Distal nerve entrapment following nerve repair

Schoeller, Thomas; Otto, Angela M.; Wechselberger, Gottfried; Pommer, B.; Papp, Christoph

doi:10.1054/bjps.1996.0319

Cited by 20 publications

(12 citation statements)

References 4 publications

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“…12 We decompressed the ulnar nerve at the time of biopsy in our case to alleviate any contribution of compression to his deficit, to prevent potential worsening compression in the face of swelling related to the biopsy, and to theoretically maximize his neural regeneration. 14,25 We believed that the small added morbidity in this case was justified given the typically poor prognosis seen with severe ulnar palsy at the arm level. 3,7,15 Had we been able to make the diagnosis of leprosy in this case without the biopsy, however, we would have recommended initial treatment with multidrug therapy and steroids and would not necessarily have intervened surgically unless his pain had not improved.…”

Section: Surgical Decompression Of Lepromatous Nervesmentioning

confidence: 89%

Pure neuritic leprosy presenting as ulnar nerve neuropathy: a case report of electrodiagnostic, radiographic, and histopathological findings

Payne¹,

Baccon²,

Dossett³

et al. 2015

JNS

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Hansen’s disease, or leprosy, is a chronic infectious disease with many manifestations. Though still a major health concern and leading cause of peripheral neuropathy in the developing world, it is rare in the United States, with only about 150 cases reported each year. Nevertheless, it is imperative that neurosurgeons consider it in the differential diagnosis of neuropathy. The causative organism is Mycobacterium leprae, which infects and damages Schwann cells in the peripheral nervous system, leading first to sensory and then to motor deficits. A rare presentation of Hansen’s disease is pure neuritic leprosy. It is characterized by nerve involvement without the characteristic cutaneous stigmata. The authors of this report describe a case of pure neuritic leprosy presenting as ulnar nerve neuropathy with corresponding radiographic, electrodiagnostic, and histopathological data. This 11-year-old, otherwise healthy male presented with progressive right-hand weakness and numbness with no cutaneous abnormalities. Physical examination and electrodiagnostic testing revealed findings consistent with a severe ulnar neuropathy at the elbow. Magnetic resonance imaging revealed diffuse thickening and enhancement of the ulnar nerve and narrowing at the cubital tunnel. The patient underwent ulnar nerve decompression with biopsy. Pathology revealed acid-fast organisms within the nerve, which was pathognomonic for Hansen’s disease. He was started on antibiotic therapy, and on follow-up he had improved strength and sensation in the ulnar nerve distribution. Pure neuritic leprosy, though rare in the United States, should be considered in the differential diagnosis of those presenting with peripheral neuropathy and a history of travel to leprosy-endemic areas. The long incubation period of M. leprae, the ability of leprosy to mimic other conditions, and the low sensitivity of serological tests make clinical, electrodiagnostic, and radiographic evaluation necessary for diagnosis. Prompt diagnosis and treatment is imperative to prevent permanent neurological injury.

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Section: Surgical Decompression Of Lepromatous Nervesmentioning

confidence: 89%

Pure neuritic leprosy presenting as ulnar nerve neuropathy: a case report of electrodiagnostic, radiographic, and histopathological findings

Payne¹,

Baccon²,

Dossett³

et al. 2015

JNS

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“… 8 Early preventive release of distal compression spots following proximal nerve injury was advised by several authors. 9 , 10 “Watch and wait” can also be applied, as regeneration may also proceed unhindered. However, our case underpins that the possibility of distal nerve compression following proximal nerve injury must be kept in mind and surgically addressed in a timely manner given its occurrence.…”

Section: Discussionmentioning

confidence: 99%

Multihit Injury of the Radial Nerve in a 62-year-old Woman: A Case Report

Heinzel

Winter

Stähl

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Summary: We report the case of a 62-year-old female patient with a triple-crush radial nerve injury, diagnosed in subsequent order following a fracture of the left humerus. The patient developed flaccid paralysis of all muscles innervated by the left radial nerve except the triceps brachii and reported a sensory deficit corresponding to the innervation territories of the posterior nerve of the forearm as well as the superficial branch of the radial nerve. Following neurolysis of the radial nerve at the humerus level, wrist extension as well as sensory perception on the dorsal aspect of the forearm recovered, but finger extension and thumb abduction were still impossible. Following neurological evaluation and nerve ultrasound, supinator syndrome was diagnosed and the patient underwent decompression surgery. Following surgical decompression, motor recovery was observable but a sensory deficit remained in the area innervated by the superficial branch of the radial nerve. In consequence, the third crush injury of the left radial nerve, that is, Wartenberg syndrome or cheiralgia paraesthetica was diagnosed. Decompression surgery of the superficial branch of the radial nerve was performed and the patient reported profound amelioration of her sensory symptoms during a follow-up examination at our outpatient clinic 6 weeks postoperatively.

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“…23 In such patients, it can be used both preoperatively, to determine the location and type of nerve injury, 24,25 and postoperatively, to assess recovery and diagnose further complications such as neuroma formation. 26,27 To date, we are not aware of any studies that sought to determine the mobility and excursion (sliding) of nerves following formal nerve repair. In our study we used ultrasound imaging to examine whether median nerve sliding was altered in patients who had undergone nerve repair following complete division of the median nerve at the wrist.…”

Section: Muscle Nerve 41: 350-354 2010mentioning

confidence: 99%

Sonographic measurements of longitudinal median nerve sliding in patients following nerve repair

et al. 2009

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Nerve sliding may be restricted following nerve repair. This could result in increased tension across the repair site and lead to poor functional recovery of the nerve. Ultrasound was used to examine longitudinal median nerve sliding in 10 patients who had previously undergone nerve repair surgery following complete division of the median nerve. The median longitudinal movement in the forearm in response to metacarpophalangeal (MCP) joint movements was 2.15 mm on the injured side, compared with 2.54 mm on the uninjured side, a difference that was significant. There was a significant reduction in nerve sliding following repair (median = 8%, range -8% to 54%; P = 0.02), which correlated with time from injury to surgery (rho = 0.87; P = 0.001). These results indicate that ultrasound can be used as an adjunct assessment tool to monitor both morphology and sliding of the nerve through the repair site. It may have future application in the investigation of patients with persisting functional impairment following primary nerve repair.

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Distal nerve entrapment following nerve repair

Cited by 20 publications

References 4 publications

Pure neuritic leprosy presenting as ulnar nerve neuropathy: a case report of electrodiagnostic, radiographic, and histopathological findings

Pure neuritic leprosy presenting as ulnar nerve neuropathy: a case report of electrodiagnostic, radiographic, and histopathological findings

Multihit Injury of the Radial Nerve in a 62-year-old Woman: A Case Report

Sonographic measurements of longitudinal median nerve sliding in patients following nerve repair

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