Acute trauma and repetitive nicrotrauma connected with certain athletic activities are oftenmentioned when describing the etiology of nerve entrapment syndromes. According to the literature it is obvious that nerve entrapment syndromes in athletes are not as rare as they were once considered to be. Certain sports or physical activities have been mentioned that lead to specific nerve entrapment syndromes – for example, cyclist’s palsy and bowler’s thumb. Unlike nerve entrapment syndromes, vascular and neurovascular syndromes in athletes seem to be more common and have been described in greater detail, while nerve entrapment syndromes in athletes have been reported only recently. To support this contention, I present currently available information about nerve entrapment syndromes in athletes. For each syndrome possible cause of compression, clinical symptoms and signs, and the most effective treatment is presented. On the upper extremity are described: spinal accessory nerve, thoracic outlet syndrome, brachial plexus, long thoracic nerve, suprascapular nerve, axillary nerve, musculocutaneous nerve, lateral ante-brachial cutaneous nerve, radial nerve above the elbow, radial tunnel syndrome, Wartenberg’s disease, distal posterior interosseous nerve, ulnar nerve at the elbow and in Guyon’s canal, median nerve at the elbow and in carpal canal, anterior interosseous nerve and digital nerves. The syndromes described on the lower extremity are: groin pain, piriformis muscle syndrome, pudendus nerve, meralgia paresthetica, sural nerve, common peroneal nerve, superficial peroneal nerve, deep peroneal nerve, tarsal tunnel syndrome, the first branch of the lateral plantar nerve, medial plantar nerve (jogger’s foot) and interdigital neuromas (metatrsalgia. In conclusion I stress that nerve entrapment syndromes must be considered in the diferential diagnosis of pain in athletes

Aim: Aim of this study is to determine if cubital tunnel view radiograph of the elbow is useful in the investigation and treatment of Ulnar nerve entrapment at the elbow. Patients and Methods: 28 patients presenting with symptoms suggestive of ulnar nerve entrapment at the elbow were prospectively studied. Detailed history and clinical examination was elicited in each patient and classified according to McGowan’s classification. Diagnosis of ulnar nerve entrapment at the elbow was confirmed by nerve conduction studies. Cubital tunnel view radiographs were taken and evaluated for any evidence of bony encroachment of the ulnar nerve bed in the cubital tunnel. Those patients with normal cubital tunnel view radiograph underwent simple ulnar nerve decompression where as those with significant bony encroachment of ulnar nerve bed underwent anterior transposition of the ulnar nerve. The results of surgery were assessed at follow up using the Wilson and Krout criteria. The difference in results in two groups was statistically analyzed by applying student ‘t’ test. Results: There were 20 patients (male=14, female 6) in the simple ulnar nerve decompression group with a mean age of 52 yrs (range 32 to 61 yrs) and 8 patients (male=6, female=2) in anterior transposition group with a mean age 59 yrs (range 45 to 69 yrs). Mean follow up was 25months (range 9 months to 32 months). According to McGowan’s classification there were 5 grade I, 9 grade II and 6 grade III patients in simple decompression group where as there were none grade I, 3 grade II and 5 grade III in anterior transposition group. All patients had neurophysiological evidence of ulnar nerve entrapment in pre-operative nerve conduction study. Wilson and Krout grading at final follow up showed 15 good, 4 fair and 1 poor result in simple decompression group and 5 good, 2 fair and 1 poor result anterior transposition group. There was no statistically significant difference between the two groups (p value < 0.001). Conclusion: Cubical tunnel view radiographs are valuable in the management of ulnar nerve entrapment at the elbow. Patients with normal radiograph can be treated by simple nerve decompression

