Nerve Compression Syndromes

神经压迫综合征
  • 文章类型: Case Reports
    本文报道一例女性患者入院,右前臂肿胀和皮下肿块,最初怀疑是多发性神经纤维瘤。然而,通过术前成像和手术,最终诊断为浅表血栓性静脉炎。这种情况导致radial神经分支陷入,导致明显的神经卡压和放射疼痛。手术包括切除炎症组织和血栓,头静脉结扎,并完全释放桡神经分支.术后病理证实为表浅血栓性静脉炎。通过这个案子,我们强调综合利用临床的重要性,成像,和手术干预,以获得更准确的诊断和治疗。这是由于浅表血栓性静脉炎引起的radial神经分支卡压的首次临床报告。
    This article reports a case of a female patient admitted with swelling and subcutaneous mass in the right forearm, initially suspected to be multiple nerve fibroma. However, through preoperative imaging and surgery, the final diagnosis confirmed superficial thrombophlebitis. This condition resulted in entrapment of the radial nerve branch, leading to noticeable nerve entrapment and radiating pain. The surgery involved the excision of inflammatory tissue and thrombus, ligation of the cephalic vein, and complete release of the radial nerve branch. Postoperative pathology confirmed the presence of Superficial Thrombophlebitis. Through this case, we emphasize the importance of comprehensive utilization of clinical, imaging, and surgical interventions for more accurate diagnosis and treatment. This is the first clinical report of radial nerve branch entrapment due to superficial thrombophlebitis.
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  • 文章类型: Journal Article
    胸小肌综合征(PMS)和四边形空间综合征(QSS)是影响上肢的罕见神经血管压迫疾病。PMS涉及胸小肌下方的压迫,和QSS是由四边形空间中的压缩产生的,这两者都是在头顶运动运动员中经典观察到的。诊断PMS和QSS可能具有挑战性,更常见,上肢病理。虽然没有黄金诊断标准,在排除更常见的病因后,在具有适当临床背景的患者中,局部镇痛肌肉阻滞反应通常是准确诊断所需的全部.治疗范围从保守的物理治疗到减压手术,保留用于难治性或严重病例,急性血管表现。减压通常会产生有利的结果,大多数患者经历显著缓解和恢复基线功能。总之,PMS和QSS,虽然罕见,可引起使人衰弱的上肢症状;准确的诊断和适当的治疗提供了极好的结果,减轻疼痛和残疾。
    Pectoralis minor syndrome (PMS) and quadrilateral space syndrome (QSS) are uncommon neurovascular compression disorders affecting the upper extremity. PMS involves compression under the pectoralis minor muscle, and QSS results from compression in the quadrilateral space-both are classically observed in overhead-motion athletes. Diagnosing PMS and QSS may be challenging due to variable presentations and similarities with other, more common, upper-limb pathologies. Although there is no gold standard diagnostic, local analgesic muscle-block response in a patient with the appropriate clinical context is often all that is required for an accurate diagnosis after excluding more common etiologies. Treatment ranges from conservative physical therapy to decompressive surgery, which is reserved for refractory cases or severe, acute vascular presentations. Decompression generally yields favorable outcomes, with most patients experiencing significant relief and restored baseline function. In conclusion, PMS and QSS, although rare, can cause debilitating upper-extremity symptoms; accurate diagnosis and appropriate treatment offer excellent outcomes, alleviating pain and disability.
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  • 文章类型: Journal Article
    尽管上肢神经压迫综合征的手术松解术非常有效,症状和体征可能持续或复发。在这种情况下,在建议治疗之前,必须进行彻底的调查。如果症状不能用其他病理解释,而不是压迫受影响的神经,如果保守治疗没有提供改善,可以考虑再操作。这篇综述概述了腕管综合征翻修的诊断和手术注意事项,肘管综合征和胸廓出口综合征。证据级别:V.
    Although surgical release of upper extremity nerve compression syndromes is highly effective, persistence or recurrence of symptoms and signs may occur. Thorough investigation is necessary in this situation before treatment is recommended. If the symptoms cannot be explained by other pathology than compression of the affected nerve and if conservative management has not provided improvement, reoperation may be considered. This review provides an overview of the diagnostic and surgical considerations in the revision of carpal tunnel syndrome, cubital tunnel syndrome and thoracic outlet syndrome.Level of evidence: V.
