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Couch B, Hayward D, Baum G, Sakthiyendran NA, Harder J, Hernandez EJ, MacKay B. A systematic review of steroid use in peripheral nerve pathologies and treatment. Front Neurol 2024; 15:1434429. [PMID: 39286807 PMCID: PMC11402678 DOI: 10.3389/fneur.2024.1434429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 08/21/2024] [Indexed: 09/19/2024] Open
Abstract
Background The use of corticosteroids has become a part of the standard of care in various pathologies but their use in peripheral nerve injury treatment is limited. Given corticosteroids' anti-inflammatory properties and their regulatory role in neuronal protein production and myelination, corticosteroids could serve as an adjunct therapy for peripheral nerve injuries. This review aims to systematically investigate the current use of corticosteroid treatment in peripheral nerve pathologies. Methods The systematic search was performed on PubMed, MEDLINE, EMBASE, Scopus, Cochrane, and Web of Science using keywords such as "corticosteroid treatment," "peripheral nerve damage," "peripheral neuropathy," and "complications." The PRISMA guidelines were used to conduct the systematic review and all articles were reviewed by the corresponding author. After the initial search, individual study titles and abstracts were further screened and categorized using an inclusion and exclusion criteria followed by a final full-text review. Results Out of the total 27,922 identified records, 203 studies were included based on the selection criteria. These studies focused on the use and efficacy of steroids across a spectrum of compression and non-compression peripheral neuropathies such as cubital tunnel syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. Various studies noted the promising role of steroids in offering pain relief, nerve block, and nerve regeneration effects. Additionally, safety considerations and potential complications regarding steroid use in peripheral nerve injuries were analyzed. Conclusion While there is currently limited clinical utilization of corticosteroids in peripheral nerve pathologies, the anti-inflammatory and regenerative effects that steroids provide may be a beneficial tool in managing various peripheral neuropathies and their associated pain. Additional clinical trials and investigation into the mechanism of action could improve the reputation of steroid use as peripheral nerve injury treatment.
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Affiliation(s)
- Brandon Couch
- Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Dan Hayward
- Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Gracie Baum
- Department of Orthopaedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | | | - Justin Harder
- Department of Orthopaedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Evan J Hernandez
- Department of Orthopaedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Brendan MacKay
- Department of Orthopaedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, United States
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Buturak Ş, Fidancı H, Yıldız M, Arlıer Z. Relationship between Gravidity, Parity, and Neurophysiological Features in Carpal Tunnel Syndrome (CTS) Patients with a History of Pregnancy. Niger J Clin Pract 2024; 27:345-351. [PMID: 38528355 DOI: 10.4103/njcp.njcp_461_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/02/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND It is not yet clear if gravidity and parity have any relationships with the electrodiagnostic parameters of carpal tunnel syndrome (CTS). OBJECTIVE To determine whether there is a relationship between electrodiagnostic findings, gravidity, and parity number in CTS. MATERIALS AND METHODS Female patients over 18 years of age with CTS were included in this retrospective cohort study. The gravidity/parity number, median nerve compound muscle action potential (CMAP), and compound nerve action potential (CNAP) of the patients were analyzed. The two subgroups of the Boston carpal tunnel syndrome questionnaire (BCTSQ): The Symptom Severity Scale (SSS) and Functional Severity Scale (FSS) were applied to the patients. CTS patients were divided into two groups aged at first pregnancy ≤20 years and >20 years. RESULTS One hundred and eight CTS extremities (seven right-sided CTS, three left-sided CTS, 49 bilateral CTS) of 59 patients were included. The median (interquartile range: 25%-75%) number of gravidity, parity, and abortion were 3 (2-5), 3 (2-4), and 0 (0-0), respectively. Right-sided CTS patients at the age of first pregnancy ≤20 years had higher BCTSQ-SSS/FSS scores and median nerve CMAP latency compared to patients at the age of first pregnancy >20 years (P = 0.029 for SSS; P = 0.042 for FSS; and P = 0.041 for CMAP latency). A negative correlation was found between the gravidity/parity numbers and median nerve CNAP/CMAP amplitudes (P = 0.028/0.031, r = -0.293/-0.289 for CNAP amplitude; and P = 0.006/0.035, r = -0.363/-0.283 for CMAP amplitude). CONCLUSION Neurophysiological findings worsen as the number of gravidity and parity increase. Electrodiagnostic and clinical features of CTS may be worsening in females below 20 years at first pregnancy.
