scholarly journals A Cadaveric Study of Ulnar Nerve Movement and Strain around the Elbow Joint

2021 ◽  
Vol 11 (14) ◽  
pp. 6487
Author(s):  
Mitsuyuki Nagashima ◽  
Shohei Omokawa ◽  
Yasuaki Nakanishi ◽  
Pasuk Mahakkanukrauh ◽  
Hideo Hasegawa ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Elbow Joint ◽  
Elbow Flexion ◽  
Linear Displacement ◽  
Medial Epicondyle ◽  
Upper Extremities ◽  
Displacement Sensor ◽  
Maximum Value ◽  
Significant Difference ◽  
Fresh Frozen

There is a lack of data on how ulnar nerve strain varies according to the location around the elbow joint. Therefore, we measured the longitudinal movement of the ulnar nerve around the elbow joint. Four fresh-frozen cadaveric upper extremities were used. A linear displacement sensor was attached to the ulnar nerve at eight measurement points at 20-mm intervals. At each point, the longitudinal movement of the ulnar nerve was measured during elbow flexion. We calculated the strain on the ulnar nerve based on the change in movement between neighboring points. Ulnar nerve movement with elbow flexion had a maximum value (mean, 10.5 mm; p < 0.001) at 2 cm proximal to the medial epicondyle. In the site distal to the medial epicondyle, the movement was small and demonstrated no significant difference between points (p = 0.1). The change in strain between mild flexion (0–60°) and deep flexion (60–120°) significantly differed at 2–4 cm and 6–8 cm proximal to the medial epicondyle (15% versus 3%, p < 0.01; 5% versus 9%, p < 0.05, respectively). The longitudinal movement of the ulnar nerve during elbow flexion occurred mainly at the site proximal to the medial epicondyle and became smaller away from the medial epicondyle.

Biomechanics of axial load transmission across the native human elbow

2020 ◽  
pp. 175857322096102
Author(s):  
Kaleb Smithson ◽  
Jacob Smith ◽  
William Hogue ◽  
Erin Mannen ◽  
Shahryar Ahmadi
Keyword(s):  
Elbow Joint ◽  
Elbow Flexion ◽  
Upper Extremities ◽  
Forearm Rotation ◽  
Contact Areas ◽  
Load Transmission ◽  
Pressure Mapping ◽  
Average Maximum ◽  
Significant Difference ◽  
Fresh Frozen

Background Elbow and forearm motion are thought to affect elbow load transmission, yet little empirical evidence exists to quantify the biomechanics. Methods Eight fresh-frozen human cadaver upper extremities were utilized. A 100 N axial force was applied across the elbow joint at elbow flexion angles of (0°, 30°, 60°, and 90°) and forearm rotation angles (0°, 45° supination, and 45° pronation). Pressure mapping sensors were placed in both the radiocapitellar and ulnotrochlear joints. Force distributions and contact areas were measured, and paired t-tests were used for comparison (p < 0.05). Results The average maximum loading percentage of the radiocapitellar and ulnotrochlear joint pressures were 57.8 ± 4.6% and 42.2 ± 4.6%, respectively. Elbow flexion angle and forearm rotation did not significantly affect the joint loading. There was no significant difference between the contact areas of each joint, although ulnotrochlear and radiocapitellar joints demonstrated an inverse relationship. Conclusion Our study is the only one to date to comprehensively evaluate loading mechanics throughout both functional elbow flexion and forearm rotation across both articulations. The load sharing ratio across the radiocapitellar and ulnotrochlear joints was 58%:42%, agreeing with previously reported ratios with limited parameters. A relationship may be present between increasing radiocapitellar and decreasing ulnotrochlear contact areas as elbow flexion increases.