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  • 文章类型: Journal Article
    没有治疗儿童前皮神经卡压综合征(ACNES)的循证指南。本综述的主要目的是审查支持当前使用的治疗干预措施的证据。根据世界卫生组织(WHO)儿童慢性疼痛管理指南,这些患者及其家属和护理人员应在生物心理社会模式的背景下进行治疗;疼痛不应纯粹作为生物医学问题进行治疗.因此,我们的第二个目的是评估这些干预措施是否在生物心理社会模型的背景下应用,利用跨学科或多学科方法。
    对文献进行范围审查,以探索儿童ACNES的治疗策略。为了确保对有关该主题的已发表文献进行全面概述,搜索不受研究类型的限制.两名审稿人独立评估标题和摘要。排除与儿童无关的记录后,对全文进行筛选纳入。任何判断上的差异都是通过与第三名审稿人讨论来解决的。
    在35个相关标题中,这次审查中包括22人。只有4篇文章提供了有关长期结果的信息。审查的总体质量被认为较低。大多数报告没有涉及心理和社会领域的治疗或教育。由于数据的实质性异质性,结构定性分析是不可行的。
    支持当前ACNES儿童治疗策略的证据质量较低。需要更多的研究来为患有这种具有挑战性的疼痛问题的患者建立基于证据的治疗算法。根据世卫组织的建议,应该更加重视生物心理社会方法。最终目标应该是开发通用治疗算法,概述适用于所有相关专业人员的ACNES方法。
    UNASSIGNED: Evidence-based guidelines for managing anterior cutaneous nerve entrapment syndrome (ACNES) in children are absent. The primary aim of this review was to scrutinize the evidence supporting currently used treatment interventions. In accordance with the World Health Organization (WHO) guidelines for managing chronic pain in children, these patients and their families and caregivers should be treated within the context of the biopsychosocial model; pain should not be treated purely as a biomedical problem. Therefore, our second aim was to evaluate whether these interventions are applied within the context of the biopsychosocial model, utilizing an inter- or multidisciplinary approach.
    UNASSIGNED: A scoping review of the literature was conducted to explore treatment strategies for ACNES in children. To ensure a comprehensive overview of published literature on this topic, the search was not restricted based on study type. Two reviewers independently assessed titles and abstracts. After excluding records unrelated to children, full texts were screened for inclusion. Any discrepancies in judgement were resolved through discussion with a third reviewer.
    UNASSIGNED: Out of 35 relevant titles, 22 were included in this review. Only 4 articles provided information on long-term outcomes. The overall quality of the review was deemed low. The majority of reports did not address treatment or education within the psychological and social domains. A structural qualitative analysis was not feasible due to the substantial heterogeneity of the data.
    UNASSIGNED: The evidence supporting current treatment strategies in children with ACNES is of low quality. More research is needed to establish an evidence-based treatment algorithm for patients with this challenging pain problem. In line with the WHO recommendation, greater emphasis should be placed on a biopsychosocial approach. The ultimate goal should be the development of a generic treatment algorithm outlining an approach to ACNES applicable to all professionals involved.
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  • 文章类型: Systematic Review
    背景:皮质类固醇注射剂经常用于肌肉骨骼疼痛的短期治疗,但是他们的使用是有争议的,因为反复暴露于皮质类固醇会导致对肌肉骨骼组织的有害影响。臭氧注射已被提议作为肌肉骨骼疼痛的可能治疗方法;然而,它们的有效性尚未与皮质类固醇相比。
    目的:通过荟萃分析评估臭氧注射与皮质类固醇注射相比减轻肌肉骨骼疼痛个体疼痛的有效性。
    方法:使用电子数据库进行了在线系统搜索,直到2023年9月。我们搜索了比较皮质类固醇注射与臭氧注射治疗不同起源的肌肉骨骼疼痛的研究。
    结果:共纳入11项研究,共534人。在总体汇总分析中,发现短期内疼痛减轻有利于皮质类固醇注射(d=0.31,95%CI0.01~0.60,p(z)0.04,I2=32%).从中期来看,两组间在减轻疼痛方面无显著差异(d=-0.17,95%CI-0.42~0.07,p(z)0.15,I2=0%).
