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Druzhinina ES, Druzhinin DS, Tikhonova OA, Zavadenko NN. [Therapeutic options in patients with neuralgic amyotrophy]. Zh Nevrol Psikhiatr Im S S Korsakova 2025; 125:39-45. [PMID: 40195099 DOI: 10.17116/jnevro202512503139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2025]
Abstract
OBJECTIVE To evaluate the outcomes of patients with neuralgic amyotrophy (NA) depending on the type of treatment received - surgical or glucocorticosteroid administration. MATERIAL AND METHODS The outcome of 101 patients with verified NA was analyzed. The mean age of NA patients was 38.21±16.09 years (8 to 76 years), of which 69.3% were males (n=70) and 30.7% were females (n=31). The diagnosis was confirmed by electromyography, cervical spine MRI, and clinical data evaluation: pain according to VAS, duration of pain, timing of diagnosis from the disease onset, and severity of muscle weakness using the MRC scale. Most patients had a classic form (50.5%, n=51), followed by a distal form (39.6%, n=40), and nerve damage above the elbow joint or cranial nerves (9.9%, n=10). Most patients were examined during the phase of pain and muscle weakness (59.4%, n=60) and in the recovery phase (40.6%, n=41). 48.5% (n=49) of patients received steroids. Surgical treatment was performed in 15.8% of cases (n=16). The median follow-up of all patients was 12 months (Q1-Q3 6.00-20.00). RESULTS Patients who received GCS recovered better - 67.7% had a complete recovery compared to patients who did not receive pathogenetic therapy. Regardless of the GCS use, the outcome also depended on the NA form and the initial severity of muscle weakness (p<0.001 and p=0.001, respectively). Comparing the outcomes in the groups with and without surgery showed no statistically significant differences. However, in the non-surgery group, a higher percentage of non-recovery was found (71.4%) compared to the group receiving surgical treatment (28.6%). In 97.4% (n=38) of cases of distal NA, ultrasound revealed focal changes in the nerves, which initially indicated a poor prognosis for recovery. CONCLUSION Steroid therapy affects muscle strength recovery in patients with NA. The NA form and the initial severity of motor deficit also affect the outcome. Surgical treatment is indicated for patients with distal NA.
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Affiliation(s)
- E S Druzhinina
- Pirogov Russian National Research Medical University (Pirogov University), Moscow, Russia
| | - D S Druzhinin
- Yaroslavl State Medical University, Yaroslavl, Russia
| | - O A Tikhonova
- Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - N N Zavadenko
- Pirogov Russian National Research Medical University (Pirogov University), Moscow, Russia
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Bang MH, Song HL, Hahn S, Kim W, Do HK. Neuralgic amyotrophy with hourglass-like constrictions: A case report. World J Clin Cases 2024; 12:6728-6735. [PMID: 39650818 PMCID: PMC11514359 DOI: 10.12998/wjcc.v12.i34.6728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 09/11/2024] [Accepted: 09/25/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Neuralgic amyotrophy (NA) is a rare disease with sudden upper limb pain followed by affected muscle weakness. The most commonly affected area in NA is the upper part of the brachial plexus, and the paraspinal muscles are rarely affected (1.5%), making these cases difficult to distinguish from cervical radiculopathy. CASE SUMMARY A 76-year-old male presented to the emergency department with left hip pain post-fall. After undergoing left femoral neck fracture surgery, he experienced sudden left shoulder pain for 10 days with subsequent left arm weakness. Cervical spine computed tomography revealed mild right asymmetric intervertebral disc bulging with a decreased C5-6disc space. Three weeks later, an electrodiagnostic study confirmed brachial plexopathy findings involving the cervical root. Magnetic resonance neurography was performed for a differential diagnosis. Contrast enhancement was identified at the upper trunk of the brachial plexus, including the C5 nerve root. A suprascapular nerve hourglass-like focal constriction (HLFC) was also identified, confirming NA. After being diagnosed with NA, the patient received 15 mg prednisolone, twice daily, for 3 weeks. Physical therapy was initiated, including left arm strengthening exercises and electrical stimulation therapy. Left shoulder muscle strength significantly improved one month after comprehensive rehabilitation. CONCLUSION NA's unique features like HLFC and paraspinal involvement are crucial for accurate diagnosis, avoiding confusion with cervical radiculopathy.
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Affiliation(s)
- Mi-Hyeon Bang
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea
| | - Ha-Lim Song
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea
| | - Seok Hahn
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea
| | - Wanil Kim
- Division of Biochemistry, Department of Convergence Medical Science, Institute of Medical Science, Gyeongsang National University College of Medicine, Jinju 52727, South Korea
| | - Hwan-Kwon Do
- Department of Physical Medicine and Rehabilitation, Dongnam Institute of Radiological and Medical Sciences, Busan 46033, South Korea
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Al Hinai R, Kelly L, O'Connor M, Berman H, Abdul Jalil L, Sowa A, McDonnell JM, Dolan R. Unraveling the mysteries of parsonage turner syndrome: A journey towards optimal management. A systematic review. J Hand Microsurg 2024; 16:100142. [PMID: 39669722 PMCID: PMC11632787 DOI: 10.1016/j.jham.2024.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/31/2024] [Accepted: 08/04/2024] [Indexed: 12/14/2024] Open
Abstract
Aims Parsonage Turner Syndrome (PTS) is a peripheral neuropathy manifesting as sudden onset pain, muscle weakness, and atrophy. This review aims to analyse long-term outcomes reported in adult patients with PTS, and establish an optimised management approach. Methods A comprehensive literature search was performed using MEDLINE, PubMed, and the Cochrane Library. Articles that met the eligibility criteria were included. Analysis on time to presentation, presentation, interventions and long-term functional outcomes was conducted. All relevant information was collected by two independent reviewers. Results Twenty-five studies, comprising 950 PTS patients, were identified. Patients averaged 43.8 years in age, with a F:M ratio of 0.6:1, and presented symptoms spanning 1-24 months prior to seeking medical attention. Management details were elucidated for 402 patients (42 %), with 87 % managed conservatively. Among conservatively managed patients, over 50 % exhibited no improvement. 62/402 (15 %) necessitated surgical interventions, including neurolysis, decompression, nerve transfers, and diaphragmatic plication. 25/31 (80.6 %) neurolysis cases demonstrated full functional recovery, including pain resolution and full muscle strength, between 1 day and 13 months (average 2.9 months). 2 nerve transfer cases achieved full forward flexion at 2.5 months. Overall, long-term outcomes of PTS, reported at 5-25 months, revealed residual neuropathic pain in 60 % and incomplete motor function return in 70 % of patients. Conclusions PTS recognition and referral challenges persist, impeding timely management. While surgical interventions are advocated after three months for incomplete recovery, long-term surgical outcomes are inadequately reported. An optimal surgical strategy for stagnant nerve recovery needs to be devised for this challenging cohort of patients.
