• Archives of Plastic Surgery
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• v.49 no.6
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• pp.750-754
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• 2022

Trigger wrist, characterized by a clicking or snapping sensation around the wrist joint during finger or wrist motion, and bifid or trifid median nerve, which occurs in carpal tunnel syndrome along with anatomical variation of median nerve, are rare conditions. We report the case of a patient with a thickened tendon caused by severe tenosynovitis and flexor tendon subluxation to the hamate hook due to bowing of the flexor retinaculum, thereby resulting in trigger wrist as well as an anatomical median nerve variation (bifid median nerve in the right wrist and trifid median nerve in the left wrist). A 59-year-old housewife visited our hospital with bilateral fingertip numbness, tingling sensation, and aggravated severe night cramping that began 2 months ago. She also complained about trigger wrist during small finger flexion. Based on magnetic resonance imaging, ultrasonography, and nerve conduction study, trifid median nerve and bilateral severe median nerve neuropathy of the wrist were diagnosed; therefore, transverse carpal tunnel release and exploration under wide-awake anesthesia were planned. Intraoperative findings showed trifid and bifid median nerves in left and right wrists, respectively. Additionally, bowing of flexor retinaculum and severe flexor tendon tenosynovitis were observed. Tenosynovitis with thickened flexor sheath resulted in subluxation of the small finger flexor tendon above the hamate hook. After transverse carpal ligament release with antebrachial fascia release and tenosynovectomy, subluxation of the flexor tendon was resolved. At 6 months postoperatively, the tingling and dullness in fingertips also resolved, and no trigger wrist or any other complications were noted.

• Biomedical Science Letters
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• v.26 no.3
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• pp.186-191
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• 2020

This study was designed to investigate the median nerve cross-sectional area of the upper extremity which is the main cause of CTS in the 20s and 30s. The median nerve cross-sectional area (MNC-area) of each part of the upper limb was measured in healthy 20s and 30s females and males without neurological diseases or other diseases. This MNC-area was compared with the hand, wrist, finger, and other body indexes. The research group was divided into 20s female and male groups, and the 30s were also divided into female and male groups. In the comparison between the ages, the hand, and wrist configurations in the 30s were significantly higher than those of the 20s. The mean median nerve cross-sectional area was significantly larger in the male group than in the female group in both 20s and 30s, and it was larger in both men and women than in the 20s. Hand and wrist configurations were also positively correlated with the median nerve cross-sectional area in both 20s and 30s. The median values of hand ratio and wrist ratio were 2.26 and 0.65, respectively. This median value of hand ratio was inversely correlated with the median nerve cross-sectional area. The median nerve cross-area of the 20s was 6.88~7.38 ㎟ in the male group and 5.69~6.99 ㎟ in the female group, respectively. The median nerve cross-area of the 30s was 6.32~8.89 ㎟ in the male group and 6.15~7.17 ㎟ in the female group, respectively. The mean median nerve cross-sectional area was positively correlated with body mass index in both groups. Most of the variables were higher in their 30s than in their 20s.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.676-680
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• 2010

Purpose: Median nerve entrapment syndrome within carpal tunnel is usually called carpal tunnel syndrome and it is the most common form of peripheral nerve entrapment syndrome. Many factors such as diabetes mellitus, hypothyroidism, hormonal replacement theraphy, corticosteroid use, rhematoid arthritis and wrist fractures may cause carpal tunnel syndrome. To the best of our knowledge, this is the first case report of median nerve entrapment syndrome due to adhesion of laceration wound after suicidal attempt. Methods: A 28-year-old woman presented with a sensory change and thenar hypotrophy on her left hand. On her history, she attempted suicide by slashing her wrist. Initial electromyography (EMG) showed that the nerve conduction velocities of median nerve was delayed. Therefore, we performed surgical procedures. When exploration, Fibrous scar tissue observed around the median nerve but nerve had not been injured. Transcarpal ligament was completely released and adjacent fibrous tissue was removed to decompress the median nerve. Results: The postoperative course was uneventful until the first year. Opposition difficulty and thenar hypotrophy were improved progressively after the surgery. Sensory abnormality was slowly improved over one year. Conclusion: We report a case of median nerve entrapment syndrome that was caused by adhesion of laceration wound after suicidal attempt. This is an unusual cause of median nerve entrapment syndrome, the symptoms were relieved after transcarpal ligament release and fibrous scar tissue removal.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.18 no.1
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• pp.49-56
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• 2012

