The pathology of the ulnar nerve in acromegaly

Tagliafico, Alberto; Resmini, Eugenia; Nizzo, Raffaella; Derchi, Lorenzo E.; Minuto, Francesco; Giusti, Massimo; Martinoli, Carlo; Ferone, Diego

doi:10.1530/eje-08-0327

Cited by 25 publications

(38 citation statements)

References 18 publications

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“…This observation suggests that a trigger finger could be another early musculoskeletal manifestation of acromegaly. 4 In 1 patient, we noted an irregular internal echo texture of the flexor tendons: the association between trigger fingers and tendon fissuration had already been reported. …”

Section: Discussionmentioning

confidence: 56%

“…In these patients, the hand function is particularly impaired by arthropathy, neuro pathy, tenosynovitis, and trigger fingers. 1,3,4 Our study showed the following: (1) the A1 pulley thickness could be measured with high-resolution sonography in acromegalic patients; (2) trigger fingers were associated with acromegaly in 25% of cases, and it was a possible early musculoskeletal complication of acromegaly because it was present especially in patients who were not receiving any treatment at the beginning of the study (6 of 7 in our series); (3) annular pulleys in acromegaly were thicker than in the unaffected group; and (4) many of the trigger fingers in the acromegalic patients resolved after 1 year of therapy for acromegaly.…”

Section: Discussionmentioning

confidence: 99%

“…2 It may lead to several systemic complications affecting the cardiovascular system, metabolism, respiratory and musculoskeletal systems, and peripheral nerves. 3 In acromegaly, musculoskelal disorders related to hand dysfunction may be due to sensory and motor disturbances caused by carpal tunnel syndrome, cubital tunnel syndrome, 3,4 and acromegalic arthropathy. 1 Acromegalic arthropathy is the most frequent and severe cause of morbidity and inability in these patients, and the hands are typically involved.…”

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confidence: 99%

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Sonographic Depiction of Trigger Fingers in Acromegaly

Tagliafico

Resmini²,

Holsbeeck

et al. 2009

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to compare the prevalence of trigger fingers in patients with acromegaly versus an unaffected control group. Methods. This study was performed with Institutional Review Board approval, and informed written consent was obtained from each patient and control participant. The diagnosis was made by a combination of clinical symptoms and sonographically measured thickening of the first annular (A1) pulley. The A1 pulley thickness was measured in 40 patients and 40 control participants by means of a 17-5 MHz high-resolution transducer. Thickening of the A1 pulley and abnormalities of the underlying flexor tendons associated with the clinical sign were diagnostic for a trigger finger. The acromegalic patients were divided into groups according to disease activity and therapy. The study was performed at the baseline and at a follow-up after 1 year. Results. At the baseline, clinical and sonographic findings were consistent with trigger fingers in 25% of patients (6 at presentation and 4 with uncontrolled disease). After 1 year, the trigger fingers recovered in the patients who were not receiving any treatment at the beginning of the study. In patients with uncontrolled disease, the condition remained unchanged. The A1 pulley thickness was greater in the acromegalic patients than control participants (mean ± SD, 0.44 ± 0.19 versus 0.24 ± 0.05 mm; P < .05). In the patients treated for acromegaly, the trigger fingers disappeared, and a reduction in the A1 pulley thickness was noted (P < .05) at the follow-up. Conclusions. Trigger fingers were observed in 25% of the acromegalic patients but in none of the control participants. The A1 pulley was significantly thicker in the acromegalic patients and normalized after 1 year in some who were treated for the disease.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Sonographic Depiction of Trigger Fingers in Acromegaly

Tagliafico

Resmini²,

Holsbeeck

et al. 2009

Journal of Ultrasound in Medicine

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“…book keepers, drivers resting the elbow on the window frame) [73], gripping tools (gardeners, farmers, builders) [74], professional motorbike runners, cyclist [75,76], repetitive elbow flexoextension [73,74] and in floor cleaners [73,77]. It is also more frequent in some systemic disorders like diabetes mellitus [16], acromegaly [78], rheumatoid arthritis [79] or amyloidosis [80]. CTS and CubTS in the same arm is not a rare finding [81][82][83].…”