Background. The use of a knotless TightRope for the stabilisation of a syndesmotic injury is a well-recognised mode of fixation. It has been described that the device can be inserted using a “closed” technique. This presents a risk of saphenous nerve entrapment and post-operative pain. Aim. We aimed to establish the actual risk of injury to the Saphenous Nerve using a “closed” technique for the insertion of a TightRope. Method. 20 TightRopes were inserted into Fresh Frozen Cadavers. This was done using the senior authors preferred technique of divergent tightropes with the distal implant directed slightly anterior to the fibula-tibia axis and the proximal implant slightly posterior in order to simulate the greatest risk to the nerve. This was done under image Intensifier guidance to simulate an intraoperative environment. The medial side of the distal tibia was then dissected to directly record and measure the relationship of the TightRope to the Saphenous Nerve. Measurements were taken using digital calipers from the centre of the button on the medial side of the TightRope to the centre of the nerve at the point of closest proximity. Results. 12 TightRopes were found to exit posterior to the nerve, 7 anterior and 1 penetrated through the centre of the nerve. The mean distance from the centre of the button to the nerve was 6.99mm (range 0.72–14.52mm, standard deviation 4.33mm). In 9 of the 20 TightRopes, the nerve was found to be less than 5mm away. Conclusion. Our findings demonstrated that the risks of damaging or indeed entrapping the Saphenous nerve were high, and therefore we would advocate an open incision on the medial side with judicious exploration to ensure there is no damage to the medial neurological structures

Introduction. Ulnar nerve entrapment is the second most common nerve entrapment syndrome of the upper extremity. Despite this, only a few studies have assessed the outcome of ulnar nerve decompression. The objectives of the study were to review the pre-operative symptoms, nerve conduction studies, the co-morbidities, operative procedures undertaken and the post-operative outcomes; and investigate and ascertain prognostic factors particularly in cases of persistence of symptoms after the surgery. Methods. We reviewed the case notes of ulnar nerve decompressions surgery performed over a period of six year period. A structured proforma was created to document the demographics, patient complaints, method of decompression, per-operative findings and symptom status at the last follow up. Outcome grading was recorded as completely relieved, improved, unchanged or worse. Analysis of data was carried out using the SPSS software (Version 16.0; Illinois). The significance level was set at 5%. Results. 136 ulnar nerve decompressions formed the study group. Minimum follow-up was three months. Numbness and paresthesia in ulnar distribution were the two most common presenting symptoms (96%). The cause of compression was identified as idiopathic in 58.2%; flexor carpi ulnaris aponeurosis in 36.7% and Arcade of Stuthers in 5.1% extremities. The outcome was satisfactory in 85.2% of patients. No obvious association was demonstrated between the outcome of surgery and duration of symptoms, presence of co-morbidities or the type of surgery performed. Interestingly out of 12 patients who got worse or had no improvement, nine (75%) had either normal nerve conduction studies or none done pre-operatively. Conclusion. This is the largest review of outcomes after ulnar nerve decompressions at elbow. The study showed that good results (85.2%) of ulnar nerve decompression at elbow in majority of patients regardless of level of surgeon's experience or procedure undertaken

We compare the management and outcome of two management stratergies for the perfused but pulseless hand following stabilisation of grade III supracondylar fractures in children. For this study we looked at 15 patients treated in two centres (all treated by the senior author) between 1995 and 2004. The patients were designated to group I if the pulseless hand had been observed or group II if they underwent immediate exploration. Data collected included time to surgery, neurological deficit, time to return of pulse and subsequent symptoms of forearm claudication. All patients were seen at week 1,3 and followed for at least 6 months post surgery. Radiographs were reviewed to determine the adequacy of reduction of the fracture. The mean age of patient was 3.8 years. Median time to surgery was 6 hours. 6 children had evidence of anterior interosseus nerve palsy. 12 cases were reduced anatomically, 3 had minimal fracture gap. Of the 8 patients in group I (observation) 2 had secondary exploration and one developed claudication symptoms. All had palpable radial pulse at 3 months.6 of the 7 patients in group II (exploration) were seen to have brachial artery tethering, 2 with median nerve entrapment. 5 of them had subsequent return of radial pulse within 24 hours. Satisfactory radiological reductionof the fracture does-not exclude vessel or nerve entrapment. We would advocate early exploration of the artery if the pulse does not return within 24 hours