Background: When applying the upper limb neurodynamic treatment ULNT1 and upper limb neurodynamic treatment ULNT2, The object of this study evaluates the pain and grip strength, nerve conduction velocity and tries to present the treatment that is effective in the carpal tunnel syndrome through the comparison of effect between tests. Methods: The ULNT1 (n=10) and ULNT2 (n=10) was applied to the carpal tunnel syndrome in patient of 20 subject for 10 time 5 set during 4 weeks. Both groups received conventional physical therapy (hot pack with 30 minutes and ICT with 15 minutes and ultra sound with 15 minutes). Results: The ULNT1 showed the difference which the result of this study significantly in the median nerve motor latency, median nerve motor amplitude, median nerve sensory latency, median nerve sensory amplitude, grip strength and pain. ULNT2 showed the difference significantly in median nerve motor latency, median nerve motor amplitude, median nerve sensory latency, median nerve sensory amplitude and pain. Conclusions: If it implements by applying the traditional physiotherapy and ULNT1 and ULNT2 to the carpal tunnel syndrome subjects according to the subject state and function, the remedial value can be more enhanced.

• Archives of Reconstructive Microsurgery
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• v.23 no.2
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• pp.86-88
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• 2014

A schwannoma is a benign soft tissue tumor arising from the nerve sheath of a Schwann cell. Clinically, a schwannoma is an asymptomatic mass rarely causing neurologic deficits. However, it can cause discomfort as well as motor and sensory disturbances by compressing the nerve of its origin. The authors encountered a huge schwannoma arising from the median nerve at the proximal forearm, which caused symptoms mainly in the ulnar nerve. The tingling sensation along the ulnar nerve disappeared completely after enucleation of the schwannoma originating from the median nerve.

• Archives of Plastic Surgery
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• v.46 no.2
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• pp.171-175
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• 2019

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.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.11 no.2
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• pp.62-70
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• 2005

The determination of peripheral nerve conduction velocity is an important part to electrodiagnosis. Its value as neurophysiologic investigative procedure has been known for many years but normal value of median and ulnar motor nerve was poorly reported in Korea. To evaluate of median and ulnar motor nerve terminal latency, amplitude of CMAP(compound muscle action potential), conduction velocity and F-wave latency for obtain clinically useful reference value. 71 normal volunteers(age, 19-65 years; 142 hands) examined who has no history of peripheral neuropathy, diabetic mellitus, chronic renal failure, endocrine disorders, anti-cancer medicine, anti-tubercle medicine, alcoholism, trauma, radiculopathy. Nicolet Viking II was use for detected terminal latency, amplitude of CMAP, conduction velocity and F-wave latency of median and ulnar motor nerve. Data analysis was performed using SPSS. Descriptive analysis was used for obtain mean and standard deviation, independent t-test was used to compare between Rt and Lt side also compare between different in genders. The results are summarized as follows: 1. Median motor nerve terminal latency was right 3.00ms, left 2.99ms and there was no significantly differences between right and left side and genders. 2. Median motor nerve amplitude of CMAP was right 17.26mV, left 1750mV and there was no significantly differences between right and left side and genders. 3. Median motor nerve conduction velocity was right 57.89m/sec, left 58.03m/sec and there was no significantly differences between right and left side and genders. 4. Median motor nerve F-wave latency was right 25.74ms, left 25.59ms and there was significantly differences between genders. 5. Ulnar motor nerve terminal latency was right 2.38ms, left 2.45ms and there was significantly differences between right and left side. 6. Ulnar motor nerve amplitude of CMAP was right 15.99mV, left 16.02mV and there was no significantly differences between right and left side and genders. 7. Ulnar motor nerve conduction velocity was right 60.35m/sec, left 59.73m/sec and there was no significantly differences between right and left side and genders. 8. Ulnar motor nerve F-wave latency was right 25.53ms, left 25.57ms and there was significantly differences between genders.