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Affiliation(s)
- Rinad Al Hinai
- School of Medicine, University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Department of Plastic and Reconstructive Surgery, Dublin, Ireland
| | - Linda Kelly
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Hannah Berman
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Linda Abdul Jalil
- St Vincent's University Hospital, Department of Plastic and Reconstructive Surgery, Dublin, Ireland
| | - Aubrie Sowa
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Jake M. McDonnell
- Royal College of Surgeons in Ireland, Dublin, Ireland
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Roisin Dolan
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Yoon AP, Lee EY, Tagliero LE, Pulos N, Spinner RJ, Bishop AT, Shin A. Predisposing factors for incomplete spontaneous recovery after Parsonage-Turner Syndrome. Acta Neurochir (Wien) 2024; 166:451. [PMID: 39532742 DOI: 10.1007/s00701-024-06350-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 11/04/2024] [Indexed: 11/16/2024]
Abstract
INTRODUCTION Parsonage-Turner Syndrome (PTS) is a rare idiopathic brachial neuritis that classically presents with sudden onset upper extremity pain followed by upper limb weakness, sensory disruption, and muscle atrophy. We hypothesized that the type of antecedent event before symptom onset would determine the degree of spontaneous recovery after PTS. METHODS We retrospectively reviewed all patients who presented with PTS to a single tertiary referral center from January 2002 to December 2021. Each medical record was reviewed to exclude patients with any other identifiable neurologic etiology. The primary outcome was improved muscle strength measured by a modified British Medical Research Council (mBMRC) grading system. The spontaneous recovery cohort included patients with appreciable or full recovery (mBMRC 4 and 5). In contrast, patients with little to no recovery (mBMRC 0 to 3) were included in the incomplete recovery group. Antecedent events, demographic variables, affected upper extremity region, time between symptom onset and final visit, and presence of nerve surgery were analyzed. Two-tailed T-test and Fisher exact tests were used to compare continuous and categorical variables. Multivariable logistic regression was modeled to identify variables associated with spontaneous recovery. RESULTS 100 patients with 144 extremities met the inclusion criteria. The average time from symptom onset to the final clinic visit was 3.5 years. 65 extremities (57.0%) spontaneously recovered without surgical intervention, whereas 49 extremities (43.0%) incompletely recovered. The spontaneous recovery cohort was younger (mean [SD] age, 47.4 [18.1] vs. 56.5 [18.7]; p = 0.02) and had fewer bilateral cases (count[%], 4 [6.5%] vs. 10 [26.3%]; p = 0.008). Multivariable logistic regression revealed that each year of increased age was associated with a 3% decreased chance of spontaneous recovery (OR[95%CI] 0.97[0.95, 0.99], p = 0.046). Bilateral involvement was associated with 93% decreased chance of recovery (OR[95%CI] 0.07[0.01, 0.39], p = 0.002), each additional muscle affected was associated with 10% decreased chance of recovery (OR[95%CI] 0.90[0.83, 0.97], p = 0.01), and traumatic antecedent events were associated with increased chance of recovery (OR[95%CI] 27.3[2.59, 287.5], p = 0.006). CONCLUSIONS Younger patients with unilateral symptoms and fewer muscle involvement have a greater chance of spontaneous recovery after PTS. PTS precipitated by trauma may have better spontaneous recovery than those precipitated by other causes. LEVEL OF EVIDENCE III
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Affiliation(s)
- Alfred P Yoon
- Division of Plastic and Reconstructive Surgery, University of California Davis School of Medicine, 2335 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Ellen Y Lee
- Department of Hand and Reconstructive Microsurgery, National University Health System Singapore, 1E Kent Ridge Rd, Singapore, 119228, Singapore
| | - Lauren E Tagliero
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Nicholas Pulos
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Robert J Spinner
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Allen T Bishop
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Alexander Shin
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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Yang D, Wu Y, Zheng L, Wu Z, Rong X, Chen B. Early aggressive constriction resection for hourglass-like constriction of peripheral nerve in the upper extremity: a retrospective study. Neurochirurgie 2024; 70:101605. [PMID: 39447510 DOI: 10.1016/j.neuchi.2024.101605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 10/08/2024] [Accepted: 10/10/2024] [Indexed: 10/26/2024]
Abstract
OBJECTIVES The hourglass like constriction (HGC) of peripheral nerves is a characteristic pathological manifestation of Neuralgic Amyotrophy. Once identified, early surgical intervention is essential. However, the method of surgery is controversial, particularly regarding whether HGC needs to be excised. This study aims to explore the efficacy of early aggressive resection of HGC in the upper limb nerves. MATERIALS AND METHODS This retrospective study focuses on 13 nerves of spontaneous upper limb paralysis treated at our hospital from June 2019 to July 2023, in which HGC was identified during surgery. During surgery, epineurectomy and interfascicular neurolysis were performed on the constricted areas. Post-neurolysis, constriction excision was carried out if any of the following conditions were met: (1) A single constriction with constriction ≥75%. (2) Constriction combined with torsion. (3) The presence of ≥2 constrictions. Regular face-to-face follow-ups were conducted postoperatively. RESULTS Four cases with a single constriction of less than 75% underwent epineurotomy and interfascicular neurolysis; eight underwent constriction excision, of which four cases with a single constriction and associated torsion had direct end-to-end suturing after excision, and four had more than two constrictions treated with autologous sural nerve grafts. Postoperative follow-ups showed good recovery in all but one case, which had unique pathological features and had underwent only epineurectomy, showing moderate recovery. CONCLUSIONS For early surgical treatment of HGCs in peripheral nerves of the upper limbs, if severe constriction, constriction combined with torsion, or the presence of more than two constrictions are identified during surgery, aggressive constriction resection may be a better option.
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Affiliation(s)
- Dandan Yang
- Department of Peripheral Nerve, RenCi Hospital, No.11 Yang Shan Road, Xu Zhou 221005, China.
| | - Yao Wu
- Department of Peripheral Nerve, RenCi Hospital, No.11 Yang Shan Road, Xu Zhou 221005, China
| | - Long Zheng
- Department of Peripheral Nerve, RenCi Hospital, No.11 Yang Shan Road, Xu Zhou 221005, China
| | - Zhenzhi Wu
- Department of Peripheral Nerve, RenCi Hospital, No.11 Yang Shan Road, Xu Zhou 221005, China
| | - Xing Rong
- Department of Peripheral Nerve, RenCi Hospital, No.11 Yang Shan Road, Xu Zhou 221005, China
| | - Buguo Chen
- Department of Peripheral Nerve, RenCi Hospital, No.11 Yang Shan Road, Xu Zhou 221005, China.
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Im YJ, Lee JH, Yoon YC, Shim JW, Kim DH, Sung DH. Single center experience with hourglass-like constriction neuropathy of suprascapular nerve. Muscle Nerve 2024; 70:1104-1110. [PMID: 39283007 DOI: 10.1002/mus.28256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 09/01/2024] [Accepted: 09/02/2024] [Indexed: 10/09/2024]
Abstract
INTRODUCTION/AIMS Hourglass-like constriction (HGC) may occur in several peripheral nerves. However, data on the prognosis of motor weakness in patients with HGC of the suprascapular nerve (SSN) are limited compared with other nerves. Here, we aimed to describe the clinical and imaging features of HGC of the SSN. METHODS We retrospectively reviewed patients diagnosed with suprascapular neuropathy using magnetic resonance imaging (MRI) or electrodiagnostic studies over 16 years. After excluding extrinsic causes, patients with HGC of the SSN detected using MRI were included. RESULTS Fourteen patients with HGC of the SSN were identified. MRI revealed that all HGCs were located between the origin of the SSN from the upper trunk of the brachial plexus and the suprascapular notch. Seven patients exhibited HGC precisely at the origin of the SSN from the brachial plexus. Four patients showed T2 hyperintensity of the SSN extending to the upper trunk of the brachial plexus or the extraforaminal cervical root. The initial treatments included observation (n = 1), steroid therapy (n = 12), suprascapular notch release (n = 1). Of the 12 patients with a sufficient follow-up period, nine fully recovered from motor weakness of the SSN with non-operative treatments. Six of the nine patients who recovered fully experienced their first clinical improvement more than 6 months after onset. DISCUSSION Treatment strategies for HGC differ depending on the affected nerve. For HGC of the SSN, due to the high spontaneous recovery rate observed in our study, conservative management for at least 6 months should be initially considered.
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Affiliation(s)
- Yu Jin Im
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Woo Shim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Du Hwan Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Duk Hyun Sung
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Kamishima T. Editorial for "MR Neurography and Quantitative Muscle MRI of Parsonage Turner Syndrome Involving the Long Thoracic Nerve". J Magn Reson Imaging 2024; 59:2190-2191. [PMID: 37670669 DOI: 10.1002/jmri.29006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 09/07/2023] Open
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Pöschl P, Pham M, Pedro MT, Antoniadis G. [Neuralgic amyotrophy: an inflammatory neuropathy and its surgical treatment]. HANDCHIR MIKROCHIR P 2024; 56:40-48. [PMID: 38272037 DOI: 10.1055/a-2226-4260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Neuralgic amyotrophy (NA) is a monofocal or oligofocal inflammatory neuropathy whose incidence has been significantly underestimated. A connection between constrictions and torsions of peripheral nerves with this disease has been increasingly established in recent years. Modern imaging techniques such as high-resolution nerve ultrasound and MR neurography have contributed to a better understanding of the pathophysiology and a better assessment of the prognosis of the disease. This has led to the concept of treating patients with such focal changes surgically in order to improve the prognosis. This review presents current ideas on the pathophysiology, clinical presentation, diagnosis and treatment of the disease. PATIENTS AND METHODS In a retrospective study, pre-, intra- and postoperative findings of 22 patients with 23 constrictions/torsions of peripheral nerves of the upper extremity were analysed. The patients underwent surgery at a nerve surgery centre over a period of 3.5 years (Dec. 2019-May 2023). The median nerve was most frequently affected (N=9), followed by the suprascapular nerve (N=6) and radial nerve (N=4). The axillary nerve (N=3) and the accessory nerve (N=1) were also involved. Surgical exploration revealed nerve torsions (N=9), nerve constrictions (N=5), fascicular torsions (N=12) and fascicular constrictions (N=9). Depending on the intraoperative findings, epineuriotomies (N=1), epi- and perineuriotomies (N=33), end-to-end sutures (N=2), and one epi- and one perineural suture were performed. RESULTS After an average follow-up of 10 months (3-28 months), 17 patients were re-examined. All of them reported a clear subjective improvement in motor deficits. Clinically and electromyographically, a reinnervation and significant increase in strength from a pre-existing strength grade of M0 to at least M3 in the vast majority of affected muscles was demonstrated in these patients. SUMMARY The incidence of NA continues to be underestimated and, in a significant proportion of patients, leads to permanent motor deficits, most likely due to constrictions and torsions of affected nerves. Surgical treatment is recommended as early as possible. Very good results can usually be achieved with epi- and perineuriotomy. In rare cases, end-to-end neurorrhaphy or nerve grafting is required.