Introduction Ulnar nerve entrapment is the second commonest upper limb nerve entrapment syndrome. The purpose of this study was to determine the safety and efficacy of the Agee endoscopic system in ulnar nerve decompression at the elbow. This is the first report of its use in the elbow. Methods Six preserved cadaveric elbow specimens were used. One surgeon performed the endoscopic releases via a three centimetre longitudinal incision between the medial epicondyle and olecranon. All six specimens were examined independently with loupe magnification. This was done by extending the original incision to 20 cm. The ulnar nerve was assessed with regard to adequate decompression. The branching of the ulnar nerve at the elbow, as well as the presevation of these branches after the endoscopic procedure, was also studied. Results In all six specimens, the arcade of Struthers, the cubital tunnel retinaculum, and the flexor carpiulnaris aponeurosis were completely divided. There were an average of three motor branches to flexor carpiulnaris at a mean position of 21 mm distal to the medial epicondyle. Most of these were on the radial side of the nerve. The ulnar nerve was also found to give one to two sensory branches, at a mean position of nine millimetres proximal to the medial epicondyle. All the motor and sensory branches were found to be intact after the endoscopic procedure. Conclusions This study shows that the Agee endoscopic system is both safe and effective. It is a relatively simple procedure but cadaveric practice is recommended to obtain familiarity with the technique and the endoscopic view of the anatomy

Carpal tunnel syndrome is the most frequent form of median nerve entrapment, accounting for 90% of all entrapment neuropathies. Routinely nerve conduction study (NCS) tests are ordered to confirm the diagnosis however; there are issues of long waiting periods and costs with it. We aimed to compare carpal tunnel questionnaire score (CTQS) by Kamath and Stothard (2003) to nerve conduction study result in the diagnosis of carpal tunnel syndrome. This prospective study involved analysis of data from all the patients referred to NHS Tayside (Dundee) hand clinic with signs and symptoms of Carpal tunnel syndrome (CTS) from September 2016 to February 2017. Statistical analysis was done using SPSS and sensitivity and specificity was calculated. The questionnaires were filled in by a team of specialist physiotherapists. Nerve conduction study tests were done by a team of consultant neurophysiologists. Both the groups were blinded to each other's assessment. We analysed 88 patients who filled in CTQS and also underwent NCS. We noted that CTQS of less than 3 correlated 100% to negative nerve conduction result. When the carpal tunnel questionnaire score was more than or equal to 5, 54 patients had positive NCS result and 6 patients had negative NCS result, giving a 90% predictability of a positive NCS result. Mean waiting period of carpal tunnel patients for NCS was 141 days. We noted from this prospective study that CTQS was sensitive enough to exclude carpal tunnel syndrome when the questionnaire score was less than 3. In addition, the questionnaire revealed a 90% probability of having carpal tunnel syndrome when CTQS was more than or equal to 5. Based on the present study, we would recommend that patients in grey zone of 3 to 4 on questionnaire should undergo NCS, resulting in only 20% of patients (based on the figures from the current study) being referred for NCS. The questionnaire can be used in primary health care or specialist physiotherapy screening clinic as a tool for diagnosing CTS with implications of cost saving and avoiding long waiting periods

Background. To investigate the new theory of hydroneurolysis and hydrodissection in the treatment of carpal tunnel syndrome (CTS). Independently of the fluid hydrodissolution works due to mechanical forces and it may have some positive effects in patients with ischemic damage caused by scar tissue pressure at the nerve's surface. Methods. A prospective blind clinical study of 31 patients suffering from carpal tunnel syndrome, established by nerve conduction studies and clinical tests. 14 patients (out of 29), who refused to undergo an open operation as a treatment to their disease at this point of time, were treated with a simple ultrasound-guided injection at the proximal carpal tunnel. In order to exclude the biochemical influence of the fluid in the treating disease we choosed to infiltrate 3 cc. of normal saline 0,9%. In the follow-up period our group was asked to answer to a new Q-DASH score and visual analogue scale (VAS) 100/100 in 2, 4 and 8 weeks. Results. At the end of the second month we found only 2 out of 14 patients of the infiltration's group with clinical improvement. As far as the control group (17 patients), there was just one patient with recovery of the symptoms at the end of the second month who avoided operation. The rest 16 patients experienced insistence or worsening of CTS while they were waiting to be operated (mean time till operation in our department's waiting list: 2 months) and underwent a surgical decompression of the median nerve. Comparing the two groups in Q-DASH score, VAS 100/100 and ultrasound cross sectional area measurements we found no statistical difference between the two groups at the endpoint of our follow-up period. Conclusion. As far as nerve entrapment syndromes we proved that normal saline hydrodissolution appears to be non effective as a conservative treatment. The mechanical way of action seems to have only very short term effects. Level of Evidence. II