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Affiliation(s)
- Ş Buturak
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - H Fidancı
- Department of Neurology, Division of Clinical Neurophysiology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - M Yıldız
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Z Arlıer
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
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Scholz C, Hohenhaus M, Pedro MT, Uerschels AK, Dengler NF. Meralgia Paresthetica: Relevance, Diagnosis, and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:655-661. [PMID: 37534445 PMCID: PMC10622057 DOI: 10.3238/arztebl.m2023.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Pain and sensory disturbance in the distribution of the lateral femoral cutaneous nerve in the ventrolateral portion of the thigh is called meralgia paresthetica (MP). The incidence of MP has risen along with the increasing prevalence of obesity and diabetes mellitus and was recently estimated at 32 new cases per 100 000 persons per year. In this review, we provide an overview of current standards and developments in the diagnosis and treatment of MP. METHODS This review is based on publications retrieved by a selective literature search, with special attention to meta-analyses, systematic reviews, randomized and controlled trials (RCTs), and prospective observational studies. RESULTS The diagnosis is mainly based on typical symptoms combined with a positive response to an infiltration procedure. In atypical cases, electrophysiological testing, neurosonography, and magnetic resonance imaging can be helpful in establishing the diagnosis. The literature search did not reveal any studies of high quality. Four prospective observational studies with small case numbers and partly inconsistent results are available. In a meta-analysis of 149 cases, pain relief was described after infiltration in 85% of cases and after surgery in 80%, with 1-38 months of follow-up. In another meta-analysis of 670 cases, there was pain relief after infiltration in 22% of cases, after surgical decompression in 63%, and after neurectomy in 85%. Hardly any data are available on more recent treatment options, such as radiofrequency therapy, spinal cord stimulation, or peripheral nerve stimulation. CONCLUSION The state of the evidence is limited in both quantity and quality, corresponding to evidence level 2a for surgical and non-surgical methods. Advances in imaging and neurophysiological testing have made the diagnosis easier to establish. When intervention is needed, good success rates have been achieved with surgery (decompression, neurectomy), and variable success rates with infiltration.
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Affiliation(s)
- Christoph Scholz
- Department of Neurosurgery, University Hospital Freiburg, Faculty of Medicine, University of Freiburg
| | - Marc Hohenhaus
- Department of Neurosurgery, University Hospital Freiburg, Faculty of Medicine, University of Freiburg
| | - Maria T. Pedro
- Department of Neurosurgery, Peripheral Nerves Section, University of Ulm at Günzburg District Hospital
| | | | - Nora F. Dengler
- Department of Neurosurgery, Charité–University Medical Center Berlin
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Nyrhi L, Kuitunen I, Ponkilainen V, Jokihaara J, Huttunen TT, Mattila VM. Incidence of Peripheral Nerve Decompression Surgery During Pregnancy and the First Year After Delivery in Finland From 1999 to 2017: A Retrospective Register-Based Cohort Study. J Hand Surg Am 2023; 48:452-459. [PMID: 36922291 DOI: 10.1016/j.jhsa.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/18/2022] [Accepted: 01/04/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE We aimed to report the incidence of peripheral nerve decompression surgery during pregnancy and 12 months after delivery in Finland from 1999 to 2017. METHODS Using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register, all women of potentially childbearing age (15-49 years) who underwent peripheral nerve decompression surgery or had a pregnancy ending in delivery from January 1, 1999, to December 31, 2017, were included. Incidence rates and incidence rate ratios for operations were calculated for both childbearing women and the age-adjusted general female population. RESULTS In total, 308 women underwent carpal tunnel release (CTR) during pregnancy, and an additional 675 women underwent CTR within 12 months after delivery. The incidence of CTR during pregnancy was 38 per 100,000 person-years, with an incidence rate ratio of 0.5 (95% CI, 0.4-0.6), when compared with that in the general population. Women who were active smokers before becoming pregnant were more likely to undergo CTR during pregnancy (odds ratio, 2.4; 95% CI, 1.8-3.0). The highest rates of CTR were observed during the first trimester. The incidence of CTR in the first postpartum year increased steadily during the first 4 months to 79 per 100,000 person-years. During the latter 8 months, incidences were similar to those in the general population (incidence rate ratio, 1.0; 95% CI, 0.9-1.2). Women who smoked were more likely to undergo CTR during the first postpartum year (odds ratio, 1.6; 95% CI, 1.3-1.9). CONCLUSIONS Carpal tunnel release is performed more rarely during pregnancy than in the age-matched general population. Postpartum incidences increased toward the end of the first year, reaching those observed in the general population after the first 4 months. Smoking before pregnancy is associated with increased incidences of CTR both during pregnancy and the first year after delivery. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Lauri Nyrhi
