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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
In carpal tunnel syndrome, the compression of the median nerve causes paresthesias within the radial-palmar aspect of the hand, plus pain in the palm and wrist. The pain can be referred to the forearm and shoulder, and may be worse at night. The muscles controlling thumb abduction and opposition may be weakened and atrophied. In peroneal nerve palsy, paralysis of the common peroneal nerve, also called the fibular nerve, affects movement of the ankle, making walking difficult. Nerve damage from injury to the knee or fibula starts the pathophysiological process. Radial nerve palsy progresses to paralysis of all extensors of the wrist and digits, along with the forearm muscles. Extremely proximal lesions may affect the triceps. Ulnar nerve palsy progresses as the lack of control and sensation causes the hand muscles to tighten, resulting in a claw-like deformity in severe cases.
Peripheral Nerve Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Mohammed Tahir Ansari, Santanu Kar, Devansh Goyal, Dyuti Deepta Rano, Rajesh Malhotra
The innervations of the triceps muscle vary significantly. The branches to the long head, medial head and lateral head about 7.1, 9.5 and 10.1 cm respectively, below the tip of acromion. Another branch to the medial head arises about 11.2 cm below the tip of the acromion [1]. These branches to the triceps usually remain between the heads of the triceps muscle and the main stem remains very close to the bone (shaft of humerus) leading to stretching of the nerve by the shaft of the humerus fracture but minimal stretching of the triceps innervating collaterals [2]. Hence the triceps are usually spared in the shaft of humerus fractures but they can be compressed in axilla against the latissimus dorsi and teres major muscles or in the triangular interval where the nerve is against the humeral shaft and two muscles (long head of triceps and teres major) [2]. Hence, compression in the axilla leading to total paralysis including triceps comprising of “very high” radial nerve palsy and compression/stretching around/below the spiral groove but above the elbow leads to sparing of the triceps (hence elbow extension is normal) leading to “high radial” nerve palsy. The nerve to the brachioradialis (BR) and extensor carpi radialis longus (ECRL) is almost always supplied by branches above or at the level of the lateral epicondyle [2]. Hence wrist extension is spared in lesions below the elbow designating “low” radial nerve palsy.
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.
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).
Comparison of the Tight Rope Technique and Clavicular Hook Plate for the Treatment of Rockwood Type III Acromioclavicular Joint Dislocation
Published in Journal of Investigative Surgery, 2018
Leyi Cai, Te Wang, Di Lu, Wei Hu, Jianjun Hong, Hua Chen
Postoperative complications occurred in five patients in Group B, including 3 superficial wound infection, 1 nerve palsy and 1 plate breakage (Table 4). The superficial wound infection resolved with oral antibiotics and daily dressing. The superficial radial nerve palsy resolved spontaneously without treatment. One patient in Group B fell after surgery, causing the plate breakage. This patient was treated with secondary surgery using the clavicular hook plate.
Immediate tendon transfer for functional reconstruction of a dorsal forearm defect after sarcoma resection
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Ryo Karakawa, Hidehiko Yoshimatsu, Yuma Fuse, Kenta Tanakura, Tomohiro Imai, Masayuki Sawaizumi, Tomoyuki Yano
The functional disability associated with sarcoma resection consists of dysfunction due to neurectomy and due to muscle resection. Tendon transfer techniques for paralysis can be applied to patients with the sarcoma on the forearm. The choice of tendons to transfer for radial nerve palsy is the main problem for reconstructive surgeons. The FCU and the FCR are widely used for restoration of finger extension. However, the choice between these two tendons remains controversial [9–12]. The FCU is the stronger flexor of the wrist, having twice as much power compared to the FCR [10]. This property of the FCU entails the following two drawbacks when used for tendon transfer; radial deviation and loss of wrist strength. Therefore, the FCR is our preferred option for the restoration of finger extension due to the drawbacks of the FCU. Its excursion is equal to that of the EDC, with slightly inferior power [11]. In our case series, the FCU was transferred in one case. In this case, the FCR had to be preserved to maintain the wrist flexion because the wide resection included the FCU. The BR transfer was performed in two patients. In these two cases, the surgery was complex, requiring reconstruction of extensive defects and bone reconstruction, respectively. Therefore, the BR tendon transfer, which is a much simpler method, was chosen to avoid a prolonged operation time. The FCR could be transferred in six out of nine patients in our series and good finger extension was obtained. This suggested that this method may be feasible even with sarcoma patients. This may be biologically plausible because tumors rarely extend beyond the interosseous membrane and the muscles and tendons of the ventral aspect are intact. This is because dense regular connective tissue is assumed to provide a more robust anatomical barrier to tumor cell infiltration [13,14]. Tables 2 and 3 showed better postoperative ROM of finger extension in the patients who underwent tendon transfer using the FCR or FCU than in the patients who underwent tendon transfer using the BR. This suggests that using FCR or FCU may be an effective way of restoring the finger extension.