    结论:我们的研究结果表明,短期注射皮质类固醇更有效地减轻肌肉骨骼疼痛,但与臭氧注射相比,在中期同样有效。尽管如此,有必要进行更高质量的临床试验来证实这些结果。
    UNASSIGNED: Corticosteroid injections are frequently used in the short-term treatment of musculoskeletal pain, but their use is controversial as repeated exposures to corticosteroids can lead to deleterious effects on musculoskeletal tissue. Ozone injections have been proposed as a possible treatment for musculoskeletal pain; however, their effectiveness has not been compared with corticosteroids.
    UNASSIGNED: To evaluate the effectiveness of ozone injections for reducing pain in individuals with musculoskeletal pain in comparison with corticosteroid injections through a meta-analysis.
    UNASSIGNED: An online systematic search was performed using electronic databases up to September 2023. We searched for studies that compared corticosteroid injections with ozone injections in the treatment of musculoskeletal pain of diverse origins.
    UNASSIGNED: Eleven studies were included comprising a total of 534 individuals. In the overall pooled analysis, a pain reduction in favor of corticosteroid injections was found in the short term (d= 0.31, 95% CI 0.01 to 0.60, p (z) 0.04, I2 = 32%). In the medium term, no significant differences were found in reducing pain between groups (d=-0.17, 95% CI -0.42 to 0.07, p (z) 0.15, I2 = 0%).
    UNASSIGNED: Our results suggest that corticosteroids injections are more effective in reducing musculoskeletal pain in the short term, but equally effective in the medium term when compared with ozone injections. Nonetheless, better-quality clinical trials are necessary to corroborate these results.
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  • 文章类型: Journal Article
    下肢压迫性神经病是一种被误解和未被诊断的疾病,以疼痛和感觉障碍为特征,肌肉无力,以及体检中特定的挑衅性动作。在临床实践中最常见的这些综合征是腓骨神经卡压,胫骨近端神经病,腓肠神经神经病,臀深综合征或坐骨神经卡压,股外侧皮神经卡压,也被称为meralgia异常。这些通常被误认为是腰丛疾病,神经根病,和肌肉肌腱疾病,出现频率更高,临床表现重叠。一个全面的回忆,体检,和电诊断研究应该有助于澄清诊断。如果诊断仍不清楚或怀疑是导致截留的次要原因,磁共振神经成像,MRI,或超声检查应明确病因,排除其他疾病,并确认诊断。这篇叙述性综述的目的是帮助临床医生熟悉这种疾病,随着诊断信心的增加,导致神经损伤的早期诊断和肌肉萎缩的预防。我们回顾了流行病学,解剖学,病理生理学,病因学,临床表现,和EDX技术和下肢压迫性神经病的解释,使用1970年至2022年出版的文章,MEDLINE,科克伦图书馆,谷歌学者,EMBASE,WebofScience,和Scopus数据库。
    Entrapment neuropathies of the lower limb are a misunderstood and underdiagnosed group of disorders, characterized by pain and dysesthesia, muscular weakness, and specific provoking movements on physical examination. The most frequent of these syndromes encountered in clinical practice are fibular nerve entrapment, proximal tibial neuropathy, sural nerve neuropathy, deep gluteal syndrome or sciatic nerve entrapment, and lateral femoral cutaneous nerve entrapment, also known as meralgia paresthetica. These are commonly mistaken for lumbar plexopathies, radiculopathies, and musculotendinous diseases, which appear even more frequently and have overlapping clinical presentations. A comprehensive anamnesis, physical examination, and electrodiagnostic studies should help clarify the diagnosis. If the diagnosis is still unclear or a secondary cause of entrapment is suspected, magnetic resonance neurography, MRI, or ultrasonography should be conducted to clarify the etiology, rule out other diseases, and confirm the diagnosis. The aim of this narrative review was to help clinicians gain familiarity with this disease, with an increase in diagnostic confidence, leading to early diagnosis of nerve damage and prevention of muscle atrophy. We reviewed the epidemiology, anatomy, pathophysiology, etiology, clinical presentation, and EDX technique and interpretation of the entrapment neuropathies of the lower limb, using articles published from 1970 to 2022 included in the Pubmed, MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Scopus databases.