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Affiliation(s)
- Peter Pöschl
- Neurologie, Neurologische Praxis Sinzing, Sinzing, Germany
| | - Mirko Pham
- Institut für Neuroradiologie, Universität Würzburg, Wurzburg, Germany
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Shi F, Zhou X, Li X. Neuralgic amyotrophy with multiple hourglass-like constrictions of anterior interosseous nerve: a case report. Front Neurol 2024; 15:1306264. [PMID: 38348170 PMCID: PMC10860705 DOI: 10.3389/fneur.2024.1306264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Abstract
Hourglass-like constrictions (HLCs) of peripheral nerves in the upper extremity were a rare form of neuralgic amyotrophy, often characterized by the sudden onset of pain in the shoulder or arm, followed by muscle weakness and amyotrophy, with limited sensory involvement. We present a case of multiple HLCs of the anterior interosseous nerve (AIN) in a 22-year-old female with left upper arm pain, finger numbness, and limited activity for 1 month. Physical examination showed weakness of the left index flexor digitorum profundus and flexor pollicis longus, with mild hypoesthesia in the first three fingers and the radial half of the ring finger. Electromyography suggested a median nerve (mainly AIN) lesion. Ultrasonographic imaging of the median nerve shows AIN bundle swelling and multiple HLCs at left upper arm. Despite conservative treatment, which included 15 days of steroid pulse therapy, Etoricoxib, and oral mecobalamin, the patient still complained of extreme pain at night without relief of any symptoms. Operation was recommended for this patient with thorough concerns of surgical advantages and disadvantages. During surgery, a total of 7 HLCs were found in her median nerve along and above the elbow joint. Only Interfascicular neurolysis was performed because the nerve constrictions were still in the early stage. The pain was almost relieved the next day. One month after surgery, she could bend her thumb and index fingers, although they were still weak. 4 months after the surgery, she was able to bend affected fingers, with muscle strength M3 level. At the same time, her fingers had fewer numbness symptoms. There was still controversy regarding treatment strategy; however, early diagnosis and surgical treatment for nerve HLCs might be a better choice to promote nerve recovery.
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Affiliation(s)
| | | | - Xueyuan Li
- Department of Hand Surgery, Ningbo No.6 Hospital, Ningbo, China
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Granata G, Tomasello F, Sciarrone MA, Stifano V, Lauretti L, Luigetti M. Neuralgic Amyotrophy and Hourglass Nerve Constriction/Nerve Torsion: Two Sides of the Same Coin? A Clinical Review. Brain Sci 2024; 14:67. [PMID: 38248282 PMCID: PMC10813384 DOI: 10.3390/brainsci14010067] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Neuralgic amyotrophy, also called Parsonage-Turner syndrome, in its classic presentation is a brachial plexopathy or a multifocal neuropathy, involving mainly motor nerves of the upper limb with a monophasic course. Recently, a new radiological entity was described, the hourglass constriction, which is characterized by a very focal constriction of a nerve, or part of it, usually associated with nerve thickening proximally and distally to the constriction. Another condition, which is similar from a radiological point of view to hourglass constriction, is nerve torsion. The pathophysiology of neuralgic amyotrophy, hourglass constriction and nerve torsion is still poorly understood, and a generic role of inflammation is proposed for all these conditions. It is now widely accepted that nerve imaging is necessary in identifying hourglass constrictions/nerve torsion pre-surgically in patients with an acute mononeuropathy/plexopathy. Ultrasound and MRI are useful tools for diagnosis, and they are consistent with intraoperative findings. The prognosis is generally favorable after surgery, with a high rate of good motor recovery.
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Affiliation(s)
- Giuseppe Granata
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.G.); (V.S.); (L.L.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.T.); (M.A.S.)
| | - Fabiola Tomasello
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.T.); (M.A.S.)
| | - Maria Ausilia Sciarrone
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.T.); (M.A.S.)
| | - Vito Stifano
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.G.); (V.S.); (L.L.)
| | - Liverana Lauretti
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.G.); (V.S.); (L.L.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.T.); (M.A.S.)
| | - Marco Luigetti
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.G.); (V.S.); (L.L.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.T.); (M.A.S.)
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Bretas F, Araújo GCSD, Ugarte ON, Acioly MA. Spontaneous radial nerve palsy with hourglass-like constriction. BMJ Case Rep 2023; 16:e253537. [PMID: 37553170 PMCID: PMC10414098 DOI: 10.1136/bcr-2022-253537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
Hourglass-like constriction (HLC) is an uncommon spontaneous mononeuropathy that is typically characterised by a sudden onset of pain followed by palsy, affecting branches of the radial (posterior interosseous nerve) and median nerves (anterior interosseous nerve). HLC of the radial nerve (RN) is rare, with only a few reported cases. Here, we report a case of a man who presented with acute wrist and finger drop due to the HLC of the RN. Surgery was recommended 5 months after clinical observation, when the lesion was resected and primarily repaired, resulting in satisfactory recovery. There is still much that remains unknown about HLC, especially for RN. The current understanding points out an inflammatory disease that should be treated conservatively for 3-7 months. The surgical technique depends mostly on the severity and extent of constriction; however, considering only RN constrictions, primary repair by neurorrhaphy or nerve grafts resulted in better functional outcomes.
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Affiliation(s)
- Fernanda Bretas
- Division of Hand Surgery, Department of Surgery and Specialties, Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
| | - Gabriel Costa Serrão de Araújo
- Division of Hand Surgery, Department of Surgery and Specialties, Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
| | | | - Marcus André Acioly
- Division of Neurosurgery, Department of Surgery and Specialties, Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
- Division of Neurosurgery, Department of Surgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Glorioso D, Palestini R, Cuccagna C, Lauretti L, Padua L. Nerve Torsion as a Pattern of Parsonage-Turner Syndrome: Literature Review and Two Representative Cases. J Clin Med 2023; 12:4542. [PMID: 37445577 DOI: 10.3390/jcm12134542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/07/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Parsonage-Turner Syndrome (PTS) is a rare peripheral nerve disease characterized by different degrees of nerve impairment. The recent development of nerve ultrasound has enabled the use of new data in the diagnosis of the disease. The aim of this study is to conduct a literature review about the ultrasound evaluation of PTS and present two clinical cases that are characteristic of the disease. (2) Methods: A review of the literature from the last 10 years on the topic containing data regarding nerve ultrasound was performed. In addition, two cases of patients on whom nerve ultrasound was performed at the first evaluation and at follow-up after the indicated treatment were described. (3) Results: The results of our review show that although it is defined as plexopathy, PTS is most often a form of multifocal neuropathy. We also report the most frequently used ultrasound classification and possible prognostic correlations and report our experience with the description of two paradigmatic clinical cases. (4) Conclusions: Further studies are needed to understand the true prognostic power of each degree of nerve impairment and the possible implications in clinical practice regarding treatment indications.
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Affiliation(s)
- Davide Glorioso
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Rita Palestini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
| | - Cristina Cuccagna
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
| | - Liverana Lauretti
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Luca Padua
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
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13
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McGurk K, Tracey JA, Daley DN, Daly CA. Diagnostic Considerations in Compressive Neuropathies. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:525-535. [PMID: 37521550 PMCID: PMC10382896 DOI: 10.1016/j.jhsg.2022.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 10/14/2022] [Indexed: 12/23/2022] Open
Abstract
Peripheral nerve compression of the upper extremity is a common pathology often necessitating surgical intervention, much is known, but much more is left to understand. For the more common pathologies, carpal tunnel syndrome, cubital tunnel syndrome, and ulnar tunnel syndrome, research and clinical efforts directed toward standardization and reduction of resource use have been attempted with varied success. Diagnosis of many of these syndromes is largely based on a proper history and physical examination. Electrodiagnostic studies continue to have value, but proportionally less than previous decades. In addition, emerging technologies, including magnetic resonance neurography, novel ultrasound evaluation techniques, and ultrasound-guided diagnostic injections, are beginning to demonstrate their ability to add value to the diagnostic algorithm, particularly when less common compressive neuropathies are present and/or the diagnosis is in question.
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Affiliation(s)
- Katherine McGurk
- Department of Orthopedic Surgery, Medical University of South Carolina Charleston, SC
| | - Joseph Anthony Tracey
- Department of Orthopedic Surgery, Medical University of South Carolina Charleston, SC
| | - Dane N. Daley
- Department of Orthopedic Surgery, Medical University of South Carolina Charleston, SC
| | - Charles Andrew Daly
- Department of Orthopedic Surgery, Medical University of South Carolina Charleston, SC
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14
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He R, Yu JL, Jin HL, Ng L, Wang JC, Li X, Gai TT, Zhou Y, Li DP. Hourglass-like constriction of the anterior interosseous nerve in the left forearm: A case report. World J Clin Cases 2023; 11:4194-4201. [PMID: 37388800 PMCID: PMC10303608 DOI: 10.12998/wjcc.v11.i17.4194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/01/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Hourglass-like constriction neuropathy is a rare neurological disorder. The main clinical manifestation is peripheral nerve injury with no apparent cause, and the pathomorphological change is an unexplained narrowing of the diseased nerve. The diagnosis and treatment of the disease are challenging and there is no accepted diagnostic or therapeutic approach.
