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Median Nerve Injury at the Elbow

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1. Relationship of the Median and Radial Nerves at the Elbow: Application to Avoiding Injury During Venipuncture or Other Invasive Procedures of the Cubital Fossa Full Text available with Trip Pro

Relationship of the Median and Radial Nerves at the Elbow: Application to Avoiding Injury During Venipuncture or Other Invasive Procedures of the Cubital Fossa The median and radial nerves are two important neural structures found in the cubital fossa. The trajectory and landmarks used to identify their location are important when procedures are done in this area.Ten fresh-frozen cadavers were dissected (20 upper limbs) and measurements were taken from the medial epicondyle to the median (...) tried to identify the course of these nerves in order to prevent their injury during procedures.After identifying the medial epicondyle, using the results we obtained, physicians may have a better understanding of where the median and radial nerves lie within the cubital fossa when performing procedures in this area.

2017 Cureus

2. Median Nerve Injury at the Elbow

Median Nerve Injury at the Elbow Median Nerve Injury at the Elbow Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Median Nerve Injury (...) at the Elbow Median Nerve Injury at the Elbow Aka: Median Nerve Injury at the Elbow , Pronator Syndrome From Related Chapters II. Pathophysiology compression of the via the pronator teres muscle III. Differential Diagnosis IV. Symptoms discomfort and ache Provoked with elbow extension s in the thumb, index and middle finger V. Signs Sensory loss over thenar eminence (not present in ) absent (contrast with ) Phalen maneuver (contrast with ) Normal sensation Sensation in fingers may also be normal VI

2018 FP Notebook

3. The effect of paired corticospinal-motoneuronal stimulation on maximal voluntary elbow flexion in cervical spinal cord injury: an experimental study. (Abstract)

injury.Neuroscience Research Australia, Sydney, Australia.PCMS comprised 100 pairs of transcranial magnetic and electrical peripheral nerve stimulation (0.1 Hz), timed so corticospinal potentials arrived at corticospinal-motoneuronal synapses 1.5 ms before antidromic motoneuronal potentials. On two separate days, sets of five maximal elbow flexions were performed by 11 individuals with weak elbow flexors post C4 or C5 spinal cord injury before and after PCMS or control (100 peripheral nerve stimuli) conditioning (...) The effect of paired corticospinal-motoneuronal stimulation on maximal voluntary elbow flexion in cervical spinal cord injury: an experimental study. Randomised, controlled, crossover study.Paired corticospinal-motoneuronal stimulation (PCMS) involves repeatedly pairing stimuli to corticospinal neurones and motoneurones to induce changes in corticospinal transmission. Here, we examined whether PCMS could enhance maximal voluntary elbow flexion in people with cervical spinal cord

2019 Spinal cord Controlled trial quality: uncertain

4. Acute Combined Median and Radial Nerve Palsies after Distal Humeral Shaft Fracture Full Text available with Trip Pro

Acute Combined Median and Radial Nerve Palsies after Distal Humeral Shaft Fracture We report a case of a 29-year-old man who presented with a distal humeral shaft fracture sustained by blunt trauma. Physical examination and nerve conduction study were consistent with injury to the median and radial nerves proximal to the elbow. The patient underwent open reduction and internal fixation of the humeral shaft fracture with neurolysis of the median and radial nerves. Repeat electromyography at 6 (...) months postoperatively showed recruitment of motor units in all muscles sampled, in keeping with clinical improvement. At 16 months follow-up, the patient was full strength in all muscle groups, was back to all activities with no restrictions, and was discharged from follow-up. Our case describes clinical improvement after surgical intervention in a patient with combined median and radial nerve palsies following distal humeral shaft fracture. Level of evidence: V.