Complex carpal injuries can be difficult to assess and manage. They usually occur following high energy injuries to the wrist. Imaging in the form of traction views and a CT scan can help understand the detail of the fracture dislocation pattern. Perilunate dislocations and perilunate fracture dislocations are commonly managed with a dorsal approach to provide an anatomic reduction. A volar approach can be used is median nerve entrapment and allows a surgical repair of the volar aspect of the lunotriquetral ligament. Perilunate dislocations are often classified into greater and lesser arc injuries. The greater arc injuries include fractures which go through the radial styloid, scaphoid, capitate or triquetrum. Lesser arc injuries are through the scapholunate ligament and lunotriquetral ligament. It is common for there to be a combination of greater and lesser arc injuries. We have also identified a complex injury which is a lunate intra-arc injury. This is a fracture through the lunate. With this translunate perilunate dislocation it is important to stabilise the lunate prior to stabilising the remainder of the carpus. The authors have reviewed a series of complex injuries and developed a classification system based on the above findings. In complex cases where reconstruction is difficult then salvage procedures can be performed. SLAC wrist procedure, proximal row carpectomy and full wrist fusion can be performed particularly in highly comminuted cases or cases with a delayed presentation

Ulnar compression neuritis at the elbow level, known as the cubital syndrome, is one of the most common nerve entrapment syndromes. There are many treatment alternatives, such as conservative treatment, submuscular transposition, simple facial release, medial epicondylectomy and anterior subcutaneous transposition. The aim of the present study is to suggest the intramuscular transposition of the ulnar nerve for the cubital syndrome treatment. With the technique based on flaps creation by “Z” lengthening of the flexorpronator muscules, the ulnar nerve is transferred in a well vascularizated area. Between 1992 and 2001, 76 patients were treated by anterior intramuscular transposition of the ulnar nerve. It was possible to follow up 27 patients, 19 males and 8 females. During the re-examination, the rough and thin grasping, the improved objective and subjective sings, as well as the return to the previous vocation, were reported. We make comparison with the international bibliography and correlation of the results to the age of the patients. We recommend the anterior intramuscular transposition of the ulnar nerve for the cubital tunnel syndrome treatment, which is technically demanding, but provides a satisfactory functional outcome

This is a review of the literature detailing the causes, presentation and appropriate investigations of patients with suprascapular nerve compression. The choices of treatment are discussed in the context of the pathology found. The recommended surgical procedures are described. Suprascapular nerve compression is an uncommon cause of persisting and diffuse shoulder pain that arises from direct trauma to the shoulder or as a result of repetitive, overhead manoeuvres producing a traction type injury. The presence of tenderness over the suprascapular notch, weakness in external rotation and especially the presence of infraspinatus or supraspinatus atrophy (either separately or in combination) with positive nerve conduction studies confirm the diagnosis of suprascapular nerve entrapment. MRI is recommended for identification of a cause of the nerve compression. Fibrous transverse ligaments have been seen causing stenosis and entrapment at the suprascapular and spinoglenoid notch. A variety of space-occupying lesions can be found in the notches including supraglenoid ganglia and tumours. Initial conservative management of the shoulder is recommended when the neuropathy results from repetitive activity in the absence of a space-occupying lesion. Early decompression of the nerve using arthroscopic debridement of the labrum and open release of the ligaments at the suprascapular and spinoglenoid notch is advocated in the presence of a ganglion cyst

