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.

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.

Outcomes of Cubital Tunnel Surgery among Patients with Absent Sensory Nerve Conduction

Neurosurgery ◽  
2004 ◽  
Vol 54 (4) ◽  
pp. 891-896 ◽  
Author(s):  
Assad Taha ◽  
Marcelo Galarza ◽  
Mario Zuccarello ◽  
Jamal Taha
Keyword(s):  
Nerve Conduction ◽  
Motor Nerve ◽  
Sensory Nerve ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Symptom Duration ◽  
Motor Nerve Conduction ◽  
Tunnel Syndrome ◽  
The Mean ◽  
Subcutaneous Transposition

Abstract OBJECTIVE To report the outcomes of cubital tunnel surgery for patients with absent ulnar sensory nerve conduction. METHODS The charts of 34 patients who exhibited clinical symptoms of ulnar nerve entrapment at the elbow and who had electromyography-confirmed prolonged motor nerve conduction across the cubital tunnel in association with absent sensory nerve conduction were reviewed. The mean age was 63 years, and the mean symptom duration was 17 months. Four patients had bilateral symptoms. Surgery was performed for 38 limbs, i.e., neurolysis for 21 limbs and subcutaneous transposition for 17 limbs. Fifteen limbs demonstrated associated ulnar nerve-related motor weakness. The mean postoperative follow-up period was 4 years (range, 3 mo to 11 yr). RESULTS Sensory symptoms (i.e., pain, paresthesia, and two-point discrimination) improved in 20 limbs (53%), and muscle strength improved in 2 limbs (13%). Improvements in sensory symptoms were not related to patient age, symptom duration, cause, severity of prolonged motor nerve conduction, select psychological factors, associated medical diseases, associated cervical pathological conditions, or type of surgery. Improvements in sensory symptoms were significantly decreased among patients who had experienced cervical disease for more than 1 year and patients with bilateral symptoms. CONCLUSION Patients with cubital tunnel syndrome who have absent sensory nerve conduction seem to experience less improvement of sensory symptoms after surgery, compared with all patients with cubital tunnel syndrome described in the literature. Bilateral symptoms and delayed surgery secondary to associated cervical spine disease seem to be significant negative factors for postoperative improvement of sensory symptoms. Sensory symptoms improved similarly among patients who underwent neurolysis or subcutaneous transposition

scholarly journals Anconeus Epitrochlearis Muscle Associated With Cubital Tunnel Syndrome: A Case Series

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 477-482
Author(s):  
Nicholas Kim ◽  
Ryan Stehr ◽  
Hani S. Matloub ◽  
James R. Sanger
Keyword(s):  
Ulnar Nerve ◽  
Nerve Conduction ◽  
Case Series ◽  
Cubital Tunnel Syndrome ◽  
Nerve Conduction Studies ◽  
Cubital Tunnel ◽  
Persistent Symptoms ◽  
Compressive Neuropathy ◽  
Tunnel Syndrome

Background: Cubital tunnel syndrome is a common compressive neuropathy of the upper extremity. The anconeus epitrochlearis muscle is an unusual but occasional contributor. We review our experience with this anomalous muscle in elbows with cubital tunnel syndrome. Methods: We retrospectively reviewed charts of 13 patients noted to have an anconeus epitrochlearis muscle associated with cubital tunnel syndrome. Results: Ten patients had unilateral ulnar neuropathy supported by nerve conduction studies. Three had bilateral cubital tunnel syndrome symptoms with 1 of those having normal nerve conduction studies for both elbows. Eight elbows were treated with myotomy of the anconeus epitrochlearis muscle and submuscular transposition of the ulnar nerve. The other 8 elbows were treated with myotomy of the anconeus epitrochlearis muscle and in situ decompression of the ulnar nerve only. All but 1 patient had either clinical resolution or improvement of symptoms at follow-up ranging from 2 weeks to 1 year after surgery. The 1 patient who had persistent symptoms had received myotomy and in situ decompression of the ulnar nerve only. Conclusions: An anomalous anconeus epitrochlearis occasionally results in compression of the ulnar nerve but is usually an incidental finding. Its contribution to compression neuropathy can be tested intraoperatively by passively ranging the elbow while observing the change in vector and tension of its muscle fibers over the ulnar nerve. Regardless of findings, we recommend myotomy of the muscle and in situ decompression of the ulnar nerve. Submuscular transposition of the ulnar nerve may be necessary if there is subluxation.