CASE SUMMARY This report describes a rare hourglass constriction of the anterior interosseous nerve in the left forearm in a 47-year-old healthy male who was treated surgically and gradually recovered function over a 6-mo follow-up period.
CONCLUSION Hourglass-like constriction neuropathy is a rare disorder. With the development of medical technology, more examinations are now available for diagnosis. This case aims to highlight the rare manifestations of Hourglass-like constriction neuropathy and provides a reference for enriching the clinical diagnosis and treatment experience.
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Affiliation(s)
- Rong He
- Bone and Hand Microsurgery, Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Yantai 264009, Shandong Province, China
| | - Jian-Long Yu
- Bone and Hand Microsurgery, Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Yantai 264009, Shandong Province, China
| | - Hai-Long Jin
- Bone and Hand Microsurgery, Shandong Wendeng Osteopathic Hospital, Weihai 264400, Shandong Province, China
| | - Liqi Ng
- Institute of Orthopaedic and Musculoskeletal Science, University College London, London HA7 4LP, United Kingdom
| | - Jin-Chao Wang
- Bone and Hand Microsurgery, Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Yantai 264009, Shandong Province, China
| | - Xin Li
- Foot and Ankle Surgery, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing 400012, China
| | - Ting-Ting Gai
- Bone and Hand Microsurgery, Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Yantai 264009, Shandong Province, China
| | - Yu Zhou
- Foot and Ankle Surgery, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing 400012, China
| | - Da-Peng Li
- Bone and Hand Microsurgery, Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Yantai 264009, Shandong Province, China
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15
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Cejas C, Pastor Rueda JM, Hernández Pinzón J, Stefanoff N, Barroso F. Neuralgic amyotrophy detected by magnetic resonance neurography: subclinical, bilateral, and multifocal brachial plexus involvement. Neurol Res 2023; 45:283-289. [PMID: 36281961 DOI: 10.1080/01616412.2022.2138038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Neuralgic amyotrophy (NA) is a painful non-traumatic peripheral nervous system condition affecting the brachial plexus. Signal abnormalities in nerves and muscles have been detected in these patients using magnetic resonance neurography (MRN). METHODS Electronic medical records and MRN images obtained in a 3 T scanner, in 14 adult patients diagnosed with NA at our Neurological institution (Neuromuscular Disorders Section), between December 2015 and December 2019 were retrospectively reviewed. The study was first approved by our Institutional Ethics Committee. RESULTS Subclinical, multifocal, and bilateral nerve signal anomalies were recorded in the brachial plexus of these patients. We identified four different types of nerve constriction without entrapment, which we categorized as follows: incomplete focal (type I), complete focal or hourglass (type II), multifocal or string of pearls (type III) and segmental (type IV). CONCLUSIONS Given that MRN is an accurate diagnostic tool to detect nerve damage, we believe abnormal findings could improve early detection of NA patients.
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Affiliation(s)
- Claudia Cejas
- Radiology Department, Fleni, Buenos Aires, Argentina
| | - José M Pastor Rueda
- Neuromuscular Disorders Section, Neurology Department, Fleni, Buenos Aires, Argentina
| | | | | | - Fabio Barroso
- Neuromuscular Disorders Section, Neurology Department, Fleni, Buenos Aires, Argentina
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16
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Cignetti NE, Cox RS, Baute V, McGhee MB, van Alfen N, Strakowski JA, Boon AJ, Norbury JW, Cartwright MS. A standardized ultrasound approach in neuralgic amyotrophy. Muscle Nerve 2023; 67:3-11. [PMID: 36040106 PMCID: PMC10087170 DOI: 10.1002/mus.27705] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 11/08/2022]
Abstract
Neuralgic amyotrophy (NA), also referred to as idiopathic brachial plexitis and Parsonage-Turner syndrome, is a peripheral nerve disorder characterized by acute severe shoulder pain followed by progressive upper limb weakness and muscle atrophy. While NA is incompletely understood and often difficult to diagnose, early recognition may prevent unnecessary tests and interventions and, in some situations, allow for prompt treatment, which can potentially minimize adverse long-term sequalae. High-resolution ultrasound (HRUS) has become a valuable tool in the diagnosis and evaluation of NA. Pathologic HRUS findings can be grouped into four categories: nerve swelling, swelling with incomplete constriction, swelling with complete constriction, and fascicular entwinement, which may represent a continuum of pathologic processes. Certain ultrasound findings may help predict the likelihood of spontaneous recovery with conservative management versus the need for surgical intervention. We recommend relying heavily on history and physical examination to determine which nerves are clinically affected and should therefore be assessed by HRUS. The nerves most frequently affected by NA are the suprascapular, long thoracic, median and anterior interosseous nerve (AIN) branch, radial and posterior interosseous nerve (PIN) branch, axillary, spinal accessory, and musculocutaneous. When distal upper limb nerves are affected (AIN, PIN, superficial radial nerve), the lesion is almost always located in their respective fascicles within the parent nerve, proximal to its branching point. The purpose of this review is to describe a reproducible, standardized, ultrasonographic approach for evaluating suspected NA, and to share reliable techniques and clinical considerations when imaging commonly affected nerves.
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Affiliation(s)
- Natalie E Cignetti
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rebecca S Cox
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Vanessa Baute
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Marissa B McGhee
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeffrey A Strakowski
- Ohio State Department of Physical Medicine and Rehabilitation, Columbus, Ohio, USA
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - John W Norbury
- Division of Physical Medicine and Rehabilitation, Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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17
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Ripellino P, Arányi Z, van Alfen N, Ventura E, Peyer AK, Cianfoni A, Gobbi C, Pedrick E, Sneag DB. Imaging of neuralgic amyotrophy in the acute phase. Muscle Nerve 2022; 66:709-714. [PMID: 36214185 DOI: 10.1002/mus.27732] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/23/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/AIMS Hourglass-like constrictions (HGCs) occur in neuralgic amyotrophy (NA), but the earliest time at which they can be recognized by imaging is poorly understood. We aimed to determine the prevalence of abnormal imaging findings in the acute phase of NA. METHODS Magnetic resonance neurography (MRN) and high-resolution ultrasound (US) examinations were performed at five sites. The investigation included 39 patients with acute NA who underwent imaging within 31 days of symptom onset. Correlation between imaging and electromyography (EMG) findings was measured. RESULTS US was performed in 29 patients and MRN in 23; 16 patients underwent US only, 10 MRN only, and 13 had both. US and MRN showed nerve abnormalities within 1 mo from NA onset in 90% of patients. HGCs were found in 74% (29/39) of the patients: 4 within 1 wk, 8 within 2 wk, 5 within 3 wk, and 12 within 4 wk. The earliest HGC on US was found within 12 h, and on MRN within 3 days from symptom onset. MRN demonstrated a denervation edema pattern of affected muscles in 91% of the patients. The shortest time to observe an edema pattern on MRN was 8 days. EMG was performed in 30 patients and revealed fibrillation potentials in affected muscles in 22 (73%). A denervation edema pattern on MRN was significantly associated with the presence of HGCs both on MRN and US, and with fibrillation potentials on EMG. DISCUSSION In the early phase of NA, US and MRN are useful diagnostic techniques for demonstrating nerve abnormalities.
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Affiliation(s)
- Paolo Ripellino
- Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
| | - Zsuzsanna Arányi
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elisa Ventura
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
| | | | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
- Department of Neuroradiology, Inselspital, Bern, Switzerland
| | - Claudio Gobbi
- Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
| | - Emily Pedrick
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Darryl Brett Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
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18
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Campbell WW, Landau M. Treatment and Management of Segmental Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Kim W, Kang SH, An JY. Posterior Interosseous Fascicular Constriction Within the Radial Nerve in a Diabetic Patient With Bilateral Neuralgic Amyotrophy: A Case Report. Front Neurol 2021; 12:701571. [PMID: 34566846 PMCID: PMC8457354 DOI: 10.3389/fneur.2021.701571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Neuralgic amyotrophy (NA) is an acute, monophasic, painful inflammatory dysimmune focal, or multifocal mononeuropathy. The lesion in NA is not always restricted to the brachial plexus but also involves individual nerves or branches. The prognosis of NA is less favorable than previously assumed, but the reasons for poor recovery remain unknown. Nerve constriction may be one of the causes of poor prognosis in NA. Case Presentation: Herein, we described a 54-year-old male with a history of type 2 diabetes in whom bilateral neuralgic amyotrophy developed with constriction of the posterior interosseous fascicle within the radial nerve. The patient experienced sudden-onset severe pain in both shoulders followed, 2 days later, by weakness in bilateral shoulders and the left forearm extensors over the subsequent month. The left forearm extensors were more severely affected than both shoulder girdle muscles. He noted a 7-kg weight loss for 1 month before pain onset. After diagnosing diabetic NA based on the clinical symptoms, imaging, and electrophysiological studies, treatment with systemic steroids improved pain and weakness in both shoulder muscles. Weakness in the left forearm extensors persisted after 1 month of steroid treatment. Follow-up ultrasound revealed constriction of the posterior interosseous fascicle within the main trunk of the left radial nerve at the elbow. Surgical exploration at 6 months after onset identified fascicle constriction, for which neurolysis was performed. Weakness in the extensors of the wrist and fingers did not improve during the 16-month follow-up. Conclusion: A single constriction of the fascicle within a peripheral nerve may often be under-recognized if NA presents with variable degrees of weakness in bilateral upper limbs. Furthermore, fascicular constriction without edema of the parent nerve may be easily missed on the initial ultrasound. A lack of early recognition of nerve constriction and delay in surgical intervention can result in unfavorable outcomes. The physician should consider the possibility of the fascicular constriction when evaluating patients suspected of brachial NA with significant weakness in the distal upper limb compared to the proximal weakness or weakness of the distal upper limb that does not improve over time.
