Najčastejším symptomatickým prejavom syndrómu iliotibiálneho traktu (ITBS – iliotibial band syndrome) je bolesť bočnej časti kolena, ktorá je spojená s opakovanými pohybovými aktivitami. Pacienti bolesť často udávajú ako bodavú v oblasti okolo laterálneho femorálneho epikondylu, ktorá môže vyžarovať dole iliotibiálnym smerom do holennej kosti. V proximálnej časti stehna dostáva iliotibiálny trakt (ITB) fasciálne časti z hlbokej fascie stehna, m. gluteus maximus a m. tensor fasciae latae. ITBS sa vo väčšine prípadov úspešne lieči neoperačným manažmentom, hoci niekedy je potrebný chirurgický zákrok. Etiológia ITBS je predmetom kontroverzných diskusií. Pre ITBS bolo navrhnutých niekoľko etiológií, vrátane trenia ITB o laterálny femorálny epikondyl, kompresie tukového tkaniva a spojivového tkaniva a chronický zápal burzy ITB. ITBS je diagnóza založená na klinickom prejave. Dôležitým nálezom pri klinickom vyšetrení je lokálna citlivosť laterálnej časti kolena pod epikondylom a nad kĺbovou líniou. Rehabilitácia u pacientov so ITBS predstavuje dôležitú časť komplexnej liečby, ktorá zohráva kľúčovú úlohu pri liečbe ITBS.
Summary: The most common symptomatic manifestation of iliotibial band syndrome (ITBS) includes pain in the lateral part of the knee, which is associated with repetitive movement activities. Patients often describe pain in the area around the lateral femoral epicondyle, which can radiate down the iliotibial direction into the tibia. In the proximal part of the thigh, the iliotibial tract (ITB) receives fascial parts from the deep fascia of the thigh, gluteus maximus, and tensor fasciae latae. ITBS is often successfully treated with non-operative management, although surgery is sometimes required. The etiology of ITBS has been the subject of controversial discussions. Various etiologies have been proposed for ITBS, including friction of the ITB against the lateral femoral epicondyle, compression of the adipose tissue and the connective tissue, and chronic inflammation of the ITB bursa. ITBS is a diagnosis based on clinical presentation. Local tenderness of the lateral part of the knee below the epicondyle and above the joint line is an important finding during physical examination. Rehabilitation in patients with ITBS is an important part of comprehensive treatment that plays a key role in the therapy of ITBS.
- MeSH
- Amputation, Surgical * methods adverse effects MeSH
- Sprains and Strains complications MeSH
- Adult MeSH
- Fracture Fixation methods adverse effects MeSH
- Prosthesis Implantation MeSH
- Complex Regional Pain Syndromes * drug therapy pathology therapy MeSH
- Humans MeSH
- Pain Management methods MeSH
- Treatment Failure MeSH
- Knee Injuries complications therapy MeSH
- Hand Injuries complications therapy MeSH
- Disease Progression MeSH
- Accidental Falls MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
OBJECTIVE: The aim of the study was to investigate the associations of cross-sectional area (CSA) of the median nerve measured by ultrasonography, the median to ulnar nerve ratio (MUR), the median to ulnar nerve difference (MUD) and the ratio of CSA of the median nerve to height squared (MHS) in relation to electrodiagnostic classification of moderate and severe carpal tunnel syndrome (CTS) and thus to identify patients suitable for surgical treatment. MATERIALS AND METHODS: A prospective study was conducted in patients aged ≥ 18 years who underwent both median and ulnar nerve ultrasonography and electrodiagnostic studies (EDS). 124 wrists of 62 patients were examined. The patients' characteristics were acquired through a questionnaire. CTS was diagnosed using EDS and classified according to the guidelines of the Czech Republic Association of Electrodiagnostic Medicine. The CSA of the median nerve and of the ulnar nerve were measured at the carpal tunnel inlet. RESULTS: Median nerve CSA at the tunnel inlet ≥ 12 mm2 correlates with electrodiagnostic classification of moderate to severe carpal tunnel syndrome. At this cut-off value, the sensitivity of ultrasonography is 82.4%, its specificity is 87.7%, the positive predictive value is 82.4%, the negative predictive value is 87.7%. MUD, MUR and MHS perform worse than the median nerve CSA, as shown by their lower area under the receiver operating characteristic curve. CONCLUSIONS: Ultrasound could help us indicate surgical treatment for CTS, especially in patients with clinical findings. Our results suggest a cut-off value of CSA at the tunnel inlet of ≥ 12mm2.