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 Cubital tunnel syndrome

2021 ◽  
Vol 6 (9) ◽  
pp. 743-750
Author(s):  
Abdus S. Burahee ◽  
Andrew D. Sanders ◽  
Colin Shirley ◽  
Dominic M. Power
Keyword(s):  
Ulnar Nerve ◽  
Motor Nerve ◽  
Nerve Transfer ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Common Procedure ◽  
Tunnel Syndrome ◽  
Distal Nerve ◽  
Denervated Muscles ◽  
Simple Decompression

Cubital tunnel syndrome (CuTS) is the second most common compression neuropathy of the upper limb, presenting with disturbance of ulnar nerve sensory and motor function. The ulnar nerve may be dynamically compressed during movement, statically compressed due to reduction in tunnel volume or compliance, and tension forces may cause ischaemia or render the nerve susceptible to subluxation, further causing local swelling, compression inflammation and fibrosis. Superiority of one surgical technique for the management of CuTS has not been demonstrated. Different techniques are selected for different clinical situations with simple decompression being the most common procedure due to its efficacy and low complication rate. Adjunctive distal nerve transfer for denervated muscles using an expendable motor nerve to restore the axon population in the distal nerve is in its infancy but may provide a solution for severe intrinsic weakness or paralysis. Cite this article: EFORT Open Rev 2021;6:743-750. DOI: 10.1302/2058-5241.6.200129

Q&A: Rating Multiple Pelvic Fractures

2015 ◽  
Vol 20 (2) ◽  
pp. 11-11
Author(s):  
James B. Talmage
Keyword(s):  
Nerve Conduction ◽  
Motor Nerve ◽  
Cubital Tunnel Syndrome ◽  
Conduction Delay ◽  
Motor Nerve Conduction ◽  
Sixth Edition ◽  
Axon Loss ◽  
Tunnel Syndrome ◽  
Current Article ◽  
Physical Findings

Abstract Part 1 of this series examined many of the rules in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, regarding rating nerve entrapment or focal neuropathies; the current article, part 2, examines how to read and match the findings in an electrodiagnostic report to the criteria in Appendix 15-B, Electrodiagnostic Evaluation of Entrapment, as explained in Section 15.4f, and determine the severity of the test findings as listed in Table 15-23. Physicians who perform nerve conduction studies often use their own definitions of mild, moderate, and severe; these definitions are not standardized and frequently differ from the electrophysiologic definitions used in the AMA Guides, Sixth Edition. When examiners rate focal entrapment neuropathy, they must match data from the electrodiagnostic report to the criteria in Appendix 15-B, and a figure shows a hypothetical motor nerve conduction report for a case that shows both mild neuropathy (conduction delay) of the median nerve at the wrist (carpal tunnel syndrome) and severe neuropathy (axon loss) of the ulnar nerve at the elbow (cubital tunnel syndrome). If both fibrillations and positive waves are seen in the same muscle, the reviewer can be more confident that other electromyographic potentials were not misinterpreted as fibrillations. Prepared with the results of electrodiagnostic studies, the evaluator can work through the steps of history, physical findings, and functional scale to determine the final upper limb impairment according to the AMA Guides.