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  • 文章类型: Journal Article
    下肢的周围神经可能在其解剖过程中的各个点处被捕获。虽然临床评估和神经传导研究是诊断的主要手段,有多种成像选项,特别是超声和磁共振成像(MRI),这提供了有关神经卡压的潜在原因和位置的重要信息,可以帮助指导管理。本文概述了下肢各种神经的解剖过程,包括坐骨神经,胫神经,足底内侧神经,足底外侧神经,数字神经,腓总神经,腓骨深神经,腓浅神经,腓肠神经,闭孔神经,股外侧皮神经和股神经。解释了每个神经陷入的常见位置和原因。神经卡压的常见超声和MRI表现,直接和间接,被描述,提供了更常见的下肢神经卡压病例的各种例子。关键相关性陈述本文介绍了下肢神经卡压的常见部位及其成像特征。它使放射科医生掌握了评估诱捕性神经病所需的知识,这是疼痛和功能障碍的重要原因。关键点•超声和MRI通常用于研究神经卡压综合征。•超声检查结果包括神经低回声,口径变化和超声波Tinel标志。•MRI检查结果包括神经T2信号增加,肌肉萎缩和去神经支配水肿。•成像可以揭示致病病变,包括疤痕,质量和解剖变异。
    Peripheral nerves of the lower limb may become entrapped at various points during their anatomical course. While clinical assessment and nerve conduction studies are the mainstay of diagnosis, there are multiple imaging options, specifically ultrasound and magnetic resonance imaging (MRI), which offer important information about the potential cause and location of nerve entrapment that can help guide management. This article overviews the anatomical course of various lower limb nerves, including the sciatic nerve, tibial nerve, medial plantar nerve, lateral plantar nerve, digital nerves, common peroneal nerve, deep peroneal nerve, superficial peroneal nerve, sural nerve, obturator nerve, lateral femoral cutaneous nerve and femoral nerve. The common locations and causes of entrapments for each of the nerves are explained. Common ultrasound and MRI findings of nerve entrapments, direct and indirect, are described, and various examples of the more commonly observed cases of lower limb nerve entrapments are provided.Critical relevance statement This article describes the common sites of lower limb nerve entrapments and their imaging features. It equips radiologists with the knowledge needed to approach the assessment of entrapment neuropathies, which are a critically important cause of pain and functional impairment.Key points• Ultrasound and MRI are commonly used to investigate nerve entrapment syndromes.• Ultrasound findings include nerve hypo-echogenicity, calibre changes and the sonographic Tinel\'s sign.• MRI findings include increased nerve T2 signal, muscle atrophy and denervation oedema.• Imaging can reveal causative lesions, including scarring, masses and anatomical variants.
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  • 文章类型: Journal Article
    描述旋前圆柱综合征的超声表现以及超声引导下的水解剖对其管理的作用。
    proonatorteres综合征是众所周知的正中神经在两个pronatorters头之间的压迫性神经病。然而,该综合征的临床表现可能是无痛的,前臂掌侧近端疼痛模糊,导致诊断延迟。我们描述了我们在健康的年轻羽毛球运动员中进行超声引导下正中神经水切开术的前旋肌综合征的管理经验。我们强调临床表现,动态超声扫描(USS)在诊断和有效治疗中的作用。
    总而言之,管理PTS可能具有挑战性,这个案例突出了超声引导下的水解剖的重要性,当保守措施未能改善症状时。需要进一步的研究来评估和比较这些干预措施的长期结果。
    UNASSIGNED: To describe the sonographic appearance of pronator teres syndrome and the role of ultrasound-guided hydrodissection for its management.
    UNASSIGNED: Pronator teres syndrome is a well-known compressive neuropathy of the median nerve between the two heads of pronator teres. However, the clinical presentation of this syndrome can be indolent with vague pain at the proximal volar forearm leading to a delay in diagnosis. We describe our experience in the management of pronator teres syndrome in a healthy young badminton player with ultrasound-guided median nerve hydrodissection. We highlight the clinical presentation, the role of dynamic Ultrasound scan (USS) in the diagnosis and effective treatment of pronator teres syndrome.
