Diverticular disease continued

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Diverticular disease

Normal colon

Sites of diverticulum formation

Taenia coli Mucosa

Circular muscle Lumen

Blood vessels penetrating muscle

Arterial supply

Mesentery (mesocolon)

Faecolith in diverticulum

Taenia coli

Mucosa

Circular muscle Lumen

Diverticulum

Blood vessels penetrating muscle

Arterial supply

Mesentery (mesocolon)

Fig. 9c

^^ Mononeuropathies caused by nerve compression from surrounding structures.

Carpal tunnel syndrome: Compression of the median nerve within the carpal tunnel of the hand. Predisposing factors include pregnancy, hypothy-

Oroidism, acromegaly and wrist joint disease.

Ulnar nerve entrapment: Compression of the ulnar nerve as it passes along the ulnar groove behind the medial epicondyle of the humerus. Predisposing factors include arthritis of the elbow joint, previous supracondylar fractures. Meralgia paraesthetica: Lateral cutaneous nerve of the thigh may be com-

Ú pressed by the inguinal ligament in pregnancy, obesity or tight trousers.

Common peroneal compression: Compression of the common peroneal

Z nerve as it winds around the neck of the fibula. Common mechanisms is with plaster casts, proximal fibula fractures.

Facial nerve compression: Mass in parotid gland, mass in the auditory canal. V^ |A/R: See A.

^^ ^lE Common. Carpal tunnel is 8x more common in females.

H: Sensory changes in distribution of nerve, pins and needles, numbness, pain. Carpal tunnel: Median nerve (radial 3l2 digits of the hand), often worse at night and exacerbated by certain tasks, e.g. typing. Ulnar nerve: Ulnar nerve (last 1/2 digits of the hand).

Meralgia paraesthetica: sensory disturbance over anterolateral aspect of thigh. Common peroneal compression: Dorsum of foot may have impaired sensation.

E: Putting pressure on the site of nerve compression may bring on or worsen the symptoms. Sensory impairment in the affected nerve distribution. Weakness, wasting (if prolonged) of muscles in affected nerve distribution (e.g. thenar eminence muscles in carpal tunnel syndrome).

Carpal tunnel syndrome: Tapping overthe carpal tunnel (Tinel's test), hyper-flexing of the wrists for 1 min (Phalen's test) reproduces symptoms. An important differential is C6-C7 radiculopathy, suggested by other motor signs (e.g. brachioradialis weakness, loss of triceps reflex or sensory involvement of the palm of the hand or forearm).

Ulnar nerve: Weakness of long finger flexors and intrinsic muscles of the hand, the end result would be a 'claw hand'. Sensory impairment in the fifth finger and ulnar border of the hand.

Common peroneal nerve: Foot drop, sensory disturbance of the leg and dorsum of foot. There may be weakness of ankle eversion but there is preserved ankle inversion (sparing of tibialis posterior) and preserved ankle reflex. Main differential is L5 radiculopathy (where ankle inversion is affected).

P: Nerve compression can result in nerve ischaemia and segmental demyelination (neuropraxia), which can eventually cause axonal degeneration.

I: Nerve conduction studies: Often unnecessary but allows confirmation. Bloods: TFT, glucose (diabetes can cause mononeuropathies), ESR.

M: Carpal tunnel syndrome: Nonsurgical measures include steroid injections into the carpal tunnel, wrist splints and treatment of cause. Surgical decompression consists of division of the flexor retinaculum.

Ulnar nerve: Conservative management or surgical release of the nerve from the ulnar groove, resiting the course anterior to the medial epicondyle (anterior nerve transposition).

Meralgia paraesthetica: Encourage weight loss, avoid tight clothing. Common peroneal compression: Conservative approach often results in recovery; however, exploration and decompression may be required. Facial nerve compression: Excision of cause (e.g. parotid gland mass).

_C Recurrence following conservative measures is common. Irreversible loss of nerve function if progressive compression with weakness, wasting and sensory loss.

P: Depends on cause and treatment, but persistent symptoms are not uncommon.

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