Ulnar Nerve Cross-Sectional Area for the Diagnosis of Cubital Tunnel Syndrome: A Meta-Analysis of Ultrasonographic Measurements

2018 ◽  
Vol 99 (4) ◽  
pp. 743-757 ◽  
Author(s):  
Ke-Vin Chang ◽  
Wei-Ting Wu ◽  
Der-Sheng Han ◽  
Levent Özçakar
Keyword(s):  
Ulnar Nerve ◽  
Meta Analysis ◽  
Cubital Tunnel Syndrome ◽  
Cross Sectional Area ◽  
Cubital Tunnel ◽  
Sectional Area ◽  
Cross Sectional ◽  
Tunnel Syndrome

scholarly journals The pathology of the ulnar nerve in acromegaly

2008 ◽  
Vol 159 (4) ◽  
pp. 369-373 ◽  
Author(s):  
Alberto Tagliafico ◽  
Eugenia Resmini ◽  
Raffaella Nizzo ◽  
Lorenzo E Derchi ◽  
Francesco Minuto ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Clinical History ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Control Group ◽  
Cross Sectional ◽  
Sensory Disturbances ◽  
History Of ◽  
Tunnel Syndrome ◽  
Written Informed Consent

ContextAcromegalic patients may complain of sensory disturbances in their hands. Cubital tunnel syndrome, the ulnar nerve neuropathy at the cubital tunnel (UCT), in acromegalic patients has never been reported.ObjectiveTo describe and assess the prevalence of UCT in acromegalic patients and the effects of 1 year of therapy on UCT.PatientsWe examined prospectively 37 acromegalic patients with no history of polyneuropathy, acute trauma at the elbow, no diabetes or hypothyroidism with clinical examination, nerve conduction studies (NCS), and high-resolution ultrasound (US). A control group was made by 50 volunteers. The local ethics committee approved the study and written informed consent was obtained from all subjects involved in the study.InterventionClinical history, physical examination, NCS, and US were used to diagnose UCT at the beginning of the study and after 1 year.ResultsIn 8 of 37 patients, a diagnosis of UCT was made at the beginning of the study reflecting a prevalence of 21%. After 1 year, 5 of 8 (62.5%) patients reported clinical and NCS improvements and evident US reduction of nerve cross-sectional area (CSA; 16.7±2.9 mm2 vs 12.2±3.1 mm2; P<0.001). In 3 of 8 (37.5%) patients, the UCT was unchanged. Ulnar nerve CSA was significantly increased in acromegalic patients with UCT (16.7±2.9 mm2 vs 11.1±2.3 mm2; P<0.047).ConclusionUlnar neuropathy could occur in acromegalic patients and can improve in 62% of cases with disease control. Due to the different management and therapeutic approach, it would be important to make differential diagnosis between cubital and carpal tunnel syndrome in acromegaly.

Cross-sectional area of the ulnar nerve after decompression at the cubital tunnel

2016 ◽  
Vol 41 (8) ◽  
pp. 838-842 ◽  
Author(s):  
S. Duetzmann ◽  
K. G. Krishnan ◽  
F. Staub ◽  
J.-S. Kang ◽  
V. Seifert ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Cross Sectional Area ◽  
Cubital Tunnel ◽  
Slight Reduction ◽  
Sectional Area ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
The Mean ◽  
The Cross

A total of 48 patients undergoing surgical decompression of the ulnar nerve at the cubital tunnel between February 2010 and May 2013 were retrospectively studied to determine changes in the cross-sectional area of the nerve by the technique of neurosonography. The mean follow-up was 46 months. Post-operative follow-up examination of the cross-sectional area of the ulnar nerve showed a slight reduction in the mean value from 13.8 mm2 (pre-operative) to 12.9 mm2 (post-operative). Of the 48 patients, 36 showed a reduction in the cross-sectional area. No correlation was detected between the clinical and sonographic outcomes. Ultrasound seems to be of limited value in the post-operative assessment of patients with entrapment neuropathy of the ulnar nerve. Level of Evidence: IV

Sonographic Follow-Up of Patients With Cubital Tunnel Syndrome Undergoing in Situ Open Neurolysis or Endoscopic Release: The SPECTRE Study

Hand ◽  
2019 ◽  
pp. 155894471985781
Author(s):  
Stefano Lucchina ◽  
Cesare Fusetti ◽  
Marco Guidi
Keyword(s):  
Clinical Outcome ◽  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Sonographic Examination ◽  
Cross Sectional ◽  
Endoscopic Release ◽  
Significant Difference ◽  
Tunnel Syndrome

