OBJECTIVE: To explore the safety of classic Acupotomy in the treatment of carpal tunnel syndrome. METHODS: Twenty six adult specimens (15 males and 11 females), aged 60 to 95(82.54±6.94) years old, were selected from 10% formalin antiseptic fixation. There were 52 sides(two of them could not be tested). The study period was from November 2017 to May 2018. The specimens were collected from the body donation center of the school of basic medicine, Peking University. The operation of releasing the transverse carpal ligament on the human body specimen was simulated by the classic acupotomy, and the distance from the four points to the surrounding anatomical structure was measured to calculate the direct injury rate to the nerve and blood vessels, and the shortest distance between the acupotomy and the nerve and blood vessels was defined as ≥2 mm as safety. RESULTS: In the experimental operation, the direct injury rate of nerve and blood vessel was 14% and 12% respectively. There was significant difference in the rate of direct nerve injury between the four injection points (<0.05). There was no significant difference in the rate of direct vascular injury between the four injection points (>0.05). Among the four points, there was a statistically significant difference in the safety of nerves(<0.05), and the safety of point 1 and point 3 of radial injection was higher than that of point 2 and point 4 of ulnar injection(<0.05). There was significant difference in the safety of blood vessels between the four points(<0.05), and the safety of radial point 1 was higher than that of ulnar point 2 and point 4 (<0.05). CONCLUSION The safety of the classic Acupotomy for carpal tunnel syndrome is related to the location of the needle entry point, and the safety of theradial proximal end of the needle is the highest.
Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Carpal Tunnel Syndrome ; Female ; Humans ; Ligaments, Articular ; Male ; Median Nerve ; injuries ; Middle Aged ; Needles ; Wrist Joint

Forearm fractures are common injuries in childhood. Median nerve entrapment is a rare complication of forearm fractures, but several cases have been reported in the literature. This case report discusses the diagnosis and management of median nerve entrapment in a 13-year-old male who presented acutely with a both-bone forearm fracture and numbness in the median nerve distribution. Following the delayed diagnosis, surgical exploration revealed complete nerve entrapment and a nerve graft was performed.
Adolescent ; Bony Callus ; Delayed Diagnosis ; Diagnosis ; Forearm Injuries ; Forearm ; Fractures, Bone ; Humans ; Hypesthesia ; Male ; Median Nerve ; Nerve Compression Syndromes ; Transplants

The reported cases of upper limb nerve injury followed by needle procedure such as intramuscular injection or routine venipuncture are rare. However, it should not be overlooked, because neurological injury may cause not only minor transient pain but also severe sensory disturbance, hand deformity and motor dysfunction with poor recovery. Recognizing competent level of anatomy and adept skill of needle placement are crucial in order to prevent this complication. If a patient notices any experience of abnormal pain or paresthesia during the needle procedures, an administrator should be alert to the possibility of nerve injury and should withdraw the needle immediately. Careful monitoring of the injection site for hours is required for early detection of nerve injury.
Administrative Personnel ; Catheterization, Peripheral ; Hand Deformities ; Humans ; Injections, Intramuscular* ; Median Neuropathy ; Needles ; Paresthesia ; Peripheral Nerve Injuries ; Phlebotomy* ; Radial Neuropathy ; Ulnar Neuropathies ; Upper Extremity*

Dystonia is a movement disorder characterized by involuntary muscle contractions. Patients with dystonia may experience uncontrollable twisting, repetitive movements, or abnormal posture. A 55-year-old man presented with an involuntary left forearm supination, which he had experienced for five years. There was no history of antecedent trauma to the wrist or elbow. Although conventional therapeutic modalities had been performed, the symptoms persisted. When he visited our hospital, electromyography was performed. Reduced conduction velocity was evident at the elbow-axilla segment of the left median nerve. We suspected that there was a problem on the median nerve between the elbow and the axilla. For this reason, we performed an ultrasonography and magnetic resonance imaging study. A spindle-shaped soft tissue mass was observed at the left median nerve that suggested the possibility of neurofibroma. Dystonia caused by traumatic or compressive peripheral nerve injury has often been reported, but focal dystonia due to a neurogenic tumor is extremely rare. Here, we report our case with a review of the literature.
Axilla ; Dystonia ; Dystonic Disorders* ; Elbow ; Electromyography ; Forearm ; Humans ; Magnetic Resonance Imaging ; Median Nerve ; Median Neuropathy ; Middle Aged ; Movement Disorders ; Muscle, Smooth ; Neurofibroma ; Peripheral Nerve Injuries ; Posture ; Supination ; Ultrasonography ; Wrist

OBJECTIVETo study clinical results of the manual reduction in treatment.

