Primary Osteosarcoma of the Breast: Report of 2 Cases

Two distinct histologic variants of primary breast osteosarcoma in 2 elderly women are described. The first patient was an 88-year-old woman with a long-standing, slow-growing, 18-cm mass in her right breast. The second patient was a 96-year-old woman with a recently self-detected, painless, 7.5-cm lump in her left breast. Clinically, there was no evidence of metastasis, and both women underwent simple mastectomy. Histologic features of both specimens were those of high-grade primary breast osteosarcoma. The first patient's tumor was classified as a chondroblastic variant, and the second as an osteoblastic variant of osteosarcoma. The patients were alive without evidence of local recurrence or hematogenous spread at a 16- and 4-month follow-up, respectively. Primary mammary osteosarcoma should be distinguished from metaplastic/ sarcomatoid carcinoma with heterologous osseous/cartilaginous differentiation or malignant phyllodes tumor because it has a different biological behavior and requires a different treatment approach.

Study of the ulnar nerve compromise at the wrist of patients with carpal tunnel syndrome

INTRODUCTION

That the ulnar nerve compromise occurs concomitant with the carpal tunnel syndrome (CTS) has been cited by previous studies. It seems that the previously mentioned incidence is much higher than what we observe in our electrodiagnosis studies.

MATERIAL AND METHOD

A prospective study was designed to evaluate the incidence of ulnar nerve compromise in patients with electrodiagnostic evidence of CTS according to age and sex, and also to determine the site of ulnar nerve involvement.

RESULTS

One hundred and sixty five limbs with standard elestrodiagnostic criteria of CTS were evaluated In 9.7% of the tested limbs, the ulnar nerve was involved. The site of the involvement was the wrist area in 43.75%. The elbow region was involved in 43.75%, and in 12.5%, the forearm region was involved. The most prevalent age range of concomitant involvement was 45-54 years old. In patents who had sensory symptoms in the 4th and 5th fingers, the incidence of concomitant ulnar nerve compromise was significantly higher (p < 0.001) than the patients without these symptoms.

DISCUSSION

In patients with CTS, concomitant ulnar nerve compromise is much lower than the incidence mentioned in previous researches. Apparently the rate of involvement in wrist and elbow are equal. It is recommended that in evaluation of patients for CTS especially when the patient has sensory symptoms in the hand, special attention is paid to ulnar nerve involvement and two nerve comparison tests are interpreted with caution.

The economic burden of carpal tunnel syndrome: long-term earnings of CTS claimants in Washington State

BACKGROUND

The long-term earnings losses borne by injured workers, beyond those covered by workers' compensation insurance, are rarely estimated. The post-claim earnings of a cohort of carpal tunnel syndrome (CTS) claimants are tracked over a period of 6 years and compared to the earnings of claimants with either upper extremity fractures or dermatitis.

METHODS

Quarterly earnings records of 4,443 workers in Washington State who filed claims with the State Fund in 1993 or 1994 for CTS are compared to those of 2,544 with upper-extremity fracture claims and 1,773 with medical-only dermatitis claims. Multivariate regression was used to identify the effect of injury type on earnings from that of other potential predictors.

RESULTS

CTS claimants recover to about half of their pre-injury earnings level relative to that of comparison groups after 6 years; they also endured periods on time-loss three times longer than claimants with upper extremity fractures. CTS surgery claimants had better outcomes than those who did not have surgery. Earnings recovery fractions among CTS claimants were better for workers who: (1) were younger; (2) had stable pre-claim employment; (3) lived in the Puget sound area; (4) worked for large businesses; (5) worked in non-construction/transportation industries; or (6) were in the higher pre-injury earnings categories. Cumulative excess loss of earnings of the 4,443 CTS claimants was 197 million dollars to 382 million dollars over 6 years, a loss of 45,000-89,000 dollars per claimant. This underscores the importance of prevention, early diagnosis, and accommodation for return to work.

The Relationship Between Electrodiagnostic Findings and Patient Symptoms and Function in Carpal Tunnel Syndrome

OBJECTIVE

To examine whether, in patients with carpal tunnel syndrome (CTS), electrodiagnostic study findings were associated with patient symptom severity and functional limitations after controlling for potentially confounding variables including depression, somatization, and pain-related catastrophizing.

DESIGN

Cross-sectional design including data from 2 ongoing CTS studies.

SETTING

Patients enrolled from hospitals and clinics in Washington State between October 2002 and February 2006.

