Presenting step-by-step procedures written by experts in the field, this comprehensive clinical guide discusses the diagnosis (electrodiagnostic and ultrasound) and management of compressive neuropathies of the upper extremity. Compressive (or compression) neuropathy, also known as entrapment neuropathy or trapped nerve, is a common condition of the upper extremity in which the nerves of the arm – median, ulnar and radial being the most common – are compressed, causing pain and discomfort as well as possible pathological and anatomical changes. Carpal and cubital tunnel syndrome are the most well-known and treated, with nerve release and decompression surgeries being the usual treatment, though the variety of neuropathies and management strategies goes beyond these conditions.
Chapters included describe in detail the latest, cutting-edge management strategies for the various manifestations of compressive neuropathy of the hand and wrist – carpal tunnel syndrome, cubital tunnel syndrome, ulnar nerve syndrome, radial tunnel syndrome, pronator teres syndrome, Wartenberg’s syndrome, thoracic outlet syndrome and suprascapular neuropathy – as well as revision carpal and cubital tunnel surgical treatment options. Plentiful intraoperative photos and detailed illustrations, along with clinical case material and pearls and pitfalls, make this the ideal resource for orthopedic, hand and plastic surgeons aiming for the most optimal outcomes.
Author(s): Dean G. Sotereanos (editor), Loukia K. Papatheodorou (editor)
Publisher: Springer
Year: 2020
Language: English
Pages: 303
Preface
Abbreviations
Contents
Contributors
1: The Basics of Electrodiagnostic Testing Carpal Tunnel and Cubital Tunnel Syndrome
EMG/NCV
Conclusion
References
2: Ultrasound Anatomy of the Median and Ulnar Nerves
Introduction
Imaging Technique of Peripheral Nerves
General Requirements
Optimization of Sonographic Imaging
Imaging of Healthy Peripheral Nerves
Median Nerve (C6–T1)
Introduction
Innervation
Topographic Ultrasound Anatomy
Carpal Tunnel Syndrome
Ulnar Nerve (C7–T1)
Introduction
Topographic Ultrasound Anatomy
Cubital Tunnel Syndrome
Conclusion
References
3: Diagnosis and Clinical Presentation of Carpal Tunnel Syndrome
Introduction
Clinical Presentation
Physical Examination
Clinical Diagnostic Tools
EMG/NCS
Ultrasound
References
4: Standard Open Carpal Tunnel Release
Open Carpal Tunnel Release
Technique
Open Carpal Tunnel Release with Tenosynovectomy
Technique
Carpal Tunnel Release Using Indiana Tome
Technique
Conclusion
References
5: Carpal Tunnel Release with Two Small Cross-Aligned Incisions
Carpal Tunnel Syndrome: Demographics and Historical Data
Anatomy of the Carpal Tunnel and the Variations of the Median Nerve
Surgical Techniques and Complains or Complications Following CTS Surgery
The Mini Open Surgical Technique with Two Small Cross Aligned Incisions (TSCAI)
Postoperative Care
Results
Discussion
References
6: Endoscopic Carpal Tunnel Release
Introduction
Indication: Contraindications
Surgical Technique
Anatomy
Positioning
Instrumentation
Anaesthesia
Approach and Release of TCL
Follow-up Protocol
Complications
Outcomes
Conclusions
References
7: Complications of Carpal Tunnel Release
Introduction
Classification of Carpal Tunnel Surgery Complications
Intraoperative Complications
Intraoperative Magnification Can Minimize Intraoperative Complications!