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Affiliation(s)
- Woojun Kim
- Department of Neurology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Soo Hwan Kang
- Department of Orthopedic Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jae Young An
- Department of Neurology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea
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20
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Krishnan KR, Sneag DB, Feinberg JH, Wolfe SW. Anterior Interosseous Nerve Syndrome Reconsidered: A Critical Analysis Review. JBJS Rev 2021; 8:e2000011. [PMID: 32890049 DOI: 10.2106/jbjs.rvw.20.00011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Anterior interosseous nerve syndrome (AINS) represents a form of neuralgic amyotrophy (Parsonage-Turner syndrome). AINS does not originate from external compression of the AIN in the forearm. Fascicular constrictions (FCs) of the median nerve are identified within the anterior interosseous fascicular group at or above the medial epicondyle. Spontaneous recovery is not ensured, leaving up to 30% of patients with permanent weakness or palsy. Fascicular microneurolysis of the median nerve, performed at or above the elbow, is a treatment option for patients who do not recover spontaneously.
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Affiliation(s)
- Karthik R Krishnan
- Center for Brachial Plexus and Traumatic Nerve Injury (K.R.K., D.B.S., J.H.F., and S.W.W.) and Department of Radiology and Imaging (D.B.S.), Hospital for Special Surgery, New York, NY.,Weill Medical College of Cornell University, New York, NY
| | - Darryl B Sneag
- Center for Brachial Plexus and Traumatic Nerve Injury (K.R.K., D.B.S., J.H.F., and S.W.W.) and Department of Radiology and Imaging (D.B.S.), Hospital for Special Surgery, New York, NY.,Weill Medical College of Cornell University, New York, NY
| | - Joseph H Feinberg
- Center for Brachial Plexus and Traumatic Nerve Injury (K.R.K., D.B.S., J.H.F., and S.W.W.) and Department of Radiology and Imaging (D.B.S.), Hospital for Special Surgery, New York, NY.,Weill Medical College of Cornell University, New York, NY
| | - Scott W Wolfe
- Center for Brachial Plexus and Traumatic Nerve Injury (K.R.K., D.B.S., J.H.F., and S.W.W.) and Department of Radiology and Imaging (D.B.S.), Hospital for Special Surgery, New York, NY.,Weill Medical College of Cornell University, New York, NY
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21
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Krishnan KR, Sneag DB, Feinberg JH, Nwawka OK, Lee SK, Arányi Z, Wolfe SW. Outcomes of Microneurolysis of Hourglass Constrictions in Chronic Neuralgic Amyotrophy. J Hand Surg Am 2021; 46:43-53. [PMID: 32868098 DOI: 10.1016/j.jhsa.2020.07.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/08/2020] [Accepted: 07/24/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Wide variability in the recovery of patients affected by neuralgic amyotrophy (NA) is recognized, with up to 30% experiencing residual motor deficits. Using magnetic resonance imaging and ultrasound (US), we identified hourglass constrictions (HGCs) in all affected nerves of patients with chronic motor paralysis from NA. We hypothesized that chronic NA patients undergoing microsurgical epineurolysis and perineurolysis of constrictions would experience greater recovery compared with patients managed nonsurgically. METHODS We treated 24 patients with chronic motor palsy from NA and HGCs identified on magnetic resonance imaging and US either with microsurgical epineurolysis and perineurolysis of HGCs (11 of 24) or nonsurgically (13 of 24). Muscle strength (both groups) and electrodiagnostic testing (EDX) (operative group) was performed before and after surgery. Preoperative EDX confirmed muscle denervation in the distribution of affected nerve(s). All patients met criteria for microneurolysis: 12 months without improvement since onset or failure of clinical and EDX improvement after 6 months documented by 3 successive examinations, each at least 6 weeks apart. RESULTS Mean time from onset to surgery was 12.5 ± 4.0 months. Average time to most recent post-onset follow-up occurred at 27.3 months (range, 18-42 months; 15 nerves). Average time to latest follow-up among nonsurgical patients was 33.6 months (range, 18-108 months; 16 nerves). Constrictions involved individual fascicular groups (FCs) of the median nerve and the suprascapular, axillary and radial nerves proper (HGCs). Nine of 11 operative patients experienced clinical recovery compared with 3 of 13 nonsurgical patients. EMG revealed significant motor unit recovery from axonal regeneration in the operative group. CONCLUSIONS Microsurgical epineurolysis and perineurolysis of FCs and HGCs was associated with significantly improved clinical and nerve regeneration at an average follow-up of 14.8 months compared with nonsurgical management. We recommend microneurolysis of HGCs and FCs as a treatment option for patients with chronic NA who have failed to improve with nonsurgical treatment. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Karthik R Krishnan
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - Darryl B Sneag
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY; Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - Joseph H Feinberg
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY
| | - Ogonna K Nwawka
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY; Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - Steve K Lee
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - Zsuzsanna Arányi
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Scott W Wolfe
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY; Weill Medical College of Cornell University, New York, NY.
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22
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Vetrano IG, Nazzi V. Letter to the Editor. Treatment of spontaneous anterior interosseous nerve palsy. J Neurosurg 2020; 133:1274-1275. [PMID: 32679556 DOI: 10.3171/2020.4.jns201156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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23
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Kesserwani H. Isolated Musculocutaneous Neuropathy Secondary to an Immune-Mediated Brachial Plexopathy: A Case Report of a Rare Phenotype With a Side Note on Patterns of Weakness and an Update on Nerve Pathology. Cureus 2020; 12:e10267. [PMID: 33042705 PMCID: PMC7538028 DOI: 10.7759/cureus.10267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We describe a 50-year-old man who developed a low-frequency pattern of weakness, musculocutaneous neuropathy, with weakness of the biceps, coracobrachialis and brachialis in an immune-mediated brachial plexopathy. The aim of this article is to highlight both the low- and high-frequency patterns of weakness of the immune-mediated brachial plexopathies, and we focus on the patterns of recognition. We then segue into the pathology of the immune-mediated plexopathies and highlight the recent spectacular magnetic resonance imaging studies that demonstrate hourglass constrictions of peripheral nerves outside of the brachial plexus in afflicted patients. This opens up a window for the exciting possibility of neurolysis of constricted nerves in patients who have not responded adequately to immunotherapy.
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24
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Gstoettner C, Mayer JA, Rassam S, Hruby LA, Salminger S, Sturma A, Aman M, Harhaus L, Platzgummer H, Aszmann OC. Neuralgic amyotrophy: a paradigm shift in diagnosis and treatment. J Neurol Neurosurg Psychiatry 2020; 91:879-888. [PMID: 32487526 DOI: 10.1136/jnnp-2020-323164] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 01/22/2023]
Abstract
Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome, is characterised by sudden pain attacks, followed by patchy muscle paresis in the upper extremity. Recent reports have shown that incidence is much higher than previously assumed and that the majority of patients never achieve full recovery. Traditionally, the diagnosis was mainly based on clinical observations and treatment options were confined to application of corticosteroids and symptomatic management, without proven positive effects on long-term outcomes. These views, however, have been challenged in the last years. Improved imaging methods in MRI and high-resolution ultrasound have led to the identification of structural peripheral nerve pathologies in NA, most notably hourglass-like constrictions. These pathognomonic findings have paved the way for more accurate diagnosis through high-resolution imaging. Furthermore, surgery has shown to improve clinical outcomes in such cases, indicating the viability of peripheral nerve surgery as a valuable treatment option in NA. In this review, we present an update on the current knowledge on this disease, including pathophysiology and clinical presentation, moving on to diagnostic and treatment paradigms with a focus on recent radiological findings and surgical reports. Finally, we present a surgical treatment algorithm to support clinical decision making, with the aim to encourage translation into day-to-day practice.