PARTICIPANTS

Adults with CTS (N=215) (based on symptoms and abnormal electrodiagnostic findings) were analyzed. Exclusion criteria were any mass, tumor, severe trauma, or deformity in the hand or wrist, radiculopathy, polyneuropathy, pregnancy, lactation, or severe CTS.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ) functional status scale assessed the ability to perform 9 common hand-related tasks. The CTSAQ symptom severity scale included 11 items that assess pain, numbness, and weakness. Patients also rated their average hand and wrist pain in the last month.

RESULTS

With and without controlling for patient characteristics, including age, sex, body mass index, symptom duration, depression, somatization, and pain-related catastrophizing, there were no statistically significant relationships between the electrodiagnostic findings and patient functional status and symptom severity.

CONCLUSIONS

Electrodiagnostic findings and patient CTS-related symptoms and function appear to be independent measures. Clinicians and researchers interested in CTS outcomes need to assess both.

Clinical profile, electrodiagnosis and outcome in patients with carpal tunnel syndrome: a Singapore perspective

INTRODUCTION

Carpal tunnel syndrome (CTS ) is the most common entrapment neuropathy seen in our neurodiagnostic laboratory referrals. We describe the clinical profile, and outcome in patients with electrophysiological diagnosis of CTS seen in our centre over a six month period.

METHODS

A retrospective study was carried out and included 134 consecutive patients with CTS referred to the Neurodiagnostic Laboratory, National Neuroscience Institute, from October 2003 to March 2004, for the confirmatory testing. Severity grade was assigned following American Association of Electrodiagnostic Medicine criteria of CTS.

RESULTS

The majority of patients were female (81.3 percent) with mean age of presentation being 53.6 years. Chinese women constitute the majority racial group. Paraesthesia (70.1 percent) and numbness (19.4 percent) were the presenting sensory symptoms. In the nerve conduction study, 108 patients had bilateral CTS with 35 having unilateral symptoms. Dominant hand involvement was present in 92.3 percent. Overall, 40.3 percent had mild, 46.3 percent had moderate and 13.4 percent had severe CTS, with median duration of symptoms of two, four and 12 months, respectively. Follow-up data were available for 115 patients. 27 patients with surgical treatment showed resolution or improvement in 53.3 percent with moderate CTS, and 83.3 percent with severe CTS, at three-month follow-up. 14 patients turned up for six-month follow-up and 92.9 percent showed improvement in symptoms. 88 patients were managed conservatively; symptoms were unchanged or worsened in 80.6 percent with mild CTS, 65.9 percent with moderate CTS, and 62.5 percent with severe CTS at three-month follow-up. Of the 54 patients who turned up for six-month follow-up, the clinical symptom remain unchanged or worsened in 68.5 percent.

CONCLUSION

The severity of CTS is associated with longer duration of symptoms. Sensory symptoms and dominant hand involvement is more common. There is a high default rate in the clinical follow-up. Early surgical intervention results in either resolution or improvement in symptoms, whereas conservative management does not affect the natural history with symptoms that persisted or worsened with time.

Dor e parestesias nos membros superiores e diagnóstico da síndrome do túnel do carpo

Nós avaliamos a freqüência e localização de dor e parestesias em pacientes com síndrome do túnel do carpo (STC) e em indivíduos da população geral, pareados por gênero e idade. Determinamos a sensibilidade e a especificidade desses sintomas para o diagnóstico de STC. Dor foi um sintoma comum nos dois grupos de pacientes. Parestesia ocorreu com mais freqüência em pacientes com STC (p<0,05). No grupo com STC, a dor era localizada no pescoço (42,8%), membros superiores (36,8%) e mãos (82,8%). Nos pacientes sem STC, a dor se localizava na cabeça (11,4%), região axial (37,1%) e membros inferiores (22,8%). Nós concluímos que, em relação ao diagnóstico de STC, dor e parestesias apresentam sensibilidade baixa e especificidade alta quando as queixas estão presentes nos membros superiores; e sensibilidade e especificidade altas (>75%) quando são localizadas nas mãos.