Five patients with entrapment of the suprascapular nerve treated in a 7 year period (2000–2006) were reviewed. There were 4 males and 1 female with an average age of 35 years (15–59). The patients presented with non-specfic pain around the scapula and shoulder. Four of the patients had marked wasting and weakness of the supraspinatus and infraspinatus muscles. One patient had congenital non-union of the clavicles. One patient was a competitive pole vaulter but there was no apparent aetiological factor in the other 3. The diagnosis was confirmed with nerve conduction studies in all the patients. All underwent MRI scan which was normal in 4 patients and showed a cyst in the spinoglenoid notch in the 5. th. Four patients had an open release of the suprascapular nerve, the patients whose MRI showed a cyst was found at surgery to have an abnormal vessel compressing the nerve. One patient had an arthroscopic release of the suprascapular nerve. Four patients were available for follow-up. The follow-up averaged 22 months (6–58). All patients had complete relief of pain and almost complete recovery of strength. In conclusion, the diagnosis of suprascapular nerve entrapment must be entertained when patients present with non-specific periscapular pain and wasting of the supraspnatus and infraspinatus muscles. MRI must be done to rule out cysts. Surgical release is successful and can be done arthroscopically

INTRODUCTION: CTS is the most common nerve entrapment syndrome. Repeated flexion and extension activities of the wrist coupled with certain finger flexion causes oedema and compression of the median nerve within the carpal tunnel of the wrist. Several treatment options, both conservative and surgical are available to relieve the pressure on the median nerve. Although studies support the efficacy of splinting for CTS the length of splinting, type of splints, day or night use and the effects on other variables are still less agreed. MATERIALS AND METHODS: A Randomised control trial with subjects randomised to a splint and a control group. 44 patients(60 hands) evaluated at recruitment, 2,8 and 12 weeks. Difference in Levine’s symptom and functional severity scores, between the two groups, used as the primary outcome measure. STATISTICAL METHODS: Repeated measure analysis(ANOVA) and paired t test used for statistical analysis between the two groups. RESULTS: There was no difference between the two groups at baseline. Improvement in symptom severity score in the splinted group at the end of 12 weeks(p< 0.05). No difference in functional severity between the two groups. CONCLUSION: Splintage helps to improve symptoms related to carpal tunnel syndrome in a short term period. This is the duration that the patients referred by GP’s have to wait before seeing a hand specialist. Hence they can be treated with splints during this period to give them symptomatic relief

Aims: We studied the ulnar nerves of five cadaveric specimens at Guyon’s canal to determine the presence, incidence and position of Renaut bodies. These are fusiform structures composed of fibroblast-like cells found within the endoneurium. Although their aetiology and role is unconfirmed, they do show a predilection for sites of nerve entrapment. Methods: Following dissection of the ulnar nerve sections were stained with toluidine blue and immunostains to demonstrate either Schwann cells, basal laminae, or axons. Fascicular topography, the number of perineurial cell layers and the number and distribution of Renaut bodies were recorded for each section. Results: Two points arise from our demonstration of a consistent appearance of Renaut bodies at the deep distal hiatus of Guyon’s canal. First, markers of subclinical nerve compression are present. Second, our results show that this subclinical compression occurs not in Guyon’s canal itself, but at its deep exit, the deep distal hiatus. Conclusion: These findings have clinical implications for the relief of Guyon’s canal syndrome. Decompression of the space alone may not be adequate. It would seem reasonable to argue that to optimise conditions for nerve recovery, the deep distal hiatus should be released as routine in all Guyon’s canal decompression procedures

Background: Intervertebral discs and vertebrae deform under load, narrowing the intervertebral foramen and increasing the risk of nerve entrapment. Little is known about these deformations in elderly spines. Purpose: To test the hypothesis that, in ageing spines, vertebrae deform more than discs, and contribute to time-dependent creep. Methods: 117 thoracolumbar motion segments, mean age 69 yr, were compressed at 1 kN for 0.5, 1 or 2 hr. Immediate “elastic” deformations were followed by “creep”. A three-parameter model was fitted to experimental data to characterise their viscous modulus E1, elastic modulus E2 (initial stiffness), and viscosity η (resistance to fluid flow). Intradiscal pressure (IDP) was measured using a miniature needle-mounted transducer. In 17 specimens loaded for 0.5 hr, an optical MacReflex system measured compressive deformations separately in the disc and each vertebral body. Results: On average, the disc contributed 28% of the spine’s elastic deformation, and 51% of the creep. Elastic, creep, and total deformations of 84 motion segments over 2 hrs averaged 0.87mm, 1.37mm and 2.24mm respectively. Measured deformations were predicted accurately by the model, but E1, E2 and η depended on loading duration. E1 and η decreased with advancing age and degeneration, in proportion to falling IDP (p< 0.001). Total compressive deformation increased with age, but rarely exceeded 3mm. Conclusions: In ageing spines, vertebral bodies show greater elastic deformations than intervertebral discs, and a similar amount of creep. Deformations depend largely on IDP, but appear to be limited by impaction of adjacent neural arches. Total deformations are sufficient to cause foraminal stenosis in some individuals. Conflicts of Interest: none. Source of Funding: Action Medical Research