Early Complications
Inadequate Decompression of the Median Nerve
Hematoma
Infection
Rare Major Early Complications
Late Postoperative Complications
Recurrence of Carpal Tunnel Syndrome
New Symptoms Appearance
Loss of Hand Grip Strength
Tendon Complications
Trigger Finger
Adhesions Between Flexor Tendons
Bowstringing of the Flexor Tendons
Painful Scar
Pillar Pain
Piso-Triquetral Pain Syndrome
Complex Regional Pain Syndrome
Conclusions
References
8: Revision Carpal Tunnel Surgical Options
Etiology of Recurrent Carpal Tunnel
Evaluation
Principles of Surgical Treatment for Revision Carpal Tunnel Syndrome
Techniques with Expected Outcomes
Repeat Simple Decompression
Synovial and Tenosynovial Flap
Hypothenar Fat Pad Flap
Synthetic Wraps
Vein Wrapping
Muscle Flaps
Vascularized Fascial Flaps
Remote Pedicle or Free Flaps
Outcomes Including Comparative Studies
References
9: Hypothenar Fat Pad Flap: Surgical Technique
Introduction
Anatomic Dissections and Vascular Basis for the Hypothenar Fat Pad Flap
Surgical Technique
Pearls
Conclusion
References
10: Tumors and Tumor-Like Lesions Mimicking Peripheral Neuropathies
General Aspects
Diagnostic Approach
Differential Diagnosis
Treatment
Categorization
Lipomatous Tumors
Lipomas
Nerve Lipomatosis
Parosteal Lipomas
Ganglion and Synovial Cysts
Reactive and Inflammatory Lesions
Tenosynovitis
Neuritis Ossificans
Inflammatory Pseudotumor of Peripheral Nerve (IPPN)
Peripheral Nerve Sheath Tumors
Schwannomas
Neurofibromas
Peripheral Nerve Compression and Malignancy
Compression from Lymph Nodes & Peripheral Nerve Lymphomatosis
Metastatic Disease to Brachial Plexus and Peripheral Nerves
Soft Tissue Sarcomas
MPNST
Synovial Sarcoma of Nerves
References
11: Clinical Presentation and Diagnosis of Cubital Tunnel Syndrome
Introduction
Presentation
Physical Examination
Classification
Electrodiagnostic Studies
Imaging
Plain Radiographs
Ultrasound
MRI
Conclusion
References
12: In Situ Decompression of Cubital Tunnel
Introduction
Operative Treatment
In Situ Decompression
Complications
Conclusions
References
13: Endoscopic Ulnar Nerve Release
Introduction
Endoscopic Cubital Tunnel Release (Decompression of Ulnar Nerve In-Situ)
Indications
Contra-indications
Surgical Techniques
Surgical Technique Using Storz Equipment (Karl Storz, Tuttlingen, Germany) [12, 16]
Cannula Technique (Integra LifeSciences, Plainsboro, NJ, USA) [14, 15]
Surgical Technique Using Agee Device (3M, Orthopaedic Products, St Pauls, MN, USA) [13, 17]
Tips and Tricks
Postoperative Protocol
Complications
Results
Current Literature
Endoscopic Cubital Tunnel Release and Anterior Transposition
Indications
Contraindications
Surgical Technique
Tips and Tricks
Postoperative Protocol
Complications
Results
Current Literature
Learning New Techniques
References
14: Subcutaneous Transposition of the Ulnar Nerve
Introduction
Pertinent Anatomical Considerations
Biomechanical Considerations
Techniques of Anterior Subcutaneous Transposition
Subcutaneous Pocket
Fasciodermal Sling
Fascial Sling
Adipose Flap
Medial Intermuscular Septal Sling
Ligamentofascial/Ligamentodermal Sling
Additional Considerations
Outcomes of Anterior Subcutaneous Transposition
Complications
Conclusions
References
15: Submuscular Transposition of the Ulnar Nerve
Introduction
Background
History of Submuscular Transposition
Comparative Trials
Surgical Indications
Submuscular Transposition of the Author’s Preferred Surgical Technique
Outcomes
Summary
References
16: Minimal Medial Epicondylectomy
Introduction
Indications
Surgical Technique
Complications
Outcomes
Conclusion
References
17: Revision Cubital Tunnel: Surgical Options
Introduction
Etiology
Evaluation
History
Physical Examination
Testing
Management
Surgical Techniques
Subcutaneous Transposition
Submuscular Transposition
Conclusion
References
18: Nerve Transfers for Neuropathies of the Median and Ulnar Nerve
