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Duarte ML, da Silva MO, Soares ODSR. Tortuosity and Pulsatility of the Tibial Artery - Two Case Reports of a Rare Etiology of Tarsal Tunnel Syndrome. Acta Medica (Hradec Kralove) 2023; 66:161-164. [PMID: 38588395 DOI: 10.14712/18059694.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Tarsal tunnel syndrome is a neuropathic compression of the tibial nerve and its branches on the medial side of the ankle. It is a challenging diagnosis that constitutes symptoms arising from damage to the posterior tibial nerve or its branches as they proceed through the tarsal tunnel below the flexor retinaculum in the medial ankle, easily forgotten and underdiagnosed. Neural compression by vascular structures has been suggested as a possible etiology in some clinical conditions. Tibial artery tortuosity is not that rare, but only that it affects the nerve can cause tarsal tunnel syndrome. Therefore, a study care must be taken to avoid false-positive errors.
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Affiliation(s)
- Márcio Luís Duarte
- Radiology professor at Universidade de Ribeirão Preto Campus Guarujá, Guarujá-SP, Brazil.
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Turgut MC, Saglam G, Toy S. Efficacy of extracorporeal shock wave therapy for pillar pain after open carpal tunnel release: a double-blind, randomized, sham-controlled study. Korean J Pain 2021; 34:315-321. [PMID: 34193637 PMCID: PMC8255150 DOI: 10.3344/kjp.2021.34.3.315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/20/2021] [Accepted: 04/19/2021] [Indexed: 01/10/2023] Open
Abstract
Background Pillar pain may develop after carpal tunnel release surgery (CTRS). This prospective double-blinded randomized trial investigated the effectiveness of extracorporeal shock wave therapy (ESWT) in pillar pain relief and hand function improvement. Methods The sample consisted of 60 patients with post-CTRS pillar pain, randomized into two groups. The ESWT group (experimental) received three sessions of ESWT, while the control group received three sessions of sham ESWT, one session per week. Participants were evaluated before treatment, and three weeks, three months, and six months after treatment. The pain was assessed using the visual analogue scale (VAS). Hand functions were assessed using the Michigan hand outcomes questionnaire (MHQ). Results The ESWT group showed significant improvement in VAS and MHQ scores after treatment at all time points compared to the control group (P < 0.001). Before treatment, the ESWT and control groups had a VAS score of 6.8 ± 1.3 and 6.7 ± 1.0, respectively. Three weeks after treatment, they had a VAS score of 2.8 ± 1.1 and 6.1 ± 1.0, respectively. Six months after treatment, the VAS score was reduced to 1.9 ± 0.9 and 5.1 ± 1.0, respectively. The ESWT group had a MHQ score of 54.4 ± 7.7 before treatment and 73.3 ± 6.8 six months after. The control group had a MHQ score of 54.2 ± 7.1 before treatment and 57.8 ± 4.4 six months after. Conclusions ESWT is an effective and a safe non-invasive treatment option for pain management and hand functionality in pillar pain.
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Affiliation(s)
- Mehmet Cenk Turgut
- Erzurum Regional Training and Research Hospital, Clinic of Orthopedics and Traumatology, Erzurum, Turkey
| | - Gonca Saglam
- Erzurum Regional Training and Research Hospital, Clinic of Physical Therapy and Rehabilitation, Erzurum, Turkey
| | - Serdar Toy
- Ağrı Training and Research Hospital, Clinic of Orthopedics and Traumatology, Ağrı, Turkey
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Abstract
The median artery is usually a transient vessel during the embryonic period. However, this artery can persist in adult life as the persistent median artery. This paper aims to describe this relevant anatomical variation for surgeons, review the literature and discuss its clinical implications. A routine dissection was performed in the upper left limb of a male adult cadaver of approximately 50-60 years of age, embalmed in formalin 10%. The persistent median artery was identified emerging as a terminal branch of the common interosseous artery with a path along the ulnar side of the median nerve. In the wrist, the persistent median artery passed through the carpal tunnel, deep in the transverse carpal ligament. The dissection in the palmar region revealed no anastomosis with the ulnar artery forming the superficial palmar arch. The common digital arteries emerged from the ulnar artery and the persistent median artery. Such variation has clinical and surgical relevance in approaching carpal tunnel syndrome and other clinical disorders in the wrist.
