Nerve Compression Syndromes

神经压迫综合征
  • 文章类型: Case Reports
    方法:本病例报告描述了一名患者,该患者在radium神经的浅表感觉分支的分布中出现感觉异常,并接受了手术治疗。术中,有一个独特的内部压缩的原因是一个罕见的浅桡动脉变异运行在它附近。神经从动脉动员,筋膜释放。患者术后症状缓解。
    结论:据我们所知,这种压迫的原因以前没有描述过,在鉴别诊断中应考虑。此外,在静脉穿刺和手术入路期间,临床医生应该意识到这种解剖变异。
    METHODS: This case report describes a patient with paresthesia in the distribution of the superficial sensory branch of the radial nerve that was treated with surgery. Intraoperatively, there was a unique cause of internal compression by a rare superficial radial artery variant running adjacent to it. The nerve was mobilized from the artery with fascial releases. The patient had symptom resolution postoperatively.
    CONCLUSIONS: To our knowledge, this cause of compression has not been described before and should be considered in a differential diagnosis. In addition, clinicians should be aware of this anatomical variant during venipunctures and surgical approaches.
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  • 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: Case Reports
    方法:一名65岁的女性患者,表现为右手腕弥漫性疼痛和肿胀,右手感觉异常,大鱼间消瘦。她的磁共振成像扫描提示腕部屈肌腱鞘炎,正中神经受多个水稻体压迫。她接受了切除活检和正中神经减压术。通过聚合酶链反应(GeneXpert)检测结核分枝杆菌,组织病理学发现干酪样肉芽肿。患者术后开始接受抗结核化疗。
    结论:在印度等地方病国家,结核性屈肌腱鞘炎必须始终是腕关节肿胀的鉴别诊断。
    METHODS: A 65-year-old female patient presented with complaints of diffuse pain and swelling in her right wrist with paresthesia in her right hand with thenar wasting. Her magnetic resonance imaging scan was suggestive of flexor tenosynovitis of the wrist with compression of the median nerve with multiple rice bodies. She underwent excisional biopsy along with median nerve decompression. Mycobacterium tuberculosis was detected by polymerase chain reaction (GeneXpert), and histopathology identified caseous granulomas. The patient was started on antitubercular chemotherapy postoperatively.
    CONCLUSIONS: In endemic countries such as India, tuberculous flexor tenosynovitis must always be a differential diagnosis in cases of wrist swelling with rice bodies.
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  • 文章类型: Case Reports
    前皮神经卡压综合征(ACNES)的特征是腹壁神经痛。我们报告了一名85岁的女性,在双极髋关节置换术中由固定装置引起的ACNES。预防ACNES作为围手术期周围神经损伤,在手术过程中保持病人在适当的位置是很重要的。阳性Carnett标志意味着腹痛起源于腹壁,可用于诊断ACNES。因此,医师应检查Carnett的体征,以区分术后发生腹痛的患者的ACNES。
    Anterior cutaneous nerve entrapment syndrome (ACNES) is characterized by abdominal wall neuralgia. We report an 85-year-old woman with ACNES caused by a fixation device during the bipolar hip arthroplasty. To prevent ACNES as a perioperative peripheral nerve injury, it is important to maintain patients in the appropriate position during the operation. A positive Carnett\'s sign means the abdominal pain originates from the abdominal wall and is useful in diagnosing ACNES. Thus, physicians should examine Carnett\'s sign to differentiate ACNES in patients with abdominal pain developing after an operation.
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  • 文章类型: Case Reports
    当不是最常见的综合征如腕管综合征或肘管综合征时,周围神经卡压是一种未被诊断的病理。腓浅神经(SPN)的症状性病变发生率低,因为它的诊断有时很复杂。它基于详尽的体格检查和成像测试,例如超声(US)或磁共振成像(RMI)。保守治疗有时可能不够,在难治性病例中需要手术技术。我们介绍了一名通过超声和诊断神经阻滞诊断为腓浅神经卡压的患者,随后通过深部筋膜隧道水平的水力解剖技术解决了该患者。自应用该技术以来,临床过程的完整分辨率令人满意。
    Peripheral nerve entrapment is an underdiagnosed pathology when it is not the most common syndromes such as carpal tunnel syndrome or cubital tunnel syndrome. The symptomatic lesion of the superficial peroneal nerve (SPN) has a low incidence, being its diagnosis sometimes complex. It is based on a exhaustive physical examination and imaging tests such as ultrasound (US) or magnetic resonance imaging (RMI). Conservative treatment may sometimes not be sufficient, requiring surgical techniques in refractory cases. We present a patient diagnosed with superficial peroneal nerve entrapment by ultrasound and diagnostic nerve block that was subsequently resolved by hydrodissection technique at the level of the deep crural fascia tunnel. The results were satisfactory with a complete resolution of the clinical process since the application of this technique.