Introduction
Nerve Transfer Principles
Diagnosis
Ulnar Nerve Compression
Ulnar Nerve Compression Below the Elbow
Motor SETS Transfer in Cases of Severe Lower Ulnar Compression
Surgical Technique: AIN to Deep Ulnar Motor Branch SETS Technique
Sensory Reconstruction
High Ulnar Neuropathy
Motor Reconstruction
Sensory Reconstruction
Median Nerve Compression
Low Median Neuropathy
Motor Reconstruction
Sensory Reconstruction
High Median Neuropathy
Motor Reconstruction
Sensory Reconstruction
Summary
References
19: Ulnar Tunnel Syndrome (Guyon Canal)
Introduction
Anatomy
Pathoetiology
Clinical Findings
Diagnostics
Treatment
Summary
References
20: Radial Tunnel Syndrome - Posterior Interosseous Nerve Compression Syndrome
Introduction
Anatomy
The Radial Nerve
The Radial Tunnel
Etiology
Controversy
Physical Examination
Radial Tunnel Syndrome
Posterior Interosseous Nerve Compression Syndrome
Imaging Studies
Electrodiagnostic Testing
Treatment
Surgical Approaches
Anterior Approach [84]
Posterior Approach [85]
Lateral Approaches
Between BR and ECRL
Transbrachioradialis [36] (Fig. 20.5)
Endoscopic Assisted Methods
Outcomes
Conclusion
References
21: Pronator Teres Syndrome: Anterior Interosseous Nerve Compressive Neuropathy
Introduction
Anatomy
Pathoanatomy
Clinical Manifestations
Diagnosis
Pronator Syndrome
Anterior Interosseous Nerve Syndrome
Electromyography and Nerve Conduction Studies
Imaging Studies
Treatment
Nonsurgical Management
Surgical Management
References
22: Lateral Antebrachial Nerve Entrapment
Lateral Antebranchial Cutaneous Neuropathy
Anatomy
Clinical Presentation
Epidemiology
Socioeconomic Effects
Risk Factors
Pathophysiology
Diagnosis
Differential Diagnosis
Treatment
Conservative
Operative
Conclusion
References
23: Wartenberg’s Syndrome
Introduction
Anatomy
Pathophysiology
Presentation and Differential Diagnosis
Further Investigation
Electrodiagnostic Tests
Ultrasound Examination
Magnetic Resonance Imaging
Treatment
References
24: Thoracic Outlet Syndrome
Anatomy
History
Classification
Arterial Thoracic Outlet Syndrome
Venous Thoracic Outlet Syndrome
Neurogenic Thoracic Outlet Syndrome
Diagnosis
Physical Examination
Adson’s Test
Wright’s Hyperabduction Test
Roos’ Test
Hunter’s Test (Brachial Plexus Tension Test)
Halsted Maneuver
Upper Limb Tension Test of Elvey
Diagnostic Studies
Electrodiagnostic Testing
Treatment
Transaxillary Rib Resection
Supraclavicular Rib Resection
Anterior Scalenectomy and Brachial Plexus Neurolysis
Combined Approach: Transaxillary Resection of the First Rib and Anterior and Middle Scalenectomy
Treatment of Vascular Thoracic Outlet Syndrome
Results
Recurrent Thoracic Outlet Syndrome
Summary
References
25: Vein Wrapping of Peripheral Nerves: Surgical Technique
Introduction
Historical Perspective
Indications
Surgical Technique
Outcomes
References
26: Cervical Radiculopathy Mimicking Carpal Tunnel Syndrome
Epidemiology
Cervical Radiculopathy
Carpal Tunnel Syndrome
Etiology
Cervical Radiculopathy
Carpal Tunnel Syndrome
Diagnosis
Cervical Radiculopathy
Carpal Tunnel Syndrome
Electrodiagnostic Studies
Treatment
Cervical Radiculopathy
Carpal Tunnel Syndrome
Discussion
The Double Crush Hypothesis
Conclusion
References
27: Suprascapular Neuropathy
Introduction
Anatomy
Clinical Presentation and Exam
Suprascapular Notch Compression
Spinoglenoid Notch Compression
Spinoglenoid Notch and/or Suprascapular Notch Due to Ganglion Cyst
Diagnostic Tests
Radiological Imaging
Nerve Conduction Velocity (NCV) and Electromyography (EMG)
Diagnostic Injections
Treatment
Open Decompression of the Suprascapular Notch and Spinoglenoid Notch
Arthroscopic Technique for Decompression of the Suprascapular Notch
Arthroscopic Labral Repair with and without Ganglion Decompression
Arthroscopic Spinoglenoid Ligament Release
Results
Conclusion
References
Index