Carpal tunnel syndrome is the commonest nerve entrapment syndrome. There is still controversy over the method of anaesthesia for this procedure. There have been many studies to show the effectiveness of local infiltration anaesthesia. However, patients do not always tolerate it, as one of the disadvantages of local anaesthetic is pain on infiltration. Experimental studies have shown that warming local anaesthetic can reduce the pain of injection in normal subjects. The aim of our study is to assess the effect of warming local anaesthetic for carpal tunnel surgery. We conducted a prospective randomised controlled trial. Sample size was calculated. The study group consisted of patients undergoing carpal tunnel surgery. The treatment group received local anaesthetic at 37°C, the control group at room temperature. Patients were asked to indicate the degree of discomfort on a visual analogue scale (0 to 100). There was a significant reduction in pain scores in the treatment group. Warming the local anaesthetic produced a mean visual analogue score of 13.8 versus 43 for the control group. These results were statistically significant (p< 0.05). Many carpal tunnel releases are performed under General Anaesthetic . One of the main reasons cited was poor patient tolerance to local anaesthetic infiltration due to pain. Our results show a significant reduction in the reported pain by warming the local anaesthetic for carpal tunnel release. We suggest that warming local anaesthetic should be best practice for anaesthesia in carpal tunnel release

As they pass trough fibrous, osteofibrous and fibromuscular tunnels, peripheral nerves from their origin in the spinal cord to their effector organ, risk compression, damage and impairment of their end function. Patients present with signs and symptoms usually associated with the motor or sensory function of the involved nerve. Careful linking of these signs and symptoms can indicate a specific compressive or painful pathology commonly known as a tunnel or canalicular syndrome, and very often known as entrapment compression neuropathy. While the names may vary, according to the compressed nerve, the anatomical area affected, the motion producing the compression or the name of the describing author, these syndromes all originate from the entrapment of the nerve elements in a narrow anatomical space. Narrowing can be caused by changes intrinsic or extrinsic to the tunnel. Patients present to their physician with symptoms that can range from vague complaints of diffuse pain or numbness to specific complaints of muscle weakness or of sensory changes over localized skin areas. A careful history and physical exam must be done prior to ordering tests, scans, or electrodiagnostic studies which should be used to confirm or clarify clinical findings. MR imaging will, with an increase in resolution and a refinement in application, be of use prior to surgical exploration. Treatment of nerve entrapment syndromes, whether conservative or surgical, must address the etiology causing nerve compression. Surgical decompression (open or endoscopic) remains the resort when conservative therapy fails. In this Symposium “Nerve entrapment” the competent authors will present the general overview, MR images and electrodiagnostic of the syndromes and especially entrapment syndromes in athletes

