Tophaceous Gout Causing the Carpal Tunnel Syndrome and Flexor Digitorum Dysfunction: A Case Report

Carpal tunnel syndrome is the most common peripheral compression neuropathy and can be caused by many diseases and conditions, including the formation of gouty tophi in various structures of the tunnel. This publication provides a review of literature and a case report on Carpal tunnel syndrome in a 58-year-old male patient with tophaceous gout. The case is characterized by the extremely rare combination of median nerve compression and tendons dysfunction due to the tophi deposits in the flexor tendons of the hand.

Comparison of Behavioral and Physiological Measures of the Status of the Cochlear Nonlinearity

While an audiogram is a useful method of characterizing hearing loss, it has been suggested that including a complementary, suprathreshold measure, for example, a measure of the status of the cochlear active mechanism, could lead to improved diagnostics and improved hearing-aid fitting in individual listeners. While several behavioral and physiological methods have been proposed to measure the cochlear-nonlinearity characteristics, evidence of a good correspondence between them is lacking, at least in the case of hearing-impaired listeners. If this lack of correspondence is due to, for example, limited reliability of one of such measures, it might be a reason for limited evidence of the benefit of measuring peripheral compression. The aim of this study was to investigate the relation between measures of the peripheral-nonlinearity status estimated using two psychoacoustical methods (based on the notched-noise and temporal-masking curve methods) and otoacoustic emissions, on a large sample of hearing-impaired listeners. While the relation between the estimates from the notched-noise and the otoacoustic emissions experiments was found to be stronger than predicted by the audiogram alone, the relations between the two measures and the temporal-masking based measure did not show the same pattern, that is, the variance shared by any of the two measures with the temporal-masking curve-based measure was also shared with the audiogram.

A New Palmo-Shoulder Compression Association

Carpal tunnel syndrome is a most common peripheral compression neuropathy (1). It is caused by mechanical compression of the median nerve as it traverses the carpal tunnel of the wrist. Classic signs and symptoms are numbness of the lateral three digits and weakness of the thenar muscles due to atrophy (2). Important diagnostic tests in- clude electromyography (EMG) and nerve con- duction studies. The gold standard for the surgical treatment is transection of the transverse carpal ligament.

Cubital tunnel syndrome in Noonan syndrome secondary to hypoplasia of the humeral trochlea

This report describes the case of a 45-year-old woman with Noonan syndrome who developed cubital tunnel syndrome secondary to hypoplasia of the humeral trochlea. Cubital tunnel syndrome, the second-most common peripheral compression neuropathy, is caused by compression of the ulnar nerve at the elbow. Noonan syndrome, an autosomal dominant multisystem disorder, is characterized by variable cognitive deficit and skeletal, ectodermal and hematologic anomalies. Results show three distinctive anatomical features such as (1) hypoplasia of the humeral trochlea and medial epicondyle, (2) absence of the medial intermuscular septum and (3) lack of Osborn’s ligament.

Cubital tunnel syndrome with small occult ganglion: A case report of bike rider

Cubital tunnel syndrome, the second-most common peripheral compression neuropathy, is associated with dynamic pressure in the cubital tunnel with the elbow flexion position. Medial elbow ganglion originated from the ulnohumeral joint causing cubital tunnel syndrome has been reported. This report describes the case of a 48-year-old man who developed numbness in his left ring and little finger after prolonged motorbike touring. He gradually showed decreased hand grip strength with medial elbow joint pain. Ultrasonography and magnetic resonance images revealed small occult ganglion at the medial side of elbow joint. Surgical resection of ganglion and ulnar nerve decompression relieved the ulnar neuropathy symptom. Prolonged motorbike riding while maintaining the elbow flexion position might exacerbate the symptom of cubital tunnel syndrome in patients with even a small space-occupying lesion such as the small occult ganglion.

Interventional Treatment of Neuropathic Pain

Neuropathic pain has been reported to be highly prevalent, severely disabling, and often refractory to pharmacological and noninterventional conservative treatment. There is an emerging body of exciting evidence to support interventional therapies in selected refractory neuropathic pain states, although more randomized controlled trials or comparative effective trials are needed. This chapter updates the scientific evidence in support of the efficacy of neural blockade techniques and neural ablative procedures in neuropathic pain states, including peripheral compression or trauma-related neuropathic pain, herpes zoster and postherpetic neuralgia (PHN), lumbosacral and cervical radiculopathy, sympathetically maintained pain, complex regional pain syndrome (CRPS), trigeminal neuralgia and trigeminal neuropathy, and painful diabetic polyneuropathies.

Usefulness of ultrasound assessment of median nerve mobility in carpal tunnel syndrome

Background Carpal tunnel syndrome (CTS) is the most common peripheral compression neuropathy of the upper extremity. Recently, dynamic ultrasound (US) imaging has shown differences in median nerve mobility between the affected and unaffected sides in CTS. Purpose The present study was performed to compare the median nerve mobility between patients with CTS and healthy individuals, and to correlate median nerve mobility with the severity of CTS. Material and Methods A total of 101 patients (128 wrists) with CTS and 43 healthy individuals (70 wrists) were evaluated. Electrodiagnostic studies were initially conducted to determine the neurophysiological grading scale (NGS). The cross-sectional area (CSA) of the median nerve and the grade of median nerve mobility were measured using US. Results The mean grade of median nerve mobility in the CTS group (1.9) was significantly lower than that in the control group (2.6; P < 0.001). There were significant negative correlations between the grade of median nerve mobility and distal motor latency of the median nerve (r = –0.218, P = 0.015), NGS (r = –0.207, P = 0.020) and CSA of the median nerve (r = –0.196, P = 0.028). Conclusion The grade of median nerve mobility was negatively correlated with the severity of CTS. US assessment of median nerve mobility may be useful in diagnosing and determining the severity of CTS.