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Search Results for : Ulnar Nerve Entrapment
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Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
Endoscopically assisted release of the ulnar nerve for cubital tunnel syndrome.
Author(s): Flores, LP
Journal: Acta Neurochir (Wien) 2010 Jun 19; Vol. 152, Issue 4; Page(s) 619-25
[Medline ID - 20024689]

PURPOSE: Recently, the simple decompression of the ulnar nerve has been advocated as the best surgical approach for the treatment of the cubital tunnel syndrome. Encouraged by the positive results observed with the use of the endoscopic approach for the treatment of the carpal tunnel syndrome, there have been reports about the use of endoscopes for decompression of the ulnar nerve at the level of the elbow since 1999. The objective of this study was to demonstrate the surgical results obtained with a simple and replicable technique employed for endoscopic release of the ulnar nerve in cases of cubital tunnel syndrome. METHODS: It was retrospectively studied thirteen patients who presented signs and symptoms of cubital tunnel syndrome and who were operated on by an endoscopically assisted technique, from 2007 to 2009. The approach included the use of a 0 degrees lens neuroendoscope u sually employed for ventricular endoscopy. Preoperative clinical and electrophysiological data were collected and compared to those observed 6 months after the surgery. The Dellon's scale was used for rating the severity of the lesions, and the postoperative outcome was assessed based on the Bishop rating system. RESULTS: All procedures were completed successfully via the endoscopically assisted approach, and no surgery had to be converted to an open operation. Postoperatively, 76.9% of the cases were completely free of signs and symptoms (8 and 9 points on the Bishop scale), 15.3% presented with light complaints (7 points), and only one subject (7.6%) reached 5 points on the outcome scale. Complete normalization of the electrophysiological studies was also observed in seven patients, most of whom were classified preoperatively as Dellon's grades I and II, but three of whom were classified as grade III. Normalization of the sensory conduction studies was observed in ten cases, normalization of the motor conduction studies in six subjects, and in four patients, there was improvement in electromyographic parameters. CONCLUSIONS: The endoscopically assisted approach for decompression of the ulnar nerve at the level of the elbow is a minimally invasive technique that demonstrated surgical results similar to those reported via the open approach. It may have additional advantages such as the reduction of soft tissue manipulation, faster mobilization of the arm, and quicker return of the patients to their daily activities.

Ulnar nerve penetration by a volar ganglion in the Guyon canal.
Author(s): Chalidis, BE; Sachinis, NC; Dimitriou, CG
Journal: Plast Reconstr Surg 2010 Jan 12; Vol. 124, Issue 5; Page(s) 264e-6e
[Medline ID - 20009809]

ABSTRACT NOT AVAILABLE

Minimalist cubital tunnel treatment.
Author(s): Abuelem, T; Ehni, BL
Journal: Neurosurgery 2010 Mar 17; Vol. 65, Issue 4 Suppl; Page(s) A145-9
[Medline ID - 19927059]

OBJECTIVE: The surgical treatment of cubital tunnel syndrome by various techniques is often met with disappointing results. An optimal treatment is not agreed upon. The authors propose a collection of techniques which they believe optimizes outcome and minimizes iatrogenic injuries. METHODS: A combination of a novel skin incision which minimizes scar and iatrogenic cutaneous nerve injury, a technique of in situ decompression, and an atraumatic technique of ensuring complete nerve exploration proximal and distal to the incision is presented; these methods have been in use by the senior author for a number of years. RESULTS: Numerous reports have demonstrated that the success of in situ ulnar nerve release by division of Osborne's fascia is equivalent to the success rates of more invasive operations for the condition of ulnar neuropathy. The authors share this view in the majority of cases of ulnar neuropathy, and they present a technique that can be expanded, if necessary, on the basis of surgical findings, with only a few indications for the greater epicondylectomy or transposition procedures. CONCLUSION: The authors present a means of treating cubital tunnel syndrome. Failure of in situ cubital tunnel release, as with failure of any ulnar procedure, can be attributed to intraoperative ulnar nerve injury, injury to the medial antebrachial cutaneous nerve, inadequate longitudinal exploration and release, scar formation with recurrent compression and/or traction, and the possibility that decompression could lead to iatrogenic symptomatic nerve subluxation. The authors discuss the rationale for a minimalist open surgical approach for the treatment of cubital tunnel syndrome, and each of these concerns is addressed.

Ultrasonographic and functional changes of the ulnar nerve at Guyon's canal after carpal tunnel release.
Author(s): Ginanneschi, F; Filippou, G; Reale, F; Scarselli, C; Galeazzi, M; Rossi, A
Journal: Clin Neurophysiol 2010 Mar 10; Vol. 121, Issue 2; Page(s) 208-13
[Medline ID - 19955016]

OBJECTIVE: To describe morphologic and functional modifications of the ulnar nerve at the wrist in carpal tunnel syndrome (CTS) after carpal tunnel release (CTR). METHODS: Ultrasonography was used to study the cross sectional area (CSA) of the ulnar nerve at Guyon's canal, before and 1 and 6 months after CTR, in 18 CTS patients. A parallel electrophysiological and clinical analysis was also conducted. RESULTS: CSA of the ulnar nerve significantly increased 6 months after CTR. Ten (55%) cases showed abnormal CSA values compared to a control group before surgery and five (28%) at 6 month follow-up. In addition, there were improvements in the motor and sensory ulnar axon recruitment properties and the conduction values in sensory ulnar fibres. Patients with extra-median distribution of paresthesia (4 subjects) were free from symptoms. CONCLUSIONS: CTR has a significant effect not only on the anatomical geometry of Guyon's canal, but also on the morphology and function of the ulnar nerve. SIGNIFICANCE: In CTS, high pressure in the carpal tunnel may result in anatomical changes of ulnar nerve, thus causing functional impairment to the ulnar fibres. CTR appears to reverse some of this damage.