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Affiliation(s)
- Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes A Mayer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department for Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen at the Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Stephanie Rassam
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Laura A Hruby
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Salminger
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Agnes Sturma
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Bioengineering, Imperial College London, London, UK
| | - Martin Aman
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Hand, Plastic and Reconstructive Surgery, Burn Center-Hand and Plastic Surgery, University of Heidelberg, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Leila Harhaus
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center-Hand and Plastic Surgery, University of Heidelberg, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Hannes Platzgummer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria .,Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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Schickendantz MS, Yalcin S. Conditions and Injuries Affecting the Nerves Around the Elbow. Clin Sports Med 2020; 39:597-621. [PMID: 32446578 DOI: 10.1016/j.csm.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Sports-related peripheral neuropathies account for 6% of all peripheral neuropathies and most commonly involve the upper extremity. The routes of the median, radial, and ulnar nerves are positioned in arrangements of pulleys and sheaths to glide smoothly around the elbow. However, this anatomic relationship exposes each nerve to risk of compression. The underlying mechanisms of the athletic nerve injury are compression, ischemia, traction, and friction. Chronic athletic nerve compression may cause damage with moderate or low pressure for long or intermittent periods of time.
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Affiliation(s)
- Mark S Schickendantz
- Cleveland Clinic Sports Health Center, 5555 Transportation Boulevard, Garfield Heights, Ohio 44125, USA.
| | - Sercan Yalcin
- Cleveland Clinic Sports Health Center, 5555 Transportation Boulevard, Garfield Heights, Ohio 44125, USA
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Update on classification, epidemiology, clinical phenotype and imaging of the nonsystemic vasculitic neuropathies. Curr Opin Neurol 2020; 32:684-695. [PMID: 31313704 DOI: 10.1097/wco.0000000000000727] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Single-organ vasculitis of the peripheral nervous system (PNS) is often designated nonsystemic vasculitic neuropathy (NSVN). Several variants or subtypes have been distinguished, including migratory sensory neuropathy, postsurgical inflammatory neuropathy, diabetic radiculoplexus neuropathies, skin-nerve vasculitides, and, arguably, neuralgic amyotrophy. NSVN often presents as nondiabetic lumbosacral radiculoplexus neuropathy (LRPN). This review updates classification, clinical features, epidemiology, and imaging of these disorders. RECENT FINDINGS A recent study showed the annual incidence of LRPN in Olmstead County, Minnesota to be 4.16/100 000:2.79/100 000 diabetic and 1.27/100 000 nondiabetic. This study was the first to determine the incidence or prevalence of any vasculitic neuropathy. In NSVN, ultrasonography shows multifocal enlargement of proximal and distal nerves. In neuralgic amyotrophy, MRI and ultrasound reveal multifocal enlargements and focal constrictions in nerves derived from the brachial plexus. Histopathology of these chronic lesions shows inflammation and rare vasculitis. Diffusion tensor imaging of tibial nerves in NSVN revealed decreased fractional anisotropy in one study. SUMMARY Single-organ PNS vasculitides are the most common inflammatory neuropathies. Neuralgic amyotrophy might result from PNS vasculitis, but further study is necessary. The usefulness of focal nerve enlargements or constrictions in understanding pathological mechanisms, directing biopsies, and monitoring disease activity in NSVN should be further investigated.
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Kodama N, Ando K, Takemura Y, Imai S. Treatment of spontaneous anterior interosseous nerve palsy. J Neurosurg 2020; 132:1243-1248. [DOI: 10.3171/2018.11.jns181609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe purpose of this study was to clarify the clinical outcomes of spontaneous anterior interosseous nerve palsy (AINP) treated nonsurgically or surgically.METHODSThe authors retrospectively evaluated the clinical course of 27 patients affected with AINP, treated nonsurgically or surgically. Thirteen patients underwent surgical treatment (interfascicular neurolysis), and 14 patients underwent conservative nonsurgical treatment. The mean patient age at the onset of symptoms was 49 years (range 17–77 years). The mean follow-up duration from onset to the latest follow-up examination was 23 months (range 12–38 months).RESULTSIn 12 of 14 patients receiving conservative treatment, signs of recovery from the palsy were obtained within 6 months. These patients showed a recovery of manual muscle test (MMT) grade ≥ 3. In contrast, 2 patients who took more than 12 months from symptom onset to initial recovery showed poor recovery (MMT grade ≤ 2). Surgical treatment was performed in 13 patients because of no sign of recovery from palsy. The mean period from symptom onset to the operation was 8.4 months (range 6–14 months). Ten of 13 patients who underwent surgical treatment within 8 months after symptom onset showed good recovery, with MMT grade ≥ 4. However, 3 patients who underwent surgical treatment more than 12 months after onset showed recovery with MMT grade ≤ 3.CONCLUSIONSConservative treatment for AINP may be continued when patients show signs of recovery within 6 months after symptom onset. In contrast, surgical treatment may be performed within 8 months from the onset of symptoms when the patients show no recovery signs for 6 months.
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Alfen N. Trapped or twisted? Teasing out anterior interosseous neuropathy. Muscle Nerve 2020; 61:268-270. [DOI: 10.1002/mus.26811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Nens Alfen
- Department of Neurology and Clinical Neurophysiology 920, Donders Institute for Brain, Cognition and BehaviorRadboud University Medical Center Nijmegen The Netherlands
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Le Hanneur M, Maldonado AA, Howe BM, Mauermann ML, Spinner RJ. "Isolated" Suprascapular Neuropathy: Compression, Traction, or Inflammation? Neurosurgery 2019. [PMID: 29529303 DOI: 10.1093/neuros/nyy050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several hypotheses have been proposed for the pathophysiology of suprascapular nerve (SSN) palsy, including compression, traction, and nerve inflammation. OBJECTIVE To provide insight into the pathophysiology of isolated nontraumatic SSN palsy by performing critical reinterpretations of electrodiagnostic (EDX) studies and magnetic resonance (MR) images of patients with such diagnosis. METHODS We retrospectively reviewed all patients referred to our institution for the past 20 yr with a diagnosis of nontraumatic isolated suprascapular neuropathy who had an upper extremity EDX study and a shoulder or brachial plexus MR scan. Patient charts were reviewed to analyze their initial clinical examination, and their original EDX study and MR images were reinterpreted by an experienced neurologist and a musculoskeletal radiologist, respectively, both blinded from the authors' hypothesis and from each other's findings. RESULTS Fifty-nine patients were included. Fifty of them (85%) presented with at least 1 finding that was inconsistent with an isolated SSN palsy. Forty patients (68%) had signs on physical examination beyond the SSN distribution. Thirty-one patients (53%) had abnormalities on their EDX studies not related to the SSN. Twenty-two patients (37%) had denervation atrophy in other muscles than the spinati, or neural hyperintensity in other nerves than the SSN on their MR scans, without any evidence of SSN extrinsic compression. CONCLUSION The great majority of patients with presumed isolated SSN palsy had clinical, electrophysiological, and/or imaging evidence of a more diffuse pattern of neuromuscular involvement. These data strongly support an inflammatory pathophysiology in many cases of "isolated" SSN palsy.
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Affiliation(s)
- Malo Le Hanneur
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,De-partment of Orthopedics and Trauma-tology - Service of Hand, Upper Limb, and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Andres A Maldonado
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Plastic, Hand, and Reconstructive Sur-gery, BG Unfallklinik Frankfurt, Frankfurt, Germany
| | | | | | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Sneag DB, Arányi Z, Zusstone EM, Feinberg JH, Queler SC, Nwawka OK, Lee SK, Wolfe SW. Fascicular constrictions above elbow typify anterior interosseous nerve syndrome. Muscle Nerve 2019; 61:301-310. [DOI: 10.1002/mus.26768] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Darryl B. Sneag
- Department of Radiology and ImagingHospital for Special Surgery New York New York
| | | | | | - Joseph H. Feinberg
- Department of Physiatry, Sports MedicineHospital for Special Surgery New York New York
| | - Sophie C. Queler
- Department of Radiology and ImagingHospital for Special Surgery New York New York
| | - O. Kenechi Nwawka
- Department of Radiology and ImagingHospital for Special Surgery New York New York
| | - Steve K. Lee
- Department of Orthopedic Surgery, Hand, and Upper ExtremityHospital for Special Surgery New York New York
| | - Scott W. Wolfe
- Department of Orthopedic Surgery, Hand, and Upper ExtremityHospital for Special Surgery New York New York
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Wang Y, Liu T, Song L, Zhang Z, Zhang Y, Ni J, Lu L. Spontaneous peripheral nerve palsy with hourglass-like fascicular constriction in the upper extremity. J Neurosurg 2019; 131:1876-1886. [PMID: 30611131 DOI: 10.3171/2018.8.jns18419] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/03/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spontaneous paralysis from hourglass-like fascicular constriction of peripheral nerves is rare, its clinical manifestations are not well documented, and its pathogenesis remains unknown. The unclear origin of this disorder and difficulty in diagnosis result in its uncertain management. The authors sought to gain a more thorough understanding of this condition through describing the anatomy, clinical features, etiology, and treatment of hourglass-like constriction. METHODS The authors retrospectively reviewed 20 patients (22 nerves) with hourglass-like constriction. The patients' clinical information was reviewed. Preoperative sonographic assessment and electrophysiological examination of involved nerves were performed. Surgical treatments included interfascicular neurolysis and neurorrhaphy. Samples of tissue subjected to resected constriction were sent for pathological analysis. The patients had regular face-to-face follow-up visits. RESULTS Acute pain was always the first symptom and was followed by paralysis. Paralysis progression was rapid and serious. Surgical exploration indicated an hourglass-like constricted segment completely unrelated to the compressive structures. Electrophysiological analysis showed severe denervation, and histopathological examination showed inflammatory cell infiltration, demyelination, and reduction of nerve fibers. CONCLUSIONS Hourglass-like fascicular constrictive neuropathy has an integrative effect from multiple different mechanisms. Surgical intervention is beneficial for selected patients who do not recover in a timely fashion and have hourglass-like lesions confirmed by preoperative ultrasound imaging. The authors recommend that early surgical intervention of the nerve be offered to patients who do not show any signs of recovery 3 months after onset. Both interfascicular neurolysis and neurorrhaphy are effective treatment methods. Mild to moderate constriction can usually be treated successfully by interfascicular neurolysis alone, whereas more advanced lesions with loss of fascicle continuity (severe constriction) may be best treated with resection and direct neurorrhaphy.