- MeSH
- Acupuncture methods MeSH
- Acupuncture Therapy * methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Carpal Tunnel Syndrome * therapy MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Na podkladě fyzikálních příčin vznikají v pracovní zátěži mononeuropatie (úžinové syndromy i komprese periferních nervů) i polyneuropatie. Nejčastějším fyzikální vlivem je přetížení, dále následuje expozice vibracím přenášeným na horní končetiny, ale také chlad, vlhko, nepříznivá pracovní poloha, tlak na nerv proti tvrdé podložce. Úžinové syndromy i zevní komprese periferního nervu vedou k ischemii fasciklů i jednotlivých axonů, k rozvoji edému, k poruše venózního odtoku, k vzestupu tlaku v úžině a nakonec i k fokální demyelinizaci či axonální lézi. Nadlimitní vibrace přenášené na horní končetinu vedou ke spazmům arteriol, k ischemii tkáně na akru HK, k poškození senzitivních a pak i motorických vláken a k rozvoji vibrační neuropatie. Důležité je klinické a elektrofyziologické zhodnocení. Následuje léčba a komplexní preventivní opatření.
Mononeuropathies (entrapment syndromes and compressions of peripheral nerves) and polyneuropathies develop during occupational exposition on the ground of physical reasons. The most common physical impact is overload, followed by exposition to vibrations transmitted to upper extremities, then cold, humidity, unfavorable position in work, and pressure on the nerve against a hard structure. Entrapment syndromes and outer compressions of peripheral nerves lead to the ischemic changes of fascicles and single axons, to development of oedema, to failure of the venous outflow, to the increase of pressure in entrapment and lastly to the focal demyelinization or axonal lesion. Over-limit vibration transferred via the upper extremity cause spasms of arteriols, leading to the tissue ischemia at the terminal structures of hand and fingers, to lesion of sensitive and later of motor nerve fibres and to the development of vibration neuropathy. Clinical and electrophysiological evaluation of these disorders is important. Treatment and the complex prophylactic measures follow.
- MeSH
- Electrodiagnosis methods MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Occupational Diseases diagnosis prevention & control MeSH
- Polyneuropathies MeSH
- Carpal Tunnel Syndrome diagnosis etiology therapy MeSH
- Nerve Compression Syndromes * diagnosis etiology therapy MeSH
- Tendon Entrapment MeSH
- Check Tag
- Humans MeSH
The palmaris profundus muscle is a rare anatomical variation of the forearm muscles. It has been described in both cadaveric and clinical studies as a possible cause of carpal tunnel syndrome. We observed three cases of this variant in recent years and decided to perform a scoping review of this uncommon anatomical entity. Major databases were searched to identify all relevant clinical and anatomical studies containing anatomical descriptions of the muscle, including its origin, insertion, and concomitant presence of the proper palmaris longus muscle or the bifid median nerve. In clinical cases, we studied the surgical approach. Sixty-four articles met our inclusion criteria and contained 88 cases of palmaris profundus muscle. The most common origin was the ventral aspect of the radius in the area of insertion of the pronator teres muscle observed in 11 cases (12.5 %). We found 65 cases (73.3%) in which the tendon was inserted into the palmar aponeurosis or palmar fascia after entering the carpal canal. The concomitant presence of the proper palmaris longus muscle was described in 47 cases (53.4%). We identified 10 cases (10.8%) of the bifid median nerve. In 49 of 69 clinical cases (71%), the surgical approach was to resect the variant muscle. The importance of this variant should not be underestimated due to its potential to compress the median nerve. We found a significant disparity in the muscle origin sites, but uniformity of muscle insertion. In cases where the muscle is found during carpal canal surgery, it should be partially resected to ensure complete nerve decompression.
