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Park JE, Sneag DB, Choi YS, Oh SH, Choi S. Fascicular Involvement of the Median Nerve Trunk in the Upper Arm: Manifestation as Anterior Interosseous Nerve Syndrome With Unique Imaging Features. Korean J Radiol 2024; 25:449-458. [PMID: 38685735 PMCID: PMC11058432 DOI: 10.3348/kjr.2023.1218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/26/2024] [Accepted: 02/10/2024] [Indexed: 05/02/2024] Open
Abstract
Selective fascicular involvement of the median nerve trunk above the elbow leading to anterior interosseous nerve (AIN) syndrome is a rare form of peripheral neuropathy. This condition has recently garnered increased attention within the medical community owing to advancements in imaging techniques and a growing number of reported cases. In this article, we explore the topographical anatomy of the median nerve trunk and the clinical features associated with AIN palsy. Our focus extends to unique manifestations captured through MRI and ultrasonography (US) studies, highlighting noteworthy findings, such as nerve fascicle swelling, incomplete constrictions, hourglass-like constrictions, and torsions, particularly in the posterior/posteromedial region of the median nerve. Surgical observations have further enhanced the understanding of this complex neuropathic condition. High-resolution MRI not only reveals denervation changes in the AIN and median nerve territories but also illuminates these alterations without the presence of compressing structures. The pivotal roles of high-resolution MRI and US in diagnosing this condition and guiding the formulation of an optimal treatment strategy are emphasized.
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Affiliation(s)
- Jae Eun Park
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, USA
| | - Yun Sun Choi
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea.
| | - Sung Hoon Oh
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - SeongJu Choi
- Department of Orthopedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
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2
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Pöschl P, Pham M, Pedro MT, Antoniadis G. [Neuralgic amyotrophy: an inflammatory neuropathy and its surgical treatment]. HANDCHIR MIKROCHIR P 2024; 56:40-48. [PMID: 38272037 DOI: 10.1055/a-2226-4260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Neuralgic amyotrophy (NA) is a monofocal or oligofocal inflammatory neuropathy whose incidence has been significantly underestimated. A connection between constrictions and torsions of peripheral nerves with this disease has been increasingly established in recent years. Modern imaging techniques such as high-resolution nerve ultrasound and MR neurography have contributed to a better understanding of the pathophysiology and a better assessment of the prognosis of the disease. This has led to the concept of treating patients with such focal changes surgically in order to improve the prognosis. This review presents current ideas on the pathophysiology, clinical presentation, diagnosis and treatment of the disease. PATIENTS AND METHODS In a retrospective study, pre-, intra- and postoperative findings of 22 patients with 23 constrictions/torsions of peripheral nerves of the upper extremity were analysed. The patients underwent surgery at a nerve surgery centre over a period of 3.5 years (Dec. 2019-May 2023). The median nerve was most frequently affected (N=9), followed by the suprascapular nerve (N=6) and radial nerve (N=4). The axillary nerve (N=3) and the accessory nerve (N=1) were also involved. Surgical exploration revealed nerve torsions (N=9), nerve constrictions (N=5), fascicular torsions (N=12) and fascicular constrictions (N=9). Depending on the intraoperative findings, epineuriotomies (N=1), epi- and perineuriotomies (N=33), end-to-end sutures (N=2), and one epi- and one perineural suture were performed. RESULTS After an average follow-up of 10 months (3-28 months), 17 patients were re-examined. All of them reported a clear subjective improvement in motor deficits. Clinically and electromyographically, a reinnervation and significant increase in strength from a pre-existing strength grade of M0 to at least M3 in the vast majority of affected muscles was demonstrated in these patients. SUMMARY The incidence of NA continues to be underestimated and, in a significant proportion of patients, leads to permanent motor deficits, most likely due to constrictions and torsions of affected nerves. Surgical treatment is recommended as early as possible. Very good results can usually be achieved with epi- and perineuriotomy. In rare cases, end-to-end neurorrhaphy or nerve grafting is required.
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Affiliation(s)
- Peter Pöschl
- Neurologie, Neurologische Praxis Sinzing, Sinzing, Germany
| | - Mirko Pham
- Institut für Neuroradiologie, Universität Würzburg, Wurzburg, Germany
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Meiling JB, Boon AJ, Niu Z, Howe BM, Hoskote SS, Spinner RJ, Klein CJ. Parsonage-Turner Syndrome and Hereditary Brachial Plexus Neuropathy. Mayo Clin Proc 2024; 99:124-140. [PMID: 38176820 DOI: 10.1016/j.mayocp.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/10/2023] [Accepted: 06/23/2023] [Indexed: 01/06/2024]
Abstract
Parsonage-Turner syndrome and hereditary brachial plexus neuropathy (HBPN) present with indistinguishable attacks of rapid-onset severe shoulder and arm pain, disabling weakness, and early muscle atrophy. Their combined incidence ranges from 3 to 100 in 100,000 persons per year. Dominant mutations of SEPT9 are the only known mutations responsible for HBPN. Parsonage and Turner termed the disorder "brachial neuralgic amyotrophy," highlighting neuropathic pain and muscle atrophy. Modern electrodiagnostic and imaging testing assists the diagnosis in distinction from mimicking disorders. Shoulder and upper limb nerves outside the brachial plexus are commonly affected including the phrenic nerve where diaphragm ultrasound improves diagnosis. Magnetic resonance imaging can show multifocal T2 nerve and muscle hyperintensities with nerve hourglass swellings and constrictions identifiable also by ultrasound. An inflammatory immune component is suggested by nerve biopsies and associated infectious, immunization, trauma, surgery, and childbirth triggers. High-dose pulsed steroids assist initial pain control; however, weakness and subsequent pain are not clearly responsive to steroids and instead benefit from time, physical therapy, and non-narcotic pain medications. Recurrent attacks in HBPN are common and prophylactic steroids or intravenous immunoglobulin may reduce surgical- or childbirth-induced attacks. Rehabilitation focusing on restoring functional scapular mechanics, energy conservation, contracture prevention, and pain management are critical. Lifetime residual pain and weakness are rare with most making dramatic functional recovery. Tendon transfers can be used when recovery does not occur after 18 months. Early neurolysis and nerve grafts are controversial. This review provides an update including new diagnostic tools, new associations, and new interventions crossing multiple medical disciplines.