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    文章类型: Case Reports
    背景:考虑到肌腱鞘和软组织结构中糖胺聚糖的积聚,亨特综合征儿童的神经压迫综合征患病率很高。由于相同的病理,关节和肌腱挛缩通常与骨科疾病并存。虽然腕管综合征和手术治疗在这个人群中已经得到了很好的报道,关于下肢神经压迫综合征及其在亨特综合征中的治疗的文献很少。
    方法:我们报告了一个有亨特综合征病史的13岁男性病例,该病例表现为在腓骨和髌骨隧道区域的脚趾行走和压痛。他接受了双侧腓总神经和髌骨隧道松解术,发现严重的神经压迫和肥大的软组织结构,在病理学上显示纤维肌肉瘢痕。术后,患者家属报告主观上下肢活动能力和足底屈曲改善。
    结论:在这种情况下,临床诊断为腓骨和tal神经受压,并通过手术松解术和术后踝关节铸造有效治疗。鉴于亨特综合征中常见的骨科合并症差异很大,并且该人群中缺乏经过验证的电诊断规范值,病史和体格检查以及神经压迫综合征的考虑等同于成功的检查和治疗Hunter综合征患儿的步态异常。
    BACKGROUND: Children with Hunter syndrome have a high prevalence of nerve compression syndromes given the buildup of glycosaminoglycans in the tendon sheaths and soft tissue structures. These are often comorbid with orthopedic conditions given joint and tendon contractures due to the same pathology. While carpal tunnel syndrome and surgical treatment has been well-reported in this population, the literature on lower extremity nerve compression syndromes and their treatment in Hunter syndrome is sparse.
    METHODS: We report the case of a 13-year-old male with a history of Hunter syndrome who presented with toe-walking and tenderness over the peroneal and tarsal tunnel areas. He underwent bilateral common peroneal nerve and tarsal tunnel releases, with findings of severe nerve compression and hypertrophied soft tissue structures demonstrating fibromuscular scarring on pathology. Post-operatively, the patient\'s family reported subjective improvement in lower extremity mobility and plantar flexion.
    CONCLUSIONS: In this case, peroneal and tarsal nerve compression were diagnosed clinically and treated effectively with surgical release and postoperative ankle casting. Given the wide differential of common comorbid orthopedic conditions in Hunter syndrome and the lack of validated electrodiagnostic normative values in this population, the history and physical examination and consideration of nerve compression syndromes are tantamount for successful workup and treatment of gait abnormalities in the child with Hunter syndrome.
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  • 文章类型: Case Reports
    引起声带麻痹的迷走神经病变是迷走神经刺激器(VNS)放置的罕见并发症。它可能与术中神经损伤或装置刺激有关。这里我们介绍第一个延迟的情况,与VNS线圈放置相关的压缩性迷走神经病变,表现为进行性声音嘶哑和声带麻痹。进行线圈去除和迷走神经溶解以减轻压迫。放置较大的3mmVNS线圈以继续治疗。在可能的情况下,应采用具有较大内径的线圈以防止这种复杂性。VNS相关迷走神经压迫的频率可能需要进一步研究。
    Vagal neuropathy causing vocal fold palsy is an uncommon complication of vagal nerve stimulator (VNS) placement. It may be associated with intraoperative nerve injury or with device stimulation. Here we present the first case of delayed, compressive vagal neuropathy associated with VNS coil placement which presented with progressive hoarseness and vocal cord paralysis. Coil removal and vagal neurolysis was performed to relieve the compression. Larger 3 mm VNS coils were placed for continuation of therapy. Coils with a larger inner diameter should be employed where possible to prevent this complication. The frequency of VNS-associated vagal nerve compression may warrant further investigation.
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  • 文章类型: Case Reports
    骨隧道综合征是踝关节内侧胫神经及其分支的神经性压迫。这是一个具有挑战性的诊断,它构成了由于胫骨后神经或其分支的损伤而引起的症状,因为它们穿过踝关节内侧屈肌支持带下方的骨隧道,容易被遗忘和诊断不足。在某些临床条件下,血管结构对神经的压迫已被认为是可能的病因。胫骨动脉弯曲并不罕见,但只有它影响到神经才会导致骨隧道综合症。因此,研究必须注意避免假阳性错误。
    Tarsal tunnel syndrome is a neuropathic compression of the tibial nerve and its branches on the medial side of the ankle. It is a challenging diagnosis that constitutes symptoms arising from damage to the posterior tibial nerve or its branches as they proceed through the tarsal tunnel below the flexor retinaculum in the medial ankle, easily forgotten and underdiagnosed. Neural compression by vascular structures has been suggested as a possible etiology in some clinical conditions. Tibial artery tortuosity is not that rare, but only that it affects the nerve can cause tarsal tunnel syndrome. Therefore, a study care must be taken to avoid false-positive errors.