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Affiliation(s)
| | | | | | | | | | - Jinsong Ni
- 3Pathology, the First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
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Druzhinin DS, Naumova ES, Nikitin SS, Novikov ML, Spirin NN, Fedorov AV. [Sonographic characteristics of non-traumatic focal hourglass-like nerve constriction]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:10-13. [PMID: 30499489 DOI: 10.17116/jnevro201811810110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To describe the sonographic phenomenon of the focal 'hourglass-like constriction' of the peripheral nerves (FCPN). MATERIAL AND METHODS The authors described 7 patients meeting the criteria for the diagnosis of neuralgic amyotrophy with unilateral FCPN identified with ultrasound in 4 cases and detected intraoperatively in 3 cases (preliminary ultrasound was not performed). The US scanner Sonoscape Pro mode gray scale in the transverse and longitudinal scanning, linear probe 8-15 MHz and Logiq9 scanner with elastography were used. RESULTS FCPN was detected in the single nerve in 4 patients, in two nerves in 2 patients and in 3 nerves in one patient. Among all the nerves involved in the pathological process, the radial nerve and its branches were affected in 73% (8 nerves); the ulnar nerve was involved in 18% (2 nerves) and the musculo-cutaneous nerve in 9%. The length of the constriction of the peripheral nerve did not exceed 1.7 mm. The deformation coefficient (DC) of constriction area was 3.8 to .,9; the change in the elasticity in the form of an increase of DC to 5.9 when compared to the intact portion of the nerve and a decrease in echogenicity were observed in one patient. CONCLUSION High-resolution ultrasound of the nerve can be an informative method for the diagnosis of idiopathic non-traumatic FCPN mononeuropathy.
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Affiliation(s)
- D S Druzhinin
- Yaroslavl State Medical University, Ministry of Health of Russia, Yaroslavl, Russia
| | - E S Naumova
- Society of Experts in Neuromuscular Disease; Medical Center 'Practical Neurology', Moscow, Russia
| | - S S Nikitin
- Society of Experts in Neuromuscular Disease; Medical Center 'Practical Neurology', Moscow, Russia
| | | | - N N Spirin
- Yaroslavl State Medical University, Ministry of Health of Russia, Yaroslavl, Russia
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Sneag DB, Rancy SK, Wolfe SW, Lee SC, Kalia V, Lee SK, Feinberg JH. Brachial plexitis or neuritis? MRI features of lesion distribution in Parsonage-Turner syndrome. Muscle Nerve 2018; 58:359-366. [DOI: 10.1002/mus.26108] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 02/11/2018] [Accepted: 02/17/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Darryl B. Sneag
- Department of Radiology and Imaging; Hospital for Special Surgery, 535 East 70th Street; New York New York 10021 USA
| | - Schneider K. Rancy
- College of Medicine, SUNY Downstate Medical Center; Brooklyn New York USA
| | - Scott W. Wolfe
- Department of Orthopedic Surgery, Hand, and Upper Extremity; Hospital for Special Surgery; New York New York USA
| | - Susan C. Lee
- Department of Radiology and Imaging; Hospital for Special Surgery, 535 East 70th Street; New York New York 10021 USA
| | - Vivek Kalia
- Department of Radiology and Imaging; Hospital for Special Surgery, 535 East 70th Street; New York New York 10021 USA
| | - Steve K. Lee
- Department of Orthopedic Surgery, Hand, and Upper Extremity; Hospital for Special Surgery; New York New York USA
| | - Joseph H. Feinberg
- Department of Physiatry, Sports Medicine; Hospital for Special Surgery; New York New York USA
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Hourglass-like constriction of the suprascapular nerve: a contraindication for minimally invasive surgery. J Shoulder Elbow Surg 2018; 27:e29-e37. [PMID: 29102255 DOI: 10.1016/j.jse.2017.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/17/2017] [Accepted: 08/28/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Suprascapular nerve (SSN) entrapment is usually ascribed to static or dynamic compression. When no cause of compression is found, SSN entrapment is defined as idiopathic. Focal hourglass-like constriction (H-LC) of the SSN that results in muscle paralysis represents an unusual condition that may be misinterpreted and erroneously diagnosed as SSN entrapment or as neuralgic amyotrophy. METHODS With the aim of finding clinical and surgical clues that could differentiate the traditional form of idiopathic SSN entrapment from the rare H-LC, a series of 6 cases of SSN palsy caused by H-LC is presented. RESULTS All but 1 supraspinatus muscle recovered M5 muscle strength. The Constant shoulder score was excellent in 3 patients, good in 1, fair in 1, and poor in 1. DISCUSSION If a diagnosis is not made in time, H-LC may evolve from mild to severe nerve torsion that may require a shift in surgical procedure from epineurotomy and external neurolysis to focal resection and suture. If an incorrect therapy is chosen, the chance of recovery might be definitively compromised with the persistence of muscle palsy. Conversely, when SSN palsy persists despite notch decompression, especially when it is performed with a limited open approach or arthroscopically, concerns about the real etiology and location of nerve compression responsible for the nerve palsy may arise. CONCLUSION When approaching SSN pathology, H-LC should be considered as a potential cause of nerve palsy, as it may represent a contraindication for a limited open approach or arthroscopic decompression.