Correlation between the lengths of the upper limb and cubital tunnel: potential use in patients with proximal ulnar nerve entrapment.
Author(s): Tubbs, RS; Loukas, M; Apaydin, N; Cossey, TD; Yal; çin, B; Shoja, MM; Cohen-Gadol, AA
Journal: Surg Radiol Anat 2010 Jun 25; Vol. 32, Issue 3; Page(s) 239-42
[Medline ID - 19943048]

INTRODUCTION: We hypothesized that a correlation may exist between the length of the upper limb and the length of the cubital tunnel, which transmits the ulnar nerve from the arm to the forearm. If true, this association might aid in predicting individuals at greater risk of developing ulnar nerve compression at this site. MATERIALS AND METHODS: A total of 46 cadaveric upper limbs were dissected. The lengths of the upper limb and cubital tunnel were measured and analysis made of any correlation between these two distances. RESULTS: The average length of the cubital tunnel was found to be 2.7 cm (range 1.2-4.7 cm, SD 0.82), and the average length of the upper limb was 62.5 cm (range 51-72 cm, SD 4.33). No significant difference was found with either length of the tunnel between left and right sides or amon g genders. Neither the ratio of upper limb length to length of the cubital tunnel between genders nor the ratio between left and right sides was found to have a positive correlation. CONCLUSIONS: These data suggest that the cubital tunnel length maintains similar proportion to upper limb length among genders and sides and that a correlation between these two distances does not exist.

Unusual coexistence of a variant abductor digiti minimi and reversed palmaris longus and their possible relation to median and ulnar nerves entrapment at the wrist.
Author(s): Georgiev, GP; Jelev, L
Journal: Rom J Morphol Embryol 2010 Apr 23; Vol. 50, Issue 4; Page(s) 725-7
[Medline ID - 19942973]

During routine anatomical dissection of the left upper limb of a 73-year-old female cadaver, a unique coexistence of variant muscles was found. In the forearm region, a largely developed reversed palmaris longus was discovered. Its short distal tendon was in close relation to the median nerve. In the neighboring hypothenar region, an unusual abductor digiti minimi was also observed. Its muscular body was composed of two portions - medial and lateral one, arising from the reversed palmaris longus tendon. The lateral portion passed over the ulnar nerve and artery in the canal of Guyon. In the literature, there are descriptions of entrapment neuropathies caused by either reversed palmaris longus or variant abductor digiti minimi. Here, for the first time we describe a coexistence of these variant muscles and suggest it as a possible, even rare, cause of both the median and ulnar nerves entrapment and ulnar artery thrombosis.

Ultrasonography in patients with ulnar neuropathy at the elbow: comparison of cross-sectional area and swelling ratio with electrophysiological severity.
Author(s): Bayrak, AO; Bayrak, IK; Turker, H; Elmali, M; Nural, MS
Journal: Muscle Nerve 2010 Jun 9; Vol. 41, Issue 5; Page(s) 661-6
[Medline ID - 19941341]

The aim of this study was to determine the diagnostic value of ultrasonographic measurements in ulnar neuropathy at the elbow (UNE) and to assess the relationship between the measurements and the electrophysiological severity. The largest anteroposterior diameter (LAPD) and cross-sectional area (CSA) measurements of the ulnar nerve were noted at multiple levels along the arm, and the distal-to-proximal ratios were calculated. Almost all of the measurements and swelling ratios between patients and controls showed statistically significant differences. The largest CSA, distal/largest CSA ratio, CSA at the epicondyle, and proximal LAPD had larger areas under the curve than other measurements. The sensitivity and specificity in diagnosing UNE were 95% and 71% for the largest CSA, 83% and 85% for the distal/largest CSA ratio, 83% and 81% for the CSA at the epicondyle, and 93% and 43% for the proximal LAPD, respectively. There was a statistically significant correlation between the electrophysiological severity scale score (ESSS) and the largest CSA, the CSA at the epicondyle and 2 cm proximal to the epicondyle, and the LAPD at the level of the epicondyle (P < 0.05). None of the swelling ratios showed a significant correlation with the ESSS. The largest CSA measurement is the most valuable ultrasonographic measurement both for diagnosis and determining the severity of UNE.

