Ultrasound‐Guided Hydrodissection of the Median Nerve in Pronator Syndrome: Where Is the “Pronator Tunnel”?

2020 ◽  
Vol 39 (7) ◽  
pp. 1463-1464
Author(s):  
Vincenzo Ricci ◽  
Marco Becciolini ◽  
Levent Özçakar
Keyword(s):  
Median Nerve ◽  
Ultrasound Guided ◽  
Pronator Syndrome

Poster 260: Trifid Median Nerve: A Rare Finding During Ultrasound Guided Carpal Tunnel Injection

PM&R ◽  
2017 ◽  
Vol 9 ◽  
pp. S214-S214
Author(s):  
Michael Schaefer ◽  
Ana M. Garcia ◽  
Jose A. Rosa Padilla
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Ultrasound Guided ◽  
Rare Finding ◽  
Tunnel Injection

scholarly journals Volume Matters in Ultrasound-Guided Perineural Dextrose Injection for Carpal Tunnel Syndrome: A Randomized, Double-Blinded, Three-Arm Trial

2020 ◽  
Vol 11 ◽  
Author(s):  
Meng-Ting Lin ◽  
Chun-Li Liao ◽  
Ming-Yen Hsiao ◽  
Hsueh-Wen Hsueh ◽  
Chi-Chao Chao ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Group Analysis ◽  
Post Injection ◽  
Ultrasound Guided ◽  
Electrophysiological Studies ◽  
Tunnel Syndrome ◽  
Double Blinded

Ultrasound-guided perineural dextrose injection (PDI) has been reported effective for carpal tunnel syndrome (CTS). Higher volume of injectate may reduce adhesion of median nerve from other tissues, but volume-dependent effects of PDI in CTS remain unknown. We aimed to investigate whether PDI with different injectate volumes had different effects for CTS participants. In this randomized, double-blinded, three-arm trial, 63 wrists diagnosed with CTS were randomized into three groups that received ultrasound-guided PDI with either 1, 2 or 4 ml of 5% dextrose water. All participants finished this study. Primary outcome as visual analog scale (VAS) and secondary outcomes including Boston Carpal Tunnel Questionnaire (BCTQ), Disability of the Arm, Shoulder and Hand score (QuickDASH), electrophysiological studies and cross-sectional area (CSA) of the median nerve at carpal tunnel inlet were assessed before and after PDI at the 1st, 4th, 12th and 24th weeks. For within-group analysis, all three groups (21 participants, each) revealed significant improvement from baseline in VAS, BCTQ and QuickDASH at the 1st, 4th, 12th and 24th weeks. For between-group analysis, 4 ml-group yielded better VAS reduction at the 4th and 12th weeks as well as improvement of BCTQ and QuickDASH at the 1st, 4th, and 12th weeks, compared to other groups. No significant between-group differences were observed in electrophysiological studies or median nerve CSA at any follow-up time points. There were no severe complications in this trial, and transient minor adverse effects occurred equally in the three groups. In conclusion, ultrasound-guided PDI with 4 ml of 5% dextrose provided better efficacy than with 1 and 2 ml based on symptom relief and functional improvement for CTS at the 1st, 4th, and 12th week post-injection, with no reports of severe adverse effects. There was no significant difference between the three groups at the 24th-week post-injection follow-up.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03598322.

scholarly journals How Much Volume of Local Anesthesia and How Long Should You Wait After Injection for an Effective Wrist Median Nerve Block?

Hand ◽  
2017 ◽  
Vol 13 (3) ◽  
pp. 281-284 ◽  
Author(s):  
Lyndsay M. Lovely ◽  
Yasmin Z. Chishti ◽  
Jennifer L. Woodland ◽  
Donald H. Lalonde
Keyword(s):  
Pilot Study ◽  
Median Nerve ◽  
Local Anesthesia ◽  
Nerve Block ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Needle Stick ◽  
Local Methods ◽  
Long Time ◽  
The Ideal