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Affiliation(s)
- João Gabriel Alexander
- Universidade Federal do Espírito Santo (UFES), Departamento de Morfologia, Laboratório de Estudos em Morfologia Aplicada (LEMA), Vitória, ES, Brasil
| | - Matheus Coelho Leal
- Universidade Federal do Espírito Santo (UFES), Departamento de Morfologia, Laboratório de Estudos em Morfologia Aplicada (LEMA), Vitória, ES, Brasil
| | - Josemberg da Silva Baptista
- Universidade Federal do Espírito Santo (UFES), Departamento de Morfologia, Laboratório de Estudos em Morfologia Aplicada (LEMA), Vitória, ES, Brasil
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Klifto KM, Dellon AL. Persistent Genital Arousal Disorder: Review of Pertinent Peripheral Nerves. Sex Med Rev 2019; 8:265-273. [PMID: 31704111 DOI: 10.1016/j.sxmr.2019.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/01/2019] [Accepted: 10/11/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Persistent genital arousal disorder (PGAD) is a condition that is still poorly understood. Etiologies reported for PGAD are vascular, neurological, pharmacological, and psychological. Determining the neurophysiological etiology of PGAD began with developing an understanding of the underlying biomechanics of the pudendal nerve and the female sexual response. AIM To summarize the anatomy, physiology, etiologies, diagnostics, and treatments of the pertinent peripheral nerves involved in the pathology of PGAD. METHODS We performed a PubMed, Cochrane, Embase, Web of Science, and Google Scholar search for English-language articles in peer-reviewed journals with no predefined time period for inclusion. Terms included "humans"[All Fields] AND "persistent"[All Fields] AND/OR ("genitalia"[All Fields] OR "genital"[All Fields]) AND/OR "arousal"[All Fields] AND/OR ("disease"[All Fields] OR "disorder"[All Fields]) AND/OR "nerve"[All Fields]. The main outcomes of the papers were reviewed. MAIN OUTCOME MEASURE The main outcome measures were the anatomy and physiology, etiologies, history and physical examination, diagnostic imaging, and current evidence for the treatment of PGAD related to the peripheral nervous system. RESULTS Most of the literature for PGAD originates from case studies. The diagnosis of PGAD itself is still a debated topic of discussion. More recent data published indicate that this disease affects males, as well. CONCLUSION Nerve entrapment may be a source of continuous arousal. Associated PGAD symptoms would depend on the segment of the nerve involved. Unwelcomed or unwanted arousal has been observed as the most common detrimental symptom. Pelvic 3-tesla magnetic resonance imaging is recommended in all patients with suspected nerve entrapment. Lumbosacral 3-tesla magnetic resonance imaging is recommended if a Tarlov cyst or a herniated intervertebral disc is suspected. If the peripheral nerve is the source of the pathology, surgical intervention may be curative. A multidisciplinary team approach consisting of a medical provider, pelvic floor physical therapist, and sex therapist has demonstrated benefits. There are currently no Food and Drug Administration-approved evidenced-based treatments for PGAD. Klifto KM, Dellon AL. Persistent Genital Arousal Disorder: Review of Pertinent Peripheral Nerves. Sex Med Rev 2020;8:265-273.