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Affiliation(s)
- James B Meiling
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Zhiyv Niu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Sumedh S Hoskote
- Department of Pulmonary Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Christopher J Klein
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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Hagemann C, Antoniadis G, Pham M, Bischoff C, Ghosh T, Grieser T, Naumann M, Holzapfel K. [Diagnostics and treatment of hourglass-like nerve constrictions and torsions in neuralgic amyotrophy]. DER NERVENARZT 2023; 94:1157-1165. [PMID: 37943327 DOI: 10.1007/s00115-023-01562-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/10/2023]
Abstract
Neuralgic amyotrophy is a disease of the peripheral nervous system characterized by severe neuropathic pain followed by peripheral paralysis. A distinction is made between a hereditary and an idiopathic form, which is assumed to have an autoimmunological origin. Conservative medicinal treatment mainly consists of nonsteroidal anti-inflammatory drugs (NSAID), opioids and glucocorticoids; however, despite treatment, symptoms in the form of pain or paralysis persist in over 50% of cases. Inflammation can lead to strictures and torsions of peripheral nerves, which can be visualized by imaging using nerve sonography or magnetic resonance (MR) neurography and confirmed intraoperatively during surgical exploration. Based on the currently available data, patients with strictures and torsions of peripheral nerves can benefit from neurosurgical treatment.
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Affiliation(s)
- Christian Hagemann
- Klinik für Neurologie und klinische Neurophysiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - Gregor Antoniadis
- Sektion "Periphere Nervenchirurgie", Neurochirurgische Klinik der Universität Ulm am Bezirkskrankenhaus Günzburg, Günzburg, Deutschland
| | - Mirko Pham
- Diagnostische und interventionelle Neuroradiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Christian Bischoff
- Neurologische Gemeinschaftspraxis am Marienplatz, Burgstraße 7, 80331, München, Deutschland
| | - Tanupriya Ghosh
- Klinik für Neurologie und klinische Neurophysiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - Thomas Grieser
- Diagnostische und interventionelle Radiologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Markus Naumann
- Klinik für Neurologie und klinische Neurophysiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - Korbinian Holzapfel
- Klinik für Neurologie und klinische Neurophysiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
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Rusin G, Morga R, Spaczyńska-Boczar M, Rudnicki W, Kwinta BM, Luczynska E, Słowik A, Antczak J. Neuralgic amyotrophy with bilateral radial nerve torsion: A unique case and review of the literature. Neurologia 2023; 38:707-710. [PMID: 37996215 DOI: 10.1016/j.nrleng.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/29/2022] [Indexed: 11/25/2023] Open
Affiliation(s)
- G Rusin
- Department of Neurology, University Hospital in Krakow, Jakubowskiego 2, Krakow, Poland.
| | - R Morga
- Department of Neurosurgery, University Hospital in Krakow, Jakubowskiego 2, Krakow, Poland
| | - M Spaczyńska-Boczar
- Department of Neurology, University Hospital in Krakow, Jakubowskiego 2, Krakow, Poland
| | - W Rudnicki
- Electroradiology Department, Jagiellonian University Medical College, Jakubowskiego 2, Krakow, Poland
| | - B M Kwinta
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Jakubowskiego 2, Krakow, Poland
| | - E Luczynska
- Electroradiology Department, Jagiellonian University Medical College, Jakubowskiego 2, Krakow, Poland
| | - A Słowik
- Department of Neurology, University Hospital in Krakow, Jakubowskiego 2, Krakow, Poland; Department of Neurology, Jagiellonian University Medical College, Jakubowskiego 2, Krakow, Poland
| | - J Antczak
- Department of Neurology, University Hospital in Krakow, Jakubowskiego 2, Krakow, Poland; Department of Neurology, Jagiellonian University Medical College, Jakubowskiego 2, Krakow, Poland
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He R, Yu JL, Jin HL, Ng L, Wang JC, Li X, Gai TT, Zhou Y, Li DP. Hourglass-like constriction of the anterior interosseous nerve in the left forearm: A case report. World J Clin Cases 2023; 11:4194-4201. [PMID: 37388800 PMCID: PMC10303608 DOI: 10.12998/wjcc.v11.i17.4194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/01/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Hourglass-like constriction neuropathy is a rare neurological disorder. The main clinical manifestation is peripheral nerve injury with no apparent cause, and the pathomorphological change is an unexplained narrowing of the diseased nerve. The diagnosis and treatment of the disease are challenging and there is no accepted diagnostic or therapeutic approach.
CASE SUMMARY This report describes a rare hourglass constriction of the anterior interosseous nerve in the left forearm in a 47-year-old healthy male who was treated surgically and gradually recovered function over a 6-mo follow-up period.
CONCLUSION Hourglass-like constriction neuropathy is a rare disorder. With the development of medical technology, more examinations are now available for diagnosis. This case aims to highlight the rare manifestations of Hourglass-like constriction neuropathy and provides a reference for enriching the clinical diagnosis and treatment experience.
