Outcomes of Microneurolysis of Hourglass Constrictions in Chronic Neuralgic Amyotrophy

Krishnan, Karthik R.; Sneag, Darryl B.; Feinberg, Joseph H.; Nwawka, O. Kenechi; Lee, Steve K.; Arányi, Zsuzsanna; Wolfe, Scott W.

doi:10.1016/j.jhsa.2020.07.015

Cited by 33 publications

(33 citation statements)

References 33 publications

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“… 25 In recalcitrant cases, surgical neurolysis has also demonstrated efficacy. 26 The timely and accurate diagnosis of PTS, which is often delayed, can help alleviate any undue stress for the patient and direct appropriate management.…”

Section: Discussionmentioning

confidence: 99%

Parsonage-Turner Syndrome Following COVID-19 Vaccination: MR Neurography

et al. 2022

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Vaccination is one of the several known triggers of Parsonage-Turner syndrome (PTS). This report describes 2 individuals with clinical presentations of PTS whose symptoms began 13 hours and 18 days following receipt of the Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273 COVID-19 vaccine, respectively. The diagnosis of PTS was confirmed using both electrodiagnostic testing and 3 Tesla magnetic resonance (MR) neurography. While research is needed to understand the association between PTS and COVID-19 vaccination, MR neurography may be used to confirm suspected cases of PTS as COVID-19 vaccines continue to be distributed worldwide.

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Section: Discussionmentioning

confidence: 99%

Parsonage-Turner Syndrome Following COVID-19 Vaccination: MR Neurography

et al. 2022

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“…Prolonged pain with no signs of motor recovery is associated with a poorer prognosis. Overall, there is wide variability in the recovery of patients affected by PTS, including an estimated 30% of patients who experience residual motor deficits 10 …”

Section: Discussionmentioning

confidence: 99%

“…Surgical exploration with internal and fascicular neurolysis was performed at all constriction sites 9 . In a follow-up study, Krishnan et al 10 reports that of 24 patients with PTS and HGCs on imaging, 11 patients were treated surgically with neurolysis and 13 patients were treated nonsurgically. Nine patients (82%) in the operative group experienced clinical recovery compared with 3 patients (23%) in the nonoperative group 10 …”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Parsonage Turner Syndrome With Primary Nerve Transfers

et al. 2022

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Parsonage Turner syndrome (PTS) is the development of severe, spontaneous pain with subsequent nerve palsy. Unfortunately, many patients never achieve full functional recovery, and many have chronic pain. The use of nerve transfers in PTS has not been reported in the literature. We present 4 cases of PTS treated surgically with primary nerve transfer and neurolysis of the affected nerve following the absence of clinical and electrodiagnostic recovery at 5 months from onset. In addition, we present a cadaver dissection demonstrating an interfascicular dissection of the anterior interosseous nerve (AIN) into its components to enable a fascicular transfer in partial AIN neuropathy. Two patients with complete axillary neuropathy underwent a neurorrhaphy between the nerve branch to the lateral head of the triceps and the anterior/middle deltoid nerve branch of the axillary nerve. Two patients with partial AIN neuropathy involving the FDP to the index finger (FDP2) underwent a neurorrhaphy between an extensor carpi radialis brevis nerve branch and the FDP2 nerve branch. All patients had neurolysis of the affected nerves. All subjects recovered at least M4 motor strength. The cadaver dissection demonstrates 3 separate nerve fascicles of the AIN into FPL, FDP2, and pronator quadratus that can be individually selected for reinnervation with a fascicular nerve transfer. Functional recovery for patients with PTS with neurolysis alone is variable. Surgical treatment with neurolysis and a nerve transfer to improve functional recovery when no recovery is seen by 5 months is an option.

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“…There is increasing evidence that patients with spontaneous peripheral neuropathies such as anterior interosseous nerve palsy after a shoulder surgical procedure, posterior interosseous nerve palsy, or Parsonage-Turner syndrome may benefit from peripheral nerve decompression if spontaneous recovery is not present early [80][81][82][83] . In terms of nerve injury, a surprising number (32.5%) of complete nerve lacerations were missed on the initial evaluation 84 , emphasizing the need for thorough knowledge and examination of the nerve function.…”

Section: Peripheral Nervementioning

confidence: 99%

What’s New in Hand and Wrist Surgery

Bohn

Wise

2022

Journal of Bone and Joint Surgery

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The intent is to serve as an update of the hand surgery literature for the practicing general orthopaedic surgeon. Carpal Tunnel SyndromeCarpal tunnel syndrome is one of the most common disorders in hand surgery. Nevertheless, the optimum method for diagnosis remains controversial. A growing body of evidence suggests that electrodiagnostic studies [1][2][3][4] are not more sensitive and specific than diagnosis by ultrasound or clinical history and examination. D'Auria et al. 5 examined the role of electrodiagnostic studies compared with clinical judgment and found that the utility of electrodiagnostic studies may be greatest in patients for whom a diagnosis of carpal tunnel syndrome is questionable. Even so, electrodiagnostic studies are performed in many patients with carpal tunnel syndrome 6 . Less expensive, office-based diagnostic tools such as the Carpal Tunnel Syndrome 6 (CTS-6), a 26-point scale that incorporates aspects of the history and clinical examination to predict the probability of carpal tunnel syndrome, and ultrasound will likely supplant the routine use of electrodiagnostic studies for carpal tunnel syndrome.Strong evidence exists for the use of night splints and corticosteroid injections for early treatment of carpal tunnel syndrome. In a comparison of the 2 treatments, 100 patients with a diagnosis of carpal tunnel syndrome were randomized to a night splint or a corticosteroid injection 7 . In the 95 patients who completed follow-up, corticosteroid injections were superior in terms of nocturnal paresthesias, pain, and Boston Carpal Tunnel Questionnaire (BCTQ) function and symptom domains at 1, 3, and 6 months.A novel study on hand function with decreased sensation showed that a digital nerve block to the thumb had the greatest negative impact on dexterity and a loss of sensation in the index and long fingers caused decreased grip and chuck pinch strength, thus explaining the common symptoms of decreased dexterity and strength in patients with carpal tunnel syndrome 8 .Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G899).

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Outcomes of Microneurolysis of Hourglass Constrictions in Chronic Neuralgic Amyotrophy

Cited by 33 publications

References 33 publications

Parsonage-Turner Syndrome Following COVID-19 Vaccination: MR Neurography

Parsonage-Turner Syndrome Following COVID-19 Vaccination: MR Neurography

Surgical Treatment of Parsonage Turner Syndrome With Primary Nerve Transfers

What’s New in Hand and Wrist Surgery

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