scholarly journals Ulnar Neuropathy at the Elbow: From Ultrasound Scanning to Treatment

2021 ◽  
Vol 12 ◽  
Author(s):  
Kamal Mezian ◽  
Jakub Jačisko ◽  
Radek Kaiser ◽  
Stanislav Machač ◽  
Petra Steyerová ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Dynamic Compression ◽  
Scientific Evidence ◽  
Cubital Tunnel Syndrome ◽  
Dynamic Imaging ◽  
Ulnar Neuropathy ◽  
Us Guidance ◽  
Adjacent Structures ◽  
Flexion Extension ◽  
Excellent Spatial Resolution

Ulnar neuropathy at the elbow (UNE) is commonly encountered in clinical practice. It results from either static or dynamic compression of the ulnar nerve. While the retroepicondylar groove and its surrounding structures are quite superficial, the use of ultrasound (US) imaging is associated with the following advantages: (1) an excellent spatial resolution allows a detailed morphological assessment of the ulnar nerve and adjacent structures, (2) dynamic imaging represents the gold standard for assessing the ulnar nerve stability in the retroepicondylar groove during flexion/extension, and (3) US guidance bears the capability of increasing the accuracy and safety of injections. This review aims to illustrate the ulnar nerve's detailed anatomy at the elbow using cadaveric images to understand better both static and dynamic imaging of the ulnar nerve around the elbow. Pathologies covering ulnar nerve instability, idiopathic cubital tunnel syndrome, space-occupying lesions (e.g., ganglion, heterotopic ossification, aberrant veins, and anconeus epitrochlearis muscle) are presented. Additionally, the authors also exemplify the scientific evidence from the literature supporting the proposition that US guidance is beneficial in injection therapy of UNE. The non-surgical management description covers activity modifications, splinting, neuromobilization/gliding exercise, and physical agents. In the operative treatment description, an emphasis is put on two commonly used approaches—in situ decompression and anterior transpositions.

A CASE REPORT OF ACUTE CUBITAL TUNNEL SYNDROME CAUSED BY VENOUS THROMBOSIS

Hand Surgery ◽  
2015 ◽  
Vol 20 (01) ◽  
pp. 137-139 ◽  
Author(s):  
Yoshihiro Abe ◽  
Masahiko Saito
Keyword(s):  
Case Report ◽  
Venous Thrombosis ◽  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Nerve Compression ◽  
Ulnar Neuropathy ◽  
Cubital Tunnel ◽  
Ulnar Nerve Compression ◽  
Compression Neuropathy ◽  
Tunnel Syndrome

Compression neuropathy of the ulnar nerve at the elbow is well-recognised as cubital tunnel syndrome (CuTS). Many causes of ulnar neuropathy at the elbow have been identified. A previously unreported finding of ulnar nerve compression in the cubital tunnel caused by a thrombosed proximal ulnar recurrent artery vena comitans is described.

Severe Tardy Ulnar Nerve Palsy caused by Traumatic Cubitus Valgus Deformity: Functional Outcome of Subcutaneous Anterior Transposition

2008 ◽  
Vol 33 (5) ◽  
pp. 575-580 ◽  
Author(s):  
S. M. JAVAD MORTAZAVI ◽  
P. HEIDARI ◽  
S. ASADOLLAHI ◽  
M. FARZAN
Keyword(s):  
Ulnar Nerve ◽  
Symptom Relief ◽  
Valgus Deformity ◽  
Cubital Tunnel Syndrome ◽  
Ulnar Neuropathy ◽  
Objective Measures ◽  
Cubitus Valgus ◽  
Ulnar Nerve Palsy ◽  
Tunnel Syndrome ◽  
Male Patients

Ten male patients with McGowan’s grade III ulnar neuropathy due to traumatic cubitus valgus deformity underwent anterior subcutaneous ulnar transposition. Evaluation was performed using subjective and objective measures, and a modified Bishop score. After operation, subjective sensory and motor disturbances were improved or resolved in most of the patients, while objective measures improved less well. Improvement in two-point discrimination (2PD) was consistently associated with symptom relief. All of the patients reported satisfaction with the operation. There were no complications or recurrences. The results of ulnar nerve transposition in our patients were comparable to the results of this operation in patients with severe idiopathic cubital tunnel syndrome. Although the outcome of surgery is not always satisfactory in severe ulnar neuropathy, symptom relief may justify performing the operation.

MINIMALIST CUBITAL TUNNEL TREATMENT

Neurosurgery ◽  
2009 ◽  
Vol 65 (suppl_4) ◽  
pp. A145-A149 ◽  
Author(s):  
Tarek Abuelem ◽  
Bruce Loyal Ehni
Keyword(s):  
Nerve Injury ◽  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Senior Author ◽  
Cutaneous Nerve ◽  
Ulnar Neuropathy ◽  
Cubital Tunnel ◽  
Success Rates ◽  
Tunnel Syndrome

Abstract 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.

Ulnar Neuropathy at the Elbow Due to Repetition: Myth or Reality?