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Affiliation(s)
- Rong He
- Bone and Hand Microsurgery, Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Yantai 264009, Shandong Province, China
| | - Jian-Long Yu
- Bone and Hand Microsurgery, Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Yantai 264009, Shandong Province, China
| | - Hai-Long Jin
- Bone and Hand Microsurgery, Shandong Wendeng Osteopathic Hospital, Weihai 264400, Shandong Province, China
| | - Liqi Ng
- Institute of Orthopaedic and Musculoskeletal Science, University College London, London HA7 4LP, United Kingdom
| | - Jin-Chao Wang
- Bone and Hand Microsurgery, Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Yantai 264009, Shandong Province, China
| | - Xin Li
- Foot and Ankle Surgery, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing 400012, China
| | - Ting-Ting Gai
- Bone and Hand Microsurgery, Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Yantai 264009, Shandong Province, China
| | - Yu Zhou
- Foot and Ankle Surgery, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing 400012, China
| | - Da-Peng Li
- Bone and Hand Microsurgery, Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Yantai 264009, Shandong Province, China
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Cignetti NE, Cox RS, Baute V, McGhee MB, van Alfen N, Strakowski JA, Boon AJ, Norbury JW, Cartwright MS. A standardized ultrasound approach in neuralgic amyotrophy. Muscle Nerve 2023; 67:3-11. [PMID: 36040106 PMCID: PMC10087170 DOI: 10.1002/mus.27705] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 11/08/2022]
Abstract
Neuralgic amyotrophy (NA), also referred to as idiopathic brachial plexitis and Parsonage-Turner syndrome, is a peripheral nerve disorder characterized by acute severe shoulder pain followed by progressive upper limb weakness and muscle atrophy. While NA is incompletely understood and often difficult to diagnose, early recognition may prevent unnecessary tests and interventions and, in some situations, allow for prompt treatment, which can potentially minimize adverse long-term sequalae. High-resolution ultrasound (HRUS) has become a valuable tool in the diagnosis and evaluation of NA. Pathologic HRUS findings can be grouped into four categories: nerve swelling, swelling with incomplete constriction, swelling with complete constriction, and fascicular entwinement, which may represent a continuum of pathologic processes. Certain ultrasound findings may help predict the likelihood of spontaneous recovery with conservative management versus the need for surgical intervention. We recommend relying heavily on history and physical examination to determine which nerves are clinically affected and should therefore be assessed by HRUS. The nerves most frequently affected by NA are the suprascapular, long thoracic, median and anterior interosseous nerve (AIN) branch, radial and posterior interosseous nerve (PIN) branch, axillary, spinal accessory, and musculocutaneous. When distal upper limb nerves are affected (AIN, PIN, superficial radial nerve), the lesion is almost always located in their respective fascicles within the parent nerve, proximal to its branching point. The purpose of this review is to describe a reproducible, standardized, ultrasonographic approach for evaluating suspected NA, and to share reliable techniques and clinical considerations when imaging commonly affected nerves.
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Affiliation(s)
- Natalie E Cignetti
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rebecca S Cox
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Vanessa Baute
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Marissa B McGhee
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeffrey A Strakowski
- Ohio State Department of Physical Medicine and Rehabilitation, Columbus, Ohio, USA
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - John W Norbury
- Division of Physical Medicine and Rehabilitation, Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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8
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Wang T, Qi H, Wang D, Wang Z, Bao S, Teng J. The role of ultrasonography in diagnosing hourglass-like fascicular constriction(s) of the anterior interosseous nerve. Acta Radiol 2021; 63:1528-1534. [PMID: 34839715 DOI: 10.1177/02841851211052995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the past, the diagnosis of hourglass-like fascicular constriction(s) of the anterior interosseous nerve mostly depended on electrophysiological examination, by which the location could not be diagnosed. There are few studies on the evaluation of hourglass-like fascicular constriction(s) by ultrasonography. PURPOSE To evaluate the role of ultrasonography in the diagnosis of hourglass-like fascicular constriction(s) of the anterior interosseous nerve. MATERIAL AND METHODS A retrospective analysis of 12 patients with hourglass-like fascicular constriction(s) of the anterior interosseous nerve was carried out, and the characteristics of the high-frequency ultrasonographic images were summarized and compared with surgical exploration. RESULTS The 12 cases of hourglass-like fascicular constriction(s) of the anterior interosseous nerve were all located in the median nerve of the distal upper arm, including nine cases of single hourglass-like fascicular constriction and three cases of multiple hourglass-like fascicular constrictions. High-frequency ultrasonography can accurately locate the hourglass-like fascicular constriction(s) of the anterior interosseous nerve and the extent of neuropathy. The ultrasonographic images of hourglass-like fascicular constriction(s) of the anterior interosseous nerve showed single or multiple hourglass-like change(s) in the median nerve of the distal upper arm. The nerve fascicles on both sides of the affected nerve with hourglass-like change thickened. CONCLUSIONS High-frequency ultrasonography could be a reliable, convenient, and non-invasive diagnostic imaging method for hourglass-like fascicular constriction(s) of the anterior interosseous nerve.
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Affiliation(s)
- Tiezheng Wang
- Department of Ultrasound, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Hengtao Qi
- Department of Ultrasound, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Dehua Wang
- Department of Hand and Foot Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, PR China
| | - Zengtao Wang
- Department of Hand and Foot Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, PR China
| | - Shougang Bao
- Department of Ultrasound, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Jianbo Teng
- Department of Ultrasound, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China
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Gstoettner C, Mayer JA, Rassam S, Hruby LA, Salminger S, Sturma A, Aman M, Harhaus L, Platzgummer H, Aszmann OC. Neuralgic amyotrophy: a paradigm shift in diagnosis and treatment. J Neurol Neurosurg Psychiatry 2020; 91:879-888. [PMID: 32487526 DOI: 10.1136/jnnp-2020-323164] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 01/22/2023]
Abstract
Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome, is characterised by sudden pain attacks, followed by patchy muscle paresis in the upper extremity. Recent reports have shown that incidence is much higher than previously assumed and that the majority of patients never achieve full recovery. Traditionally, the diagnosis was mainly based on clinical observations and treatment options were confined to application of corticosteroids and symptomatic management, without proven positive effects on long-term outcomes. These views, however, have been challenged in the last years. Improved imaging methods in MRI and high-resolution ultrasound have led to the identification of structural peripheral nerve pathologies in NA, most notably hourglass-like constrictions. These pathognomonic findings have paved the way for more accurate diagnosis through high-resolution imaging. Furthermore, surgery has shown to improve clinical outcomes in such cases, indicating the viability of peripheral nerve surgery as a valuable treatment option in NA. In this review, we present an update on the current knowledge on this disease, including pathophysiology and clinical presentation, moving on to diagnostic and treatment paradigms with a focus on recent radiological findings and surgical reports. Finally, we present a surgical treatment algorithm to support clinical decision making, with the aim to encourage translation into day-to-day practice.
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Affiliation(s)
- Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes A Mayer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department for Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen at the Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Stephanie Rassam
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Laura A Hruby
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Salminger
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Agnes Sturma
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Bioengineering, Imperial College London, London, UK
| | - Martin Aman
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Hand, Plastic and Reconstructive Surgery, Burn Center-Hand and Plastic Surgery, University of Heidelberg, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Leila Harhaus
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center-Hand and Plastic Surgery, University of Heidelberg, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Hannes Platzgummer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria .,Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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Jung YY, Choi YS, Lee CH, Kwon O, Kim M. Selective Fascicular Involvement of the Median Nerve Trunk Causing Pseudo-Anterior Interosseous Nerve Syndrome: Ultrasound and MR Imaging Features. Yonsei Med J 2020; 61:547-552. [PMID: 32469179 PMCID: PMC7255995 DOI: 10.3349/ymj.2020.61.6.547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/27/2022] Open
Abstract
Fascicular involvement of the median nerve trunk in the upper arm is uncommon in cases of peripheral neuropathy, and its symptoms are consistent with those of anterior interosseous nerve (AIN) syndrome. We report three cases of focal anterior interosseous fascicular involvement in the median nerve trunk presenting as AIN palsy. Our report emphasizes the unique ultrasonographic and magnetic resonance imaging (MRI) features of swelling, hourglass-like constriction and torsion, and entwinement of the nerve fascicle of the dorsal region of the median nerve, which were confirmed surgically. On MRI, all patients showed denervation changes in the AIN territory, as well as in the median nerve territory, without compressing structures.
