Player is loading...
A-1186 Rare conditions: unusual entrapment, torsion, 2 level
Jörg Bahm, Belgium
Friday, June 15, 2018 · 5:17 p.m. · 08m 12s
Embed
Embed code is not allowed
This talk is part of a Private webcast, embeding is not permited.Transcriptions
Note: this content has been automatically generated.
00:00:00
about this problem and euro passes your parties
00:00:04
probably more subject for a neural watches
00:00:08
and uh unfortunately most of us hand surgeons and most of
00:00:11
the euro just i'm not aware about these conditions
00:00:17
and usually entrapment behind the frequent compression syndrome you always may have to more
00:00:23
rare variants all considering the median nerve it's the carpal tunnel syndrome frequent
00:00:29
and the more proximal entrapment is more rare domino if it's the on
00:00:33
a compression up to a level and the more air at
00:00:37
the distal side for the regular oven for every nerve you may have it like this so you have to think about
00:00:43
if the pain continues and you have of course nerves like the super scrap wonderful you may have
00:00:49
and specific entrapment and you should look for it also so this
00:00:54
is part of your comment thorium when you make your diagnosis
00:00:59
the concept of a double crashes something you would see up here in presentations
00:01:05
and we have a to wonder if it is realities is really
00:01:09
existing that you have simultaneous a compression at two sides
00:01:15
and if one influence the other in the forward or backward a um
00:01:22
fashion uh if you're interested if it is factor fake there is
00:01:27
a nice review done biking recently in two thousand fifteen
00:01:31
and then we have two will understand how careful on
00:01:36
your petty make coexist with an compresses your party
00:01:41
of course conditions like diabetes or alcohol consumption
00:01:46
a very regular and these are common but there are uncommon conditions also you should know about
00:01:53
and the it's probably frequent that you have an associated
00:01:56
cervical radical percy and a couple tunnel syndrome
00:02:00
and you also have to think about both conditions before operating on the patient
00:02:06
about the the uh double crush the proper physiology uh advances
00:02:12
for hypotheses is either it is impairment off accent transport
00:02:18
or it is a so called immune response or inflammation
00:02:22
or is a problem of i am channel or it is a problem
00:02:26
of the roman continued you but your might contain which you would
00:02:29
say that there was a traumatic uh event before so it's really
00:02:35
difficult once you get to the the cutter physiology if it
00:02:39
to make the distinction between reality and a hyper jesus
00:02:45
uh when i prepared this symposium i was not aware that we'll have
00:02:49
to session which happened yesterday about inflammation and portion of performers
00:02:54
and i just knew that in my country germany wilhelm published in a
00:02:59
nineteen seventy six a torsion of the radial nerve he should nicely
00:03:04
and the since then does has been debated is this the only exist
00:03:07
and that those we asked that they saw the beautiful pictures
00:03:12
uh of the uh calling from hungary and this is
00:03:15
out of their publication actually ultrasound me show you
00:03:21
a clear entrapment and portion of the nerve and you
00:03:25
can surgically very find the question is now
00:03:28
if and this was in the uh the article related to the parsonage turner's syndrome
00:03:35
the question is if in all these cases we should look for this uh animal it is
00:03:41
and of course if present we should cure them but if they are regularly associated or
00:03:46
not there was no time for discussion yesterday probably we could have a discussion today
00:03:51
so the so called neurology i my atrophy or
00:03:55
narratives of breakup lexus or percentage turner syndrome
00:03:59
has a rather clear caught a clinic rapid instead of pain and than the policy
00:04:06
but most of these cases spontaneously resolve it may takes months
00:04:11
but normally they go back to normal in time
00:04:15
there are nevertheless harry direct forms and this has to be known also
00:04:22
when it comes to neural pathways and i apologise for the complexity of the slides
00:04:28
uh we have to have a basic knowledge how the
00:04:32
neural pathways may affect the powerful nerves both
00:04:37
motor sensitive and sympathetic fibres and you would say what has that to do
00:04:44
with the pain issue should know that half of them are painful
00:04:49
so he's made the the underlying reason non
00:04:53
surgical reason for a chronic pain syndrome
00:04:59
now to make it easy in a complex a field
00:05:04
they are either acquired or harry jerry and acquired of course would say idea betas yes i know that
00:05:11
the crunch uppity alcohol yes i know channel therapy more
00:05:16
more upcoming breast a cancer treatment we see more
00:05:20
and more neural pathways of upper extremities determined if you sit in human like b. m. body
00:05:26
but you have entities which are much more rare like the multi focal motor in your party
00:05:32
and lastly it is or irrigation of course which may also cause when you're happy
00:05:38
for the heritage terry cases it's predominantly a motor deficits
00:05:45
mostly in children and for the diagnoses you need
00:05:50
to go up to a a biopsy
00:05:53
and the next generation sequencing so a genetic analysis
00:05:58
and i just listed the five most common error terry europe at
00:06:03
his shower comedy tools and you see always the genetic change
00:06:08
so that then they had it edited motown your uppity which is also a clear cut
00:06:14
your logic entity then you have sensory uh in europe that place
00:06:19
and one which you should know when you perform couple time not all not channel
00:06:23
toss surgery is the pressure related to your party
00:06:28
which leads a genetic uh a definition it's not something you can
00:06:34
just suppose you need to send the patient to the genetic
00:06:37
click to make sure he is afflicted by this because otherwise you will do an plus surgery
00:06:44
yeah that's another entity called also just small five in europe happy and the why do
00:06:49
i know that because then you're oh just asked me to do the skin biopsy
00:06:54
to look for the small fibre alteration otherwise i would not encounter the space
00:07:00
so it's just to tell you that peripheral nerve inflammation is some sing
00:07:07
real layer the nerve will grow swallow adam uh may then the
00:07:13
fast tickets may turn inside and once that uh the swelling goes down
00:07:18
there might be distortion we are actually beginning understanding this phenomenon
00:07:23
we should have a basic knowledge about your party and the double question concept
00:07:29
and all these factors are important in to decompress if surgery
00:07:34
so we should be aware in the of these entities when we
00:07:39
do our differential diagnosis and especially in the chronic patients
00:07:43
thank you very much this is to announce a
00:07:45
symposium we have hikes here in boston how
00:07:51
hope you'll thank you uh if any any question in audience
00:07:59
oh yeah i i i
00:08:05
any comments
Conference Program
A-1183 Introduction
Jörg Bahm, Belgium
June 15, 2018 · 4:31 p.m.
121 views
A-1189 Therapy concepts
R. Winkel, Germany
June 15, 2018 · 5 p.m.
A-1186 Rare conditions: unusual entrapment, torsion, 2 level
Jörg Bahm, Belgium
June 15, 2018 · 5:17 p.m.
A-1187 Surgery of neuromas
Pierluigi Tos, Italy
June 15, 2018 · 5:25 p.m.
144 views