2018 Archives of bone and joint surgery

5. Pseudoaneurysm of brachial artery: A rare cause of median nerve compression Full Text available with Trip Pro

Pseudoaneurysm of brachial artery: A rare cause of median nerve compression The authors present an unusual clinical case of high median nerve compression caused by an iatrogenic pseudoaneurysm of the brachial artery after an angiography with a follow up of 9 months.A 73-year-old male was seen with progressive numbness, loss of opponency and diminution of strength of finger flexion in the left hand after an angiography with direct puncture of the left humeral artery. Physical examination (...) thrombosed causing severe compression of the median nerve. Microsurgical neurolysis of the median nerve was performed and the pseudoaneurysm was removed.At 9 months of follow-up the patient had total recovery of flexion of the thumb and forefinger and recovery of opposition with slight hypoesthesia on the volar surface of the radial fingers of the hand.This case represents a rare form of high median nerve compression after angiography. The increased use of endovascular procedures may cause a higher

2018 Trauma Case Reports

6. Elbow Positioning and Joint Insufflation Substantially Influence Median and Radial Nerve Locations. Full Text available with Trip Pro

Elbow Positioning and Joint Insufflation Substantially Influence Median and Radial Nerve Locations. The median and radial nerves are at risk of iatrogenic injury when performing arthroscopic arthrolysis with anterior capsulectomy. Although prior anatomic studies have identified the position of these nerves, little is known about how elbow positioning and joint insufflation might influence nerve locations.In a cadaver model, we sought to determine whether (1) the locations of the median (...) and radial nerves change with variation of elbow positioning; and whether (2) flexion and joint insufflation increase the distance of the median and radial nerves to osseous landmarks after correcting for differences in size of the cadaveric specimens.The median and radial nerves were marked with a radiopaque thread in 11 fresh-frozen elbow specimens. Three-dimensional radiographic scans were performed in extension, in 90° flexion, and after joint insufflations in neutral rotation, pronation

2015 Clinical Orthopaedics and Related Research

7. Locating the ulnar nerve during elbow arthroscopy using palpation is only accurate proximal to the medial epicondyle. Full Text available with Trip Pro

Locating the ulnar nerve during elbow arthroscopy using palpation is only accurate proximal to the medial epicondyle. Knowledge of ulnar nerve position is of utmost importance to avoid iatrogenic injury in elbow arthroscopy. The aim of this study was to determine how accurate surgeons are in locating the ulnar nerve after fluid extravasation has already occurred, and basing their localization solely on palpation of anatomical landmarks.Seven cadaveric elbows were used and seven experienced (...) using a standard medial elbow approach and the distances between the pins and ulnar nerve were measured.The median distance between the ulnar nerve and the proximal pins was 0 mm (range 0-0 mm), and between the ulnar nerve and the distal pins was 2 mm (range 0-10 mm), showing a statistically significant difference (p = 0.009). All seven proximally placed pins (100%) transfixed the ulnar nerve versus two out of seven distally placed pins (29%) (p = 0.021).In a setting simulating an already initiated

2018 Knee Surgery, Sports Traumatology, Arthroscopy

8. Reappraisal of Clinical Deficits Following High Median Nerve Injuries. Full Text available with Trip Pro

Reappraisal of Clinical Deficits Following High Median Nerve Injuries. To describe clinically apparent motor and sensory deficits in a cohort of 11 patients with isolated injury of the median nerve above the elbow and compare them against similar cases reported in the literature.Eleven patients of mean age 30 years (SD ± 14 years; 6 males, 5 females) were examined a mean of 21 weeks (SD ± 16 weeks) after an isolated high median nerve injury. Pronation, wrist flexion, and finger flexion range (...) of the index and middle fingers and the distal phalanx of the thumb.Noteworthy discrepancies were identified between the clinical motor and sensory deficits described in the literature and those observed in our patients.In most patients with a high median nerve injury, only thumb and index flexion and palmar sensation warrant surgical reconstruction. Decreased grasp and pinch strength was a major finding that should also be addressed by surgery.Prognostic IV.Copyright © 2016 American Society for Surgery