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Affiliation(s)
- Yoon Young Jung
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Yun Sun Choi
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
| | - Chang Hun Lee
- Department of Orthopedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Ohyun Kwon
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Minchul Kim
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
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Update on classification, epidemiology, clinical phenotype and imaging of the nonsystemic vasculitic neuropathies. Curr Opin Neurol 2020; 32:684-695. [PMID: 31313704 DOI: 10.1097/wco.0000000000000727] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Single-organ vasculitis of the peripheral nervous system (PNS) is often designated nonsystemic vasculitic neuropathy (NSVN). Several variants or subtypes have been distinguished, including migratory sensory neuropathy, postsurgical inflammatory neuropathy, diabetic radiculoplexus neuropathies, skin-nerve vasculitides, and, arguably, neuralgic amyotrophy. NSVN often presents as nondiabetic lumbosacral radiculoplexus neuropathy (LRPN). This review updates classification, clinical features, epidemiology, and imaging of these disorders. RECENT FINDINGS A recent study showed the annual incidence of LRPN in Olmstead County, Minnesota to be 4.16/100 000:2.79/100 000 diabetic and 1.27/100 000 nondiabetic. This study was the first to determine the incidence or prevalence of any vasculitic neuropathy. In NSVN, ultrasonography shows multifocal enlargement of proximal and distal nerves. In neuralgic amyotrophy, MRI and ultrasound reveal multifocal enlargements and focal constrictions in nerves derived from the brachial plexus. Histopathology of these chronic lesions shows inflammation and rare vasculitis. Diffusion tensor imaging of tibial nerves in NSVN revealed decreased fractional anisotropy in one study. SUMMARY Single-organ PNS vasculitides are the most common inflammatory neuropathies. Neuralgic amyotrophy might result from PNS vasculitis, but further study is necessary. The usefulness of focal nerve enlargements or constrictions in understanding pathological mechanisms, directing biopsies, and monitoring disease activity in NSVN should be further investigated.
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12
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Kodama N, Ando K, Takemura Y, Imai S. Treatment of spontaneous anterior interosseous nerve palsy. J Neurosurg 2020; 132:1243-1248. [DOI: 10.3171/2018.11.jns181609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe purpose of this study was to clarify the clinical outcomes of spontaneous anterior interosseous nerve palsy (AINP) treated nonsurgically or surgically.METHODSThe authors retrospectively evaluated the clinical course of 27 patients affected with AINP, treated nonsurgically or surgically. Thirteen patients underwent surgical treatment (interfascicular neurolysis), and 14 patients underwent conservative nonsurgical treatment. The mean patient age at the onset of symptoms was 49 years (range 17–77 years). The mean follow-up duration from onset to the latest follow-up examination was 23 months (range 12–38 months).RESULTSIn 12 of 14 patients receiving conservative treatment, signs of recovery from the palsy were obtained within 6 months. These patients showed a recovery of manual muscle test (MMT) grade ≥ 3. In contrast, 2 patients who took more than 12 months from symptom onset to initial recovery showed poor recovery (MMT grade ≤ 2). Surgical treatment was performed in 13 patients because of no sign of recovery from palsy. The mean period from symptom onset to the operation was 8.4 months (range 6–14 months). Ten of 13 patients who underwent surgical treatment within 8 months after symptom onset showed good recovery, with MMT grade ≥ 4. However, 3 patients who underwent surgical treatment more than 12 months after onset showed recovery with MMT grade ≤ 3.CONCLUSIONSConservative treatment for AINP may be continued when patients show signs of recovery within 6 months after symptom onset. In contrast, surgical treatment may be performed within 8 months from the onset of symptoms when the patients show no recovery signs for 6 months.
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Deng H, Lu B, Yin C, Xu Y, Ding Y, Mi Y, Xu P. The Effectiveness of Ultrasonography in the Diagnosis of Spontaneous Hourglasslike Constriction of Peripheral Nerve in the Upper Extremity. World Neurosurg 2020; 134:e103-e111. [DOI: 10.1016/j.wneu.2019.09.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
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Druzhinin DS, Naumova ES, Nikitin SS, Novikov ML, Spirin NN, Fedorov AV. [Sonographic characteristics of non-traumatic focal hourglass-like nerve constriction]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:10-13. [PMID: 30499489 DOI: 10.17116/jnevro201811810110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To describe the sonographic phenomenon of the focal 'hourglass-like constriction' of the peripheral nerves (FCPN). MATERIAL AND METHODS The authors described 7 patients meeting the criteria for the diagnosis of neuralgic amyotrophy with unilateral FCPN identified with ultrasound in 4 cases and detected intraoperatively in 3 cases (preliminary ultrasound was not performed). The US scanner Sonoscape Pro mode gray scale in the transverse and longitudinal scanning, linear probe 8-15 MHz and Logiq9 scanner with elastography were used. RESULTS FCPN was detected in the single nerve in 4 patients, in two nerves in 2 patients and in 3 nerves in one patient. Among all the nerves involved in the pathological process, the radial nerve and its branches were affected in 73% (8 nerves); the ulnar nerve was involved in 18% (2 nerves) and the musculo-cutaneous nerve in 9%. The length of the constriction of the peripheral nerve did not exceed 1.7 mm. The deformation coefficient (DC) of constriction area was 3.8 to .,9; the change in the elasticity in the form of an increase of DC to 5.9 when compared to the intact portion of the nerve and a decrease in echogenicity were observed in one patient. CONCLUSION High-resolution ultrasound of the nerve can be an informative method for the diagnosis of idiopathic non-traumatic FCPN mononeuropathy.