The Pain Quality Assessment Scale: Assessment of Pain Quality in Carpal Tunnel Syndrome

The Neuropathic Pain Scale (NPS) is a valid measure of the pain qualities and perceived depth of neuropathic pain. However, it does not include a number of pain qualities commonly seen in some neuropathic and non-neuropathic pain conditions. To address this limitation, additional items were added to the NPS to create a 20-item measure (Pain Quality Assessment Scale, PQAS) that would be even more useful for assessing neuropathic pain and also would be used to assess pain qualities associated with non-neuropathic pain. To evaluate the responsivity of the PQAS items to pain treatment, secondary analyses were conducted on data from a trial that compared the efficacy of lidocaine patch 5% versus a single steroid injection in 40 patients with carpal tunnel syndrome. Statistically significant (P < .0025) decreases in 10 of the 20 PQAS pain descriptor ratings occurred with both treatments, and 8 ratings showed nonsignificant trends (.0025 < P < .05) for decreasing before treatment to after treatment. No significant differences were found between the 2 treatment conditions on any of the items. The results support the validity of the PQAS items for assessing the effects of pain treatment on pain qualities of carpal tunnel syndrome.

PERSPECTIVE

Clinical trials that include measures of pain qualities can be used to identify the effects of treatments on distinct pain qualities. Measures such as the PQAS can potentially be used to help clinicians target analgesics more efficiently.

Extra-median spread of sensory symptoms in carpal tunnel syndrome suggests the presence of pain-related mechanisms

Patients with carpal tunnel syndrome (CTS) may complain of sensory symptoms outside the typical median nerve distribution. The study is aimed to understand which clinical features are associated with the extra-median distribution of symptoms in CTS. We recruited 241 consecutive CTS patients. After selection, 103 patients (165 hands) were included. The symptoms distribution was evaluated with a self-administered hand symptoms diagram. Patients underwent objective evaluation, neurographic study and a self-administered questionnaire on subjective complaints. No clinical or electrodiagnostic signs of ulnar nerve involvement were found in the 165 hands. Median distribution of symptoms was found in 60.6% of hands, glove distribution in 35.2% and ulnar distribution in 4.2%. Objective measures of median nerve lesion (tactile hypaesthesia and thenar muscles hypasthenia) and neurographic involvement were significantly more severe in median hands than in the other groups. Subjective complaints (nocturnal pain, numbness and tingling sensations) were significantly more severe in glove hands. Neurophysiological and objective measures were not correlated with subjective complaints. The severity of the objective examination and neurographic involvement and the intensity of sensory complaints appear to be independent factors that influence the symptoms distribution. Extra-median spread of sensory symptoms was associated with higher levels of pain and paresthesia. We suggest that central nervous system mechanisms of plasticity may underlie the spread of symptoms in CTS.

Frequency and severity of carpal tunnel syndrome according to level of cervical radiculopathy: Double crush syndrome?

OBJECTIVE

The double crush hypothesis (DC) proposes that a proximal lesion along an axon predisposes it to injury at a more distal site along its course through impaired axoplasmic flow. The frequency and severity of carpal tunnel syndrome (CTS) according to the level of cervical radiculopathy were investigated to evaluate the hypothesis of DC.

METHODS

The frequency of CTS was investigated in 277 patients with C6, C7 or C8 radiculopathies and correlation between CTS and radiculopathy level was determined. We also investigated whether the degrees of abnormal sensory responses were more severe in C6, C7 radiculopathies and whether motor responses were more severe in C8 radiculopathy.

RESULTS

Thirty-nine patients were diagnosed with CTS and concomitant cervical radiculopathy at the C6, 7, or C8 root levels. The frequency of coexisting CTS was not statistically different according to the level of radiculopathy. The electrophysiologic results revealed no significant correlation between median sensory parameters and C6, C7 cases, and no relationship was observed between median motor responses and C8 radiculopathy.

CONCLUSIONS

The frequency and electrophysiologic data of CTS analyzed according to cervical radiculopathy level do not support a neurophysiological explanation.

SIGNIFICANCE

Based on this study, the DC hypothesis could not be supported.

The thenar index: an objective assessment and classification of thenar atrophy based on static hand imprints and clinical implications

BACKGROUND

The aims of this study were to test the effectiveness of the subjective clinical evaluation and to search for any possibility of constituting an objective assessment system for the diagnosis of thenar atrophy based on static hand imprints.

METHODS

Static hand imprints were obtained from normal subjects (group A, n = 116) and carpal tunnel syndrome patients with thenar atrophy (group B, n = 26). Thenar index and the bilateral thenar index ratio were defined. Cutoff values were considered by analyses with receiver operating characteristic curves.