ANATOMICAL STUDY OF ARCADE OF STRUTHERS

Hand Surgery ◽  
2010 ◽  
Vol 15 (03) ◽  
pp. 157-159 ◽  
Author(s):  
Piyapong Tiyaworanan ◽  
Surut Jianmongkol ◽  
Tala Thammaroj
Keyword(s):  
Ulnar Nerve ◽  
Anatomical Study ◽  
Medial Epicondyle ◽  
Anatomical Location ◽  
Greater Tuberosity ◽  
Lateral Epicondyle ◽  
Surgical Exploration ◽  
Fresh Frozen ◽  
The Mean ◽  
Proximal Border

The incidence and the anatomical location of the arcade of Struthers as related to the arm length were studied in 62 arms of adult fresh-frozen cadavers. The distance between the greater tuberosity and the lateral epicondyle was designated as the arm length. The arcades of Struthers were identified in 85.4%. The mean arm length was 27.85 ± 1.3 cm. The mean of the distance between proximal border of the arcade of Struthers and the medial humeral epicondyle was 8.24 ± 2.06 cm. The mean ratio between the distance from the proximal border of the arcade to the tip of the medial epicondyle and arm length was 0.29 ± 0.07. We concluded that the anatomical location of the arcade as related to the arm length was 29% proximally, from the tip of the medial epicondyle. This report of the anatomical location of the arcade of Struthers related to the arm length can be useful to identify this structure in the arms which have differences in arm length during the surgical exploration and anterior transposition of the ulnar nerve procedures.

The effect of in-situ decompression on ulnar nerve stability: a cadaveric study

2017 ◽  
Vol 42 (7) ◽  
pp. 715-719 ◽  
Author(s):  
B. Butler ◽  
J. Peelman ◽  
L.-Q. Zhang ◽  
M. Kwasny ◽  
D. Nagle
Keyword(s):  
Ulnar Nerve ◽  
Medial Epicondyle ◽  
Cadaveric Study ◽  
Flexion Angle ◽  
Anterior Translation ◽  
Nerve Decompression ◽  
Flexor Carpi Ulnaris ◽  
Before And After ◽  
Fresh Frozen

Ten fresh frozen right cadaver arms were placed in a motorized jig and an in-situ ulnar nerve decompression was performed in 5 mm increments distally to the flexor carpi ulnaris (FCU) aponeurosis then proximally to the intermuscular septum. The elbows were ranged 0–135° after each incremental decompression and the ulnar nerve to medial epicodyle distance was measured to assess for nerve translation/subluxation compared with baseline (prerelease) values. None of the specimens had ulnar nerve subluxation (defined as anterior translation past the medial epicondyle) even after full decompression. Furthermore, there were no statistically significant ulnar nerve translations (defined as any difference in distance from ulnar nerve to medial epicondyle before and after each decompression) for any flexion angle or extent of decompression. This study provides biomechanical evidence that in situ ulnar nerve decompression from the FCU aponeurosis to the intermuscular septum does not result in significant ulnar nerve translation or subluxation.

scholarly journals Reinnervation of the biceps in C5–7 brachial plexus avulsion injuries: results after distal bypass surgery

2004 ◽  
Vol 16 (5) ◽  
pp. 1-4 ◽  
Author(s):  
Stefano Ferraresi ◽  
Debora Garozzo ◽  
Paolo Buffatti
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Hand Function ◽  
Elbow Flexion ◽  
Musculocutaneous Nerve ◽  
Biceps Muscle ◽  
Nerve Transfers ◽  
Significant Difference ◽  
Normal Hand ◽  
Nerve Dysfunction

Object The authors report various techniques, and their results, after performing median and ulnar nerve transfers to reanimate the biceps muscle in C5–7 avulsion-related brachial plexus injuries (BPIs). Methods Forty-three adult patients with BPIs of the upper-middle plexus underwent reinnervation of the biceps muscle; neurotization of the musculocutaneous nerve was performed using fascicles from the ulnar nerve (39 cases) and the median nerve (four cases). The different techniques included sectioning, rerouting, and direct suturing of the entire musculocutaneous nerve (35 cases); direct reinnervation of the motor branches of the musculocutaneous nerve (three cases); and reinnervation using small grafts to the motor fascicles that enter the biceps muscle (five cases). Elbow flexion recovery ranged from M2 to M4+, according to the patient's age and the level of integrity of the hand. No surgery-related failure occurred. No significant difference in outcome was related to any of the technical variants. In patients younger than age 45 years and exhibiting a normal hand function a score of M4 or better was always achieved. On average, reinnervation occurred 6 months after surgery. There was no clinical evidence of donor nerve dysfunction. Conclusions When accurate selection criteria are met, the results after this type of neurotization have proved excellent.