2016 Journal of Hand Surgery - American

9. A Touch-Observation and Task-Based Mirror Therapy Protocol to Improve Sensorimotor Control and Functional Capability of Hands for Patients With Peripheral Nerve Injury. (Abstract)

recruited 12 patients with median or ulnar nerve repair between the level of midpalm and elbow referred by the plastic surgeons.The patients were randomized into touch-observation and task-based mirror therapy or control groups, and both groups received training for 12 wk.The Semmes-Weinstein monofilament (SWM) test, two-point discrimination test, Purdue Pegboard Test (PPT), Minnesota Manual Dexterity Test (MMDT), and pinch-holding-up activity test were assessed at pretreatment, immediately after (...) A Touch-Observation and Task-Based Mirror Therapy Protocol to Improve Sensorimotor Control and Functional Capability of Hands for Patients With Peripheral Nerve Injury. To develop a practical program in the early phase after nerve repair for more rapid return of function.To investigate the effects of touch-observation and task-based mirror therapy on the sensorimotor outcomes of patients with nerve repair.An assessor-blinded study with a randomized controlled design.University hospital.We

2019 The American journal of occupational therapy : official publication of the American Occupational Therapy Association Controlled trial quality: uncertain

10. Median Nerve Injury at the Elbow

Median Nerve Injury at the Elbow Median Nerve Injury at the Elbow Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Median Nerve Injury (...) at the Elbow Median Nerve Injury at the Elbow Aka: Median Nerve Injury at the Elbow , Pronator Syndrome From Related Chapters II. Pathophysiology compression of the via the pronator teres muscle III. Differential Diagnosis IV. Symptoms discomfort and ache Provoked with elbow extension s in the thumb, index and middle finger V. Signs Sensory loss over thenar eminence (not present in ) absent (contrast with ) Phalen maneuver (contrast with ) Normal sensation Sensation in fingers may also be normal VI

2015 FP Notebook

11. Subcutaneous Injury to the Median Nerve at the Elbow Full Text available with Trip Pro

Subcutaneous Injury to the Median Nerve at the Elbow 19978265 2010 06 24 2010 06 24 0035-9157 7 Sect Study Dis Child 1914 Proceedings of the Royal Society of Medicine Proc. R. Soc. Med. Subcutaneous Injury to the Median Nerve at the Elbow. 111 Boyd S S eng Journal Article England Proc R Soc Med 7505890 0035-9157 2009 12 9 6 0 1914 1 1 0 0 1914 1 1 0 1 ppublish 19978265 PMC2003248

1914 Proceedings of the Royal Society of Medicine

12. Evaluation of nerve transfer options for treating total brachial plexus avulsion injury: a retrospective study of 73 participants Full Text available with Trip Pro

reconstructed by intercostal nerve transfer (31 cases). Overall, the recommended surgical treatment for total brachial plexus-avulsion injury is phrenic nerve transfer for elbow flexion, accessory nerve + intercostal nerve transfer for shoulder function, intercostal nerves transfer for elbow extension, entire contralateral C7 transfer for median nerve function, and intercostal nerve transfer for finger extension. The trial was registered at ClinicalTrials.gov (identifier: NCT03166033). (...) brachial plexus avulsion injury were followed up for an average of 7.3 years. Our analysis demonstrated no significant difference in elbow-flexion recovery between phrenic nerve-transfer (25 cases), phrenic nerve-graft (19 cases), intercostal nerve (17 cases), or contralateral C7-transfer (12 cases) groups. Restoration of shoulder function was attempted through anterior accessory nerve (27 cases), posterior accessory nerve (10 cases), intercostal nerve (5 cases), or accessory + intercostal nerve

2018 Neural Regeneration Research

13. Early Functional Recovery of Elbow Flexion and Supination Following Median and/or Ulnar Nerve Fascicle Transfer in Upper Neonatal Brachial Plexus Palsy. (Abstract)