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Affiliation(s)
- D S Druzhinin
- Yaroslavl State Medical University, Ministry of Health of Russia, Yaroslavl, Russia
| | - E S Naumova
- Society of Experts in Neuromuscular Disease; Medical Center 'Practical Neurology', Moscow, Russia
| | - S S Nikitin
- Society of Experts in Neuromuscular Disease; Medical Center 'Practical Neurology', Moscow, Russia
| | | | - N N Spirin
- Yaroslavl State Medical University, Ministry of Health of Russia, Yaroslavl, Russia
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Wang Y, Liu T, Song L, Zhang Z, Zhang Y, Ni J, Lu L. Spontaneous peripheral nerve palsy with hourglass-like fascicular constriction in the upper extremity. J Neurosurg 2019; 131:1876-1886. [PMID: 30611131 DOI: 10.3171/2018.8.jns18419] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/03/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spontaneous paralysis from hourglass-like fascicular constriction of peripheral nerves is rare, its clinical manifestations are not well documented, and its pathogenesis remains unknown. The unclear origin of this disorder and difficulty in diagnosis result in its uncertain management. The authors sought to gain a more thorough understanding of this condition through describing the anatomy, clinical features, etiology, and treatment of hourglass-like constriction. METHODS The authors retrospectively reviewed 20 patients (22 nerves) with hourglass-like constriction. The patients' clinical information was reviewed. Preoperative sonographic assessment and electrophysiological examination of involved nerves were performed. Surgical treatments included interfascicular neurolysis and neurorrhaphy. Samples of tissue subjected to resected constriction were sent for pathological analysis. The patients had regular face-to-face follow-up visits. RESULTS Acute pain was always the first symptom and was followed by paralysis. Paralysis progression was rapid and serious. Surgical exploration indicated an hourglass-like constricted segment completely unrelated to the compressive structures. Electrophysiological analysis showed severe denervation, and histopathological examination showed inflammatory cell infiltration, demyelination, and reduction of nerve fibers. CONCLUSIONS Hourglass-like fascicular constrictive neuropathy has an integrative effect from multiple different mechanisms. Surgical intervention is beneficial for selected patients who do not recover in a timely fashion and have hourglass-like lesions confirmed by preoperative ultrasound imaging. The authors recommend that early surgical intervention of the nerve be offered to patients who do not show any signs of recovery 3 months after onset. Both interfascicular neurolysis and neurorrhaphy are effective treatment methods. Mild to moderate constriction can usually be treated successfully by interfascicular neurolysis alone, whereas more advanced lesions with loss of fascicle continuity (severe constriction) may be best treated with resection and direct neurorrhaphy.
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Affiliation(s)
| | | | | | | | | | - Jinsong Ni
- 3Pathology, the First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
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Sneag DB, Rancy SK, Wolfe SW, Lee SC, Kalia V, Lee SK, Feinberg JH. Brachial plexitis or neuritis? MRI features of lesion distribution in Parsonage-Turner syndrome. Muscle Nerve 2018; 58:359-366. [DOI: 10.1002/mus.26108] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 02/11/2018] [Accepted: 02/17/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Darryl B. Sneag
- Department of Radiology and Imaging; Hospital for Special Surgery, 535 East 70th Street; New York New York 10021 USA
| | - Schneider K. Rancy
- College of Medicine, SUNY Downstate Medical Center; Brooklyn New York USA
| | - Scott W. Wolfe
- Department of Orthopedic Surgery, Hand, and Upper Extremity; Hospital for Special Surgery; New York New York USA
| | - Susan C. Lee
- Department of Radiology and Imaging; Hospital for Special Surgery, 535 East 70th Street; New York New York 10021 USA
| | - Vivek Kalia
- Department of Radiology and Imaging; Hospital for Special Surgery, 535 East 70th Street; New York New York 10021 USA
| | - Steve K. Lee
- Department of Orthopedic Surgery, Hand, and Upper Extremity; Hospital for Special Surgery; New York New York USA
| | - Joseph H. Feinberg
- Department of Physiatry, Sports Medicine; Hospital for Special Surgery; New York New York USA
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Hourglass-like constriction of the suprascapular nerve: a contraindication for minimally invasive surgery. J Shoulder Elbow Surg 2018; 27:e29-e37. [PMID: 29102255 DOI: 10.1016/j.jse.2017.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/17/2017] [Accepted: 08/28/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Suprascapular nerve (SSN) entrapment is usually ascribed to static or dynamic compression. When no cause of compression is found, SSN entrapment is defined as idiopathic. Focal hourglass-like constriction (H-LC) of the SSN that results in muscle paralysis represents an unusual condition that may be misinterpreted and erroneously diagnosed as SSN entrapment or as neuralgic amyotrophy. METHODS With the aim of finding clinical and surgical clues that could differentiate the traditional form of idiopathic SSN entrapment from the rare H-LC, a series of 6 cases of SSN palsy caused by H-LC is presented. RESULTS All but 1 supraspinatus muscle recovered M5 muscle strength. The Constant shoulder score was excellent in 3 patients, good in 1, fair in 1, and poor in 1. DISCUSSION If a diagnosis is not made in time, H-LC may evolve from mild to severe nerve torsion that may require a shift in surgical procedure from epineurotomy and external neurolysis to focal resection and suture. If an incorrect therapy is chosen, the chance of recovery might be definitively compromised with the persistence of muscle palsy. Conversely, when SSN palsy persists despite notch decompression, especially when it is performed with a limited open approach or arthroscopically, concerns about the real etiology and location of nerve compression responsible for the nerve palsy may arise. CONCLUSION When approaching SSN pathology, H-LC should be considered as a potential cause of nerve palsy, as it may represent a contraindication for a limited open approach or arthroscopic decompression.