- MeSH
- Muscle, Skeletal surgery MeSH
- Humans MeSH
- Median Nerve surgery MeSH
- Neurosurgical Procedures adverse effects MeSH
- Forearm MeSH
- Carpal Tunnel Syndrome * surgery etiology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Nowadays, median nerve entrapment is a frequent issue. Many physicians are familiar with the most common median entrapment, which is the carpal tunnel syndrome (CTS). By contrast, less frequent entrapments, historically called “pronator syndrome” are still misdiagnosed as overuse syndrome, flexor tendinitis or other conditions. This article is meant to introduce proximal median nerve entrapments, followed by a case report of the rarest example – anterior interosseous nerve syndrome (AIN syndrome).
- MeSH
- Adult MeSH
- Case Reports as Topic MeSH
- Humans MeSH
- Median Nerve surgery pathology transplantation MeSH
- Neurosurgical Procedures classification methods MeSH
- Median Neuropathy * surgery pathology MeSH
- Forearm surgery pathology MeSH
- Pronation MeSH
- Carpal Tunnel Syndrome surgery etiology therapy MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Review MeSH
PURPOSE: Cubital tunnel syndrome is a well-described entity with many reported etiologies and anatomical compression sites. Accessory ossicles of either traumatic or congenital origin might occur around the elbow joint. Only one case reporting such ossicles compressing the ulnar nerve exists in previous literature. We aim to present this entity with a detailed description of the patient history and treatment. CASE REPORT: We report a case of 30-year-old female presenting with classical signs of cubital tunnel syndrome-positive Wartenberg's and Froment's signs, hypoesthesia in the fourth and fifth finger with decreased finger duction strength but without gross hypotrophy of interosseous and hypothenar muscles. Tinel's sign was positive over the ulnar sulcus and an accessory ossicle was found on the elbow radiograph within the ulnar sulcus. The first signs of calcification in this patient were reported 6 years prior in a follow-up after the dislocation of her elbow joint following a bike accident. The EMG confirmed ulnar nerve neuropathy in the elbow area. The ossicle was extirpated, the ulnar nerve was decompressed in the ulnar sulcus in a standard manner and the symptoms quickly resolved. The patient has been regularly visiting our outpatient clinic for the next 12 years without any complaints considering her elbow and the ulnar nerve. CONCLUSION: This is a rare case of cubital tunnel syndrome caused by an accessory ossicle of traumatic origin. Simple bone extirpation with ulnar nerve release followed by anterior subcutaneous transposition is the recommended method of treatment. No report of congenital accessory bones causing ulnar nerve compression in the elbow exists in the literature.
- MeSH
- Adult MeSH
- Ossification, Heterotopic * diagnosis diagnostic imaging MeSH
- Humans MeSH
- Elbow MeSH
- Elbow Joint * physiology MeSH
- Ulnar Nerve MeSH
- Cubital Tunnel Syndrome * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
Při posuzování zdravotního stavu pro účely sociálního zabezpečení se kompresní syndrom jednoho z hlavních nervů horní končetiny vyskytuje jako onemocnění, které může mít dopad na pracovní schopnost i na soběstačnost. Má v posudkovém lékařství své místo v oblasti pojistné i nepojistné agendy. Práce dává náhled nejen na klinické projevy vlastního syndromu karpálního tunelu, ale také na jeho dopad v posudkové oblasti jako takové.
When assessing health status for social security purposes, compression syndrome of the median nerve, one of the main nerves of the upper limb, appears as a condition that can affect work ability and self-sufficiency. It has its place in social medicine in the area of insurance and non-insurance agendas. The work provides insight not only into the clinical manifestations of carpal tunnel syndrome itself, but also into its impact in the assessed area as such.
- MeSH
- Diagnosis, Differential MeSH
- Middle Aged MeSH
- Humans MeSH
- Median Nerve anatomy & histology MeSH
- Disability Evaluation * MeSH
- Sick Leave legislation & jurisprudence MeSH
- Carpal Tunnel Syndrome * diagnosis physiopathology therapy MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Review MeSH