Early Functional Recovery of Elbow Flexion and Supination Following Median and/or Ulnar Nerve Fascicle Transfer in Upper Neonatal Brachial Plexus Palsy. Nerve transfers using ulnar and/or median nerve fascicles to restore elbow flexion have been widely used following traumatic brachial plexus injury, but their utility following neonatal brachial plexus palsy remains unclear. The present multicenter study tested the hypothesis that these transfers can restore elbow flexion and supination (...) in infants with neonatal brachial plexus palsy.We retrospectively reviewed the cases of thirty-one patients at three institutions who had undergone ulnar and/or median nerve fascicle transfer to the biceps and/or brachialis branches of the musculocutaneous nerve after neonatal brachial plexus palsy. The primary outcome measures were postoperative elbow flexion and supination as measured with the Active Movement Scale (AMS). Patients were followed for at least eighteen months postoperatively unless

2014 The Journal of Bone and Joint Surgery. American Volume

14. Tiny Tip: Is this a ‘CASE’ of an elbow fracture?

examination is vital to rule out potential injuries to the brachial artery, median, radial and/or ulnar nerves. Chandra Avery MD Dr. Avery is a Staff Physician at IWK Health Centre, Halifax, Nova Scotia. (Visited 702 times, 1 visits today) Graham Wilson Graham Wilson is a medical student at Dalhousie University. Latest posts by Graham Wilson ( ) - June 23, 2017 Follow CRACKCast Schedule Mondays: CRACKCast Tuesdays: Medical Concepts Wednesdays: Opinion Thursdays: Throwbacks Fridays: National Interest (...) Tiny Tip: Is this a ‘CASE’ of an elbow fracture? Tiny Tip: Is this a ‘CASE’ of an elbow fracture? - CanadiEM Tiny Tip: Is this a ‘CASE’ of an elbow fracture? In , by Graham Wilson June 23, 2017 An elbow fracture is a common pediatric injury in emergency medicine. These fractures present challenges in diagnosis due to the maturing skeletal anatomy and the subtlety of these injuries. 1 Plain radiographs are adequate to detect elbow fractures in most cases and a systematic approach can help

2017 CandiEM

15. Overview of sport-related injuries

injury may be acute, subacute, or chronic, and occurs due to direct cord damage caused by compression and/or infiltration, or compromise of the vascular supply to the cord. Diagnosis is made by x-ray or MRI of the spine, but spinal cord injury may occur with no findings on imaging. Most commonly results from contact sport, as well as from motor vehicle accidents, gunshot or stab wounds, or workplace accidents during heavy physical labour. May involve the upper 2 or 3 nerve roots (partial injury (...) ) or all 5 nerve roots (complete injury). Both partial and complete brachial plexus injuries can be successfully repaired, but complete injuries require multiple major operations over the course of several years, while partial injuries can often be corrected in a single operation. Rotator cuff tears can result from an acute traumatic event, repetitive or vigorous overhead activity (such as throwing a baseball or weightlifting), or chronic degeneration. The most common presenting symptom is shoulder

2018 BMJ Best Practice

16. Repair of a median nerve transection injury using multiple nerve transfers, with long-term functional recovery. Full Text available with Trip Pro

Repair of a median nerve transection injury using multiple nerve transfers, with long-term functional recovery. Complete loss of median nerve motor function is a rare but devastating injury. Loss of median motor hand function and upper-extremity pronation can significantly impact a patient's ability to perform many activities of daily living independently. The authors report the long-term follow-up in a case of median nerve motor fiber transection that occurred during an arthroscopic elbow (...) procedure, which was then treated with multiple nerve transfers. Motor reconstruction used the nerves to the supinator and extensor carpi radialis brevis to transfer to the anterior interosseous nerve and pronator. Sensory sensation was restored using the lateral antebrachial cutaneous (LABC) nerve to transfer to a portion of the sensory component of the median nerve, and a second cable of LABC nerve as a direct median nerve sensory graft. The patient ultimately recovered near normal motor function