METHODSFrom October 2010 to April 2013,39 children with Monteggia fracture associated with anterior interosseous nerve injury were treated by manual reduction and fixation on buckling rotation backward,including 17 females and 22 males with an average age of 6.3 years old ranging from 3.2 to 11 years old. Among them, 15 cases were on the right side and 24 cases on the left. The course of disease was 40 minutes to 8 days (averaged 1.5 days). There were 7 cases with skateboard injured, 13 cases with stumble injured, 11 cases with falling injured,8 cases with air bed injured. According to Bado classification, 13 cases were type II, 22 cases were type III, 4 cases were type IV.

RESULTSThe distal forefinger showed exercise normally in 34 cases at 3 weeks after treatment, and the patients restored normal activities at 6 weeks after treatment. All patients were follow-up from 54 days to 6 months (averaged 67 days. According to Mayo elbow functional evaluation standard,the scoring result was 19.62±1.35 in activity, 45.00 ± 0.00 in pain, 9.87 ± 0.80 in stability, 25.00±0.00 in strength, 99.49 ±1.92 in total. The outcome of all patients was excellent and good evaluation results.

CONCLUSIONIf the anterior interosseous nerve injury could be identified early and treated timely, patients could gradually restore reasonable function and recover with satisfactory results. Raising understanding of anterior interosseous nerve injury can effectively reduce misdiagnosis.

Arm Bones ; injuries ; innervation ; surgery ; Child ; Child, Preschool ; Female ; Forearm Injuries ; surgery ; Fracture Fixation, Internal ; Humans ; Male ; Median Nerve ; injuries ; Monteggia's Fracture ; surgery

Chronic lunate dislocations are very rare injuries comprising of less than 10% of all wrist injuries. Volar lunate dislocations account for less than 3% of perilunate dislocations. We present a case of a missed volar lunate dislocation for 6months after initial injury. He fell down and had hyperextension injury during his sports activity. When the patient visit in our hospital, neurologic symptom was developed in distribution of median nerve. Tingling sensation and radiation symptom was found in affected hand. A plain radiograph revealed a volar lunate dislocation. Nerve conduction studies confirmed compression of the median nerve at the wrist, carpal tunnel level. Operation was performed with open reduction of lunate, fixation with K-wires and anchor suture. The outcome was excellent in relieving pain, function, range of motion, grip strength. There was improvement in Mayo wrist score and disabilities of the arm, shoulder and hand score. So we report a patient and a operation technique which can be considered in similar cases.
Arm ; Bone Wires* ; Dislocations* ; Hand ; Hand Strength ; Humans ; Median Nerve ; Neural Conduction ; Neurologic Manifestations ; Range of Motion, Articular ; Sensation ; Shoulder ; Sports ; Sutures* ; Wrist ; Wrist Injuries

BACKGROUND: Nerve conduction study(NCV) in elderly patients is considered as a useful diagnostic tool for elderly patients with peripheral neuropathy. OBJECTIVE: Here the author investigates parameters of NCV in elderly Hansen patients out of Sorokdo hospital and compares them with those of healthy elders. METHODS: The author enrolled 28 patients who were visiting OPD for surgical wound care. Out of them 8 patients were dropped off because of hypersensitive response to the test stimulation or having failed to attatch the electrodes on severely deformed hands and fingers. Consequently parameters of NCV such as latency, amplitude, and conduction velocity in upper extremities of 20 patients were investigated and compared with those of healthy elders at similar age range. RESULTS: The patients were 12 in male and 73 years old on the average. In sensory nerve study, the parameters for median nerve showed 5.52+/-3.5msec in latency, 23.01+/-16.71uV in amplitude, and 29.03+/-13.16m/s in conduction velocity. For ulnar nerve, 5.82+/-3.76, 19.48+/-11.51, and 27.61+/-13.19 respectively. In motor nerve study, parameters for median nerve showed 9.35+/-1.64, 3.45+/-2.03, 47.95+/-9.91 respectively. And for ulnar nerve, they were 9.13+/-1.20, 2.95+/-2.50, and 43.70+/-7.24 respectively. In comparison with healthy elders, latency for Hansen patients was prolonged longer, lower amplitude, and also slower nerve conduction velocity. CONCLUSION: This study was performed for elderly Hansen patients for the first time demestically. Even the results may not be generalized for the whole Hansen patients because of the limited number of study cases and not being standarized according to the grade of disability, this study may be considered as a useful reference for further NCV for Hansen patients.
Aged ; Electrodes ; Fingers ; Hand ; Humans ; Leprosy* ; Male ; Median Nerve ; Neural Conduction* ; Peripheral Nervous System Diseases ; Ulnar Nerve ; Upper Extremity ; Wounds and Injuries