2006 ◽  
Vol 11 (5) ◽  
pp. 1-3, 7-11
Author(s):  
Richard T. Katz
Keyword(s):  
Causal Relationship ◽  
Task Force ◽  
Case Reports ◽  
Scientific Evidence ◽  
Elbow Flexion ◽  
Cubital Tunnel Syndrome ◽  
Ulnar Neuropathy ◽  
Cumulative Trauma Disorder ◽  
Tunnel Syndrome ◽  
Repetitive Strain

Abstract Repetitive strain injury (RSI), also known as cumulative trauma disorder, implies that an injury exists and was caused by repetitive strain, but both implications are debatable. Ulnar neuropathy at the elbow (UNE), also known as cubital tunnel syndrome, is the second most common upper extremity compression neuropathy (after carpal tunnel syndrome). This article examines one particular aspect of the RSI debate: Is there scientific evidence to support a causal relationship between UNE and repetitive elbow flexion and extension in the workplace? The authors extensively searched published articles, books, and federal task force publications to look for evidence supporting a causal relationship between UNE and RSI. This included a literature review followed by a study of pertinent review articles, bibliographies, national task force reports related to musculoskeletal problems in the workplace, and relevant case reports. In brief, after extensive searches the authors found no credible medical literature to support a causal relationship between RSI and UNE. Case reports and cadaver studies provide tenuous support for causation of UNE by high-force activities such as pitching in baseball. The only prospective study that systematically assessed any causal relationship between RSI and UNE showed there is none. This article includes a three-page Feature Companion, “Rating Guidance: Ulnar Neuropathy,” that identifies common errors and provides an example rating report.

scholarly journals Management of cubital tunnel syndrome by anterior trans-muscular transposition of the ulnar nerve

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
Ahmed Shawky Ammar ◽  
Mohamed Ahmed El Tabl ◽  
Dalia Salah Saif
Keyword(s):  
Clinical Outcome ◽  
Ulnar Nerve ◽  
Visual Analog Scale ◽  
Electrophysiological Study ◽  
Cubital Tunnel Syndrome ◽  
Nerve Entrapment ◽  
Cubital Tunnel ◽  
Analog Scale ◽  
Tunnel Syndrome ◽  
Dash Questionnaire

Abstract Background Various surgical options are used for the treatment of ulnar nerve entrapment at the elbow. In this study, anterior trans-muscular transposition of the ulnar nerve was used for the treatment of cubital tunnel syndrome. Objectives To evaluate the surgical results of anterior trans-muscular transposition technique for the treatment of cubital tunnel syndrome with particular emphasis on clinical outcome. Methods Forty patients with cubital tunnel syndrome were operated using anterior trans-muscular transposition technique. Patients were classified into post-operative clinical outcome grades according to the Wilson & Krout criteria, and they were followed up by visual analog scale (VAS), the Disability of Arm Shoulder and Hand (DASH) questionnaire, electrophysiological study, and post-operative clinical evaluation. Results Forty patients with cubital tunnel syndrome who underwent anterior trans-muscular transposition of the ulnar nerve show a significant clinical improvement at 24 months post-surgery regarding visual analog scale (VAS), the Disability of Arm Shoulder and Hand (DASH) questionnaire, electrophysiological study, and the Wilson & Krout grading as 87.5% of the patients recorded excellent and good outcome. Conclusion Anterior transmuscular transposition of the ulnar nerve is a safe and effective treatment for ulnar nerve entrapment at the elbow.

ASSOCIATIONS BETWEEN ULNAR NERVE STRAIN AND ACCOMPANYING CONDITIONS IN PATIENTS WITH CUBITAL TUNNEL SYNDROME

Hand Surgery ◽  
2014 ◽  
Vol 19 (03) ◽  
pp. 329-333 ◽  
Author(s):  
Kensuke Ochi ◽  
Yukio Horiuchi ◽  
Toshiyasu Nakamura ◽  
Kazuki Sato ◽  
Kozo Morita ◽  
...  
Keyword(s):  
Disease Severity ◽  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Tunnel Syndrome ◽  
The Mean ◽  
Simple Decompression

Pathophysiology of cubital tunnel syndrome (CubTS) is still controversial. Ulnar nerve strain at the elbow was measured intraoperatively in 13 patients with CubTS before simple decompression. The patients were divided into three groups according to their accompanying conditions: compression/adhesion, idiopathic, and relaxation groups. The mean ulnar nerve strain was 43.5 ± 30.0%, 25.5 ± 14.8%, and 9.0 ± 5.0% in the compression/adhesion, idiopathic, and relaxation groups respectively. The mean ulnar nerve strains in patients with McGowan's classification grades I, II, and III were 18.0 ± 4.2%, 27.1 ± 22.7%, and 33.7 ± 24.7%, respectively. The Jonckheere-Terpstra test showed that there were significant reductions in the ulnar nerve strain among the first three groups, but not in the three groups according to McGowan's classification. Our results suggest that the pathophysiology, not disease severity, of CubTS may be explained at least in part by the presence of ulnar nerve strain.

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