Restoration of Elbow Flexion in Traumatic Upper Brachial Plexus Palsy in Adults: Outcome with Intraplexus Distal Nerve Transfers in 78 Patients

2018 ◽  
Vol 37 (04) ◽  
pp. 285-290
Author(s):  
Mario Siqueira ◽  
Roberto Martins ◽  
Wilson Faglioni Junior ◽  
Luciano Foroni ◽  
Carlos Heise
Keyword(s):  
Brachial Plexus ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Traumatic Injury ◽  
Surgical Techniques ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Nerve Transfers ◽  
Significant Difference ◽  
Distal Nerve

Objective To present the functional outcomes of distal nerve transfer techniques for restoration of elbow flexion after upper brachial plexus injury. Method The files of 78 adult patients with C5, C6, ± C7 lesions were reviewed. The attempt to restore elbow flexion was made by intraplexus distal nerve transfers using a fascicle of the ulnar nerve (group A, n = 43), or a fascicle of the median nerve (group B, n = 16) or a combination of both (group C, n = 19). The result of the treatment was defined based on the British Medical Research Council grading system: muscle strength < M3 was considered a poor result. Results The global incidence of good/excellent results with these nerve transfers was 80.7%, and for different surgical techniques (groups A, B, C), it was 86%, 56.2% and 100% respectively. Patients submitted to ulnar nerve transfer or double transfer (ulnar + median fascicles transfer) had a better outcome than those submitted to median nerve transfer alone (p < 0.05). There was no significant difference between the outcome of ulnar transfer and double transfer. Conclusion In cases of traumatic injury of the upper brachial plexus, good and excelent results in the restoration of elbow flexion can be obtained using distal nerve transfers.

scholarly journals Biomechanical Comparison of UCL Repair Using Suspensory Fixation Versus UCL Reconstruction

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110389
Author(s):  
R. Nelson Mead ◽  
Trevor J. Nelson ◽  
Orr Limpisvasti ◽  
Neal S. ElAttrache ◽  
Melodie F. Metzger
Keyword(s):  
Motion Tracking ◽  
Full Range ◽  
Ulnar Collateral Ligament ◽  
Elbow Flexion ◽  
Collateral Ligament ◽  
Repair Technique ◽  
Significant Difference ◽  
Suspensory Fixation ◽  
Fresh Frozen ◽  
Biomechanical Comparison

Background: Medial ulnar collateral ligament (mUCL) repair is growing in popularity as a treatment for younger athletes with mUCL tears. One of the most recent techniques utilizes a collagen-coated suture tape to augment the repair. The most popular repair technique uses a screw for proximal fixation in the humerus. We present an alternative technique that uses suspensory fixation in the proximal humerus. Purpose: To biomechanically compare elbow valgus stability and load to failure of a novel alternative repair technique with suspensory fixation to an mUCL reconstruction. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen cadaveric elbows were dissected to expose the mUCL. Medial elbow stability was tested with the mUCL in an intact, deficient—either repaired or reconstructed—state. The repair technique used a suspensory fixation with suture augmentation, and the docking technique was used on all reconstructions. A 3-N·m valgus torque was applied to the elbow, and valgus rotation of the ulna was recorded via motion tracking cameras as the elbow was cycled through a full range of motion. After kinematic testing, specimens were loaded to failure at 70° of elbow flexion. Results: Both ulnar collateral ligament reconstruction and repair restored valgus stability to levels that were not statistically different from intact at all angles of flexion. There was no significant difference in the ultimate torque to failure between repaired and reconstructed mUCLs. Conclusion: There was no significant difference in the valgus strength between the mUCL repair with suspensory fixation and the mUCL reconstruction. Clinical Relevance: Suspensory fixation is an alternative method for proximal fixation in the mUCL without compromising the strength of the construct.