OBJECTIVE: To provide the evidences for the choice of normal reference value of nerve conduction velocity (NCV) in clinical forensic appraisal. METHODS: One hundred and fourteen cases with normal peripheral nerve and 155 cases with injured peripheral nerve were collected. The NCV of homonymous nerves in two limbs were detected. In the normal cases, the NCV of the left limbs were used as the normal reference values. The NCV of the right limbs were compared with that of left limbs, the commendatory normal reference values from Beijing Xiehe Hospital and Shanghai Huashan Hospital. In the injured cases, the results of NCV in injuried limbs were compared with the results of healthy limbs and the reference values from Beijing Xiehe Hospital and Shanghai Huashan Hospital. RESULTS: In the normal group, there was no statistical difference between the left and right limbs in NCV results of homonymous nerve (P > 0.05). The false positive rates (FPR) were 0, 11.4% and 5.2% for three choices normal reference respectively. The false negative rates (FNR) were 0, 9.7% and 12.3% for three choices normal reference in injuried group. Thee false negative cases were all slight nerve injury. CONCLUSION The reference value of self-control method could decrease the FPR of normal cases and FNR of injured cases. In clinical forensic appraisal of peripheral nerve, the nerve condition study results from healthy homonymous nerve should be regarded as the reference value at first, supplemented by reference values from clinical labs.
Adolescent ; Adult ; Electrodiagnosis/methods* ; Forearm ; Forensic Medicine ; Humans ; Median Nerve/physiology* ; Middle Aged ; Neural Conduction/physiology* ; Peripheral Nerve Injuries/diagnosis* ; Peripheral Nerves/physiology* ; Reference Values ; Ulnar Nerve/physiology* ; Young Adult

PURPOSE: We conduct a comprehensive review of demography, vector and cause of injury and results of zone 5 volar wrist lacerations. MATERIALS AND METHODS: From July 2001 and June 2010, a total of 170 patients with zone 5 wrist lacerations were reviewed retrospectively. Sex, age, vector and cause of injury, injured structures and results were investigated. The correlations between the wound length, vector, cause of injury and number of injured structures were analyzed statistically. RESULTS: The most common cause of injury is self-inflicted wrist injury followed by incidental accident, industrial accident, and the glass is the most common vector. Thirty six patients underwent primary repair only and 134 patients explored then underwent teno-neuro-arteriorraphy. Error rate between the preoperative and intraoperative evaluations was 30.6%, particularly greater than 50% in cases of flexor digitorum profundus and radial artery injuries. The most common injured structure was palmaris longus followed by flexor carpi radialis, flexor carpi ulnaris and median nerve. The cause and vector of injury did not correlate with the number of injured structures. Relationship between the mean length of wounds and the number of injured structures showed weak positive correlation. CONCLUSION: In zone 5 wrist lacerations, exploration should be performed if the laceration involved over dermis layer. In addition to the surgical treatment, psychological care of these injuries is necessary.
Accidents, Occupational ; Demography ; Dermis ; Glass ; Humans ; Lacerations ; Median Nerve ; Radial Artery ; Retrospective Studies ; Wrist ; Wrist Injuries

BDNF belongs to the neurotrophin family and important molecular mediator of functional and structural plasticity. The highest levels of BDNF are found in the hippocampus and hypothalamus of the adult rat. Hypothalamus is important because of its high degree of plasticity, but little is known about distribution of BDNF in hypothalamic nuclei. Therefore, it is necessary to study distribution and expression pattern of BDNF in each hypothalamic nuclei to understand changes of BDNF through various neural damages including spinal cord injury. Through this experiment, we found specific BDNF expression pattern in some regions of hypothalamus and the results are as follows. 1) BDNF expressions were found in median eminence, arcuate nucleus, supraoptic nucleus, and periventricular nucleus of rat hypothalamus. 2) BDNF immunoreactive cells and nerve fibers were of various shapes and sizes. 3) Glial cells also express BDNF in certain hypothalamic nuclei. These results seem to be useful for future investigations of neurochemical changes in the hypothalamus induced by various neural trauma or degenerative changes
Adult ; Animals ; Arcuate Nucleus ; Brain-Derived Neurotrophic Factor ; Hippocampus ; Humans ; Hypothalamus ; Median Eminence ; Nerve Fibers ; Neuroglia ; Plastics ; Rats ; Spinal Cord Injuries ; Supraoptic Nucleus