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Affiliation(s)
- Kevin M Klifto
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - A Lee Dellon
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
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Monie AP, Price RI, Lind CRP, Singer KP. Change in Low Back Movement Patterns After Neurosurgical Intervention for Lumbar Spondylosis. J Manipulative Physiol Ther 2018; 41:111-122. [PMID: 29482826 DOI: 10.1016/j.jmpt.2017.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/20/2017] [Accepted: 08/23/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the use of computer-aided combined movement examination (CME) to measure change in low back movement after neurosurgical intervention for lumbar spondylosis and to use a CME normal reference range (NRR) to compare and contrast movement patterns identified from lumbar disk disease, disk protrusion, and nerve root compression cases. METHODS A test-retest, cohort observational study was conducted. Computer-aided CME was used to record lumbar range of motion in 18 patients, along with pain, stiffness, disability, and health self-report questionnaires. A minimal clinically important difference of 30% was used to interpret meaningful change in self-reports. z Scores were used to compare CME. Post hoc observation included subgrouping cases into 3 discrete pathologic conditions-disk disease, disk protrusion, and nerve root compression-to report intergroup differences in CME. RESULTS Self-report data indicated that 11, 7, and 10 patients improved by ≥30% in pain, stiffness, and function, respectively. Three patients experienced clinically significant improvement in health survey. A CME pattern reduced in all directions suggested disk disease. Unilaterally restricted movement in side-flexed or extended directions suggested posterolateral disk protrusion with or without ipsilateral nerve root compression. Bilateral restrictions in extension suggested posterior disk protrusion with or without nerve root compression. In 11 of the 18 cases, CME converged toward the NRR after surgery. CONCLUSION We described the use of CME to identify atypical lumbar movement relative to an NRR. Data from this short-term postoperative study provide preliminary evidence for CME movement patterns suggestive of disk disease, disk protrusion, and nerve root compression.
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Affiliation(s)
- Aubrey P Monie
- The Centre for Musculoskeletal Studies, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia.
| | - Roger I Price
- Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Christopher R P Lind
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Kevin P Singer
- The Centre for Musculoskeletal Studies, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
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Abstract
Entrapment neuropathy is the result of pressure on a peripheral nerve as it passes through a narrow canal that is bounded by stiff tissues. In spite of their ubiquitous nature, they are underdiagnosed, underreported, and sometimes not properly managed, especially in developing countries. Entrapment neuropathies are of various types, but the most common type is carpal tunnel syndrome. Mechanisms involved in the pathophysiology of entrapment neuropathies include mechanical compression and nerve ischemia. A clear understanding of the various types and the underlying mechanisms of entrapment neuropathies are invaluable in the decision-making process involved in the management of every patient with the condition.
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Affiliation(s)
- Kolawole Wasiu Wahab
- Department of Medicine, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Emmanuel O Sanya
- Department of Medicine, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Philip B Adebayo
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Musbaudeen O Babalola
- Department of Surgery, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Hakeem G Ibraheem
- Department of Surgery, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
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Roberts CS. Chiropractic Management of a Patient With Neck-Tongue Syndrome: A Case Report. J Chiropr Med 2016; 15:321-324. [PMID: 27857642 DOI: 10.1016/j.jcm.2016.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 08/05/2016] [Accepted: 08/05/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this case report was to describe the chiropractic management of a patient with neck-tongue syndrome (NTS). CLINICAL FEATURES A 34-year-old female patient sought treatment at a chiropractic clinic for symptoms involving neck pain associated with left-sided paresthesia of the tongue that had persisted for >2 years. A diagnosis of NTS was made. INTERVENTION AND OUTCOME The patient was treated with spinal manipulation, myofascial release, and home exercises. After 2 weeks, she was symptom free. At the 2-year follow-up, the patient remained free of symptoms. CONCLUSION This patient with NTS responded favorably to a course of chiropractic care.
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Bang JH, Gil YC, Yang HJ, Jin JD, Lee JH, Lee HY. Multiple muscular variations in the neck, upper extremity, and lower extremity biased toward the left side of a single cadaver. J Korean Med Sci 2015; 30:502-5. [PMID: 25829821 PMCID: PMC4366974 DOI: 10.3346/jkms.2015.30.4.502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/02/2014] [Indexed: 11/23/2022] Open
Abstract
Although numerous reports have found accessory or supernumerary muscles throughout the human body, multiple appearances of these variations biased toward one side of body are rare. We report a 76-yr-old male cadaver with an accessory head of the biceps brachii and palmaris profundus, and a muscular slip between the biceps femoris and semitendinosus on the left side in addition to a bilateral accessory belly of the digastric muscle. No remarkable nervous, vascular, or visceral variation accompanied these variations. An interruption of normal somitogenesis or myogenesis may be a cause of these variations.