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017. [DOI: 10.1002/mus.25708 order by 8029-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Katalin DéVay
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - Maja Rosero
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - PéTer Barsi
- MRI Research Center; Semmelweis University; Budapest Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm; Berlin Germany
| | - Thomas Schelle
- Department of Neurology; Städtisches Klinikum Dessau; Dessau Germany
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017. [DOI: 10.1002/mus.25708 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Katalin DéVay
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - Maja Rosero
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - PéTer Barsi
- MRI Research Center; Semmelweis University; Budapest Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm; Berlin Germany
| | - Thomas Schelle
- Department of Neurology; Städtisches Klinikum Dessau; Dessau Germany
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017. [DOI: 10.1002/mus.25708 and 1880=1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Katalin DéVay
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - Maja Rosero
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - PéTer Barsi
- MRI Research Center; Semmelweis University; Budapest Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm; Berlin Germany
| | - Thomas Schelle
- Department of Neurology; Städtisches Klinikum Dessau; Dessau Germany
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017. [DOI: 10.1002/mus.25708 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Katalin DéVay
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - Maja Rosero
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - PéTer Barsi
- MRI Research Center; Semmelweis University; Budapest Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm; Berlin Germany
| | - Thomas Schelle
- Department of Neurology; Städtisches Klinikum Dessau; Dessau Germany
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40
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017. [DOI: 10.1002/mus.25708 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Katalin DéVay
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - Maja Rosero
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - PéTer Barsi
- MRI Research Center; Semmelweis University; Budapest Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm; Berlin Germany
| | - Thomas Schelle
- Department of Neurology; Städtisches Klinikum Dessau; Dessau Germany
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017. [DOI: 10.1002/mus.25708 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Katalin DéVay
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - Maja Rosero
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - PéTer Barsi
- MRI Research Center; Semmelweis University; Budapest Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm; Berlin Germany
| | - Thomas Schelle
- Department of Neurology; Städtisches Klinikum Dessau; Dessau Germany
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017. [DOI: 10.1002/mus.25708 order by 8029-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology; Semmelweis University; Balassa u. 6, Budapest 1083 Hungary
| | - Katalin DéVay
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - Maja Rosero
- Department of Traumatology; Szt. István and László Hospital; Budapest Hungary
| | - PéTer Barsi
- MRI Research Center; Semmelweis University; Budapest Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm; Berlin Germany
| | - Thomas Schelle
- Department of Neurology; Städtisches Klinikum Dessau; Dessau Germany
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Commentary on Management of Atraumatic Posterior Interosseous Nerve Palsy. J Hand Surg Am 2017; 42:831-832. [PMID: 28969809 DOI: 10.1016/j.jhsa.2017.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 07/23/2017] [Indexed: 02/02/2023]
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Gruber L, Loizides A, Löscher W, Glodny B, Gruber H. Focused high-resolution sonography of the suprascapular nerve: A simple surrogate marker for neuralgic amyotrophy? Clin Neurophysiol 2017; 128:1438-1444. [DOI: 10.1016/j.clinph.2017.04.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/18/2017] [Accepted: 04/30/2017] [Indexed: 01/24/2023]
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ArÁnyi Z, Csillik A, DéVay K, Rosero M, Barsi P, BÖhm J, Schelle T. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017; 56:1054-1062. [PMID: 28556181 DOI: 10.1002/mus.25708] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/21/2017] [Accepted: 05/23/2017] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The aim of this study was to assess the value of ultrasonography in neuralgic amyotrophy. METHODS Fifty-three patients with 70 affected nerves were examined with high-resolution ultrasound. RESULTS The most commonly affected nerve was the anterior interosseous (23%). Ultrasonographic abnormalities in the affected nerves, rather than in the brachial plexus, were observed, with an overall sensitivity of 74%. Findings included the swelling of the nerve/fascicle with or without incomplete/complete constriction and rotational phenomena (nerve torsion and fascicular entwinement). A significant difference was found among the categories of ultrasonographic findings with respect to clinical outcome (P = 0.01). In nerves with complete constriction and rotational phenomena, reinnervation was absent or negligible, indicating surgery was warranted. DISCUSSION Ultrasonography may be used as a diagnostic aid in neuralgic amyotrophy, which was hitherto a clinical and electrophysiological diagnosis, and may also help in identifying potential surgical candidates. Muscle Nerve 56: 1054-1062, 2017.
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Affiliation(s)
- Zsuzsanna ArÁnyi
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Anita Csillik
- MTA-SE NAP B Peripheral Nervous System Research Group, Department of Neurology, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Katalin DéVay
- Department of Traumatology, Szt. István and László Hospital, Budapest, Hungary
| | - Maja Rosero
- Department of Traumatology, Szt. István and László Hospital, Budapest, Hungary
| | - PéTer Barsi
- MRI Research Center, Semmelweis University, Budapest, Hungary
| | - Josef BÖhm
- Neurologische Praxis, Dr. Friedrich Behse/Dr. Josef Böhm, Berlin, Germany
| | - Thomas Schelle
- Department of Neurology, Städtisches Klinikum Dessau, Dessau, Germany
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Noda Y, Sekiguchi K, Tokuoka H, Oda T, Hamaguchi H, Kanda F, Toda T. Ultrasonographic findings of proximal median neuropathy: A case series of suspected distal neuralgic amyotrophy. J Neurol Sci 2017; 377:1-5. [PMID: 28477674 DOI: 10.1016/j.jns.2017.03.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 11/26/2022]
Abstract
Spontaneous anterior interosseous nerve (AIN) palsy develops following the resolution of nerve pain, which may be considered as distal neuralgic amyotrophy. NA is assumed to have a complex etiology, but an autoimmune mechanism is likely involved. However, precise assessment of the lesion is challenging. We examined five consecutive patients with suspected spontaneous AIN palsy using ultrasonography. On electromyography, all patients exhibited denervation potentials in the muscles, not only in the AIN territory, but also in the proximal median nerve territory (e.g., the flexor carpi radialis or pronator teres). Ultrasonography of the median nerve demonstrated neural swelling at the proximal side of the medial epicondyle in four patients and an hourglass-like constriction of the nerve fascicle in three patients. Four patients were diagnosed with distal neuralgic amyotrophy; of these, three received intravenous immunoglobulin administration, but only limited beneficial effect was achieved in one patient with early stage disease. One patient showed significant median nerve hypertrophy on ultrasonography and was diagnosed with neurolymphomatosis following the detection of malignant lymphoma during a systemic survey. Our experience demonstrates that ultrasonography for proximal median neuropathy presenting as AIN palsy may be useful for the accurate lesion assessment.
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Affiliation(s)
- Yoshikatsu Noda
- Division of Neurology, Kobe University Graduate School of Medicine, Japan
| | - Kenji Sekiguchi
- Division of Neurology, Kobe University Graduate School of Medicine, Japan.
| | - Hideki Tokuoka
- Division of Neurology, Kobe University Graduate School of Medicine, Japan
| | - Tetsuya Oda
- Department of Neurology, Kita-HARIMA Medical Center, Japan
| | | | - Fumio Kanda
- Division of Neurology, Kobe University Graduate School of Medicine, Japan
| | - Tatsushi Toda
- Division of Neurology, Kobe University Graduate School of Medicine, Japan
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Sneag DB, Saltzman EB, Meister DW, Feinberg JH, Lee SK, Wolfe SW. MRI bullseye sign: An indicator of peripheral nerve constriction in parsonage-turner syndrome. Muscle Nerve 2017; 56:99-106. [DOI: 10.1002/mus.25480] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/30/2016] [Accepted: 11/15/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Darryl B. Sneag
- Department of Radiology and Imaging; Hospital for Special Surgery; 535 East 70th Street New York New York USA 10021
- Weill Medical College of Cornell University; New York New York USA
| | - Eliana B. Saltzman
- Center for Brachial Plexus and Traumatic Nerve Injury; Hospital for Special Surgery; New York New York USA
- Department of Medical Education; Icahn School of Medicine at Mount Sinai; New York New York USA
| | - David W. Meister
- Center for Brachial Plexus and Traumatic Nerve Injury; Hospital for Special Surgery; New York New York USA
| | - Joseph H. Feinberg
- Weill Medical College of Cornell University; New York New York USA
- Center for Brachial Plexus and Traumatic Nerve Injury; Hospital for Special Surgery; New York New York USA
| | - Steve K. Lee
- Weill Medical College of Cornell University; New York New York USA
- Center for Brachial Plexus and Traumatic Nerve Injury; Hospital for Special Surgery; New York New York USA
| | - Scott W. Wolfe
- Weill Medical College of Cornell University; New York New York USA
- Center for Brachial Plexus and Traumatic Nerve Injury; Hospital for Special Surgery; New York New York USA
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Sunagawa T, Nakashima Y, Shinomiya R, Kurumadani H, Adachi N, Ochi M. Correlation between “hourglass-like fascicular constriction” and idiopathic anterior interosseous nerve palsy. Muscle Nerve 2016; 55:508-512. [DOI: 10.1002/mus.25361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/28/2016] [Accepted: 08/02/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Toru Sunagawa
- Department of Orthopedic Surgery; Hiroshima University Hospital; 1-2-3 Kasumi Hiroshima 734-8551 Japan
- Laboratory of Analysis and Control of Upper Extremity Function; Institute of Biomedical and Health Sciences, Hiroshima University; Hiroshima Japan
| | - Yuko Nakashima
- Department of Orthopedic Surgery; Hiroshima University Hospital; 1-2-3 Kasumi Hiroshima 734-8551 Japan
| | - Rikuo Shinomiya
- Department of Orthopedic Surgery; Hiroshima University Hospital; 1-2-3 Kasumi Hiroshima 734-8551 Japan
| | - Hiroshi Kurumadani
- Laboratory of Analysis and Control of Upper Extremity Function; Institute of Biomedical and Health Sciences, Hiroshima University; Hiroshima Japan
| | - Nobuo Adachi
- Department of Orthopedic Surgery; Hiroshima University Hospital; 1-2-3 Kasumi Hiroshima 734-8551 Japan
| | - Mitsuo Ochi
- Department of Orthopedic Surgery; Hiroshima University Hospital; 1-2-3 Kasumi Hiroshima 734-8551 Japan
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Anterior interosseous nerve and posterior interosseous nerve involvement in neuralgic amyotrophy. Clin Neurol Neurosurg 2016; 151:108-112. [DOI: 10.1016/j.clineuro.2016.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/15/2022]
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50
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Sunagawa T, Nakashima Y, Shinomiya R. Spontaneous recovery of a case with suspected hourglass-like fascicular constriction and anterior interosseous nerve palsy. J Hand Surg Eur Vol 2016; 41:886-7. [PMID: 26188692 DOI: 10.1177/1753193415596108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- T Sunagawa
- Department of Orthopedic Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Y Nakashima
- Department of Orthopedic Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - R Shinomiya
- Department of Orthopedic Surgery, Hiroshima University Hospital, Hiroshima, Japan
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