Physical Medicine / OMM
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30823
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Browsing Physical Medicine / OMM by Author "Ferguson, Drew"
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Item GUYON'S CANAL SYNDROME AFTER CUBITAL TUNNEL RELEASE: A CASE REPORT(2022) Yasuda, Tai; Ferguson, Drew; Selod, OmarBackground:Compression of the ulnar nerve typically occurs at the cubital tunnel and less commonly at Guyon's canal. The cubital tunnel is located between the olecranon and the medial epicondyle. A known risk factor for developing cubital tunnel syndrome is repetitive motions at the elbow, commonly found in tennis players and smokers. Guyon's canal is located at the medial wrist between the hook of hamate and pisiform. Compression at Guyon's canal is rare and most commonly occurs in cyclists. In this case, Guyon's canal compression was found after an ulnar nerve decompression and cubital tunnel syndrome in the contralateral extremity. Case Presentation:The patient is a 74-year-old female that presented to the physiatry clinic for bilateral weakness, numbness and tingling in the fourth and fifth fingers. Symptoms in the right hand began approximately eight years ago. She had a right ulnar nerve decompression with persistent numbness since then. Symptoms on the left hand began three months prior to presentation. Social history was significant for an 80-pack year smoking history. Physical exam revealed positive Formant's sign bilaterally and positive Tinel's sign at the right wrist, right elbow, and left wrist. Electrodiagnostic findings were consistent with left sided cubital tunnel syndrome and right sided compression at Guyon's canal. Conclusions:The use of EMG and NCS studies are helpful in diagnosing ulnar nerve lesions. However, if a cubital tunnel syndrome is found, a distal Guyon's canal compression may be masked. In this case, an undiagnosed Guyon's canal compression may have been hidden in the initial EMG study. Additionally, proximal compression of a nerve may contribute to the disruption neurofilament structure, resulting in the distal nerve to be more sensitive to compression.In patients with persistent symptoms of ulnar nerve compression after surgical cubital tunnel release, repeat EMG studies to screen for Guyon's canal compression should be considered.Item Parsonage Turner syndrome following COVID19 vaccination in a cancer patient: A case report(2022) Ferguson, Drew; Yasuda, Tai; Selod, OmarBackground: Parsonage Turner syndrome (PTS) is a rare condition involving inflammation of the brachial plexus. Causes of PTS include inflammatory processes following infections, vaccinations, and surgery. PTS following COVID19 infections and COVID19 vaccinations have been reported. In this case, the patient presented with severe shoulder pain and weakness in the left upper extremity following the second dose of the COVID19 vaccine. This case is complicated by a history of recent chemotherapy and positive COVID19 infection. Case Description: The patient is a 56-year-old male presenting to the physiatry clinic with severe left shoulder pain and weakness for five months beginning approximately twenty-four hours after the second dose of the COVID19 vaccination. Symptoms were exacerbated with abduction and external rotation. He has a history of renal cell carcinoma with metastasis treated with chemotherapy and a history of COVID19 infection prior to the vaccine. Physical exam revealed left deltoid atrophy with limited abduction and external rotation. Electrodiagnostic evidence of left sided brachial plexopathy involving the upper, middle, and lower trunks was found on EMG/NCS. MRI of the left shoulder showed edematous signal in proximal and infraspinatus muscles, consistent with PTS. Conclusions: Although the etiology of PTS is largely unclear, there is a large immune component in the development of PTS considering most cases occur after infections and vaccinations. Dysregulation of the immune system following chemotherapy may have contributed to the development of PTS in this case. COVID19 infection prior to the vaccine series may have also contributed to a heightened immune response. Risk factors for PTS include recent infections, vaccinations, and surgery. Considering the role of the immune system in developing PTS, immunocompromised conditions should also be considered as possible risk factors. It is important to identify patients at increased risk for PTS and discuss PTS as a potential adverse effect of the COVID19 infection and vaccine.