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017. [DOI: 10.1002/mus.25708 order by 8029-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Katalin DéVay
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - Maja Rosero
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - PéTer Barsi
- MRI Research Center; Semmelweis University; Budapest Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm; Berlin Germany
| | - Thomas Schelle
- Department of Neurology; Städtisches Klinikum Dessau; Dessau Germany
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017. [DOI: 10.1002/mus.25708 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Katalin DéVay
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - Maja Rosero
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - PéTer Barsi
- MRI Research Center; Semmelweis University; Budapest Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm; Berlin Germany
| | - Thomas Schelle
- Department of Neurology; Städtisches Klinikum Dessau; Dessau Germany
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017. [DOI: 10.1002/mus.25708 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Katalin DéVay
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - Maja Rosero
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - PéTer Barsi
- MRI Research Center; Semmelweis University; Budapest Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm; Berlin Germany
| | - Thomas Schelle
- Department of Neurology; Städtisches Klinikum Dessau; Dessau Germany
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21
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017. [DOI: 10.1002/mus.25708 and 1880=1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Katalin DéVay
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - Maja Rosero
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - PéTer Barsi
- MRI Research Center; Semmelweis University; Budapest Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm; Berlin Germany
| | - Thomas Schelle
- Department of Neurology; Städtisches Klinikum Dessau; Dessau Germany
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22
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017. [DOI: 10.1002/mus.25708 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Katalin DéVay
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - Maja Rosero
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - PéTer Barsi
- MRI Research Center; Semmelweis University; Budapest Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm; Berlin Germany
| | - Thomas Schelle
- Department of Neurology; Städtisches Klinikum Dessau; Dessau Germany
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23
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017. [DOI: 10.1002/mus.25708 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Katalin DéVay
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - Maja Rosero
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - PéTer Barsi
- MRI Research Center; Semmelweis University; Budapest Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm; Berlin Germany
| | - Thomas Schelle
- Department of Neurology; Städtisches Klinikum Dessau; Dessau Germany
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017. [DOI: 10.1002/mus.25708 order by 8029-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Katalin DéVay
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - Maja Rosero
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - PéTer Barsi
- MRI Research Center; Semmelweis University; Budapest Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm; Berlin Germany
| | - Thomas Schelle
- Department of Neurology; Städtisches Klinikum Dessau; Dessau Germany
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017; 56:1054-1062. [PMID: 28556181 DOI: 10.1002/mus.25708] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/21/2017] [Accepted: 05/23/2017] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The aim of this study was to assess the value of ultrasonography in neuralgic amyotrophy. METHODS Fifty-three patients with 70 affected nerves were examined with high-resolution ultrasound. RESULTS The most commonly affected nerve was the anterior interosseous (23%). Ultrasonographic abnormalities in the affected nerves, rather than in the brachial plexus, were observed, with an overall sensitivity of 74%. Findings included the swelling of the nerve/fascicle with or without incomplete/complete constriction and rotational phenomena (nerve torsion and fascicular entwinement). A significant difference was found among the categories of ultrasonographic findings with respect to clinical outcome (P = 0.01). In nerves with complete constriction and rotational phenomena, reinnervation was absent or negligible, indicating surgery was warranted. DISCUSSION Ultrasonography may be used as a diagnostic aid in neuralgic amyotrophy, which was hitherto a clinical and electrophysiological diagnosis, and may also help in identifying potential surgical candidates. Muscle Nerve 56: 1054-1062, 2017.
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Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Katalin DéVay
- Department of Traumatology, Szt. István and László Hospital, Budapest, Hungary
| | - Maja Rosero
- Department of Traumatology, Szt. István and László Hospital, Budapest, Hungary
| | - PéTer Barsi
- MRI Research Center, Semmelweis University, Budapest, Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm, Berlin, Germany
| | - Thomas Schelle
- Department of Neurology, Städtisches Klinikum Dessau, Dessau, Germany
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Sneag DB, Saltzman EB, Meister DW, Feinberg JH, Lee SK, Wolfe SW. MRI bullseye sign: An indicator of peripheral nerve constriction in parsonage-turner syndrome. Muscle Nerve 2017; 56:99-106. [DOI: 10.1002/mus.25480] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/30/2016] [Accepted: 11/15/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Darryl B. Sneag
- Department of Radiology and Imaging; Hospital for Special Surgery; 535 East 70th Street New York New York USA 10021
- Weill Medical College of Cornell University; New York New York USA
| | - Eliana B. Saltzman
- Center for Brachial Plexus and Traumatic Nerve Injury; Hospital for Special Surgery; New York New York USA
- Department of Medical Education; Icahn School of Medicine at Mount Sinai; New York New York USA
| | - David W. Meister
- Center for Brachial Plexus and Traumatic Nerve Injury; Hospital for Special Surgery; New York New York USA
| | - Joseph H. Feinberg
- Weill Medical College of Cornell University; New York New York USA
- Center for Brachial Plexus and Traumatic Nerve Injury; Hospital for Special Surgery; New York New York USA
| | - Steve K. Lee
- Weill Medical College of Cornell University; New York New York USA
- Center for Brachial Plexus and Traumatic Nerve Injury; Hospital for Special Surgery; New York New York USA
| | - Scott W. Wolfe
- Weill Medical College of Cornell University; New York New York USA
- Center for Brachial Plexus and Traumatic Nerve Injury; Hospital for Special Surgery; New York New York USA
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Sunagawa T, Nakashima Y, Shinomiya R, Kurumadani H, Adachi N, Ochi M. Correlation between “hourglass-like fascicular constriction” and idiopathic anterior interosseous nerve palsy. Muscle Nerve 2016; 55:508-512. [DOI: 10.1002/mus.25361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/28/2016] [Accepted: 08/02/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Toru Sunagawa
- Department of Orthopedic Surgery; Hiroshima University Hospital; 1-2-3 Kasumi Hiroshima 734-8551 Japan
- Laboratory of Analysis and Control of Upper Extremity Function; Institute of Biomedical and Health Sciences, Hiroshima University; Hiroshima Japan
| | - Yuko Nakashima
- Department of Orthopedic Surgery; Hiroshima University Hospital; 1-2-3 Kasumi Hiroshima 734-8551 Japan
| | - Rikuo Shinomiya
- Department of Orthopedic Surgery; Hiroshima University Hospital; 1-2-3 Kasumi Hiroshima 734-8551 Japan
| | - Hiroshi Kurumadani
- Laboratory of Analysis and Control of Upper Extremity Function; Institute of Biomedical and Health Sciences, Hiroshima University; Hiroshima Japan
| | - Nobuo Adachi
- Department of Orthopedic Surgery; Hiroshima University Hospital; 1-2-3 Kasumi Hiroshima 734-8551 Japan
| | - Mitsuo Ochi
- Department of Orthopedic Surgery; Hiroshima University Hospital; 1-2-3 Kasumi Hiroshima 734-8551 Japan
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Arányi Z, Csillik A, Dévay K, Rosero M, Barsi P, Böhm J, Schelle T. Ultrasonographic identification of nerve pathology in neuralgic amyotrophy: Enlargement, constriction, fascicular entwinement, and torsion. Muscle Nerve 2015; 52:503-11. [PMID: 25703205 DOI: 10.1002/mus.24615] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The aim of this study was to characterize the ultrasonographic findings on nerves in neuralgic amyotrophy. METHODS Fourteen patients with neuralgic amyotrophy were examined using high-resolution ultrasound. RESULTS Four types of abnormalities were found: (1) focal or diffuse nerve/fascicle enlargement (57%); (2) incomplete nerve constriction (36%); (3) complete nerve constriction with torsion (50%; hourglass-like appearance); and (4) fascicular entwinement (28%). Torsions were confirmed intraoperatively and were seen on the radial nerve in 85% of patients. A significant correlation was found between no spontaneous recovery of nerve function and constriction/torsion/fascicular entwinement (P = 0.007). CONCLUSION Ultrasonographic nerve pathology in neuralgic amyotrophy varies in order of severity from nerve enlargement to constriction to nerve torsion, with treatment ranging from conservative to surgical. We postulate that the constriction caused by inflammation is the precursor of torsion and that development of nerve torsion is facilitated by the rotational movements of limbs.