RESULTS

No statistically significant difference could be demonstrated in thenar index values of dominant and nondominant hands between genders and age groups (p > 0.05). A statistically significant difference was observed between severity groups in group B (p < 0.05). There was a statistically significant difference between thenar index and bilateral thenar index ratio values of groups A and B (p < 0.05). Cutoff values were considered a thenar index of 31 and a bilateral thenar index ratio of 0.8, which revealed acceptable specificity (95.3 percent) and sensitivity (77.4 percent). A new quantitative classification for thenar atrophy severity is proposed.

CONCLUSIONS

Understanding the true onset and natural progression of thenar atrophy can only be anticipated with the aid of an objective assessment system. Currently, this method should be regarded as a system for patient records and comparison for presurgical and postsurgical data. The authors believe that the thenar index classification has some merit for future use. It seems that additional objective and scientific evaluation systems and novel approaches are still needed to demystify the true nature of carpal tunnel syndrome.

Prediction of the neurophysiological diagnosis of carpal tunnel syndrome from the demographic and clinical data

OBJECTIVE

To use demographic and clinical data to identify the clinical pattern that best predicts the diagnosis of carpal tunnel syndrome (CTS), as defined by neurophysiologic studies.

METHODS

A diagnostic cross-sectional study in 2535 consecutive patients (3907 upper limbs) older than 12 years old who were referred for nerve conduction studies in the upper limbs between August 2001 and January 2003 in 3 university hospitals and 2 private neurophysiology services in the state of Rio Grande do Sul, Brazil.

RESULTS

A neurophysiologic diagnosis of CTS was established in 39.1% of these upper limbs. The presence of paresthesias or pain at least 2 of the first 4 digits in association with one of the following: female gender, symptoms worsening at night or on awakening, an BMI > or =30, thenar atrophy, or other sign (Tinel's, Phalen's, or Reversed Phalen's signs); were the best pattern associated with the diagnosis.

CONCLUSIONS

We have found that the clinical picture alone does not seem sufficient, in majority of the population, to correctly predict the diagnosis of CTS, as defined by median nerve neuropathy at the carpal tunnel. We believe that a compressive lesion of the median nerve at the carpal tunnel can be present both in patients with no typical symptoms of CTS (including asymptomatic individuals) and in patients in which neurophysiologic studies are negative.

SIGNIFICANCE

Further studies separating patients into these groups will allow us to identify the long-term prognosis as well as the ideal therapeutic approach for each of these clinical situations.

Carpal tunnel syndrome and development of trigger digit

Although the coexistence of carpal tunnel syndrome and trigger digit in the same hand is well documented, the interactive relationship between them is unclear. This study was conducted to examine the factors that may impact on the development of trigger digit in the hand with idiopathic carpal tunnel syndrome. One hundred and eighty-one patients were enrolled. Their gender, age, dominant side, severity of carpal tunnel syndrome, history or presence of trigger digit, and treatment type were recorded. The patients were evaluated for the presence of trigger digit at 1, 3, 6 and 12 months after surgery or the initial evaluation. Two hundred and sixty-five hands in 152 patients were included in the final assessment. Logistic regression analysis revealed that surgery was a significant risk factor for the onset of trigger digit and may accelerate development of trigger digit when carpal tunnel syndrome was mild to moderate, but not when it was severe. In severe disease, other unknown factors, such as hypertrophy of the flexor tenosynovium, may mask the effect of surgery.

Carpal tunnel syndrome: comparison of the compound muscle action potentials recorded at the thenar region from ulnar and median nerve stimulation

Thenar muscles are primarily innervated by the median nerve. However, compound muscle action potentials (CMAPs) evoked by ulnar nerve stimulation can be recorded at the thenar region due to proximity of some ulnar-innervated muscles, and from volume conduction events. This study was to determine if loss of thenar muscle mass from carpal tunnel syndrome (CTS) could alter the size of ulnar CMAPs obtained at the thenar region, because of changes in the physical surroundings and electrical conductivity. Supramaximal CMAPs were recorded over the thenar eminence to electrical stimulation of the ulnar nerve at the wrist and median nerve at the palm in 102 hands with CTS. Needle EMG was done in the thenar muscles. Severity of needle EMG abnormality was negatively correlated with median-evoked CMAP amplitude (r = -0.76), but not with ulnar-evoked CMAP amplitude (r = -0.12). There was no correlation between the absolute amplitudes of the median and ulnar CMAPs (r = -0.13). Needle EMG abnormality had modest negative correlation (r = -0.43) with median/ulnar CMAP amplitude ratio. Mean median/ulnar CMAP amplitude ratios for normal EMG and for mild, moderate, and severe needle EMG abnormalities were 3.72, 3.31, 1.56, and 0.37, respectively. The absolute amplitude of the ulnar CMAP recorded at the thenar area does not seem to be influenced significantly by the degree of thenar muscle loss (atrophy) from median nerve pathology. However, if the median/ulnar CMAP amplitude ratio falls below 0.5, the study suggests severe loss of motor units in the thenar muscles.

