Pudendal nerve entrapment syndrome is an unusual cause of chronic pelvic pain. We experienced a case of pudendal neuralgia associated with a ganglion cyst. A 60-year-old male patient with a tingling sensation and burning pain in the right buttock and perineal area visited our outpatient rehabilitation center. Pelvis magnetic resonance imaging showed the presence of multiple ganglion cysts around the right ischial spine and sacrospinous ligament, and the pudendal nerve and vessel bundle were located between the ischial spine and ganglion cyst at the entrance of Alcock's canal. We aspirated the lesions under ultrasound guidance, and consequently his symptoms subsided during a 6-month follow-up. This is the first report of pudendal neuralgia caused by compression from a ganglion cyst around the sacrospinous ligament.
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Intestinal entrapment between two vertebral bodies is very rare. In all previous cases, it occurred by major trauma. However, the bowel entrapment between two vertebral bodies without trauma has never been reported, not to mention as the cause of lower extremity radicular pain. We describe the case of an 82-year-old female patient with right lower extremity radicular pain without recent trauma history. The patient was diagnosed sigmoid colon entrapment between the L5 and S1 vertebrae by lumbar spinal computerized tomography and magnetic resonance imaging, and showed improvement in radicular pain after manual reduction of interpositioned colon during surgery. Intestinal entrapment between two vertebrae without trauma is caused by degenerative and vacuum changes of the intervertebral disc combined with the anterior longitudinal ligament injury.
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To demonstrate the prevalence and characteristics of subclinical ulnar neuropathy at the elbow in diabetic patients.
One hundred and five patients with diabetes mellitus were recruited for the study of ulnar nerve conduction analysis. Clinical and demographic characteristics were assessed. Electrodiagnosis of ulnar neuropathy at the elbow was based on the criteria of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM1 and AANEM2). The inching test of the ulnar motor nerve was additionally performed to localize the lesion.
The duration of diabetes, the existence of diabetic polyneuropathy (DPN) symptoms, the duration of symptoms, and HbA1C showed significantly larger values in the DPN group (p<0.05). Ulnar neuropathy at the elbow was more common in the DPN group. There was a statistically significant difference in the number of cases that met the three diagnostic criteria between the no DPN group and the DPN group. The most common location for ulnar mononeuropathy at the elbow was the retrocondylar groove.
Ulnar neuropathy at the elbow is more common in patients with DPN. If the conduction velocities of both the elbow and forearm segments are decreased to less than 50 m/s, it may be useful to apply the AANEM2 criteria and inching test to diagnose ulnar neuropathy.
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Objective: The aim of this study is to know the usefulness of ultrasonographic evaluation in the musculoskeletal disease.
Method: Thirty-nine cases with musculoskeletal pain were evaluated by physical examination, Cyriax selective tension technique, simple X-ray, electromyography, arthrography, Computed tomography, Magnetic resonance image and the high-resolution realtime ultrasonography to define the location of pain. The ultasonographic results were compared to other diagnostic methods.
Results: The ultrasonographic findings are as follow; 22 tendinitis, 7 entrapment neuropathies, 6 bursitis, 2 ligament injuries, and 2 rotator cuff injuries. Clinical diagnosis were matched with ultrasonographic findings in 30 cases out of 39. The most common ultrasonographic findings in 22 tendinitis cases were hypoechogenicity in affected tendon. Ultrasonographic findings in 7 entrapment neuropathies were 6 nerve swellings and 1 nerve flattening.
Conclusion: The ultrasonography can provide detailed images of musculoskeletal system, including tendons, nerves and subcutaneous tissue. Therefore the ultrasonography is very useful in diagnosis and treatment of some musculoskeletal diseases such as tendinitis and entrapment neuropathy.
Cystic entrapment of infraspinatus branch of suprascapular nerve is a rare cause of shoulder pain with infraspinatus atrophy. We discuss the ultrasonographic diagnosis and ultrasonography- guided aspiration of the cyst as a treatment.
Case: A 37-year-old, ship-yard laborer had experienced left shoulder discomfort and pain without trauma history. Physical examination showed profound selective atrophy of left infraspinatus muscle. Simple X-ray of shoulder showed normal findings. Electrodiagnostic examination revealed delayed motor latency of infraspinatus branch of suprascapular nerve and denervation potentials of infraspinatus muscle exclusively. Ultrasonographic finding showed 13.5⁓21.5 mm sized cystic mass around left infraspinatus notch. Ultrasonography-guided aspiration was done, and then electrical stimulation therapy and strengthening exercise of left shoulder were performed. Symptoms were improved.
We report a rare case of cystic entrapment of infraspinatus branch of suprascapular nerve in a patient without traumatic insult.
Objective: To determine the frequency, involved nerves and sites of entrapment neuropathy in string players.
Method: The subjects were 24 string playing musicians and age matched 24 normal controls. Questionnaire, physical examination were taken in the musicians and the electrodiagnostic study was performed in both the musician and the control groups. Electrodiagnostic study included nerve conduction study of median and ulnar nerves. The distal motor latency, segmental motor conduction velocity, distal sensory latency, and amplitude of sensory nerve action potentials were measured. Each parameter of nerve conduction study was compared in two groups and was correlated to the string playing duration.