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  • 文章类型: Journal Article
    背景:儿童慢性腹痛偶尔由前皮神经卡压综合征(ACNES)引起。诊断和治疗这种典型的周围腹壁神经病具有挑战性。管理通常从微创压痛点注射开始。然而,这些注射可能是繁重的,甚至可能被孩子或他们的父母拒绝。然而,手术神经切除术更具侵入性。用5%利多卡因药物贴剂治疗已成功用于多种周围神经病变。
    目的:此单中心回顾性病例系列旨在评估利多卡因贴剂在ACNES患儿中的有效性和耐受性。
    方法:研究了在2021年12月至2022年12月期间接受10天利多卡因贴片治疗的18岁以下被诊断为ACNES的儿童。患者记录文件用于收集治疗结果,包括基于NRS和并发症的疼痛减轻。
    结果:诊断为ACNES的16名儿童中有12名(平均年龄13岁;F:M比3:1)开始使用利多卡因贴片治疗。两名患者获得了无痛状态,并在4和7个月的随访中保持无痛状态。第三个孩子报告说疼痛持续减轻,但由于暂时性局部皮疹而停止治疗。另外五名患者报告仅在贴剂应用期间疼痛减轻。其余四个孩子没有缓解疼痛。无不良反应报告。
    结论:利多卡因贴剂可缓解大部分ACNES患儿的疼痛。
    Chronic abdominal pain in children is occasionally caused by anterior cutaneous nerve entrapment syndrome (ACNES). Diagnosing and treating this typical peripheral abdominal wall neuropathy is challenging. Management usually starts with minimally invasive tender point injections. Nevertheless, these injections can be burdensome and might even be refused by children or their parents. However, a surgical neurectomy is far more invasive. Treatment with a Lidocaine 5% medicated patch is successfully used in a variety of peripheral neuropathies.
    This single center retrospective case series aimed to evaluate the effectiveness and tolerability of lidocaine patches in children with ACNES.
    Children aged under 18 diagnosed with ACNES who were treated with a 10 day lidocaine patch treatment between December 2021 and December 2022 were studied. Patient record files were used to collect treatment outcomes including pain reduction based on NRS and complications.
    Twelve of sixteen children (mean age 13 years; F:M ratio 3:1) diagnosed with ACNES started the lidocaine patch treatment. Two patients achieved a pain free status and remained pain free during a 4 and 7 months follow-up. A third child reported a lasting pain reduction, but discontinued treatment due to a temporary local skin rash. Five additional patients reported pain reduction only during application of the patch. The remaining four children experienced no pain relief. No adverse effects were reported.
    Lidocaine patches provides pain relief in a substantial portion of children with ACNES.
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  • 文章类型: Case Reports
    前皮神经卡压综合征(ACNES)是中度至重度慢性疼痛的原因,感觉过敏/感觉减退,并改变了前腹壁特定区域的热/冷感知,指肋间神经的一个或多个前支的神经支配区域。目前可用的治疗选择都没有证明是长期有效或决定性的。近年来,我们已经开始治疗纯粹的感觉神经病,像这样,随着无线周围神经刺激器(PNS)的植入,实现模块化和个性化镇痛的安全性。我们报告了一名41岁男子患有第8肋间神经ACNES两年的病例。我们首先对第8肋间右神经的前皮分支进行了两个连续的超声引导诊断块,然后选择患者进行超声引导神经减压,然后进行神经调制和脉冲射频(PRF)。考虑到充分就业,年轻的年龄,以及必须重复多次治疗的可能性,我们考虑他在超声引导下进行周围神经刺激(PNS)植入,我们在右第8肋间神经前支植入了无线导线,和编程的强直刺激100HzPW200ms。患者报告疼痛立即缓解,并且再也没有因为这个问题服用药物,在两年的随访中。PNS在慢性神经性疼痛的治疗中起着越来越重要的作用,尤其是在像ACNES这样的敏感神经病中。我们支持未来对这一主题的研究。
    Anterior cutaneous nerve entrapment syndrome (ACNES) is a cause of moderate to severe chronic pain, hyperesthesia/hypoesthesia, and altered perception of heat/cold in a specific region of the anterior abdominal wall, referable to the territory of innervation of one or more anterior branches of the intercostal nerves. None of the therapeutic options currently available has proved to be effective in the long term or decisive. In recent years, we have begun to treat purely sensory neuropathies, such as this, with the implantation of wireless peripheral nerve stimulators (PNS), achieving the safety of modular and personalized analgesia. We report the case of a 41-year-old man suffering from ACNES of the 8th intercostal nerve for two years. We first performed two consecutive ultrasound-guided diagnostic blocks of the anterior cutaneous branch of the 8th intercostal right nerve and then elected the patient for ultrasound-guided nerve decompression followed by neuromodulation and pulsed-radiofrequency (PRF). Taking into account full employment, young age, and the likelihood of having to repeat the treatment several times, we considered him for Peripheral Nerve Stimulation (PNS) implantation under ultrasound guidance, and we implanted the wireless lead at the anterior branch of the right 8th intercostal nerve, and programmed tonic stimulation 100 Hz PW 200 ms. The patient reported immediate pain relief and never took medication for this problem again, at two years follow-up. PNS has had an increasing role in the management of chronic neuropathic pain, especially in merely sensitive neuropathies like ACNES. We support future research on this theme.
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