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Ilari Kuitunen
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland; School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Jarkko Jokihaara
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - Tuomas T Huttunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
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Moro-López-Menchero P, García-Bravo C, Fernández-de-las-Peñas C, Güeita-Rodríguez J, Jiménez-Antona C, Palacios-Ceña D. Understanding the Non-Surgical Treatment Experience of Female Patients with Carpal Tunnel Syndrome: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12349. [PMID: 36231644 PMCID: PMC9564778 DOI: 10.3390/ijerph191912349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
Carpal tunnel syndrome (CTS) is a peripheral neuropathy of the upper extremity, characterized by pain, loss of strength, and decreased fine motor function. This study describes the experiences of women with CTS who received non-surgical treatments. A qualitative phenomenological study was undertaken. Purposive sampling was used. Women with clinical and electromyographic diagnoses of CTS were included. Eighteen in-depth interviews were conducted among women with CTS, and field notes were kept. The Giorgi's approach was used for qualitative analysis of the data collected. Five themes emerged: (a) Seeking help and waiting for a diagnosis, (b) trying non-surgical therapeutic options, (c) avoiding invasive options, (d) treatment expectations, and (e) relationships with clinicians. The women described how diagnoses were delayed because women delay seeking help and referrals to medical specialists. Women avoid surgical options and prefer to opt for more conservative approaches, such as splinting or physical therapy. The main reason for avoiding surgical treatment is the fear of limitations and that surgery will not fully eliminate the symptoms. Conflicts may arise in the relationship with the clinician, and they demand to be able to participate in the decision-making process.
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Affiliation(s)
- Paloma Moro-López-Menchero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine and Research Group of Humanities and Qualitative Research in Health Science (Hum&QRinHS), Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Cristina García-Bravo
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine and Research Group of Humanities and Qualitative Research in Health Science (Hum&QRinHS), Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine and Research Group of Manual Therapy, Dry Needling and Therapeutic Exercise (GITM-URJC), Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Javier Güeita-Rodríguez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine and Research Group of Humanities and Qualitative Research in Health Science (Hum&QRinHS), Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Carmen Jiménez-Antona
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine and Research Group of Humanities and Qualitative Research in Health Science (Hum&QRinHS), Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine and Research Group of Humanities and Qualitative Research in Health Science (Hum&QRinHS), Universidad Rey Juan Carlos, 28922 Madrid, Spain
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Moro-López-Menchero P, Cigarán-Méndez MI, Florencio LL, Güeita-Rodríguez J, Fernández-de-Las-Peñas C, Palacios-Ceña D. Facing symptoms and limitations: a qualitative study of women with carpal tunnel syndrome. Scand J Occup Ther 2022:1-11. [PMID: 35995148 DOI: 10.1080/11038128.2022.2112970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a neuropathic pain condition characterised by pain, paresthesia, loss of strength and disability. OBJECTIVE To explore the experiences of women with CTS regarding the management of symptoms and limitations. METHODS A qualitative phenomenological study was conducted. Women with a clinical and electromyographic diagnosis of CTS recruited from the Neurology Department of a Public Hospital were included. Purposeful sampling was performed. Data were collected using in-depth interviews and researchers' field notes. Analysis proposed by Giorgi was used. RESULTS A total of 18 women with CTS were included. Two themes emerged: a) Living with CTS symptoms and limitations: describing the symptoms experienced, triggers of their symptoms and how they define CTS. Also, describing the difficulties that they experience on a daily basis, at home when handling tools, communicating, driving, and at work; and b) developing daily strategies for managing limitations: developing potential daily strategies to overcome daily limitations and/or compensate for them, and seeking professional help. CONCLUSIONS AND SIGNIFICANCE Current results provide insight on how symptoms and daily limitations are experienced by a group of women with CTS. These findings could help occupational therapists to understand the day-to-day difficulties and the reasons for developing certain strategies.
