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Diabetic Neuropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
With carpal tunnel syndrome, there is a sensory deficit in the palmar aspect of the first three fingers that follows the development of paresthesias, pain, numbness, swelling, or prickling of the fingers. The symptoms are often felt in a variety of situations, including during rest, performing activities with the hands such as typing on a computer keyboard, or when driving a vehicle. Peroneal nerve palsy causes footdrop, which is weakened dorsiflexion and eversion of the foot, and sometimes a sensory deficit within the anterolateral aspect of the lower leg, dorsum of the foot, or in the webbed space between the first and second metatarsals. While L5 radiculopathy causes similar abnormalities, it usually weakens hip abduction by affecting the gluteus medius and weak foot inversion (tibialis posterior). Common symptoms of radial nerve palsy include wristdrop, which is weakness of the wrist and finger extensors, plus loss of sensation in the dorsal aspect of the first dorsal interosseous muscle. Similar motor abnormalities are caused by C7 radiculopathy. Compression of the ulnar nerve near the elbow may cause paresthesias, plus a sensory deficit in the fifth digit and the medial half of the fourth digit. There may be weakness and atrophy of the thumb adductor, fifth digit abductor, and the interosseous muscles. If chronic ulnar palsy is severe, a clawhand deformity will occur. Sensory symptoms are similar to those caused by C8 root dysfunction that is secondary to cervical radiculopathy. The difference is that radiculopathy usually affects more proximal aspects of the C8 dermatome.
Peripheral Nerve Examination in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
It is an important muscle as it is supplied before the nerve divides into the superficial and deep branch at the level of the lateral epicondyle. By testing this muscle, one can assess the level of the radial nerve injury. Test the muscle by instructing the patient to flex the elbow further from 90° in forearm neutral pronation and supination against resistance (Figure 14.6).
Orthopaedic Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Immediately refer to the orthopaedic team patients with: Grossly angulated or comminuted fracture.Compound fracture.Radial nerve palsy.
CT Analysis of a Potential Safe Zone for Placing External Fixator Pins in the Humerus
Published in Journal of Investigative Surgery, 2021
Juncai Ye, Qiao Li, Zhineng Chen, Hongyong Zhao, Jiefeng Huang, Jing Nie
Iatrogenic radial nerve injures are a common complication during placement of external fixator pins along the lateral aspect of the humeral shaft. Iatrogenic injury to the radial nerve is a devastating complication for both patients and surgeons, and is related to the specific anatomical characteristics of the radial nerve. Many anatomical studies have sought to understand the relationship between the course of the radial nerve along the humerus and the placement of humeral pins [9, 14, 15]. Gausepohl et al. demonstrated that the safe zone for pin placement in the distal humerus was within 60 mm above the lateral condyle, as determined through study of the anatomical shape of the humerus [16]. Wegmann et al. recommended that the insertion point of the pins should >172 mm or <27 mm proximal from the ERC [9]. In a similar study, Sukegawa et al. reported that the safe zone was located at a point where the distance was >135.0 mm to the ERC or the distance was <44 mm to the ERC [10]. However, a limitation of those studies was that they focused only on the radial nerve in the lateral humerus, which may limit their applicability to cases showing radial nerve involvement in another region.
Multimodality Intraoperative Neurophysiological Monitoring (IONM) During Shoulder Surgeries
Published in The Neurodiagnostic Journal, 2020
Faisal R. Jahangiri, James Blaylock, Nida Qadir, Jason A. Ramsey
Lopiz et al. (2018) prospectively analyzed the incidence and postoperative EMG studies of suprascapular nerve (SSN) and axillary nerve injuries with regards to rotator cuff tear arthropathy (RCTA). The study evaluates different characteristics of nerve functioning; conduction velocity, amplitude, and distal latency in both limbs for comparison, and change in amplitude of >50% considered as abnormal. The authors found that the incidence of axillary nerve and SSN was much higher than expected. A case report by Sherfey and Edwards (2009) presented a radial nerve injury secondary to cement extrusion during humeral arthroplasty for displaced proximal humeral fracture without IONM. Neurodiagnostic studies at ten weeks postoperatively confirmed radial nerve palsy due to a thermal injury. The patient exhibited complete radial nerve palsy, which recovered six months postoperatively with physical and occupational therapies (Sherfey and Edwards 2009).
Brachial distal biceps injuries
Published in The Physician and Sportsmedicine, 2019
Drew Krumm, Peter Lasater, Guillaume Dumont, Travis J. Menge
The biceps brachii muscle is made up of a short head and a long head. The short head originates on the coracoid process, while the long head originates on the supraglenoid tubercle. They each insert on the radial tuberosity. This muscle’s main action is to supinate the forearm, but it also assists in elbow flexion. Since the short head has a more distal attachment on the tuberosity than the long head, it is a greater contributor to elbow flexion. The long head attaches to the apex of the tuberosity and is a greater contributor to supination than the short head. The biceps is innervated by the musculocutaneous nerve and receives its blood supply from branches of the brachial artery. On clinical exam, the distal biceps tendon may be mistaken for the lacertus fibrosus, also known as the bicipital aponeurosis, which originates from the short head of the biceps and helps protect the neurovascular bundle in the antecubital fossa. The lateral antebrachial cutaneous nerve (LABCN), which is the terminal cutaneous branch of the musculocutaneous nerve, is at risk for injury in operative repair of distal biceps avulsion injuries. It is located between the biceps and brachialis muscles and pierces the deep fascia just lateral to the distal biceps tendon. The nerve is located in the subcutaneous tissue of the antecubital fossa and supplies sensation to the lateral aspect of the forearm. The radial nerve is also at risk for injury. The radial nerve is located between the brachioradialis and brachialis near the distal humerus. It bifurcates into the posterior interosseous nerve and radial sensory nerve in the antecubital fossa [6].