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Peripheral Nerve Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Nikhil Agrawal, Chaitanya Mudgal
Ulnar nerve injuries are common and can result from a variety of mechanisms including trauma, compression neuropathy, ulnar artery aneurysms and much more. As a hand surgeon, or as a physician involved in the care of peripheral nerves, it is inevitable that you will encounter ulnar nerve pathology in your practice. Recognizing potential injury can be simple; however, there is nuance in distinguishing it from spinal cord injury or brachial plexus injury. In addition, when combined with other nerve, tendon or vascular injuries knowing the examinations specific for the ulnar nerve is vital. Furthermore, we will discuss how to better localize where the pathology is occurring. Regarding the diagnosis of compression neuropathy, a nerve conduction study in isolation is inadequate, and a good physical examination is essential [1]. The steps in a comprehensive physical examination are to carefully observe, palpate, check sensation, utilize provocative manoeuvres and perform a precise motor examination.
Diabetic Neuropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Treatments for peroneal nerve palsy include resting from any activities that worsen the condition, ice packs, anti-inflammatory medications, bracing of the ankle and foot, strengthening and stretching exercises, and surgery. Surgical procedures include peroneal nerve decompression via an incision made over the neck of the fibula. The fascia surrounding the nerves to the lateral side of the leg is released. The early surgery is performed, the better will be the recovery. Physical therapy interventions include a range of motion exercises. Other treatment methods involve cold therapy, electrical stimulation, ultrasound, and iontophoresis. Treatment of radial nerve palsy includes OTC drugs or prescription analgesics, physical therapy, splinting or casting, transcutaneous electrical nerve stimulation, and surgery to remove compressive cysts, tumors, or broken bones. Treatment of ulnar nerve palsy includes OTC analgesics, corticosteroids, splinting, physical therapy, physical therapy, and surgery.
Surgery of the Peripheral Nerve
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Ravikiran Shenoy, Gorav Datta, Max Horowitz, Mike Fox
Decompression of the ulnar nerve at the wrist is a relatively uncommon procedure. Nerve compression may be associated with space-occupying lesions, anomalous muscles or trauma. It is imperative that the patient is examined from the cervical spine downwards, and clinical findings should be correlated with neurophysiology.
Evaluation of A Better Approach for Open Reduction Of Severe Gartland Type III Supracondylar Humeral Fracture
Published in Journal of Investigative Surgery, 2021
Two patients developed ulnar nerve injury postoperatively. In these patients, the medial K-wires were removed 1 day postoperatively, and new K-wires were fixed laterally; the patients recovered after 1 month. Usually, the ulnar nerve is damaged by K-wires; hence, removal of the K-wires may help the ulnar nerve recover. All patients with preoperative radial nerve injuries recovered within 1–2 months postoperatively. One patient with a cephalic vein injury developed severe arm swelling on the second day postoperatively. By raising the affected limb, the plasters were taken off, and the swelling was relieved on the third day. Only one patient needed neurological repair. Only one patient had artery rupture, the continuity of blood vessel was still existed, but the intima of blood vessel was obviously damaged, thrombosis was formed, and blood flow was interrupted. But when we observed the blood supply of the forearm, it did not appear to be bad; hence, we ligated the vessel. It recovered well postoperatively.
Effect of dry needling on cubital tunnel syndrome: Three case reports
Published in Physiotherapy Theory and Practice, 2019
Sudarshan Anandkumar, Murugavel Manivasagam
Peripheral nerve entrapments typically occur at mechanical interfaces in the upper extremity. The most common entrapment is of the median nerve at the carpal tunnel (Ibrahim, Khan, Goddard, and Smitham, 2012). Ulnar nerve entrapment is the second most common entrapment neuropathy and may occur at the wrist, thoracic outlet, or elbow (Elhassan and Steinmann, 2007). In the elbow, ulnar nerve entrapment occurs at the cubital tunnel and was described as “cubital tunnel syndrome” cubital tunnel syndrome by Feindel and Stratford in 1958 (Wojewnik and Bindra, 2009). Other nomenclatures that have previously been used to describe this entrapment are “ulnar nerve entrapment syndrome,” “sulcus ulnaris syndrome,” and “tardive ulnar neuritis” (Assmus, Antoniadis, and Bischoff, 2015; Qing et al., 2014).
Acute ulnar nerve compression associated with pisiform fracture – a case report and literature review
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Min Kai Chang, Robert Tze Jin Yap
We present a case of ulnar nerve neuropraxia secondary to pisiform fracture that was first managed by closed manual reduction under anaesthesia, then pisiform excision with ulnar nerve decompression. Notably, the ulnar nerve symptoms were not evident in the initial assessment, indicating an acute progressive neurological deficit or that other concomitant injuries may have masked the symptoms. To avoid chronic complications of ulnar nerve compression and to appropriately manage the patient, it is prudent to adequately evaluate the ulnar neurovascular function in the initial screening. This may involve examining under adequate anaesthesia and appropriate imaging modalities. If routine radiographs in anteroposterior, lateral, pronated oblique views fail to demonstrate pisiform fracture, and clinical examination is ambiguous for ulnar nerve injury, magnetic resonance imaging can be considered.