Ulnar neuropathy at the elbow is the second most frequent entrapment neuropathy and is considered idiopathic in most patients. However, several anatomic variations, including the anconeus epitrochlearis muscle, have been reported to cause ulnar nerve compression. The anconeus epitrochlearis muscle is a common anatomic variation, with a prevalence of up to 34%, but the clinical diagnosis of ulnar neuropathy of the elbow as a result of this variation is rare, with an unknown prevalence. It is a congenital accessory muscle between the medial humeral epicondyle and the olecranon that covers the posterior aspect of the cubital tunnel and is usually an operative finding, not a preoperative diagnosis. Ulnar neuropathy as a result of the anconeus epitrochlearis muscle usually has different characteristics than idiopathic disease, including younger age at onset, more rapid progression with a short duration of symptoms, distinct neurophysiology with velocity drop or conduction block of the ulnar nerve, and edema of the anconeus epitrochlearis muscle on magnetic resonance imaging. Neurophysiologic findings in anconeus epitrochlearis-associated ulnar neuropathy indicate subacute onset of symptoms rather than the chronic demyelinating process that is seen in idiopathic ulnar neuropathy. Medial elbow pain may be more exacerbated in these patients rather than the more common sensorial symptoms. This is probably the result of static compression of the nerve and increased cubital tunnel pressure, even when the elbow is in extension. This article describes a case of ulnar nerve entrapment of the elbow in a 28-year-old woman as a result of compression by the anconeus epitrochlearis muscle and includes magnetic resonance imaging findings, surgical correlations, and clinical and neurophysiologic findings. [Orthopedics. 2016; 39(5):e988-e991.].
Retrosternal displacement of the medial clavicular metaphysis after a medial physeal fracture is a rare and potentially fatal injury because of possible damage of neurovascular structures, trachea and oesophagus. As the medial clavicular epiphysis does not ossify until 18-20 years of age and the medial clavicular physis is the last to close, around 22-25 years of age, this injury is difficult to demonstrate with plain radiographs in younger patients and is often mistaken for a sternoclavicular joint dislocation. We report on a 16-year-old boy with a fracture of the medial clavicular physis with retrosternal displacement of the metaphysis that was diagnosed with MRI, and discuss the diagnostic tools and treatment options in this rare injury.
A simple, inexpensive technique for fixation of proximal opening-wedge osteotomy of the first metatarsal for correction of moderate or severe hallux valgus (HV) is described. After the opening-wedge osteotomy and bone grafting of the first metatarsal have been performed, 2 Kirschner wires are introduced for internal fixation and removed 8 weeks postoperatively. Twenty-three patients with symptomatic HV who had a proximal medial opening-wedge osteotomy of the first metatarsal in combination with a distal soft tissue procedure and bunionectomy were evaluated retrospectively. All osteotomies healed without complications and satisfaction was achieved in 22 patients. Hallux varus developed in 1 patient. Preoperatively, mean HV angle (HVA) was 41° (range, 35°-61°) and mean 1-2 intermetatarsal angle (IMA) was 19° (range, 16°-24°). Postoperatively, mean HVA was 14° (range, 10°-17°) and mean 1-2 IMA was 7° (range, 5°-9°). The mean decrease in the HVA was 27° (P<.001) and the mean decrease in the 1-2 IMA was 12° (P<.001). [Orthopedics. 2016; 39(6):e1213-e1217.].
Tarsal tunnel syndrome (TTS), resulting from compression of the posterior tibial nerve (PTN) within the tarsal tunnel, is a relatively uncommon entrapment neuropathy. Many cases of tarsal tunnel syndrome are idiopathic; however, some causes, including space-occupying lesions, may lead to occurrence of TTS symptoms. Schwannoma, the most common tumor of the sheath of peripheral nerves, is among these space-occupying lesions, and may cause TTS when it arises within the tarsal tunnel, and it may mimic TTS even when it is located outside the tarsal tunnel and cause a significant delay in diagnosis. The possibility of an occult space-occupying lesion compressing the PTN should be kept in mind in the differential diagnosis of TTS, and imaging studies that are usually not used in entrapment neuropathies may be of importance in such patients. This case report presents a 65-year-old woman with TTS symptoms and neurophysiologic findings secondary to an occult schwannoma of the PTN proximal to the tarsal tunnel. Avoidance of delay in diagnosis in secondary cases is emphasized.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.