Results: Three musicians (12.5%) were diagnosed as entrapment neuropathy: One, left ulnar neuropathy at the elbow and the wrist and left median neuropathy at the wrist; Two, left ulnar neuropathy at the elbow. Ulnar motor conduction velocity of right forearm segment and left elbow segment were significantly reduced in the musicians compared to those of the controls (P＜0.05). The distal sensory latency of left ulnar nerve was significantly prolonged in musicians compared to that of the controls (P＜0.05). The string playing duration significantly correlated with the distal motor latency of right median nerve (R=0.632, P＜0.05) and the distal sensory latency of left median nerve (R=0.518, P＜0.05).
Conclusions: These results suggest that some entrapment neuropathies could be developed due to cumulative trauma in string players. Elbow and wrist segment of left ulnar nerve, forearm segment of right ulnar nerve are possible sites of entrapment neuropathy in string players.
Objective: To determine the reference values for the diagnosis of isolated entrapment neuropathies of medial and lateral plantar nerve and inferior calcaneal nerve distal to the tarsal tunnel.
Method: The subjects were neurologically healthy 30 adults (15 males, 15 females). Distal motor nerve conduction study of medial and lateral plantar nerves and inferior calcaneal nerve was performed. The recording muscles for medial and lateral plantar nerves and inferior calcaneal nerve were flexor hallucis brevis, flexor digiti minimi brevis, and abductor digiti minimi pedis, respectively. The stimulation was done at distal and proximal to the tarsal tunnel to differentiate the tarsal tunnel syndrome and the entrapment neuropathy of distal to the tarsal tunnel. The distance of recording and distal stimulation site was fixed to 10 cm for medial and lateral plantar nerves. The skin temperature was maintained 33oC or above. The proximal latency, distal latency, peak to peak amplitude, conduction velocity and residual latency were measured. The reference values were obtained by 95 percentile values.
Results: The reference values for the diagnosis of isolated entrapment neuropathies of medial plantar nerve, lateral plantar nerve and inferior calcaneal nerve distal to tarsal tunnel are as follows.
1) Medial plantar nerve: distal latency, ＞ 4.3 msec; side to side difference, ＞ 0.7 msec
2) Lateral plantar nerve: distal latency, ＞ 4.1 msec; side to side difference, ＞ 0.6 msec
3) Latency difference of medial and lateral plantar nerve: ＞ 0.7 msec
4) Inferior calcaneal nerve: distal latency, ＞ 4.3 msec; distal peak latency, ＞ 7.2 msec; side to side difference of distal onset latency, ＞ 1.5 msec; side to side difference of distal peak latency, ＞ 0.8 msec; residual latency, ＞ 3.0 msec
Conclusion: The distal motor nerve conduction method used in this study and the reference values could be used to differentiate entrapment neuropathies of medial and lateral plantar nerve and inferior calcaneal nerve distal to the tarsal tunnel from tarsal tunnel syndrome.
Objective: To determine the prevalence, location, and risk factors for the peripheral nerve entrapments of upper extremity among the crutch or cane users.
Method: We performed the clinical and electrodiagnostic assessments of both upper extremities in 43 crutch or cane users and 49 able-bodied controls.
Results: The prevalence for the nerve entrapment of upper extremity among the crutch or cane users was 27.9% by the clinical criteria and 86.0% by the electrodiagnostic criteria. Electrodiagnostically, the median nerve entrapment was 76.7%, and the ulnar nerve entrapment was 72.1% among the crutch or cane users. The carpal tunnel was the most common site for the entrapment. Body weight, duration of disability, and duration of crutch or cane use were found to be significantly correlated with the emtrapments of median nerve, whereas duration of crutch or cane use alone was significantly correlated with the entrapments of ulnar nerve.
Conclusion: The peripheral nerve entrapments of upper extremity is associated with the chronic crutch or cane use and the preventive strategies need to be developed for the patients with risks.
Baker's cyst is commonly associated with intraarticular pathology such as degenerative arthritis. Few cases of neural compression by a Baker's cyst in the popliteal fossa have been reported with intraarticular pathology. We report a case of peroneal nerve compression by an atypical Baker's cyst in a child without intraarticular pathology. A 10-year-old boy had 6-month history of the left foot drop without a known trauma. There was no swelling or pain in the knee. The electrodiagnostic study demonstrated a profound lesion of the deep peroneal nerve and a mild denervation of the superfical peroneal nerve. Magnetic resonance images displayed an atypical Baker's cyst originating from the popliteal fossa and extending to the posterolateral side of the fibular head. Clinical and electrophysiological findings improved after aspiration of the cyst.
Pain, numbness, and weakness in the upper extremity are the common problems among wheelchair users. The prevalence of nerve injury of the upper extremity in the wheelchair users has been reported variously by many authors in other nations. To determine the prevalence, location, and risk factors of upper extremity peripheral nerve entrapment among wheelchair users, we performed clinical and electrodiagnostic assessments on both upper extremities of wheelchair users (n=49) and able-bodied controls (n=49).
The prevalence of nerve entrapment of the upper extremity among the wheelchair users was 15.6% according to clinical criteria, and 46.9% according to electrodiagnostic criteria. Electrodiagnostically, median nerve entrapment was identified in 28.6% of tested cases, and ulnar nerve entrapment was identified in 22.4% of tested cases among wheelchair users. The carpal tunnel was the most common site of nerve entrapment. The duration of wheelchair use was found to be correlated negatively with median wrist to palm and wrist to digit sensory conduction velocity, whereas age correlated positively with distal median and ulnar motor latency.
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