2012 Journal of Neurosurgery

17. CRACKCast Episode 142 – Electrical and Lightning Injuries

are a common result, most often involving the median and ulnar nerves. Neuropsychiatric sequelae include anxiety, depression, mood lability, difficulty concentrating, and insomnia. These may become a persistent source of disability. HEENT: Early cataract formation vitreous and anterior chamber hemorrhages, retinal detachment, macular lacerations, and corneal or conjunctival burns. Extremities Vascular injury – thrombosis or aneurysm formation leading to tissue ischemia / necrosis Muscle necrosis Vascular (...) of ™ due to shock wave / blast effect (expansion effect from air) Hearing loss, tinnitus, vertigo, Eyes Immediate or delayed onset of cataracts Paralysis of ciliary muscle Other injuries Due to blunt trauma or blast injury ….we’ll re-summarize this in the next question! [6] List clinical findings (early and late) associated with electrical injuries. Early: go head to toe CNS Apnea, LOC, amnesia, peripheral nerve damage/paralysis, keraunoparalysis Cardiovascular Asystole (DC or lightning

2018 CandiEM

18. Nociceptive and Histomorphometric Evaluation of Neural Mobilization in Experimental Injury of the Median Nerve Full Text available with Trip Pro

Nociceptive and Histomorphometric Evaluation of Neural Mobilization in Experimental Injury of the Median Nerve The carpal tunnel syndrome is the most common peripheral neuropathy in the upper limb, but its treatment with conservative therapies such as neural mobilization (NM) is still controversial. The aim of this study was to investigate the efficacy of the NM as treatment in a model of median nerve compression. 18 Wistar rats were subjected to compression of the median nerve in the right (...) elbow proximal region. Were randomly divided into G1 (untreated), G2 (NM for 1 minute), and G3 (NM for 3 minutes). For treatment, the animals were anesthetized and the right forelimb received mobilization adapted to humans, on alternated days, from the 3rd to the 13th day postoperatively (PO), totaling six days of therapy. Nociception was assessed by withdrawal threshold, and after euthanasia histomorphometric analysis of the median nerve was performed. The nociceptive evaluation showed in G2 and G3

2013 The Scientific World Journal

19. CRACKCast E052 – Orthopedics – Humerus and Elbow

parallel to the median nerve until half-way down the humerus, and then it moves medially It passes BEHIND the medial epicondyle which puts it at risk of injury. Elbow Bursae: Olecranon bursa (elbow skin gliding) Radiohumeral bursa (supination/pronation) Bicep tendon cushioning bursa – protects the radius during elbow flexion Clinical features: History: standard stuff Physical: Compare bilaterally In kids: Note the position it is held in: Extension type supra-condylar #’s are held at the side with an S (...) injury – hyperextension with a valgus force levers the ulna from the trochlea The distal humerus gets lodged on the coronoid process Arm held in 45 degrees of flexion Assess for brachial artery and median nerve injury From initial injury, reduction, or swelling Radiographs are important pre-reduction to investigate for possible fractures Reduction: Facilitated by procedural sedation, intra-articular anesthesia or regional block Assistant provides counter traction Elbow at 30 degrees of flexion

2016 CandiEM

20. Transfer of median and ulnar nerve fascicles for lesions of the posterior cord in infraclavicular brachial plexus injury: report of 2 cases. (Abstract)

Transfer of median and ulnar nerve fascicles for lesions of the posterior cord in infraclavicular brachial plexus injury: report of 2 cases. In infraclavicular lesions of brachial plexus, severe lesions of the posterior cord often occur when medial and lateral cord function is preserved to a greater or lesser extent. In these cases, shoulder function may be preserved by activity of the muscles innervated by the suprascapular nerve, but complete paralysis exists in the deltoid, triceps (...) , and brachioradialis, and all wrist and finger extensors. Classical reconstruction procedures consist of nerve grafts, but their results in adults are disappointing. We report an approach transferring: (1) an ulnar nerve fascicle to the motor branch of the long portion of the triceps brachii muscle, (2) a median nerve branch from the pronator teres to the motor branch of the extensor carpi radialis longus, and (3) a median nerve branch from the flexor carpi radialis to the posterior interosseous nerve. We describe

2012 Journal of Hand Surgery - American

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