China
Africa
Explore chapters and articles related to this topic
Peripheral Nerve Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
J Terrence Jose Jerome, Dafang Zhang
Anterior interosseous nerve syndrome is an isolated lesion to the anterior interosseous nerve fibres, which innervates the flexor pollicis longus, the flexor digitorum profundus to the index finger and middle finger, and the pronator quadratus. The cause of anterior interosseous syndrome is varied and unclear. While direct compression of the anterior interosseous nerve has been reported, a pseudo-anterior interosseous nerve syndrome can arise from a brachial neuritis or Parsonage–Turner syndrome. The etiology of Parsonage–Turner syndrome may be autoimmune, post-viral or post-traumatic, and may involve an interplay of genetic and environmental factors. In the absence of direct compression, the mainstay of treatment of anterior interosseous nerve syndrome is observation before performing surgical decompression, as spontaneous recovery has been reported even after one year of symptoms [8].
Arthroscopic inferior transverse scapular ligament release at the spinoglenoid notch and ganglion cyst decompression using the extra-articular Plancher portal
Published in Andreas B. Imhoff, Jonathan B. Ticker, Augustus D. Mazzocca, Andreas Voss, Atlas of Advanced Shoulder Arthroscopy, 2017
Stephanie C. Petterson, Joseph M. Ajdinovich, Kevin D. Plancher
Several mechanisms of suprascapular nerve compression at the spinoglenoid ligament have been suggested. Early literature suggested injury could be attributed to intimal damage from microemboli in the vasa nervorum.6 Repetitive traction and microtrauma have also been cited as probable causes,2,3,7–9 as the spinoglenoid ligament tightens when the shoulder is in a position for overhead throwing (e.g., abduction and external rotation), resulting in increased pressure on the suprascapular nerve10 (Figure 41.2). Anatomic variants such as a stenotic notch, ossified ligament, or even superiorly-oriented fibers of the subscapularis muscle may lead to nerve compression.11,12 The relatively fixed position of the suprascapular nerve as it traverses the lateral edge of the scapular spine combined with its close proximity to the posterior glenohumeral joint can cause compression by a soft tissue mass or ganglion cyst as a result of a labral or capsule injury. These ganglia may form when a capsule or labrum tears and synovial fluid is forced into the tissue as a one way valve, no different than meniscal cysts in the knee.13 Direct blunt force trauma or forced external rotation of the upper extremity can also contribute to irritation at the compression point. Lastly, while rare, a patient may have a neuropathy from a Parsonage Turner syndrome, although, it is more common for this viral neuritis to attack other nerves.
Peripheral nerve disorders
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Michael Fox, David Warwick, H. Srinivasan
The anterior interosseous nerve can be selectively compressed at the same sites as the proximal median nerve. However, spontaneous (and usually temporary) physiological failure (Parsonage–Turner syndrome) is a more likely cause. There is motor weakness without sensory symptoms. The patient is unable to make the ‘OK sign’ – pinching with the thumb and index finger joints flexed, like a ring – because of weakness of the flexor pollicis longus and flexor digitorum profundus. Isolated loss of flexor pollicis longus can occur. Pressure over the belly of this muscle in the forearm will flex the thumb-tip, thus excluding tendon rupture. The condition usually settles spontaneously within a few months. If it does not, surgical exploration and release or tendon transfer may be considered.
Applying a clinical decision-making model to a patient with severe shoulder pain ultimately diagnosed as neuralgic amyotrophy
Published in Physiotherapy Theory and Practice, 2022
The use of a clinical decision-making model may be a helpful tool for making difficult clinical decisions. The purpose of this case report is to describe how an established clinical decision-making model was able to assist a physical therapist (PT) in making a diagnosis of Amyotrophic Neuralgia or Neuralgia Amyotrophy (NA). NA (also called Parsonage-Turner syndrome or brachial neuritis) is a rare clinical syndrome consisting of acute and severe pain affecting the shoulder and is often accompanied by shoulder or arm weakness. It is characterized by inflammation to one or more branches or cords of the brachial plexus (National Organization for Rare Disorders, 2005; van Alfen, 2007) and affects the long thoracic nerve and suprascapular nerves most commonly (Gupta, Winalski, and Sundaram, 2014). It is more common in men than women and incidence peaks around age 40. The etiology of NA is unknown, but an immune-mediated inflammatory reaction has been suggested as a possible cause (Feinberg and Radecki, 2010). Many factors including recent surgery, infections, recent immunization and immune or genetic susceptibilities can make the patient more prone to NA. Feinberg and Radecki (2010) reported that viral infections are the most common risk factor for NA while the second most common is recent immunization.
Current concepts review: peripheral neuropathies of the shoulder in the young athlete
Published in The Physician and Sportsmedicine, 2020
Tamara S. John, Felicity Fishman, Melinda S. Sharkey, Cordelia W. Carter
The natural history of scapular winging due to LTN palsy is typically spontaneous resolution with nonoperative management within the first 6–18 months, but has been reported to have a more protracted course (up to 24 months) in palsies of atraumatic etiology, such as brachial neuritis (e.g. Parsonage Turner Syndrome). In athletes, a shorter time course to resolution (6–9 months) has been reported [19,20]. Initial treatment is supportive, consisting of therapeutic exercises to preserve motion and strengthen the compensatory musculature of the shoulder. The most disabling deficiency in patients with scapular winging stems from the inability to fix the scapula against the rib cage during active flexion and abduction [21–23]. Scapular braces are designed to improve scapular position and theoretically improve pain and shoulder motion. Although some studies have shown that the use of scapular bracing does not provide significant pain relief in a large portion of patients with scapular winging [24], scapular bracing nonetheless remains a treatment option for patients with 3 cm or greater of scapular winging and those with limited range of motion [24].
MR neurography of the brachial plexus in adult and pediatric age groups: evolution, recent advances, and future directions
Published in Expert Review of Medical Devices, 2020
Alexander T. Mazal, Ali Faramarzalian, Jonathan D. Samet, Kevin Gill, Jonathan Cheng, Avneesh Chhabra
Parsonage- turner syndrome (brachial neuritis) is generally seen as an isolated syndrome and rarely, as a familial variant. The patients typically present with shoulder and neck pain followed by weakness. The C5 and C6 nerves, and upper trunk are the most commonly affected nerves with downstream neuropathy change of the suprascapular nerve and/or axillary nerve. T2 hyperintense signal will be observed in affected root, trunk, and cord segments. Diffuse increased T2 signal intensity will also be seen in regional musculature, alongside other muscle denervation changes, such as fatty replacement and atrophy. Uncommonly, one may also detect torsion of the nerve segment(s) leading to a triple B sign or Bull’s eye sign [61,62]. The ulnar nerve is the least commonly affected nerve in brachial neuritis.