    UNASSIGNED: In conclusion, managing PTS can be challenging, and this case highlights the importance of ultrasound-guided hydrodissection, when conservative measures have failed to improve the symptoms. Further studies are required to assess and compare the long-term outcomes of these interventions.
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  • 文章类型: Review
    桡骨隧道综合征(RTS)是由骨间后神经受压引起的,由一系列以前被描述为其他疾病过程的症状组成,与明确的诊断相反。最早在20世纪中叶被描述为“radial骨综合征”,“关于RTS的解剖和表现的知识在过去的几十年里有了显著的进步。然而,关于诊断成像仍然存在显著的争议和正在进行的研究,非手术治疗方案,以及手术干预的适应症。在这次审查中,我们将讨论RTS的解剖学考虑,相关体检结果,潜在的诊断方式,以及几种治疗方案的结果。
    Radial tunnel syndrome (RTS) is caused by compression of the posterior interosseous nerve and consists of a constellation of symptoms that have previously been characterized as aspects of other disease processes, as opposed to a distinct diagnosis. First described in the mid-20th century as \"radial pronator syndrome,\" knowledge regarding the anatomy and presentation of RTS has advanced markedly over the past several decades. However, there remains notable controversy and ongoing research regarding diagnostic imaging, nonsurgical treatment options, and indications for surgical intervention. In this review, we will discuss the anatomic considerations of RTS, relevant physical examination findings, potential diagnostic modalities, and outcomes of several treatment options.
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  • 文章类型: Journal Article
    感觉异常午痛通常是特发性的,但有时症状可能是由于股外侧皮神经(LFCN)的创伤性损伤或肿块性病变压迫该神经引起的。在这篇文章中,文献回顾了美感异常的异常原因,包括不同类型的创伤性损伤和肿块性病变对LFCN的压迫。此外,介绍了我们中心对异常疼痛的手术治疗的经验。PubMed对异常疼痛的异常原因进行了搜索。特别注意了可能导致LFCN损伤的因素以及可能指向肿块病变的线索。此外,我们对2014年4月至2022年9月期间所有手术治疗的感觉异常疼痛病例的数据库进行了审查,以确定感觉异常疼痛的异常原因.总共确定了66篇文章,报道了异常疼痛感觉异常原因的结果:37篇关于LFCN的创伤性损伤,29篇关于LFCN被肿块性病变压迫。文献中最常见的外伤原因是医源性,包括髂前上棘周围的不同手术,腹内手术和手术定位。在我们自己的187例手术数据库中,外伤性LFCN损伤14例,症状与肿块病变有关4例。重要的是要考虑创伤原因或肿块性病变对存在感觉异常的患者的压迫。
    Meralgia paresthetica is often idiopathic, but sometimes symptoms may be caused by traumatic injury to the lateral femoral cutaneous nerve (LFCN) or compression of this nerve by a mass lesion. In this article the literature is reviewed on unusual causes for meralgia paresthetica, including different types of traumatic injury and compression of the LFCN by mass lesions. In addition, the experience from our center with the surgical treatment of unusual causes of meralgia paresthetica is presented. A PubMed search was performed on unusual causes for meralgia paresthetica. Specific attention was paid to factors that may have predisposed to LFCN injury and clues that may have pointed at a mass lesion. Moreover, our own database on all surgically treated cases of meralgia paresthetica between April 2014 and September 2022 was reviewed to identify unusual causes for meralgia paresthetica. A total of 66 articles was identified that reported results on unusual causes for meralgia paresthetica: 37 on traumatic injuries of the LFCN and 29 on compression of the LFCN by mass lesions. Most frequent cause of traumatic injury in the literature was iatrogenic, including different procedures around the anterior superior iliac spine, intra-abdominal procedures and positioning for surgery. In our own surgical database of 187 cases, there were 14 cases of traumatic LFCN injury and 4 cases in which symptoms were related to a mass lesion. It is important to consider traumatic causes or compression by a mass lesion in patients that present with meralgia paresthetica.
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