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Affiliation(s)
- Zsuzsanna Arányi
- Department of Neurology, MTA-SE NAP B Peripheral Nervous System Research Group, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Anita Csillik
- Department of Neurology, MTA-SE NAP B Peripheral Nervous System Research Group, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Katalin Dévay
- Department of Traumatology, Szt. István and László Hospital, Budapest, Hungary
| | - Maja Rosero
- Department of Traumatology, Szt. István and László Hospital, Budapest, Hungary
| | - Péter Barsi
- MRI Research Center, Semmelweis University, Budapest, Hungary
| | - Josef Böhm
- Department of Neurology, Kreiskrankenhaus Freiberg, Freiberg, Germany
| | - Thomas Schelle
- Department of Neurology, Städtisches Klinikum Dessau, Dessau, Germany
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Kodama A, Sunagawa T, Ochi M. Early treatment of anterior interosseous nerve palsy with hourglass-like fascicular constrictions by interfascicular neurolysis due to early diagnosis using ultrasonography: A case report. J Hand Surg Eur Vol 2015; 40:642-3. [PMID: 24413575 DOI: 10.1177/1753193413518692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A Kodama
- Department of Orthopaedic Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - T Sunagawa
- Department of Orthopaedic Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - M Ochi
- Department of Orthopaedic Surgery, Hiroshima University Hospital, Hiroshima, Japan
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Abstract
Whereas minor injuries to peripheral nerves merely lead to a circumscribed damage of the myelin sheath which is completely healed within 3 months, penetrating injuries lead to degeneration of the distal axonal fragment (Waller degeneration) and simultaneously to time-dependent alterations in the effector organs, in the perikarya in the medulla and spinal ganglia as well as in the brain. Animal experimental studies and also findings in humans confirm that the conditions for regeneration of nerve fibers are most favorable in the first days and weeks following injury. Therefore, for optimal therapy it should be clarified as early as possible whether there is a chance for reinnervation using exclusively conservative therapy or whether an operative reconstruction is necessary due to the severity of structural damage. Imaging investigation procedures, such as neurosonography and magnetic resonance (MR) neurography can provide decisive information on this aspect. As a rule, the decision on the indications for a nerve operation should be made within the first 3 months. Even with optimal therapy the healing process of severe neural injuries is often unsatisfactory. For some years novel procedures for improvement of nerve regeneration have been tested in animal experiments which involve totally different points in the healing process. It is hoped that with these approaches procedures for improvement in the treatment of nerve injuries in humans can be developed in the near future.
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Surgical treatment of posterior interosseous nerve paralysis in a tennis player. J Orthop 2014; 11:110-2. [PMID: 25104896 DOI: 10.1016/j.jor.2014.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 04/15/2014] [Indexed: 11/22/2022] Open
Abstract
We report a rare case of posterior interosseous nerve (PIN) paralysis in a tennis player. The PIN, a 2 cm section from a bifurcation point of the radial nerve, presented increased stiffness in the surgical findings and treated with free sural nerve grafting after excision of the degenerative portion of the PIN. We speculate that PIN paralysis associated with hourglass-like constriction can be caused and exacerbated by repetitive forearm pronation and supination in playing tennis.
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Nakashima Y, Sunagawa T, Shinomiya R, Ochi M. High-resolution ultrasonographic evaluation of "hourglass-like fascicular constriction" in peripheral nerves: a preliminary report. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1718-1721. [PMID: 24613638 DOI: 10.1016/j.ultrasmedbio.2013.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/29/2013] [Accepted: 12/06/2013] [Indexed: 06/03/2023]
Abstract
An hourglass-like constriction is a focal fascicular lesion observed in one or a few places in one or a few fascicles of a peripheral nerve trunk, and usually affects the anterior interosseous (AIN) or posterior interosseous (PIN) nerve. Constrictions have previously been discovered only by surgical exploration, and have been unable to be recognized on pre-operative imaging. We encountered some cases in which the lesion was able to be diagnosed pre-operatively by high-resolution ultrasonography; these findings were then confirmed intra-operatively. Five consecutive cases were included in this study. In three cases with constrictions revealed on pre-operative ultrasound, the findings were confirmed intra-operatively. In the remaining two cases in which no constrictions were detected pre-operatively, no constriction was revealed intra-operatively. High-resolution ultrasonography may play a significant role in the diagnosis of hourglass-like constrictions, and may thus lead to significant changes in treatment strategies for AIN and PIN palsy.
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Affiliation(s)
- Yuko Nakashima
- Department of Orthopedic Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Toru Sunagawa
- Department of Orthopedic Surgery, Hiroshima University Hospital, Hiroshima, Japan.
| | - Rikuo Shinomiya
- Department of Orthopedic Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Mitsu Ochi
- Department of Orthopedic Surgery, Hiroshima University Hospital, Hiroshima, Japan
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Pan Y, Wang S, Zheng D, Tian W, Tian G, Ho PC, Cheng HS, Zhong Y. Hourglass-Like Constrictions of Peripheral Nerve in the Upper Extremity. Neurosurgery 2014; 75:10-22. [DOI: 10.1227/neu.0000000000000350] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
The development of an hourglass-like constriction in the nerve is rare, and its origin is unknown. Its clinical manifestations are not well documented, and the treatment protocol has not been established.