Section: Ulnar Nerve Compression At the Elbowmentioning

confidence: 99%

Peripheral Nerve Entrapment and their Surgical Treatment

Vanaclocha‐Vanaclocha¹,

Saiz-Sapena²,

MaríaOrtiz‐Criado³

et al. 2017

Peripheral Nerve Regeneration - From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Deve

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Nerves pass from one body area to another through channels made of connective tissue and/or bone. In these narrow passages, they can get trapped due to anatomic abnormalities, ganglion cysts, muscle or connective tissue hypertrophy, tumours, trauma or iatrogenic mishaps. Nearly all nerves can be affected. The clinical presentation is pain, paraesthesia, sensory and motor power loss. The specific clinical features will depend on the affected nerve and on the chronicity, severity, speed and mechanism of compression.Its incidence is higher under some occupations and is some systemic conditions: diabetes mellitus, hypothyroidism, acromegaly, alcoholism, oedema and inflammatory diseases. The diagnosis is suspected with the clinical presentation and provocative clinical test, being confirmed with electrodiagnostic and/or ultrasonographic studies. Magnetic Resonance Studies (MRI) rule out ganglion cysts or tumours. Conservative medical treatment is often sufficient. In refractory ones, surgical decompression should be performed before nerve damage and muscle atrophy are irreversible. The 'double crash' syndrome happens when a peripheral nerve is compressed at more than one point along its trajectory. In cases with marked muscle atrophy, a 'supercharge end-to-side' nerve transfer can be added to the decompression. After decompression in those few cases with refractory pain, a nerve neurostimulator can be applied.

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“…Peripheral nerve imaging is recognized as a complement to clinical and neurophysiological assessment in the eva luation of peripheral nerves with the ability to impact patient management, even for small and difficult nerves [17] . In daily radiological clinical practice, ultra sound (US) and magnetic resonance imaging (MRI) are the technics of choice.…”

Section: Introductionmentioning

confidence: 99%

Peripheral nerve imaging: Not only cross-sectional area

Tagliafico

2016

WJR

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suggest to use ultrasound (US) for nerve evaluation due to the fact that, in sever anatomical area, magnetic resonance imaging is not able to give additional in formations. US could be considered the firstchoice approach for the assessment of peripheral nerves. The relative drawback of peripheral nerve US is the long learning curve and the deep anatomic competence to evaluate even small nerves. In the recent years, the role of US in peripheral nerve evaluation has been widened. In the past, nerve US was mainly used to assess nerve cross sectional area, but now more advanced mea surements and considerations are desirable and can boost the role of peripheral nerve US. Nerve echotexture evaluation was defined in 2010: The ratio between the hypoechoic and hyperechoic areas of peripheral nerves on US was called "nerve density". For evaluation of patients who have peripheral neuropathies, the role of peripheral nerve is US wider than simple crosssectional area evaluation. Quantitative measurements describing the internal fascicular echotexture of peripheral nerves introduce the concept of considering US as a possible quantitative imaging biomarker technique. The potential of nerve US has started to be uncovered. It seems clear that only crosssectional area measurement is no more sufficient for a comprehensive US evaluation of peripheral nerves. AbstractPeripheral nerve imaging is recognized as a complement to clinical and neurophysiological assessment in the evaluation of peripheral nerves with the ability to impact patient management, even for small and difficult nerves.

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The pathology of the ulnar nerve in acromegaly

Cited by 25 publications

References 18 publications

Sonographic Depiction of Trigger Fingers in Acromegaly

Sonographic Depiction of Trigger Fingers in Acromegaly

Peripheral Nerve Entrapment and their Surgical Treatment

Peripheral nerve imaging: Not only cross-sectional area

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