Cubital tunnel syndrome in patients with haemophilia.
Author(s): Mortazavi, SM; Gilbert, RS; Gilbert, MS
Journal: Haemophilia 2010 Sep 8; Vol. 16, Issue 2; Page(s) 333-8
[Medline ID - 19925630]

SUMMARY: Elbow is the second most common joint involved in patients with haemophilia; however, there is little data about the involvement of ulnar nerve at elbow in patients with haemophilic arthropathy. The purpose of this study was to address this problem in the elbow and evaluate the results of anterior subcutaneous transposition of the ulnar nerve in a small group of patients with haemophilia who had been managed in two institutions. Information on six patients who were diagnosed with tardy ulnar nerve palsy in two institutions was retrospectively collected. All patients suffered form severe haemophilia A. Anterior subcutaneous transposition of the ulnar nerve had been performed in all except one. The mean age of the patients at the time of procedure was 45.8 years and the mean duration of follow-up was 60.2 months. No postoperative complication or recurrence was observed. No additional surgery was required in operated patients. Evaluation was performed using subjective and objective measures, and a modified Bishop score. After operation, subjective sensory and m otor disturbances were improved or resolved in all of the operated patients, while objective measures improved less well. Ulnar nerve can be involved in cubital tunnel in patients with haemophilia. Anterior subcutaneous transposition of the ulnar nerve is an effective procedure for improving patients' symptoms, with low risk of complications.

Chronic neuropathic pain in spinal cord injured patients: what is the effectiveness of surgical treatments excluding central neurostimulations?
Author(s): Robert, R; Perrouin-Verbe, B; Albert, T; Bussel, B; Hamel, O
Journal: Ann Phys Rehabil Med 2010 Mar 5; Vol. 52, Issue 2; Page(s) 194-202
[Medline ID - 19909710]

OBJECTIVES: Analyzing the literature and elaborating recommendations on the following topics: relevance of dorsal root entry zone (DREZ) lesions, surgical treatment for posttraumatic syringomyelia, other therapeutic approaches (peripheral nerve root pain, nerve trunk pain and Sign Posterior Cord [SCI] pain). MATERIAL AND METHODS: The methodology used, proposed by the French Society of Physical Medicine and Rehabilitation (SOFMER), includes a systematic review of the literature, the gathering of information regarding current clinical practices and a validation by a multidisciplinary panel of experts. RESULTS: Ninety-two articles were selected, 10 with a level of evidence at 2, 82 with a level of evidence at 4. Some articles lacked information on the type of injury, the pain characteristics and the symptoms' evolution over time. DREZ: This type of procedure has been validated for its effectiveness on pain at the level of injury (transitional zone pain), but is inefficient for pain located below the level of injury. Posttraumatic syringomyelia (PTS): suspected when there is an increased neurological impairment, changes below the level of injury (mainly bladder dysfunctions) or a sudden onset of pain. The surgery associates arachnoid grafting, cyst drainage, expansile dural plasty (same treatment for posttraumatic tethered spinal cord and posttraumatic myelomalacia). PERIPHERAL NERVE ROOT, NERVE TRUNK OR TRANSITIONAL ZONE PAIN: Surgical implants (screws or clips) can generate radicular pain caused by inflammation and they can even move around with time. The material-induced constraints can also trigger pain. Surgical removal of osteosynthesis material (with an eventual saddle block) remains a simple procedure yielding good results. Correcting surgeries can also be performed (malunion and nonunion). Finally, compressive neuropathies (carpal tunnel syndrome, ulnar nerve entrapment) already have a well-defined treatment. CONCLUSION: The literature review can define the relevance of surgical treatments on some types of SCI pain. However, the results of many articles are difficult to analyze, as they do not report clinical or follow-up data.

Submuscular versus subcutaneous anterior ulnar nerve transposition: a rat histologic study.
Author(s): Lee, SK; Sharma, S; Silver, BA; Kleinman, G; Hausman, MR
Journal: J Hand Surg Am 2010 Mar 2; Vol. 34, Issue 10; Page(s) 1811-4
[Medline ID - 19897324]

PURPOSE: The 2 most common methods of ulnar nerve anterior transposition are submuscular and subcutaneous. Controversy exists as to which technique yields superior results. The purpose of this study was to examine the histologic differences between the 2 methods in a rat model. METHODS: Twenty forelimbs in 10 adult Sprague-Dawley rats had bilateral ulnar nerve transpositions; one side with the submuscular method, and the other side with the subcutaneous method. Animals were killed 6 weeks after the index surgery and the forelimbs were examined for histologic evidence of the health of the axons and perineural scar formation. RESULTS: Nerve health was assessed using a 4-part classification in which 4 = normal nerve, 3 = abnormal axons in one-third cross-sectional area (CSA), 2 = abnormal axons in two-thirds CSA, and 1 = abnormal axons in 100% CSA. Perineural scar formation was assessed using a 3-part classification in which 3 = scar completely encasing nerve, 2 = scar formation partially surrounding nerve, and 1 = no scar. The submuscular method displayed healthier ulnar nerve axons. In addition, the submuscular method displayed less perineural scar tissue. CONCLUSIONS: On this basis of this rat model, the submuscular method of ulnar nerve anterior transposition displayed histologically healthier axons and less perineural scar tissue when compared to the subcutaneous method.
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