Background:The measurement of cross-sectional area (CSA) is a diagnostic tool to detect entrapments syndrome. The aim of this study was to compare the clinical outcome in elbows undergoing endoscopic and “in situ” open cubital tunnel release for cubital tunnel syndrome (CuTS) using ultrasound-related changes in the largest CSA of the ulnar nerve. The purpose is to determine the association between clinical outcome and CSA. Methods: From May 2011 to April 2016, 60 patients with CuTS were prospectively followed and not randomly divided in two groups: 30 patients undergoing an endoscopic release (ER) and 30 patients with “in situ” open neurolysis (OR). A sonographic examination was performed by the senior authors at baseline and 3, 6, and 12 months after surgical decompression. Results: CSA values were statistically significantly lower in the ER. Hand grip strength difference with Jamar test was not statistically significant a 12 months (39 kg vs 27 kg). Static-2 point discrimination test difference was only statistically significant lower in the endoscopic group at 3, 6 and 12 months but not clinically relevant (5 mm vs 6 mm). The American Shoulder and Elbow Surgeons—Elbow questionnaire (ASES-e) function score, ASES-e Pain score, and ASES-e Satisfaction score were not statistically significant different between the two groups at 3, 6, and 12 months post operatively. Conclusions: The study confirms that in spite of lower values of CSA in the ER, there is not a statistically significant difference between the two techniques in terms of subjective outcomes. Ultrasound (US) measurements seem to have a limited value in clinical results of patients treated for entrapment neuropathy of the ulnar nerve. Type of study/LOE: Prognostic Level III

scholarly journals Ulnar Nerve Morphology in Magnetic Resonance Imaging Predicts Nerve Recovery After Surgery for Cubital Tunnel Syndrome

2020 ◽  
Author(s):  
Jong Seop Kim ◽  
Young Ju Chae ◽  
Gajendra Mani Shah ◽  
Hyun Sik Gong
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ulnar Nerve ◽  
Signal Intensity ◽  
Cubital Tunnel Syndrome ◽  
Sectional Area ◽  
Resonance Imaging ◽  
Cross Sectional ◽  
Intensity Changes ◽  
Tunnel Syndrome ◽  
Poor Outcomes

Abstract Background: Magnetic resonance imaging (MRI) is helpful for the diagnosis of cubital tunnel syndrome (CuTS), but its prognostic value for surgical outcomes is unknown. We aimed to determine whether MRI parameters correlated with outcomes after surgery for CuTS. Methods: We reviewed 40 patients who had electrodiagnostic tests and MRIs for CuTS preoperatively and had 6-month evaluations postoperatively. The MRI parameters were ulnar nerve cross-sectional area (UNCSA) measured at 6 different levels around the medial epicondyle (ME), signal intensity changes of innervated muscles of the ulnar nerve, and the presence of ganglion around the ulnar nerve. Other factors assessed were age, symptom duration, symptom severity, presence of diabetes mellitus, and electrodiagnostic parameters including motor nerve conduction velocity (mNCV). We analyzed the factors associated with fair or poor outcomes graded by Wilson-Krout classification. Results: The UNCSA was the largest at ME level and smallest at 3cm distal to ME level. Increased ulnar nerve signal intensity changes were found in 34 subjects and increased forearm muscle signal intensity changes were found in two. Ten patients were found to have ganglia. Twelve patients (30%) had excellent results, 19 (48%) had good, 8 (20%) had fair, and 1 (4%) had a poor result. In univariate analysis, fair or poor outcomes were associated with increased UNCSA 1 cm proximal and 1 cm distal from the ME, the presence of ganglion, and decreased mNCV. In multivariate analysis, fair or poor outcomes were associated with either increased UNCSA 1 cm distal from the ME (OR 11.15; p = 0.019), or increased UNCSA 1 cm proximal from the ME (OR 16.01; p = 0.038) and decreased mNCV (OR 0.92; p = 0.044).Conclusions: This study demonstrated that increased ulnar nerve cross-sectional area on MRI correlated with suboptimal improvement after surgery for CuTS at 6 months follow up. MRI examination for morphologic changes of the ulnar nerve can be helpful for patient consultation on the prognosis of surgery for CuTS.

scholarly journals Ultrasonographic Findings of the Ulnar Nerve Following Elbow Flexion in Patients with Cubital Tunnel Syndrome

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 2684-2691 ◽  
Author(s):  
Goo Joo Lee ◽  
Donghwi Park
Keyword(s):  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Elbow Extension ◽  
Distance Ratio ◽  
Cross Sectional ◽  
Dynamic Movement ◽  
Tunnel Syndrome ◽  
Elbow Motion

Abstract Objective To evaluate the ultrasonographic findings obtained following various degrees of elbow flexion in patients with cubital tunnel syndrome (CuTS). Design Retrospective, cross-sectional study. Setting General teaching hospital, rehabilitation unit. Subjects Electrophysiological and ultrasonographic assessments were performed on 11 elbows of healthy controls and 21 elbows of 17 patients with CuTS. Methods Dynamic movement of the ulnar nerve during elbow motion was measured. To measure ulnar nerve dynamic movement during elbow motion, the distance from the medial epicondyle (ME) to the nearest surface of the ulnar nerve toward the ME was measured at the cubital tunnel inlet at elbow extension (0°), elbow flexion to 60°, and elbow flexion to 90°. Results The distance between the ME and ulnar nerve was lower in CuTS patients than in healthy patients at all elbow flexion angles. This difference was statistically significant at 0° and 60° elbow flexion (P &lt; 0.05). When calculating the cutoff value, the distance between the ME and ulnar nerve at full elbow extension for CuTS diagnosis was 0.53 cm (sensitivity = 71.4%, specificity = 90.7%). The distance ratio between the ME and ulnar nerve for diagnosis of ulnar neuropathy at the elbow was 24.4% (sensitivity = 76.2%, specificity = 100%). Conclusion Measurement of the distance between the ME and ulnar nerve in full elbow extension may facilitate the diagnosis of patients with CuTS. These findings may be important for CuTS diagnosis, as they were also observed in patients with mild-stage CuTS.

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