No abstract

Ulnar neuropathy at the elbow is the second most common entrapment neuropathy. Ulnar nerve entrapment has several causes. A case report is presented with the presence of the M. anconeus epitrochlearis at both sides. The patient contacted our department with chronic, diffuse bilateral elbow pain irradiating into both forearms. She experienced typical nocturnal paresthesias involving digit IV and V of both hands. Tinel's sign was present just proximal to the medial epicondyle. A bilateral ulnar nerve entrapment was clinically suspected. An electromyographic (EMG) investigation revealed slowing of the motor conduction velocity in the ulnar nerve across the elbow. An ultrasound and MRI investigation demonstrated the presence of an anomalous muscle, called the M. anconeus epitrochlearis, at both sides. Treatment consisted of bilateral surgical excision of the muscle and retinacular release, followed by physical therapy. The outcome was favourable.

Fibromyalgia is a condition marked by widespread chronic pain, accompanied by a variety of other symptoms, including sleep and fatigue disorders, headaches, disorders of the autonomic nervous system, as well as cognitive and psychiatric symptoms. It occurs predominantly in women and is often associated with other systemic or autoimmune diseases. Despite its serious socio economical burden, the treatment options remain poor. In this chapter, the authors discuss the possibilities of using greater occipital nerve stimulation as a treatment for fibromyalgia, based on available clinical studies. Greater occipital nerve stimulation has already been used successfully to treat occipital neuralgia and various primary headache syndromes. Testable hypothetical working mechanisms are proposed to explain the surprising effect of this treatment on widespread bodily pain.