Background: Many surgeons and emergentologists use non–ultrasound-guided wrist nerve blocks. There is little evidence to guide the ideal volume of local anesthesia or how long we should wait after injection before performing pain-free procedures. This pilot study examined time to maximal anesthesia to painful needle stick in 14 volunteer participants receiving bilateral wrist blocks of 6 versus 11 mL of local. Methods: One surgeon performed all 14 bilateral wrist median nerve blocks in participants who remained blinded until after bandages were applied to their wrist. No one could see which wrist received the larger 11-mL volume injection versus the 6-mL block. Blinded sensory assessors then measured perceived maximal numbness time and numbness to needle stick pain in the fingertips of the median nerve distribution. Results: Failure to get a complete median nerve block occurred in seven of fourteen 6-mL wrist blocks versus failure in only one of fourteen 11-mL blocks. Perceived maximal numbness occurred at roughly 40 minutes after injection, but actual numbness to painful needle stick took around 100 minutes. Conclusions: Incomplete median nerve numbness occurred with both 6- and 11-mL non–ultrasound-guided blocks at the wrist. In those with complete blocks, it took a surprisingly long time of 100 minutes for maximal anesthesia to occur to painful needle stick stimuli to the fingertips of the median nerve distribution. Non–ultrasound-guided median nerve blocks at the wrist as described in this article lack reliability and take too long to work.

Median Nerve Compression within the Humeral Head of Pronator Teres

1994 ◽  
Vol 19 (6) ◽  
pp. 709-710 ◽  
Author(s):  
N. TULWA ◽  
D. LIMB ◽  
R. F. BROWN
Keyword(s):  
Median Nerve ◽  
Humeral Head ◽  
Nerve Compression ◽  
Fibrous Band ◽  
Compression Neuropathy ◽  
Pronator Teres ◽  
Anterior Aspect ◽  
Pronator Syndrome ◽  
Anatomical Arrangement ◽  
A Site

We describe a case of the pronator syndrome caused by compression of the median nerve by a fibrous band as the nerve passed through the humeral head of origin of pronator teres. This rare anatomical arrangement resulted in displacement of the median nerve to the anterior aspect of the medial humeral epicondyle and, as far as we are aware, has not previously been described as a site of compression neuropathy.

The sublime bridge: anatomy and implications in median nerve entrapment

2010 ◽  
Vol 113 (1) ◽  
pp. 110-112 ◽  
Author(s):  
R. Shane Tubbs ◽  
Tyler Marshall ◽  
Marios Loukas ◽  
Mohammadali M. Shoja ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Range Of Motion ◽  
Median Nerve ◽  
Nerve Entrapment ◽  
Pronator Teres ◽  
The Sublime ◽  
Potential Site ◽  
Mean Width ◽  
Pronator Syndrome ◽  
Relationship Of ◽  
The Relationship

Object The sublime bridge is a potential site of entrapment of the median nerve in the forearm. To the authors' knowledge, this structure and its relationship to the median nerve have not been studied. The aim of the present study was to quantitate this structure and elucidate its relationship to the median nerve. Methods Sixty adult cadaveric forearms underwent dissection of the sublime bridge. Relationships of this structure were observed, and measurements of its anatomy were made. The relationship of the median nerve to the sublime bridge was observed with range of motion about the forearm. Results The sublime bridge was found to be tendinous in the majority (45 [75%]) of specimens and muscular in the remaining forearms (15 [25%]). The maximal mean width of the sublime bridge was 7 cm proximally, and the minimal mean width was 3 cm distally. The mean distance from the medial epicondyle to the apex of the sublime bridge was found to be 8.1 cm. The relation of the median nerve to the bridge was always intimate. On 2 sides (1 left and 1 right) from different male specimens, the median nerve was attached to the deep aspect of the sublime bridge by a strong connective tissue band, thus forming a tunnel on the deep aspect of this structure. With range of motion of the forearm, increased compression of the median nerve by the overlying sublime bridge was seen with extension but no other movement. Conclusions Based on the authors' study, pronator syndrome is an incorrect term applied to compression of the median nerve at the sublime bridge. This potential site of median nerve compression is distinct and has characteristics that can clinically differentiate it from compression of the median nerve between the heads of the pronator teres. The authors hope that these data will be of use to the surgeon in the evaluation and treatment of patients with proximal median nerve entrapment.

Sign in / Sign up

Export Citation Format

Share Document