• Journal of the Korean Society of Physical Medicine
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• v.8 no.1
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• pp.79-89
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• 2013

PURPOSE: To identify the effects of single trial transcutaneous electrical nerve stimulation (TENS) application on chronic neuropathic pain and the repeated TENS application to development of neuropathic pain following peripheral nerve injury. METHODS: First, 20 rats were given the median nerve ligation to induce chronic neuropathic pain. After the ligation, neuropathic pain was assessed by measuring the forepaws withdrawal threshold to von Frey filaments for 3 weeks. Afterward, rats were randomly divided into TENS group and placebo-TENS group. TENS (frequency 100Hz, pulse width $200{\mu}s$) was applied to the forearm for 20 minutes. Second, 34 rats were randomly allocated into two group after median nerve ligation: TENS group and placebo-TENS group. Both interventions were applied to the forearm for 20 minutes from 1 day to 3 weeks after injury. Neuropathic pain to mechanical was measured on each rat for 3 weeks. RESULTS: Exeprimental rats showed a clear neuropathic pain-like behaviors, such as reduced forepaw withdrawal threshold to mechanical stimulation for 3 weeks, after median nerve ligation. And, TENS decreased effectively the chronic neuropathic pain originated from median nerve injury. TENS also diminished the development of neuropathic pain after nerve injury. CONCLUSION: Our animal model studying for neuropathic pain following median nerve injury may be useful to investigate peripheral neuropathic pain in human. Also, TENS may be used to mediate chronic neuropathic pain and to prevent the development of neuropathic pain following median nerve injury.

• Journal of Korean Neurosurgical Society
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• v.59 no.3
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• pp.282-286
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• 2016

Objective : Obturator neuropathy is a rare condition. Many neurosurgeons are unfamiliar with the obturator nerve anatomy. The purpose of this study was to define obturator nerve landmarks around the obturator foramen. Methods : Fourteen cadavers were studied bilaterally to measure the distances from the nerve root to relevant anatomical landmarks near the obturator nerve, including the anterior superior iliac spine (ASIS), the pubic tubercle, the inguinal ligament, the femoral artery, and the adductor longus. Results : The obturator nerve exits the obturator foramen and travels infero-medially between the adductors longus and brevis. The median distances from the obturator nerve exit zone (ONEZ) to the ASIS and pubic tubercle were 114 mm and 30 mm, respectively. The median horizontal and vertical distances between the pubic tubercle and the ONEZ were 17 mm and 27 mm, respectively. The shortest median distance from the ONEZ to the inguinal ligament was 19 mm. The median inguinal ligament lengths from the ASIS and the median pubic tubercle to the shortest point were 103 mm and 24 mm, respectively. The median obturator nerve lengths between the ONEZ and the adductor longus and femoral artery were 41 mm and 28 mm, respectively. Conclusion : The obturator nerve exits the foramen 17 mm and 27 mm on the horizontal and sagittal planes, respectively, from the pubic tubercle below the pectineus muscle. The shallowest area is approximately one-fifth medially from the inguinal ligament. This study will help improve the accuracy of obturator nerve surgeries to better establish therapeutic plans and decrease complications.

• The Korean Journal of Pain
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• v.7 no.1
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• pp.65-68
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• 1994

Carpal tunnel syndrome is the most common compressive neuropathy of the upper extremity. Clinical manifestations include pain as well as motor and sensory dysfunction in the distribution of the median nerve. As nonoperative treatment, median nerve block is performed to relieve pain for carpal tunnel syndrome. We have experienced 5 such cases. Our results support median nerve block as an excellent treatment for carpal tunnel syndrome.