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Affiliation(s)
- Jong-Ho Bang
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Korea
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Chun Gil
- Department of Anatomy, Konkuk University College of Medicine, Seoul, Korea
| | - Hee-Jun Yang
- Department of Anatomy, Gachon University School of Medicine, Incheon, Korea
| | - Jeong-Doo Jin
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Korea
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Ho Lee
- Department of Anatomy, School of Medicine, Keimyung University, Daegu, Korea
| | - Hye-Yeon Lee
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea
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Nazerani S, Kalantar Motamedi MH, Nazerani T, Saraii A, Keramati MR. Endoscopic carpal tunnel release: a 5-year experience. Trauma Mon 2014; 19:e18058. [PMID: 25717450 PMCID: PMC4310161 DOI: 10.5812/traumamon.18058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 02/28/2014] [Accepted: 05/02/2014] [Indexed: 11/17/2022] Open
Abstract
Background: Endoscopic carpal tunnel release (ECTR) has gained recognition as an alternative to the current gold standard, the open carpal tunnel release (OCTR). Detailed technical points for the ECTR have not been explained in the literature, especially for surgeons who are considering trying this technique. Objectives: In this paper, we present our 5-year experience with the ECTR and special emphasis will be placed on less frequently discussed technical points, such as the optimal site to make the skin incision and the signs to look for in a completely divided retinaculum. Patients and Methods: In this prospective nonrandomized clinical trial, 176 patients with carpal tunnel syndrome who underwent surgical operation using the Agee uni-portal endoscopic carpal tunnel release technique, over a period of 5 years, were included. The “Hand Questionnaire”, a standard questionnaire for hand surgery, was used to evaluate the patients at one, three, six and twelve month post-operative time points. Pain and scar tenderness were measured using the visual analog scale system. We propose the ‘most proximally present wrist crease’ for the skin incision and the ‘proximal to distal sequential division of the retinaculum’ as our methods of choice. Two signs, named ‘railroad’ and ‘drop in’, are proposed and these will be discussed in detail as hallmarks of complete retinaculum release. Results: Of the 176 patients who underwent the ECTR operation, 164 cases (93.2%) had no or very little pain at the one year postoperative visit, and nearly all of the patients reported no relapse of symptoms at the previously mentioned postoperative time points. Patient satisfaction and functional recovery was comparable to other published ECTR studies, and showed better short-term results of this technique over the OCTR. One deep seated infection, three cases of transient index finger paresthesia due to scope pressure on the median nerve, and one case of median nerve branch transection, were observed. Scar complications, including; tenderness, redness and pain, were significantly lower in the proximally placed incision in comparison with the distally placed incision (P < 0.005). Conclusions: The ‘most proximally present wrist crease’ and the ‘distal to proximal division of the retinaculum’ using the two signs of ‘railroad’ and ‘drop in’ to confirm a complete division of retinaculum are proposed techniques that should be considered in order to produce good outcomes in ECTR. The ‘railroad’ sign is the parallel standing of the retinaculum edges, and the ‘drop in’ sign is the dropping of the retinaculum edge into the scope denote a completely divided retinaculum.
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Affiliation(s)
- Shahram Nazerani
- Department of Surgery, Firuzgar Medical Center, Iran University of Medical Sciences, Tehran, IR Iran
- Department of Hand Surgery, Mehr Genrel Hospital, Tehran, IR Iran
- Corresponding author: Shahram Nazerani, Department of Surgery, Firuzgar Medical Center, Iran University of Medical Sciences, Vali-Asr Sq., Behafarin St., Tehran, IR Iran. Tel: +98-9121112216, Fax: +98-2122569149, E-mail:
| | | | - Tina Nazerani
- Department of Surgery, Firuzgar Medical Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Amir Saraii
- Department of Surgery, Firuzgar Medical Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Mohamad Reza Keramati
- Department of Surgery, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran
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