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Ganglions of the wrist and hand causing compressive neuropathies are rare clinical entities. Compression of the ulnar and median nerves in their respective fibro-osseous tunnels lead to characteristic patterns of motor and/or sensory deficits, which are directly related to the location of the lesion. We present a unique case of a "dumbbell" shaped ganglion invading both Guyon's canal and the carpal tunnel causing a dual compressive neuropathy of the ulnar and median nerve. We discuss the patho-anatomy, clinical assessment, investigation and surgical treatment of this condition.

Ulnar nerve neuropathy is a rare complication following the carpal tunnel release. Above all, compression neuropathy is much rare. We report an acute ulnar nerve neuropathy following open carpal tunnel release due to the volar and ulnar displacement of the flexor tendons from the carpal tunnel and review the literature.

Epidermal cyst is a dermal or subcutaneous epithelial cyst that contains keratin and is lined by true epidermis. Although extremely rare, it can cause pathology including nerve compression syndrome. We report a rare case of ulnar nerve compression in the elbow that was caused by olecranon bursitis and concomitant epidermal cyst in a 67-year-old man. The ulnar nerve was immediately adjacent to the olecranon bursa and was significantly compressed. There was no connection between the tumor and the ulnar nerve. Pain, numbness, and weakness in his ring and little fingers disappeared after resection of the cyst and bursa.

Diabetes mellitus is a medical disorder characterized by varying or persistent hyperglycemia (elevated blood sugar levels), especially after eating. People with diabetes have problems converting food to energy. The most common form of diabetes is type 2 diabetes. Foot disease is a common complication of diabetes that can have tragic consequences. Abnormal plantar pressures are considered to play a major role in the pathologies of neuropathic ulcers in the diabetic foot. The purpose of this study was to classify the plantar pressure distribution in normal and type 2 diabetes subjects with and without neuropathy. Foot scans were obtained using the F-Scan (Tekscan, USA) in-shoe pressure measurement system. Various pedobarographic parameters such as the total plantar force, total contact area, peak pressures, and percentage medial impulse (PMI) were evaluated. These parameters were subjected to analysis of variance (ANOVA) test with a >95% confidence interval, giving excellent p-values in all of the categories. When these extracted parameters were presented to the artificial neural network (ANN) for classification, the neural network classifier was seen to be correct in more than 90% of the test cases.

Heart rate is a non-stationary signal and provides a powerful interplay between the sympathetic and parasympathetic nervous systems. The heart rate variation signal can reveal disorders associated with how these nervous systems regulate the heart rate, and hence may contain indicators of this disease state, or warnings about impending or future cardiac diseases. These indicators may be present at all times or may occur at random during certain intervals in the time scale. It is difficult and time consuming to pinpoint these abnormalities in a huge cardiac data set. Heart rate variability (HRV) constitutes a tool for assessing the activities of the autonomic nervous system (ANS). In this work, we have proposed a computer based analytical system to determine the HRV, and analyzed it to obtain HRV Power-spectrum for normal, diabetes and diabetes with neuropathy subjects in deep breathing, standing and supine position. We have then designated indices based on the HRV power-spectra power values and frequency shift of these peaks from their normal frequency values. We have shown the efficacy and sensitivity of these indices, to differentiate between normals, diabetics and diabetics with ischemic heart disease. Thus we have demonstrated how effectively these HRV power-spectral indices can enable diagnosis of diabetic autonomic neuropathy. Finally, we have composed an integrated index made up of these power-spectral indices, to facilitate distinguishing and diagnosing diabetic autonomic neuropathy in terms of just one index or number.

Diabetic neuropathy is one of the physical complications of diabetes mellitus (DM) patients with a long history of diabetes. An electromyography (EMG)-based assessment may be very useful for the management of diabetic neuropathy. In the present study, we aimed to summarize all of the findings and recommendations obtained from previous studies that investigated the application of EMG to the assessment of diabetic neuropathy. An extensive search of the prominent electronic databases PubMed, Google Scholar and Scopus was performed to evaluate the following areas: (i) what are the muscles to be evaluated by EMG for neuropathy assessment, (ii) what type of EMG methodologies have been used and (iii) what recommendation can be made for neuropathy detection. The major findings are summarized as follows: (i) very few studies have analyzed the correlation of the EMG signals acquired from peripheral muscles affected in neuropathy with those obtained with non-neuropathic complications, such as ankle sprain; (ii) EMG has been applied for the detection of diabetic neuropathy more than diabetes treatment; and (iii) neuropathy detection using an EMG-based assessment were mainly performed for type 2 DM patients aged at least 50 years.

Coronavirus disease 2019 (COVID-19) continues to pose significant health challenges, with insights into long-term disease sequelae emerging. The post-viral effects resulting from COVID-19 are being investigated and ‘long COVID-19’ is now a recognised phenomenon. As part of the spectrum of comorbidities, acute-onset neuropathy is associated with infection. The public health response aimed at limiting morbidity and mortality is rooted in vaccination programmes. With the extensive roll-out of novel vaccinations, there has been careful monitoring of temporally associated health problems. Some of the documented associations include neuropathy and entrapment neuropathies. This case report details a patient presenting with bilateral carpal tunnel syndrome (CTS) post their second dose of AZD1222 (ChAdOx1 nCoV-19) vaccination. Though we do not claim causality, the emerging post-vaccination immune-mediated effects may ultimately be proven to include neuropathy exacerbation. Meticulous recording of such associations is required as it is of great relevance to the hand surgeon managing CTS.

Level of Evidence: Level V (Therapeutic)

Intraneural ganglia are rare, benign cysts that form within the epineurium of the affected nerve. Patients present with features of compressive neuropathy, including numbness. We report a 74-year-old male patient with pain and numbness on his right thumb of 1-year duration. Magnetic resonance imaging revealed a cystic lesion with a possible scaphotrapezium-trapezoid joint connection. The articular branch was not identified during the surgery and decompression with excision of the cyst wall was done. A recurrence of the mass was noted 3 years later, but the patient was asymptomatic and no additional intervention was done. Decompression alone can relieve the symptoms of an intraneural ganglion, but excision of the articular branch may be essential in preventing its recurrence.

Level of Evidence: Level V (Therapeutic)

Control of blood sugar is a very important factor in the management of all diabetics. Medications are needed in addition to dietary restrictions and regular exercise. Type 1 and Type 2 diabetes are described — the most common being Type 2. The various types of medications prescribed are also elaborated. Capillary glucose monitoring and HbA1C monitoring are important for good diabetic management. Good glycaemic control prevents complications of diabetes from developing, including nephropathy, retinopathy, neuropathy and vasculopathy.