scholarly journals The 7 Structures Distal to the Elbow That Are Critical to Successful Anterior Transposition of the Ulnar Nerve

Hand ◽  
2018 ◽  
Vol 14 (6) ◽  
pp. 776-781 ◽  
Author(s):  
John M. Felder ◽  
Susan E. Mackinnon ◽  
Megan M. Patterson
Keyword(s):  
Ulnar Nerve ◽  
Ulnar Artery ◽  
Cubital Tunnel Syndrome ◽  
Medial Epicondyle ◽  
Cubital Tunnel ◽  
Anterior Transposition ◽  
Straight Line ◽  
Tunnel Syndrome ◽  
Poor Outcomes ◽  
Flexor Digitorum

Background: Ulnar nerve transposition (UNT) surgery is performed for the treatment of cubital tunnel syndrome. Improperly performed UNT can create iatrogenic pain and neuropathy. The aim of this study is to identify anatomical structures distal to the medial epicondyle that should be recognized by all surgeons performing UNT to prevent postoperative neuropathy. Methods: Ten cadaveric specimens were dissected with attention to the ulnar nerve. Intramuscular UNT surgery was simulated in each. Distal to the medial epicondyle, any anatomical structure prohibiting transposition of the ulnar nerve to a straight-line course across the flexor-pronator mass was noted and its distance from the medial epicondyle was measured. Results: Seven structures were found distal to the medial epicondyle whose recognition is critical to ensuring a successful anterior transposition of the ulnar nerve: (1) Branches of the medial antebrachial cutaneous (MABC) nerve; (2) Osborne’s fascia; (3) branches from the ulnar nerve to the flexor carpi ulnaris (FCU); (4) crossing vascular branches from the ulnar artery to the FCU; (5) the distal medial intermuscular septum between the FCU and flexor digitorum superficialis (FDS); (6) the combined muscular origins of the flexor-pronator muscles; and (7) the investing fascia of the FDS. Measurements are given for each structure. Conclusions: Poor outcomes and unnecessary revision surgeries for cubital tunnel syndrome can be avoided with intraoperative attention to 7 structures distal to the medial epicondyle. Surgeons should expect to dissect up to 12 cm distal to the medial epicondyle to adequately address these and prevent kinking of the nerve in transposition.

scholarly journals Ulnar Nerve Enlargement at the Medial Epicondyle Negatively Correlates With Nerve Conduction Velocity in Cubital Tunnel Syndrome

Hand ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 165-169
Author(s):  
T. David Luo ◽  
Amy P. Trammell ◽  
Luke P. Hedrick ◽  
Ethan R. Wiesler ◽  
Francis O. Walker ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Nerve Conduction ◽  
Nerve Conduction Velocity ◽  
Motor Nerve ◽  
Cubital Tunnel Syndrome ◽  
Medial Epicondyle ◽  
Cubital Tunnel ◽  
Motor Nerve Conduction ◽  
Nerve Enlargement ◽  
Tunnel Syndrome

Background: In cubital tunnel syndrome (CuTS), chronic compression often occurs at the origin of the flexor carpi ulnaris at the medial epicondyle. Motor nerve conduction velocity (NCV) across the elbow is assessed preoperatively to corroborate the clinical impression of CuTS. The purpose of this study was to correlate preoperative NCV to the direct measurements of ulnar nerve size about the elbow at the time of surgery in patients with clinical and/or electrodiagnostic evidence of CuTS. Methods: Data from 51 consecutive patients who underwent cubital tunnel release over a 2-year period were reviewed. Intraoperative measurements of the decompressed nerve were taken at 3 locations: at 4 cm proximal to the medial epicondyle, at the medial epicondyle, and at the distal aspect of Osborne fascia at the flexor aponeurotic origin. Correlation analysis was performed comparing nerve size measurements to slowing of ulnar motor nerve conduction velocities (NCV) below the normal threshold of 49 m/s across the elbow. Results: Enlargement of the ulnar nerve at the medial epicondyle and nerve compression at the flexor aponeurotic origin was a consistent finding. The mean calculated cross-sectional area of the ulnar nerve was 0.21 cm2 above the medial epicondyle, 0.30 cm2 at the medial epicondyle, and 0.20 cm2 at the flexor aponeurotic origin ( P < .001). There was an inverse correlation between change in nerve diameter and NCV slowing ( r = −0.529, P < .001). Conclusions: For patients with significantly reduced preoperative NCV and clinical findings of advanced ulnar neuropathy, surgeons can expect nerve enlargement, all of which may affect their surgical decision-making.

scholarly journals Subcutaneous Versus Submuscular Anterior Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome

Medicine ◽  
2015 ◽  
Vol 94 (29) ◽  
pp. e1207 ◽  
Author(s):  
Chun-Hua Liu ◽  
Shi-Qiang Wu ◽  
Xiao-Bin Ke ◽  
Han-Long Wang ◽  
Chang-Xian Chen ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Anterior Transposition ◽  
Tunnel Syndrome