OBJECTIVE:
To identify the cause, presentation, and possible treatment for patients with nerve palsies secondary to an hourglass-like constriction in the affected nerves.
METHODS:
Patients presenting with peripheral nerve palsy caused by an hourglass-like constriction of nerves were retrospectively investigated in 2 hand centers. The patients' presentation and neurological findings were reviewed, and the immunohistochemistry of excised specimens was studied.
RESULTS:
Forty-two patients who presented with 47 nerve palsies were examined. Forty-one patients experienced a sudden onset of pain in the upper limb, followed by flaccid paralysis in the affected muscles. Ten patients had multiple nerve involvement. Surgical exploration found 1 or more hourglass-like constrictions in the nerve. The treatments included internal neurolysis, neurorrhaphy, and nerve grafting. Thirty-one of 42 patients (36 nerves) were followed up for a mean of 48 months (range, 8–157 months). Fifteen of 16 nerves treated by neurolysis, 10 of 13 nerves treated by neurorrhaphy, and 4 of 7 nerves treated by nerve grafting had good recovery. CD8-positive T-lymphocyte infiltration was observed in all the excised specimens.
CONCLUSION:
The clinical presentation of patients with hourglass-like constrictions in their nerves is similar to that of patients with neuralgic amyotrophy. Histochemical analysis suggests that the pathogenesis may be immunological in origin. The role of surgery in this condition is uncertain.
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Affiliation(s)
- Yongwei Pan
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Shufeng Wang
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Danfeng Zheng
- Department of Pathology, Peking University Health Science Center, Xueyuan Rd, Haidian District, Beijing, China
| | - Wen Tian
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Guanglei Tian
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Pak Cheong Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Hi-shan Cheng
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Yanfeng Zhong
- Department of Pathology, Peking University Health Science Center, Xueyuan Rd, Haidian District, Beijing, China
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Ochi K, Horiuchi Y, Tazaki K, Nishi K, Kawashima H, Yabe H. Spontaneous anterior interosseous nerve palsy with Churg–Strauss syndrome. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0304-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Seo JS, Kim JH, Kang DH. Simultaneous Anterior and Posterior Interosseous Nerve Syndrome Following Shoulder Arthroscopy in the Lateral Decubitus Position - Case Report -. Clin Shoulder Elb 2013. [DOI: 10.5397/cise.2013.16.2.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Qi H, Wang X, Li S, Wang G, Wang D, Wang Z, Zhang X, Teng J. The role of ultrasonography and MRI in patients with non-traumatic nerve fascicle torsion of the upper extremity. Clin Radiol 2013; 68:e479-83. [DOI: 10.1016/j.crad.2013.03.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 02/23/2013] [Accepted: 03/06/2013] [Indexed: 11/29/2022]
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Ochi K, Horiuchi Y, Tazaki K, Takayama S, Matsumura T. Surgical treatment of spontaneous anterior interosseous nerve palsy: A comparison between minimal incision surgery and wide incision surgery. J Plast Surg Hand Surg 2013; 47:213-8. [DOI: 10.3109/2000656x.2012.753079] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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38
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Nakabayashi A, Sunagawa T, Ochi M. Radial nerve palsy with hourglass-like constrictions in a child. J Hand Surg Eur Vol 2012; 37:473-4. [PMID: 22383032 DOI: 10.1177/1753193412439679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A. Nakabayashi
- Department of Orthopedic Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - T. Sunagawa
- Department of Orthopedic Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - M. Ochi
- Department of Orthopedic Surgery, Hiroshima University Hospital, Hiroshima, Japan
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39
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Ochi K, Horiuchi Y, Tazaki K, Takayama S, Matsumura T. Fascicular constrictions in patients with spontaneous palsy of the anterior interosseous nerve and the posterior interosseous nerve. J Plast Surg Hand Surg 2012; 46:19-24. [DOI: 10.3109/2000656x.2011.634558] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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40
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Hourglass-like constriction of the musculocutaneous nerve: case report. J Hand Surg Am 2010; 35:1652-4. [PMID: 20888501 DOI: 10.1016/j.jhsa.2010.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 06/26/2010] [Accepted: 07/06/2010] [Indexed: 02/02/2023]
Abstract
Hourglass-like constriction has been previously associated with the main trunk of the radial nerve, with its branch of the posterior interosseous nerve, as well as the anterior interosseous nerve, a branch of the median and axillary nerve. Here, we report a case of hourglass-like constriction of the musculocutaneous nerve lesion that showed no recognizable compressive structure.
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41
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Ochi K, Horiuchi Y, Tazaki K, Nishi K, Kawashima H, Yabe H. Spontaneous anterior interosseous nerve palsy with Churg-Strauss syndrome. Mod Rheumatol 2010; 20:514-7. [PMID: 20458608 DOI: 10.1007/s10165-010-0304-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 04/01/2010] [Indexed: 11/29/2022]
Abstract
A 74-year-old woman diagnosed with Churg-Strauss syndrome (CSS) complained of difficulty in flexing her left thumb and index finger. Electromyography demonstrated isolated anterior interosseous nerve (AIN) palsy, with no other peripheral neuropathy. We diagnosed this case as spontaneous AIN palsy complicated with CSS, the first case of this kind. Surgical treatment should be considered if no sign of recovery is seen within six months of onset.
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Affiliation(s)
- Kensuke Ochi
- Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawa-dori, Kawasaki-ku, Kawasaki, Kanagawa 210-0013, Japan.
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42
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Vigasio A, Marcoccio I. Homolateral hourglass-like constrictions of the axillary and suprascapular nerves: case report. J Hand Surg Am 2009; 34:1815-20. [PMID: 19897320 DOI: 10.1016/j.jhsa.2009.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 07/18/2009] [Accepted: 07/23/2009] [Indexed: 02/02/2023]
Abstract
In contrast with previous research, it was recently demonstrated that hourglass-like constriction is not exclusive to the elbow region. We present a report of a patient who had an axillary nerve and a suprascapular nerve hourglass-like constriction, found 7 years apart.
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Affiliation(s)
- Adolfo Vigasio
- Istituto Clinico Città di Brescia-Gruppo San Donato, 2 degrees Unità Operativa di Chirurgia della Mano e Microchirurgia Ortopedica, Brescia, Italy
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