Treatment of posterior interosseous nerve entrapment syndrome with ultrasound-guided hydrodissection:A case report

BACKGROUND Posterior interosseous nerve(PIN)entrapment syndrome is one of the causes of weakness and pain of the arm muscles,which is prone to missed diagnosis and misdiagnosis in clinic practice.This paper reports a case of PIN entrapment syndrome,with PIN injury indicated by electrophysiology.Musculoskeletal ultrasound was applied to identify that the entrapment point was located at the inlet of the Frohse arch and the outlet of the supinator muscle.Treatment with ultrasound-guided nerve hydrodissection was performed on the entrapment point,which significantly improved the symptoms.Ultrasound-guided nerve hydrodissection is an effective therapeutic method for PIN entrapment syndrome.CASE SUMMARY A male patient,35 years old,worked as an automobile mechanic.He felt slightly weak extension activity of his right fingers 2 years ago but sought no treatment.Later,the symptoms gradually became aggravated and led to finger drop,particularly severe in the right middle finger,accompanied by supination weakness of the right forearm.Neural electrophysiological examination showed that the patient had partial PIN injury of the right radius.Musculoskeletal ultrasound examination indicated PIN entrapment at the inlet of the Frohse arch and the outlet of the supinator muscle.Therefore,PIN entrapment syndrome was diagnosed.After treatment with ultrasound-guided nerve hydrodissection around the entrapment point,the dorsiflexion weakness of the right hand was significantly improved compared with before treatment.CONCLUSION Ultrasound-guided hydrodissection is efficacious for PIN entrapment syndrome,with high clinical value and great application prospects.

Ultrasound-guided rectus sheath block for anterior cutaneous nerve entrapment syndrome after laparoscopic surgery:A case report

BACKGROUND Anterior cutaneous nerve entrapment syndrome is defined as abdominal pain due to entrapped intercostal nerves.This is the first report of a patient successfully treated for anterior cutaneous nerve entrapment syndrome after laparoscopic surgery with an ultrasound-guided rectus sheath block.The rectus sheath block physically lysed adhesions and relieved pain from anterior cutaneous nerve entrapment syndrome.CASE SUMMARY The patient is a 44-year-old man who presented with severe left upper abdominal pain at an operative scar one month after laparoscopic ulcer repair.Diagnosis and treatment were performed using an ultrasound-guided rectus sheath block with 0.1%lidocaine 20 mL.The pain was relieved after the block.The diagnosis was anterior cutaneous nerve entrapment syndrome.Rectus sheath block may be effective for patients with anterior cutaneous nerve entrapment syndrome.CONCLUSION Ultrasound-guided rectus sheath block is a promising treatment modality for patients with postoperative anterior cutaneous nerve entrapment syndrome due to adhesions.

Long round-sharp needle release technique for 34 cases of superior cluneal nerve entrapment syndrome

Objective:To observe the clinical effect on superior cluneal nerve(SCN)entrapment syndrome treated with the release technique of long round-sharp needle.Methods:The syndrome differentiation based on meridian muscle region was adopted.The release technique of the long round-sharp needle was used at the lesions of meridian tendon region,Yāoyícì(Beside Yaoyi)and the transverse process of the third lumbar vertebra in 34 patients with SCN entrapment syndrome.The treatment was given once a week,4 treatments made one course.After one course treatment,the therapeutic effect was observed.The results of pain rating index(PRI),the visual analogy scores(VAS)and the present pain intensity(PPI)were compared before and after treatment.Results:Of 34 patients,28 cases(82%)were cured,6 cases(18%)effective and 0 case(0%)failed.The total effective rate was 100%.The scores of PRI,VAS and PPI were(10.78±1.98),(5.98±1.19)and(3.91±1.68)successively in 34 cases before treatment and they were(1.98±1.79),(0.89±1.12)and(0.82±0.79)after treatment.The score of every evaluation scale after treatment was lower significantly than that before treatment(all P<0.01).Conclusion:The release technique of long round-sharp needle achieves the satisfactory clinical effect on SCN entrapment syndrome.Hence,this therapeutic method deserves to be promoted.

Establishment of an animal model of extra-vertebral foramen cervical nerve entrapment by local electrical stimulation and selection of suitable stimulation parameters

A rat model of extra-vertebral foramen cervical nerve entrapment was established according to the following parameters： stimulation intensity 20 V; frequency 50 Hz; pulse width 200 μs; duration 333 ms/s for a total of 8 hours. After the electrical stimulation, rats exhibited mild muscle fiber atrophy, mild inflammatory exudates, connective tissue local fibrosis and chondrocyte metaplasia. Mean muscle fiber cross-sectional area was reduced. The nerve myelin sheath continuity was partially demyelinated. The microstructure of nerve cells was disrupted and these symptoms worsened with prolongation of the stimulation. The shoulder, neck and upper extremity muscles on the tested side demonstrated positive sharp waves and fibrillations. The severity increased with continuation of the stimulation. High amplitude and polyphasic motor unit potentials gradually appeared. Similar findings were seen in the contralateral side, but at a less severe level.

Myeloid sarcoma with ulnar nerve entrapment:A case report

BACKGROUND Myeloid sarcoma(MS) is relatively rare,occurring mainly in the skin and lymph nodes,and MS invasion of the ulnar nerve is particularly unusual.The main aim of this article is to present a case of MS invading the brachial plexus,causing ulnar nerve entrapment syndrome,and to further clinical understanding of the possibility of MS invasion of peripheral nerves.CASE SUMMARY We present the case of a 46-year-old man with a 13-year history of well-treated acute nonlymphocytic leukaemia who was admitted to the hospital after presenting with numbness and pain in his left little finger.The initial diagnosis was considered a simple case of nerve entrapment disease,with magnetic resonance imaging showing slightly abnormal left brachial plexus nerve alignment with local thickening,entrapment,and high signal on compression lipid images.Due to the severity of the ulnar nerve compression,we surgically investigated and cleared the entrapment and nerve tissue hyperplasia;however,subsequent pathological biopsy results revealed evidence of MS.The patient had significant relief from his neurological symptoms,with no postoperative complications,and was referred to the haemato-oncology department for further consultation about the primary disease.This is the first report of safe treatment of ulnar nerve entrapment from MS.It is intended to inform hand surgeons that nerve entrapment may be associated with extramedullary MS,as a rare presenting feature of the disease.CONCLUSION MS invasion of the brachial plexus and surrounding tissues of the upper arm,resulting in ulnar nerve entrapment and degeneration with significant neurological pain and numbness in the little finger,is uncommon.Surgical treatment significantly relieved the patient’s nerve entrapment symptoms and prevented further neurological impairment.This case is reported to highlight the rare presenting features of MS.