Functional Outcome of Anterior Transposition of the Vascularized Ulnar Nerve for Cubital Tunnel Syndrome

1998 ◽  
Vol 23 (5) ◽  
pp. 613-616 ◽  
Author(s):  
A. ASAMI ◽  
K. MORISAWA ◽  
T. TSURUTA
Keyword(s):  
Functional Outcome ◽  
Ulnar Nerve ◽  
Conduction Velocity ◽  
Nerve Conduction ◽  
Nerve Conduction Velocity ◽  
Clinical Results ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Anterior Transposition ◽  
Tunnel Syndrome

Anterior transposition of the ulnar nerve is a widely used treatment for cubital tunnel syndrome, but neurolysis performed at the time of surgery may impair the blood supply to the ulnar nerve. This study compared the results of intramuscular anterior transposition of the ulnar nerve with or without preserving the extrinsic vessels of the ulnar nerve in 35 patients. The postoperative nerve conduction velocity and the clinical results were better in the group in which the extrinsic vessels were presented.

scholarly journals Subcutaneous vs Submuscular Ulnar Nerve Transposition in Moderate Cubital Tunnel Syndrome

2009 ◽  
Vol 3 (1) ◽  
pp. 78-82 ◽  
Author(s):  
Dhia A.K Jaddue ◽  
Salwan A Saloo ◽  
Arkan S Sayed-Noor
Keyword(s):  
Postoperative Pain ◽  
Ulnar Nerve ◽  
Operative Time ◽  
Surgical Techniques ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Anterior Transposition ◽  
Tunnel Syndrome ◽  
And Gender ◽  
Subcutaneous Transposition

Background: The surgical treatment of Cubital tunnel syndrome (CubTS) is still a matter of debate. No consensus exists about the necessity of anterior transposition of the ulnar nerve after decompression. However, this technique is fairly common in clinical practice. Material and Methodology: In the present study we compared the operative technique (incision length, operative time), postoperative care (postoperative pain and complications) and the outcome between subcutaneous transposition and submuscular transposition of the ulnar nerve as two surgical modalities in treating moderate CubTS. Between March 2004 and March 2007, twenty six patients with moderate CubTS (according to Dellon’s grading system) were stratified according to age and gender into these two surgical techniques. The two groups were prospectively followed up 2 weeks, 6 months and 12 months postoperatively by the same observer and the operation outcome was assessed using the Bishop rating system. Results: We found that the subcutaneous transposition of the ulnar nerve was associated with shorter incision, shorter operative time, less postoperative pain, less postoperative complication and better outcome compared with the submuscular transposition. Conclusion: The authors recommend the subcutaneous technique when considering anterior transposition of the ulnar nerve in treating moderate CubTS.

Anterior transposition of the ulnar nerve with endoscopic assistance

2010 ◽  
Vol 36 (2) ◽  
pp. 126-129 ◽  
Author(s):  
T. Konishiike ◽  
K. Nishida ◽  
M. Ozawa ◽  
T. Ozaki
Keyword(s):  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Anterior Transposition ◽  
Endoscopic Assistance ◽  
Tunnel Syndrome ◽  
Stage 1

We treated 20 patients with cubital tunnel syndrome by anterior transposition of the ulnar nerve with endoscopic assistance. Five elbows were classified preoperatively as McGowan’s stage 1, 11 as stage 2 and four as stage 3. Excellent outcomes were obtained in nine and good in eight patients. Three patients had fair results. Improvement of symptoms occurred in all patients. There were no serious complications. All ulnar nerves remained anteriorly transposed.

SELF-REPORTED OUTCOME FOLLOWING ANTERIOR TRANSPOSITION OF ULNAR NERVE IN THE ELDERLY

Hand Surgery ◽  
2010 ◽  
Vol 15 (03) ◽  
pp. 169-172 ◽  
Author(s):  
S. Sreedharan ◽  
A. K. T. Yam ◽  
S. C. Tay
Keyword(s):  
Ulnar Nerve ◽  
The Elderly ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Motor Deficits ◽  
Anterior Transposition ◽  
Sensory Disturbances ◽  
Tunnel Syndrome ◽  
One Year ◽  
Operative Measures

Cubital tunnel syndrome is a common entrapment neuropathy of the upper limb. This condition can result in significant sensory disturbances and motor deficits in the distribution of the ulnar nerve. Surgical management of cubital tunnel syndrome is indicated when non-operative measures fail. However, in the elderly population, there may be a tendency to avoid surgery as nerve healing has been found to be poor. In our study, we reviewed the results of anterior transposition of ulnar nerve in patients 60 years of age and older. Our results were based on a self-reported outcome at a minimum of one year after surgery — 94.7% of our surgeries resulted in some improvement in symptoms experienced by the patients while there was an overall satisfaction rate of 83.3%. Based on our results, we recommend ulnar nerve transposition in the management of cubital tunnel syndrome in this group of patients if non-operative measures fail.

Sign in / Sign up

Export Citation Format

Share Document