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Affiliation(s)
- Paloma Moro-López-Menchero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine and Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Universidad Rey Juan Carlos, Madrid, Spain
| | | | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine and Research Group of Manual Therapy, Dry Needling and Therapeutic Exercise of Universidad Rey Juan Carlos (GITM-URJC), Universidad Rey Juan Carlos, Madrid, Spain
| | - Javier Güeita-Rodríguez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine and Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Universidad Rey Juan Carlos, Madrid, Spain
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine and Research Group of Manual Therapy, Dry Needling and Therapeutic Exercise of Universidad Rey Juan Carlos (GITM-URJC), Universidad Rey Juan Carlos, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine and Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Universidad Rey Juan Carlos, Madrid, Spain
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Goncu Ayhan S, Ayhan E, Çaglar AT, Sahin D. Ultrasonography for carpal tunnel syndrome in pregnancy: a prospective cross-sectional study. J OBSTET GYNAECOL 2022; 42:1769-1774. [PMID: 35260035 DOI: 10.1080/01443615.2022.2036970] [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: 10/18/2022]
Abstract
Confirmation of carpal tunnel syndrome (CTS) diagnosis with sonographic measurement of the median nerve cross sectional area (MN-CSA) is increasing in popularity. We aimed to analyse the ultrasonography (USG) values of MN-CSA in pregnant women with and without CTS symptoms. MN-CSAs of third trimester pregnant women were measured with USG and they were asked about the presence of CTS symptoms. Symptomatic participants were assigned to the CTS group and remaining participants were assigned to the Control group. The groups were compared according to MN-CSA. Twenty-five participants were grouped in CTS group and the remaining 64 participants were grouped in Control group. The MN-CSA was higher in the CTS group (9.44 ± 2.68) than in the Control group (7.20 ± 1.99), p = .00004. Obstetricians can use USG measurement of MN-CSA to confirm CTS diagnosis and consequently can offer conservative management, which is the widely accepted treatment modality in this cohort.Impact statementWhat is already known on this subject? CTS is the most common mononeuropathy of pregnancy, with up to 62% prevalence rates. The American Association of Neuromuscular & Electrodiagnostic Medicine practice guideline for the diagnosis of CTS recommends sonographic measurement of median nerve swelling at the carpal tunnel inlet as an accurate diagnostic test (Level A).What do the results of this study add? We found that a simple sonographic measurement of median nerve cross sectional area (MN-CSA) at the wrist appears to be a convenient method to confirm clinical CTS diagnosis in pregnant women. This study offers to use USG to confirm clinical CTS diagnosis in third trimester pregnant women before delivery.What are the implications of these findings for clinical practice and/or further research? This study will help to raise awareness of obstetricians about CTS during pregnancy. USG can be an effective first-line confirmatory test for CTS diagnosis in the pregnant population, but further research is necessary to determine a clear cut-off value for MN-CSA. We advise obstetricians to use sonographic measurement of MN-CSA in pregnant women with typical CTS symptoms, which will increase uniformity for consensus development. Obstetricians can offer advice for conservative management of CTS during pregnancy, which is the widely accepted treatment in this cohort.