Distribution of paresthesias in Carpal Tunnel Syndrome reflects the degree of nerve damage at wrist☆

OBJECTIVE

To verify whether the distribution of paresthesias in patients with Carpal Tunnel Syndrome (CTS) is related to the degree of the neurophysiological involvement.

METHODS

We performed a cross-sectional study and retrospectively evaluated 163 patients who referred to our electromyography lab and to which a clinical and electrophysiological diagnosis of CTS was made. We divided the patients into two groups: (1) patients complaining of paresthesias at the hand as a whole and (2) patients with paresthesias in the territory of the median nerve. We referred to the distribution of paresthesias at the hand as GLOVE and to the distribution in the territory of the median nerve as MEDIAN. We compared the neurophysiological impairment in GLOVE and MEDIAN distributions. Moreover, we performed multiple regression analysis to evaluate which clinical-neurophysiological variables determined GLOVE and MEDIAN distribution.

RESULTS

In our sample, 70.4% of patients had GLOVE distribution and 29.6% of patients MEDIAN distribution. The risk of presenting MEDIAN distribution increases about twice (OR = 2.07; 95% IC: 1.51-2.83) for each unitary increment of neurophysiological class.

CONCLUSIONS

The distribution of paresthesias reflects the degree of nerve damage at wrist; patients suffering of SEV/EXT CTS present MEDIAN distribution.

SIGNIFICANCE

Our data have important clinical implications because they strongly suggest that we have to consider the possibility of a severe neurophysiological involvement of the median nerve at wrist in patients complaining of MEDIAN distribution.

Hereditary neuropathy with liability to pressure palsy combined with schwannomas of the median and medial plantar nerves

A 42-year-old woman was surgically treated for carpal tunnel syndrome, revealing schwannoma of the median nerve. A year later, she developed a tarsal tunnel syndrome. At time of this diagnosis, hereditary neuropathy with liability to pressure palsies (HNPP) was diagnosed genetically and a schwannoma of the medial plantar nerve was treated surgically. The occurrence of HNPP and schwannomas in the same patient might be purely coincidental, but it is tempting to speculate that they share a common genetic basis.

Electrodiagnostic criteria for carpal tunnel syndrome in axonal polyneuropathy

Median-ulnar comparative studies (MUCSs) play an important role in the electrodiagnosis of carpal tunnel syndrome (CTS), but diagnostic criteria in patients with underlying axonal polyneuropathy have not been established. We prospectively evaluated 28 patients with axonal polyneuropathy (48 hands), blindly dichotomized into CTS cases and controls, using the lumbrical-interosseous motor (LIM), mixed palmar sensory (MPS), and digit 4 sensory (D4S) MUCS. LIM, MPS, and D4S MUCS latency differences could be calculated in 98%, 69%, and 48% of hands. Based on the maximum combination of sensitivity and specificity, diagnostic cutoffs were > or = 0.8, > or = 0.5, and > or = 0.4 ms for the LIM, MPS, and D4S studies, respectively. The LIM study was the most accurate test and the only MUCS that yielded a positive likelihood ratio greater than 10 (16.25 for a cut-off value of 1 ms) and a negative likelihood ratio less than 0.1 (0.09 for a cut-off value of 0.4 ms), resulting in meaningful differences in pretest and posttest probabilities of CTS in patients with axonal polyneuropathy. These novel MUCS electrodiagnostic criteria should facilitate more accurate electrodiagnostic confirmation of CTS in this population.