This is a retrospective comparative review of the clinical results of arthroscopic meniscal repairs between the use of meniscal arrows and sutures. The study group consists of 37 repairs in 35 patients carried out by 2 special knee surgeons over a five-year period. The arrow group consisted of 23 repairs in 21 patients. There were 14 males and 7 females. The medial meniscus was repaired in 13 and the lateral in 10 cases. Associated anterior cruciate ligament injured was present in 11 patients, of whom 9 underwent concomitant reconstruction along with the meniscal repair. The suture group comprised 14 cases. Ten were male and 4 female. There were 8 medial meniscal repairs and 6 lateral. The anterior cruciate was also torn in 8 cases, of whom 6 had it reconstructed. The repairs were carried out use #0-PDS by an out-to-in technique. The 2 groups were grossly age and sex matched. Tears were located in zone 0/1, mainly in the posterior third segment of the meniscus. The rehabilitation protocol was similar in both groups. Minimum follow up was 9 months. Patients were evaluated by clinical review; questionnaire based on the Lysholm score and case record analysis. The overall clinical success rate for the arrows group was 13/23 (56.5%) compared to 11/14 (78.6%) for the suture group. Complications noted were broken arrows – 4 cases, cutaneous nerve entrapment by suture – 1, and delayed portal healing due to suture irritation – 1. In conclusion, arthroscopic suture repair provided better clinical healing rates than meniscal arrows. Arrow breakage is a significant factor contributing to non-healing of initial tear repairs

The aim of the present investigation is to study the status of the blood-nerve barrier in the carpal tunnel syndrome and cubital tunnel syndrome using gadolinium enhanced MRI. The subjects were 68 patients (92 hands) with idiopathic carpal tunnel syndrome and 21 patients (23 elbows) with cubital tunnel syndrome. The MRI equipment used was a 0.3-T permanent magnet. Using the SE method, T1-weighted axial images were obtained. Then, we intravenously injected gadolinium for enhanced images. We studied the relationship between nerve enhancement and the symptoms of the patients. Out of 92 hands with carpal tunnel syndrome, 74 hands (80%) showed enhancement of the median nerve. The patients had 58 hands classified as Grade I (sensory disturbance only) out of which 44 hands (76%) showed nerve enhancement , as did 25 out of 29 hands (86%) classified as Grade II (I + thenar muscle atrophy) and all 5 hands (100%) classified as Grade III (II + disturbance of opposition). Enhancement was more prominent in the patients with thenar muscle atrophy. All 23 elbows with cubital tunnel syndrome revealed enhancement of the ulnar nerve. Two elbows were categorized as grade I (sensory disturbance only), 12 as grade II (I + 1’st inter-osseus muscle atrophy), and 9 as grade III (II + claw finger deformity). In general, capillaries exist inside the endoneurial spaces of peripheral nerves. Intraneural homeostasis is maintained by the perineurium as a diffusion barrier and by the blood-nerve barrier existing in the endothelium. MRI could demonstrate intraneural enhancement at the site of nerve entrapment where intraneural edema resulted from an increase in the vascular permeability of the endoneurium. We conclude that gadolinium-enhanced MR imaging can detect morphological and functional changes of peripheral nerve in patients with entrapment neuropathy

The purpose of this study was to determine the surgical risks and recurrence rate associated with the excision of osteochondroma from the long bones most frequently operated on in our institution; the femur, tibia, humerus and fibula. Two hundred and twenty four osteochondromata were excised in total between July 1992 and January 2001. The medical records and radiographs of 126 patients who had 147 osteochondromata excised from the femur, tibia, humerus and fibula were reviewed. Of these, 30 patients presented with multiple osteochondromata, accounting for 48 of the 147. Fifty three involved the femur (2 proximal), 55 the tibia (16 distal), 12 the fibula (2 distal) and 27 the proximal humerus. The mean age at excision was 12.5 years (2–18 years) and the mean follow-up was five years (1 to 10 years). There were 15 surgical complications (10% of excisions) including one compartment syndrome, five superficial wound infections, two haematoma formations which required evacuation, one partial wound dehiscence, one deep infection with sinus formation which required excision, one sural nerve and one saphenous nerve neuropraxia, one cutaneous nerve entrapment and two hypertophic scar/keloid formations. The patient with the compartment syndrome had excision of a distal femoral, proximal tibial and fibular osteochondroma during the same procedure and was diagnosed to have won Willebrand disease after the surgery. There were eight recurrences involving five patients with multiple osteochondromata and three in whom the excision was incomplete due to the proximity to neurovascular structures. Surgical risks related to excision of osteochondroma are relatively frequent and must not be underestimated. Excision should therefore only be performed if strongly indicated. The recurrence rate (5.5%) seems to be higher than previously reported in the literature (2%) and generally affects patients with multiple osteochondromata. Incomplete excision resulted in recurrence in all our cases