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  • 1
    Online Resource
    Online Resource
    Predictive Outcome Modeling of Preoperative Clinical Symptoms and Electrodiagnostic Data in Tarsal Tunnel Surgery
    Georg Thieme Verlag KG ; 2021
    In:  Journal of Brachial Plexus and Peripheral Nerve Injury Vol. 16, No. 01 ( 2021-01), p. e37-e45
    Details
    In: Journal of Brachial Plexus and Peripheral Nerve Injury, Georg Thieme Verlag KG, Vol. 16, No. 01 ( 2021-01), p. e37-e45
    Abstract: Background The relationship between tarsal tunnel syndrome (TTS), electrodiagnostic (Edx) findings, and surgical outcome is unknown. Analysis of TTS surgical release outcome patient satisfaction and comparison to Edx nerve conduction studies (NCSs) is important to improve outcome prediction when deciding who would benefit from TTS release. Methods Retrospective study of 90 patients over 7 years that had tarsal tunnel (TT) release surgery with outcome rating and preoperative tibial NCS. Overall, 64 patients met study inclusion criteria with enough NCS data to be classified into one of the following three groups: (1) probable TTS, (2) peripheral polyneuropathy, or (3) normal. Most patients had preoperative clinical provocative testing including diagnostic tibial nerve injection, tibial Phalen's sign, and/or Tinel's sign and complaints of plantar tibial neuropathic symptoms. Outcome measure was percentage of patient improvement report at surgical follow-up visit. Results Patient-reported improvement was 92% in the probable TTS group (n = 41) and 77% of the non-TTS group (n = 23). Multivariate modeling revealed that three out of eight variables predicted improvement from surgical release, NCS consistent with TTS (p = 0.04), neuropathic symptoms (p = 0.045), and absent Phalen's test (p = 0.001). The R 2 was 0.21 which is a robust result for this outcome measurement process. Conclusion The best predictors of improvement in patients with TTS release were found in patients that had preoperative Edx evidence of tibial neuropathy in the TT and tibial nerve plantar symptoms. Determining what factors predict surgical outcome will require prospective evaluation and evaluation of patients with other nonsurgical modalities.
    Type of Medium: Online Resource
    ISSN: 1749-7221
    URL: Article
    DOI: 10.1055/s-0041-1731747
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2021
    detail.hit.zdb_id: 2253037-X
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  • 2
    Online Resource
    Online Resource
    Frequency of Electrodiagnostically Measurable Berrettini Anastomosis
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of Clinical Neurophysiology Vol. 37, No. 3 ( 2020-05), p. 214-219
    Details
    In: Journal of Clinical Neurophysiology, Ovid Technologies (Wolters Kluwer Health), Vol. 37, No. 3 ( 2020-05), p. 214-219
    Abstract: Ulnar sensory palmar crossover to digit three (D3), the Berrettini anastomosis, is measurable in routine electrodiagnostic nerve conduction studies. The crossover is reported as occurring in 60% of anatomic dissections, but the frequency of measurable ulnar crossover to D3 and its potential as a nerve conduction pitfall is not established. The purpose of this article was to present descriptive statistics regarding the frequency of measurable Berrettini anastomosis in nerve conduction studies. Methods: A retrospective chart review and data analysis was completed on 248 patients representing 411 extremities with a main outcome measure of ulnar sensory stimulated nerve conduction simultaneous waveform recording on D3 and digit four (D4). Consistent electrodiagnostic technique with waveform recording data analysis in a private practice and independent university waveform verification was completed on sequential patients referred for upper extremity electrodiagnostic testing. Results: Measurable ulnar stimulated D3 sensory nerve action potentials were demonstrated in 34% of patients with amplitudes of 27%, the simultaneously recorded corresponding ulnar D4 amplitudes representing electrophysiological evidence of ulnar sensory crossover. Conclusions: The Berrettini anastomosis can frequently be seen as a small amplitude sensory nerve action potential response, but at times can be observed with an amplitude greater than 10 μV. It is possible that patients with an absent or significantly delayed median nerve response may have simultaneous inadvertent spread of stimulus to ulnar axons measurable on D3 that may be interpreted as a falsely normal response. All electromyographers need to be aware of this potential pitfall.
    Type of Medium: Online Resource
    ISSN: 0736-0258
    URL: Article
    DOI: 10.1097/WNP.0000000000000622
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2065729-8
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  • 3
    Online Resource
    Online Resource
    Electrodiagnostic Evidence of Berrettini Anastomosis
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of Clinical Neurophysiology Vol. 35, No. 2 ( 2018-03), p. 133-137
    Details
    In: Journal of Clinical Neurophysiology, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 2 ( 2018-03), p. 133-137
    Abstract: Cadaveric palmar dissections reveal an ulnar sensory crossover (Berrettini anastomosis) to the third common palmar nerve so frequently that this crossover is considered a normal part of the anatomy. No literature has documented electrophysiologic evidence of the Berrettini anastomosis (BA). Presentation of third digit ulnar sensory crossover waveforms. Methods: Retrospective chart review case series. Clinical office. Nerve conduction waveforms and data. Results: Ulnar stimulation sensory crossover waveforms to digit three consistent with BA are presented. Conclusions: Third digit BA is measurable in routine electrodiagnostic nerve conduction study in some patients. The observed BA latency is the same and the amplitude is smaller (25% to 33%) than the ulnar sensory response. The clinical significance of the BA sensory response is unclear. The presence of a BA in severe carpal tunnel syndrome may give a small amplitude normal latency sensory response that could be misinterpreted and lead to a false negative result.
    Type of Medium: Online Resource
    ISSN: 0736-0258
    URL: Article
    DOI: 10.1097/WNP.0000000000000427
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2065729-8
    Location Call Number Limitation Availability
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    Online Resource
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