative visual acuity improved in 36% of the patients. Ocular motility improved by 67% and diplopia by 62% after ODS. The primary surgery technique was two-wall decompression in 68% (19/28) of the cases, followed by one-wall decompression (21%; 6/28), and three-wall decompression (11%; 3/28). Lateral decompression (82%; 23/28) and medial wall decompression (93%; 26/28) were the primary procedures performed. Orbital floor wall decompression was performed in only 14% (4/28) of the cases. Regression analysis revealed a statistically significant effect of preoperative measured vision on postoperative vision, while accounting for age, sex, and time to surgery. Conclusions: Orbital decompression surgery is the time-sensitive first-line treatment of acute visual function loss in OCS. Our data showed a postoperative improvement in visual acuity in 36% of the patients, along with considerable improvement rates in diplopia and ocular motility. The primary surgery technique was a two-wall decompression approach with lateral wall decompression and medial wall decompression. Center-specific timeline optimization of OCS patients is essential. Full article

Background: Carpal tunnel syndrome (CTS) is a common neuropathy caused by compression of the median nerve (MN) within the carpal tunnel, which causes pain, paresthesia, or altered sensation. While a small carpal tunnel area is considered a risk factor for CTS, varying carpal tunnel dimensions in CTS patients have been obtained via axial computed tomography and magnetic resonance imaging (MRI). Methods: In this retrospective study, MR images from 49 CTS patients and 38 healthy controls were analyzed to investigate differences in the carpal tunnel area and carpal boundaries between the groups and to explore the relationships of these parameters with CTS severity. Results: Our findings revealed that compared with the controls, CTS patients presented significantly larger cross-sectional areas (CSAs) of the MN and carpal tunnel and increased MN flattening ratios. The CSAs of the MN showed moderate positive correlations with severity (r = 0.395, p < 0.001), symptom score (r = 0.354, p < 0.001), and disability score (r = 0.300, p < 0.001), while the carpal tunnel area showed weaker but significant correlations with severity (r = 0.268, p = 0.002), symptom score (r = 0.173, p = 0.026), and disability score (r = 0.183, p = 0.018). The ratios of the MN CSA to those of the carpal tunnel, the interior carpal boundary (ICB), the exterior carpal boundary (ECB), and the wrist were disproportionately greater in the CTS patients. Among them, both the MN-to-ICB and MN-to-ECB ratios had fair to good diagnostic values (area under the curve = 0.725 and 0.794, respectively). Conclusions: These results highlight the utility of MRI-derived CSA measurements and ratios in identifying pathophysiological changes in CTS patients, particularly crowding of the MN inside the carpal tunnel. Further studies are recommended to refine MRI-based diagnostic protocols for CTS. Full article

Introduction: The sports hernia (SH) is one of the most important causes of groin pain syndrome (GPS). However, despite its importance in GPS etiopathogenesis, SH is one of the least understood and poorly defined clinical conditions in sports medicine. The aim of this systematic review is to clearly define SH from a radiological point of view and to clarify the relationship between the radiological presentation of SH and its clinical manifestation. Methods: The PubMed/MEDLINE, Scopus, ISI, Cochrane Database of Systematic Reviews, and PEDro databases were consulted for systematic reviews on the role of SH in the onset of GPS. The inclusion and exclusion criteria were based on PICO tool. Results: After screening 560 articles, 81 studies were included and summarized in this systematic review. All studies were checked to identify any potential conflict of interest. The quality assessment of each individual study considered was performed in agreement with the Joanna Briggs Institute quantitative critical appraisal tools. Conclusions: The correct definition of SH is “weakness of the posterior wall of the inguinal canal”, which, in response to a Valsalva maneuver, forms a bulging that compresses the nerves passing along the inguinal canal. Thus, from an anatomical point of view, SH represents a direct inguinal hernia “in fieri”. Furthermore, an excessive dilation of the external inguinal ring represents an indirect sign of possible posterior inguinal canal wall weakness. Full article

Background: Obturator nerve entrapment can result from endogenous and exogenous causes. Due to its long course, which includes both endopelvic and exopelvic segments, the nerve is susceptible to irritation from multiple etiologies. However, as obturator nerve entrapment is relatively uncommon, a thorough understanding of endogenous factors contributing to nerve entrapment is lacking. Nevertheless, understanding the endogenous factors contributing to obturator nerve entrapment is crucial for an effective treatment approach. Material and Methods: We performed a systematic literature search on studies investigating the diagnostic and (surgical) therapeutic approaches to obturator neuropathy due to endogenous causes. Studies were grouped according to the etiology responsible for nerve irritation. Lastly, data were synthesized to create a clinical work-up flowchart for obturator nerve entrapment syndromes due to endogenous causes. Results: Data from 45 studies comprising 175 patients met our inclusion criteria. We were able to summarize these data into six broad etiologies (tumor, obturator hernia, endometriosis, cystic lesions, vascular, and idiopathic causes) responsible for nerve irritation and saw that the most important factors for therapy are the onset of the symptoms and the anatomical localization. MRI emerged as the most valuable diagnostic tool for chronic conditions, especially in identifying the precise etiology and location of nerve compression. Conclusions: This review offers a structured framework for diagnosing and managing obturator nerve entrapment due to endogenous causes. We propose a diagnostic and therapeutic algorithm based on the identified etiologies to facilitate clinical decision-making. Full article