Trigger digits: principles, management, and complications

Stenosing tenosynovitis, or trigger finger, is an entity seen commonly by hand surgeons. This problem generally is caused by a size mismatch between the flexor tendon and the first annular (A-1) pulley. Conservative management includes splinting, corticosteroid injection, and other adjuvant modalities. Surgical treatment consists of release of the A-1 pulley by open or percutaneous techniques. Complications are rare but include bowstringing, digital nerve injury, and continued triggering. Some patients require more extensive procedures to reduce the size of the flexor tendon. Comorbid conditions affect how trigger finger is treated. Patients with rheumatoid arthritis require tenosynovectomy instead of A-1 pulley release. In children trigger thumb resolves reliably with A-1 pulley release but other digits may require more extensive surgery. In diabetic patients trigger finger often is less responsive to conservative measures. An understanding of the pathomechanics, risk factors, and varied treatments for trigger finger is essential for appropriate care.

Arthroscopic dorsal radiocarpal ligament repair

PURPOSE

The goal of this study was to determine if arthroscopic repair of a dorsal radiocarpal ligament (DRCL) tear is effective in ameliorating wrist pain.

TYPE OF STUDY

Retrospective study.

METHODS

A chart review was performed of 53 patients (56 wrists) who underwent wrist arthroscopy with use of a volar radial portal. There were 21 patients with DRCL tears. Mean follow-up was 16 months. Thirteen patients underwent arthroscopic DRCL repair and/or thermal shrinkage (5 repairs, 6 repair plus shrinkage, and 2 shrinkage). Lunotriquetral tears were treated with debridement and pinning. Triangular fibrocartilage (TFC) tears were debrided or repaired. Scapholunate ligament tears/instability were treated with capsulodesis.

RESULTS

The 4 patients who underwent repair of an isolated DRCL tear had excellent results with no or mild pain. All returned to their previous occupation. Dorsal capsulodesis was performed in 7 patients with 4 fair/poor results. Nine DRCL repairs/shrinkage were in association with other procedures for ulnar-sided pathology with 6 fair/poor results.

CONCLUSIONS

Tears of the DRCL are more common than previously suspected. They are best seen through a volar radial portal and are amenable to arthroscopic repair. DRCL tears appear to be part of a spectrum of radial and ulnar-sided carpal instability as evidenced by the frequent association with scapholunate ligament tears/instability or ulnar-sided pathology. Isolated DRCL tears can be solely responsible for wrist pain. Good results are obtained with arthroscopic repair of isolated DRCL tears. The presence of a DRCL tear when seen in combination with a scapholunate, lunotriquetral, or TFC tear connotes a greater degree and/or duration of carpal instability, and portends a poorer prognosis following treatment. Recognition of this condition and further research into treatment methods is needed.

LEVEL OF EVIDENCE

Level IV.

Carpal tunnel syndrome and flexion contracture of the digits in a child with familial hypercholesterolaemia

This paper presents a 9 year-old girl who had flexion contracture of digits, carpal tunnel syndrome and multiple xanthomas covering the extremities.

Abductor pollicis longus tendon rupture in De Quervain's disease

De Quervain's disease is a stenosing tenovaginitis involving the first extensor compartment of the wrist. The similarity of its symptomatology to a number of other conditions and its controversial aetiology are only a few of the barriers which often delay its diagnosis and treatment. We report the first two cases in the literature of abductor pollicus longus tendon rupture in patients with De Quervain's disease who had been treated with conservative methods. The relevant literature is reviewed.

[Clinical study of cervical myeloradiculopathy with carpal tunnel syndrome, double crush syndrome]

The hypothesis, "double crush syndrome (DCS)", is that neural function could be impaired when single axons, having been compressed in one region, become especially susceptible to damage in another. We retrospectively review our surgical cases with both cervical lesion and carpal tunnel syndrome, i.e., DCS. From January 2001 to January 2005, we have treated 7 patients (Male-4, Female-3, average age-59.9 years old) under the diagnosis of DCS. Cervical lesions were cervical spondylosis in 4 and cervical narrow canal in 3 patients. Peripheral entrapment neuropathy was carpal tunnel syndrome in all 7 cases. Initial operation was performed for cervical lesion in 2, carpal tunnel syndrome in 2, and 3 cases were operated simultaneously. The improvement rate by Neurosurgical Cervical Spine Scale (NCSS) was average 65.8%. The average follow-up period was 18.2 months. Good results can be obtained in 5 cases, and poor results in 2 cases who underwent initial operation under the diagnosis of single lesion. It is well known that a discrepancy between neurological manifestation and neuro-imaging sometimes occurs in cervical lesions, and then DCS should be considered as a possible pathogenetic mechanism.