Objective:
To assess the usefulness of superficial ultrasonography of median nerve in accurate differentiation between neuropathic nerve and normal nerve measurement in Egyptian population.

Material and Methods:
The study was conducted on thirty patients with CTS; twelve males and eighteen females with mean age 43.93±4.51 (range 35-52y), and another thirty normal subjects; fifteen males and fifteen females, with their mean age 36.7±4.86 (range 29-45y). The Cross Sectional Area (CSA) and Flattening Ratio (FR) at different levels on both groups. Data from the study and control groups were compared. The accuracy of the ultrasonographic diagnostic criteria for CTS was evaluated using Receiver Operating Characteristic (ROC) analysis.

Results:
All measurements showed significant differences between CTS and normal groups except the CSA at pronator quadrates. Using the ROC curve, a cutoff value of CSA >10 mm2 at the level of pisiform and CSA difference > 1 between pisiform and pronator quadrates provided a 100% specificity and high overall diagnostic accuracy 98.89%.

Conclusion:
The sonographic cutoff values of the median nerve dimensions in Egyptian population could yield an accurate differentiation between neuropathic and normal median nerve.

Temporomandibular joint (TMJ) dislocations, which occur as a result of an excess of muscle activity/ spasticity in the protractor masticatory muscles, were defined as neurogenic dislocations of the TMJ. We report a case of a 36-year-old woman with sequelae of haemorrhagic stroke, which developed recurrent episodes of TMJ dislocation, interfering with the rehabilitation program and her well-being/quality of life. Conservative measures were implemented but 2 months later, TMJ dislocation episodes continued (2-3 daily). Then, type A botulinum toxin (BTX-A) injections were applied to both lateral pterygoid muscles, and these episodes ceased to happen for more than seven months. While conservative treatment is often not sufficient, surgical procedures are invasive and involve more risk, BTX-A injections, were an effective treatment option during for a longer than expected period of time.

The article presents the results of comprehensive approach to the treatment of temporomandibular dysfunction (TMD, which consisted in combination of occlusal therapy and muscle status correction with Botulinum Toxin A (BTX-A) injections or using centrally acting muscle relaxants. The study included 111 patients, 81 women and 30 men aged 18 to 45 years. According to the results of the clinical examination all patients were divided into two groups. The main group (91 patients) included patients with clinical signs of TMD. The control group (20 patients) consisted of patients without clinical signs of dysfunction and without malocclusion. The groups were comparable in sex and age. Patients of the main group were divided into 2 subgroups: in the first sub group the patients received centrally action muscle relaxants (71 people), in the second the patients were treated with BTX-A injections into masticatory muscles (20 people). In both subgroups the treatment included occlusal therapy. All patients were subjected to Magnetic Resonance Imaging (MRI) of the TMJ and masticatory muscles, as well as ultrasonography and surface Electromyography (EMG) of the masticatory muscles before and after treatment. As a result, a significant reduction in the pain syndrome, an improvement in the interrelation of intraarticular TMJ elements and a change in the structure of the masticatory muscles was revealed. The best results were achieved in the group with injections of BTX-A into the masticatory muscles. Electromyographic indexes have approached the values of the norm. The clinical signs of TMD decreased or reduced.

A 46 year old, healthy weight female patient visited our outpatient clinic with complaints of the right knee. Since a few months she experienced symptoms of a locked knee without explainable cause and localized pain on the lateral side.

A case of acute compartment syndrome is described in an old woman following branch stuck to her forearm. She just displayed a little wound with no fractures. The ulnar artery was punctured by a branch and caused a large forearm hematoma and eventually lead to an acute forearm compartment syndrome. Prompt diagnosis and surgical management bring a successful consequence. The written informed consent was obtained from the patient to publicate this case, including the following pictures.