Background/Objectives: Mechanical compression of the median nerve is believed to be responsible for idiopathic carpal tunnel syndrome (CTS) due to fibrosis of the subsynovial connective tissue (SSCT). Vascular consequences have also been observed in structures of the carpal tunnel, raising speculation regarding the role of factors such as ischemia and edema in CTS pathology. Methods: We performed a mega-analysis from our database of over 10 years of studies. Mixed-effects models were used to address the disconnect between mechanical and vascular influences on CTS; the effects of biomechanical factors and CTS status were evaluated on carpal tunnel tissue mechanics and blood flow. Altered blood flow was also induced during tissue motion to draw inferences regarding the cyclical relationship between tissue mechanics and fluid flow changes on CTS pathology. Results: Greater movement speed and flexed wrist postures were found to contribute to greater shear strain. Flexed wrist postures and greater fingertip force were found to increase median nerve blood flow. Greater CTS severity was associated with lower median nerve blood flow. Finally, brachial blood flow restriction as a surrogate for elevated carpal tunnel pressure was found to alter tissue motion and increase carpal tunnel tissue shear strain. Conclusions: Finger movement speed, force application, wrist posture, and altered fluid flow in the carpal tunnel contribute to changes in outcomes associated with the development of CTS. The mechanistic findings from this paper should be incorporated into future research to update the damage model for CTS pathology. Full article

Guyon’s canal, or the ulnar tunnel, is a critical anatomical structure at the wrist that houses the ulnar nerve and artery, making it susceptible to various pathological conditions. Pathologies affecting this canal include traumatic injuries, compressive neuropathies like ulnar tunnel syndrome, and space-occupying lesions such as ganglion cysts. Ulnar tunnel syndrome, characterised by numbness, tingling, and weakness in the ulnar nerve distribution, is a prevalent condition that can severely impair hand function. The canal’s intricate anatomy is defined by surrounding ligaments and bones, divided into three zones, each containing distinct neural structures. Variations, including aberrant muscles and vascular anomalies, can complicate diagnosis and treatment. Imaging techniques are essential for evaluating these conditions; ultrasound provides real-time, dynamic assessments, while magnetic resonance imaging (MRI) offers detailed visualisation of soft tissues and bony structures, aiding in pre-surgical documentation and pathology evaluation. This review article explores the anatomy, pathologies, and imaging modalities associated with Guyon’s canal and underscores the necessity of understanding Guyon’s canal’s anatomy and associated pathologies to improve diagnostic accuracy and management strategies. By integrating anatomical insights with advanced imaging techniques, clinicians can enhance patient outcomes and preserve hand function, emphasising the need for increased awareness and research in this often-neglected area of hand anatomy. Full article

Background: Jugular foramen syndrome (JFS) is a rare condition characterized by the compression or impairment of one or more terminal cranial nerves passing through the jugular foramen. Although malignancies are the primary cause of JFS. Methods: In this report, we present the first documented case of JFS caused by acute otitis media in an adult patient. Results: A 74-year-old woman presented with ear pain, hoarseness, dysphagia, dizziness, tinnitus, and hearing loss. A physical examination revealed a reddish-bulging tympanic membrane, left-sided hearing loss, right uvula deviation, and cranial nerve palsies affecting the ninth and tenth nerves. Imaging studies confirmed temporal bone inflammation, thrombosis of the sigmoid sinus extending into the internal jugular vein, and signs of thrombophlebitis of the jugular vein. The patient underwent a cortical mastoidectomy, sigmoid sinus decompression, and ventilation tube insertion, along with antibiotic, steroid, and anticoagulant therapy. Postoperatively, the patient’s condition improved significantly. Conclusions: This case highlights the importance of considering complicated acute otitis media in the differential diagnosis of neurological abnormalities associated with JFS. A thorough evaluation of the patient’s medical history and radiological imaging can assist in identifying the cause of the symptoms and guide appropriate surgical or conservative treatment. Further research is essential to gain more comprehensive insights into the pathophysiology and therapeutic interventions of JFS affecting the ears. Full article