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Affiliation(s)
- Sule Goncu Ayhan
- Department of Obstetrics and Gynecology, Perinatology Division, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Egemen Ayhan
- Orthopedics and Traumatology, Hand Surgery Division, University of Health Sciences Turkey, Diskapi YB Training and Research Hospital, Ankara, Turkey
| | - Ali Turhan Çaglar
- Department of Obstetrics and Gynecology, Perinatology Division, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Perinatology Division, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
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Massey JM, Gable KL. Neuromuscular Disorders and Pregnancy. Continuum (Minneap Minn) 2022; 28:55-71. [DOI: 10.1212/con.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Larsen CG, Fitzgerald MJ, Nellans KW, Lane LB. Management of de Quervain Tenosynovitis: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202109000-00009. [PMID: 34506345 DOI: 10.2106/jbjs.rvw.21.00069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
» Most cases of de Quervain tenosynovitis can be managed with nonoperative measures, and the mainstay of treatment is corticosteroid injection (CSI). The use of ultrasound may improve the accuracy of injections and can help to identify and localize injections to separate subcompartments. » For patients who are in the third trimester of pregnancy or breastfeeding, there is no contraindication to CSI as studies have shown that it can provide optimal symptomatic relief to the mother without impacting the baby. » When nonoperative treatment is unsuccessful, surgical release of the first dorsal compartment (FDC) can provide excellent symptom relief. Open release performed through a longitudinal incision allows for better visualization of the underlying anatomy, resulting in fewer injuries to underlying structures and a lower incidence of hypertrophic scarring compared with a transverse incision. » For surgeons who are comfortable performing endoscopic techniques, endoscopic FDC release can result in quicker symptom improvement, superior scar cosmesis, and a lower incidence of radial sensory nerve injury. » Studies have shown that FDC release can safely and effectively be performed using the WALANT (wide-awake local anesthesia no tourniquet) technique, which has the potential for cost savings without compromising quality or patient comfort.
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Affiliation(s)
- Christopher G Larsen
- Department of Orthopaedic Surgery, Northwell Health at North Shore University Hospital and Long Island Jewish Medical Center, New Hyde Park, New York
| | - Michael J Fitzgerald
- Department of Orthopaedic Surgery, Northwell Health at North Shore University Hospital and Long Island Jewish Medical Center, New Hyde Park, New York
| | - Kate W Nellans
- Department of Orthopaedic Surgery, Northwell Health at North Shore University Hospital and Long Island Jewish Medical Center, New Hyde Park, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Lewis B Lane
- Department of Orthopaedic Surgery, Northwell Health at North Shore University Hospital and Long Island Jewish Medical Center, New Hyde Park, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Ostrominski JW, Huang Q, Kamenker-Orlov Y. Beneath the Surface: Massive Retroperitoneal Liposarcoma Masquerading as Meralgia Paresthetica. Fed Pract 2021; 38:S61-S67. [PMID: 34177242 DOI: 10.12788/fp.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In patients presenting with focal neurologic findings involving the lower extremities, a thorough abdominal examination should be considered an integral part of the full neurologic work up.
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Affiliation(s)
- John W Ostrominski
- is a Resident Primary Care Physician; is a Pathologist in the Department of Pathology and Laboratory Medicine; and is a Primary Care Physician and Director of the Resident Primary Care Clinic; all at the West Roxbury Veterans Affairs Medical Center. John Ostrominski is Resident in Internal Medicine, Qin Huang and Yelena Kamenker-Orlov are Assistant Professors, all at Brigham and Women's Hospital and Harvard Medical School in Massachusetts
| | - Qin Huang
- is a Resident Primary Care Physician; is a Pathologist in the Department of Pathology and Laboratory Medicine; and is a Primary Care Physician and Director of the Resident Primary Care Clinic; all at the West Roxbury Veterans Affairs Medical Center. John Ostrominski is Resident in Internal Medicine, Qin Huang and Yelena Kamenker-Orlov are Assistant Professors, all at Brigham and Women's Hospital and Harvard Medical School in Massachusetts
| | - Yelena Kamenker-Orlov
- is a Resident Primary Care Physician; is a Pathologist in the Department of Pathology and Laboratory Medicine; and is a Primary Care Physician and Director of the Resident Primary Care Clinic; all at the West Roxbury Veterans Affairs Medical Center. John Ostrominski is Resident in Internal Medicine, Qin Huang and Yelena Kamenker-Orlov are Assistant Professors, all at Brigham and Women's Hospital and Harvard Medical School in Massachusetts
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Neuropathy and pregnancy: An overview. Rev Neurol (Paris) 2020; 177:220-224. [PMID: 32653214 DOI: 10.1016/j.neurol.2020.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/25/2022]
Abstract
Peripheral nerve injuries are rare in pregnant women. Nevertheless, physiological changes linked to pregnancy may induce nerve lesion. In this review we propose to focus on peripheral nerve disorders the most frequently encountered in pregnant patients. Focal neuropathy or polyneuropathy may appear during pregnancy or at delivery. In other cases, pre-existing neuropathies may deteriorate during pregnancy. In addition to clinical description, we summarised management proposed in the literature.
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