Endoscopic Anatomical Nerve Observation and Minimally Invasive Management of Cubital Tunnel Syndrome

2008 ◽  
Vol 34 (1) ◽  
pp. 115-120 ◽  
Author(s):  
A. YOSHIDA ◽  
I. OKUTSU ◽  
I. HAMANAKA
Keyword(s):  
Minimally Invasive ◽  
Ulnar Nerve ◽  
Motor Nerve ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Invasive Treatment ◽  
Pneumatic Tourniquet ◽  
Abductor Digiti Minimi ◽  
Tunnel Syndrome

Experience with the use of the Universal Subcutaneous Endoscope (USE) system in surgical treatment of cubital tunnel syndrome in 35 patients is reported. Patients included in the study had pre- and postoperative clinical and electrophysiological data, and had undergone a minimum follow-up period of 13 months. Mean patient age was 59.5 years and the mean follow-up period was 25.9 months. The operation was performed under local anaesthesia without pneumatic tourniquet and on an out-patient basis. A 1.5 cm portal is made at the cubital tunnel and the USE system is inserted next to the ulnar nerve, first distally and then proximally. The nerve is endoscopically assessed and only the tissue that compresses the nerve is released, in keeping with the principles of minimally invasive treatment. Preoperative tingling sensations disappeared postoperatively in 63% of cases. Pain and sensory disturbance recovered to normal in 92% and 89% of cases, respectively. Abnormal motor nerve conduction velocities improved in 77%. Abductor digiti minimi weakness MMT 0, 1, 2 in 16 hands recovered to MMT 4 or 5 in eight. First-dorsal interosseous weakness in 18 hands recovered to MMT 4 or 5 in seven. There were no complications in this series. The endoscopic approach facilitates inspection of the ulnar nerve so that selective release of the tissue that compresses the nerve can readily be performed. The technique has proven effective in the treatment of cubital tunnel syndrome.

scholarly journals Action of Ultrasound Therapy in Altering Motor Nerve Conduction Velocity of Ulnar Nerve

2019 ◽  
Vol 12 (2) ◽  
pp. 843-848 ◽  
Author(s):  
Prathap Suganthirababu ◽  
Jagatheesan Alagesan ◽  
Lavanya Prathap ◽  
M. Manikumar ◽  
A. Kumaresan ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Conduction Velocity ◽  
Nerve Conduction ◽  
Nerve Conduction Velocity ◽  
Motor Nerve ◽  
Motor Nerve Conduction Velocity ◽  
Ultrasound Therapy ◽  
Motor Nerve Conduction ◽  
Group A ◽  
Group B

Ultrasound therapy is one of the commonest and most popular modality used for tissue healing, pain reduction, tissue extensibility and in inflammation by physiotherapists all around the globe. Various sensitivity tests on peripheral nerves are done with ultrasound therapy, yet conclusions are still skeptical, which makes it inconclusive in progressing the modality further into management of nerve disorders. This study aimed to analyze efficiency of therapeutic ultrasound in influencing ulnar nerve conduction velocity. To Analyze the effect of ultrasound therapy in altering motor nerve conduction velocity of ulnar nerve with two therapeutic frequencies. 40 healthy individuals were included according to the selection criteria and they were explained about safety and simplicity of procedure and informed consent was obtained. All the participants were randomly assigned into two groups as 20 in each group. Group-A was given ultrasound therapy at specific site of elbow to target the ulnar nerve with 1MHz frequency and Group–B followed the same procedure with 3MHz frequency. Pre and Post to ultrasound therapy application Motor Nerve Conduction Velocity (MNCV) of ulnar nerve were recorded for both the groups. The posttest mean of MNCV for forearm segment and arm segment for Group A and Group B showed statistically significant difference (P Value <0.001).The analysis done by the statistical data also revealed that the MNCV at forearm segment showed an increase in velocity compared to its pretest values, whereas the post MNCV values at arm component showed a decrease in velocity when compared to its pretest values. Among comparison the data within the groups it is evident that group A with 1 MHz of ultrasound sonification is more capable of altering the MNCV values in comparison with the 3MHz. frequency. Findings of this study conclude that ultrasound therapy can be used effectively in altering conduction velocity of a nerve and it has a potential ability to facilitate or inhibit a nerve physiological function.

Sign in / Sign up

Export Citation Format

Share Document