Background: Lacertus syndrome, a condition characterized by median nerve compression at the elbow due to anatomical variations, is often misdiagnosed. This case report describes a 53-year-old female patient who presented with severe lateral elbow and shoulder pain, previously diagnosed with cervicalgia and tennis elbow. Methods: Upon admission, she reported significant pain (NRS—Numerical Rating Scale 8/10) and occasional radiating paresthesia in the first three digits of her left hand. Clinical examination revealed weakness in the wrist and finger flexion, which was exacerbated by a positive Cutaneous Scratch Test (CST), while Magnetic Resonance Imaging (MRI) of the cervical spine showed no definitive abnormalities. Electroneurography (ENG) indicated reduced amplitude in the left anterior interosseous nerve. Ultrasound excluded carpal tunnel syndrome but identified nerve flattening beneath the pronator teres muscle. A surgical decompression of the median nerve was performed, resulting in immediate improvement in muscle strength and significant pain reduction (NRS 1/10) postoperatively. Follow-up evaluations confirmed substantial recovery in nerve function and morphology. Conclusions: This case illustrates the atypical presentation of Lacertus syndrome, emphasizing the need for comprehensive diagnostic approaches that include clinical, imaging, and neurophysiological assessments. Awareness of this syndrome is crucial for differential diagnosis in patients exhibiting uncharacteristic symptoms, such as shoulder or elbow pain, to ensure timely and effective treatment. Full article

Background: Thoracic outlet syndrome (TOS) is an uncommon condition defined by the compression of neurovascular structures within the thoracic outlet. When conservative management strategies fail to alleviate symptoms, surgical decompression becomes necessary. The purpose of this study is to evaluate and compare the efficacy and safety of regional anesthesia (RA) using spontaneous breathing in contrast to general anesthesia (GA) for patients undergoing surgical intervention for TOS. Methods: We conducted a retrospective comparative study involving 68 patients who underwent trans-axillary first rib resection for TOS. The patient cohort was divided into two groups: 29 patients in the GA group and 39 patients in the RA group. The RA technique employed consisted of supraclavicular brachial plexus (SBP) and pectoral nerve (PECS II) blocks, accompanied by deep sedation. Key outcome measures such as pain scores, opioid consumption, and various perioperative parameters were systematically analyzed. Results: Postoperative pain levels recorded in the recovery room were significantly lower in the RA group, with a median numerical rating scale (NRS) score of zero compared to two in the GA group (p = 0.0443). Additionally, both intraoperative and postoperative opioid consumption showed a marked reduction in the RA group, with p-values of less than 0.001 and 0.0418, respectively. The RA approach was associated with shorter surgical durations (p = 0.0008), a decrease in the incidence of postoperative nausea and vomiting (PONV) (p = 0.0312), and a lower occurrence of intraoperative lung injuries (p < 0.0001). Furthermore, the length of hospital stay was significantly reduced for patients in the RA group. Conclusions: Although both groups reported low postoperative pain scores, the regional anesthesia approach exhibited distinct advantages in terms of opioid consumption, surgical duration, and overall perioperative outcomes. The utilization of SBP and PECS II blocks facilitated surgical procedures and mitigated complications, thereby positively influencing the postoperative recovery trajectory. Future prospective studies are essential to validate these findings further and to investigate long-term outcomes associated with the use of regional anesthesia in TOS surgery. Full article

Carpal Tunnel Syndrome (CTS) is a prevalent neuropathic disorder caused by chronic compression of the median nerve, leading to sensory and motor impairments. Conventional treatments, such as corticosteroid injections, wrist splinting, and surgical decompression, often fail to provide adequate outcomes for chronic or recurrent cases, emphasizing the need for innovative therapies. Hydrogels, highly biocompatible three-dimensional biomaterials with customizable properties, hold significant potential for CTS management. Their ability to mimic the extracellular matrix facilitates localized drug delivery, anti-adhesion barrier formation, and tissue regeneration. Advances in hydrogel engineering have introduced stimuli-responsive systems tailored to the biomechanical environment of the carpal tunnel, enabling sustained therapeutic release and improved tissue integration. Despite these promising developments, hydrogel applications for CTS remain underexplored. Key challenges include the absence of CTS-specific preclinical models and the need for rigorous clinical validation. Addressing these gaps could unlock the full potential of hydrogel-based interventions, which offer minimally invasive, customizable solutions that could improve long-term outcomes and reduce recurrence rates. This review highlights hydrogels as a transformative approach to CTS therapy, advocating for continued research to address translational barriers. These innovations have the potential to redefine the treatment landscape, significantly enhancing patient care and quality of life. Full article