Effects of the Elbow Flexion Angle on the Radial Nerve Location around the Humerus: A Cadaver Study for Safe Installation of a Hinged External Fixator

2018 ◽  
Vol 23 (03) ◽  
pp. 388-394 ◽  
Author(s):  
Koji Sukegawa ◽  
Kazuki Kuniyoshi ◽  
Takane Suzuki ◽  
Yusuke Matsuura ◽  
Kenji Onuma ◽  
...  
Keyword(s):  
Elbow Joint ◽  
Radial Nerve ◽  
Elbow Flexion ◽  
Cadaver Study ◽  
Safe Zone ◽  
Lateral View ◽  
Flexion Angle ◽  
Posterior Aspect ◽  
Hinged Fixator ◽  
Fresh Frozen

Background: This study aimed to investigate whether the distance between the radial nerve and rotational center of the elbow joint when observing from the lateral surface of the humerus changes according to passive elbow joint flexion for safe external fixation with a hinged fixator of the elbow joint. Methods: Twenty fresh-frozen cadaveric arms were dissected. The points where the radial nerve crosses over the posterior aspect of the humerus, crosses through the lateral center, and crosses over the anterior aspect of the humerus were defined in the lateral view of the elbow joint, using fluoroscopy, as R1, R2, and R3, respectively. The distances between the rotational center and each point on the radial nerve were measured when the flexion angle of the elbow joint was 10°, 50°, 90°, and 130°. Results: The distances between the rotational center and R1, R2, and R3 were 118 mm, 94 mm, and 65 mm, respectively, when the flexion angle was 10°; 112 mm, 93 mm, and 74 mm, respectively, for 50°; 108 mm, 93 mm, and 77 mm, respectively, for 90°; and 103 mm, 94 mm, and 83 mm, respectively, for 130°. The distance between the rotational center and R2 was constant regardless of the flexion angle. With elbow joint extension, the distances between R1 and R3 increased; the safe zone, a region where the radial nerve would not be located on the humerus, was the smallest in extension. When the elbow joint was flexed, the distances between R1 and R3 decreased; the safe zone was the largest in flexion. Conclusions: This study showed that the radial nerve location on the humerus varied based on the flexion angle of the elbow joint; the safe zone may change. A half-pin can be likely inserted safely, avoiding the elbow joint extension position.

Ulnar Nerve Strain in Functional Elbow and Shoulder Motions

2019 ◽  
Vol 24 (03) ◽  
pp. 323-328
Author(s):  
Chaiyos Vinitpairot ◽  
Surut Jianmongkol ◽  
Tala Thammaroj ◽  
Settapon Wattanakamolchai
Keyword(s):  
Ulnar Nerve ◽  
High Strain ◽  
Cellular Phone ◽  
Elbow Flexion ◽  
Daily Activities ◽  
Shoulder Abduction ◽  
Average Strain ◽  
Fresh Frozen ◽  
History Of ◽  
Or History

Background: Shoulder and elbow motions can affect ulnar nerve strain. However, there is no evidence that links this kind of strain to specific activities. The purpose of this study was to examine ulnar nerve strain at the elbow resulting from normal daily activities. Methods: This study was conducted using thirty fresh frozen cadaveric elbows from subjects who had no deformities or history of previous upper extremity surgery. Strain was calculated based on nerve elongation. Ulnar nerve strain at the elbow from motion related to common daily activities was measured in both normal nerves and nerves in which gliding motion was restricted. The results of these measurement were then compared. Results: Activities related to extreme elbow and shoulder motions, such as cellular phone use, yielded an average strain of 6.3%. In addition, we found that nerve strain increased significantly in conditions in which gliding motion was restricted. Nerve strain due to motion associated with cellular phone use, for example, rose by 69.1%. Conclusions: Elbow flexion and shoulder abduction in daily activities are associated with increases in ulnar nerve strain, but this may not cause permanent damage to the nerve. After nerve gliding motion had been restricted, nerves that normally exhibited less strain often had even increased higher levels of strain than those nerves that normally exhibited high strain.

THE ANATOMY OF ULNAR NERVE BRANCHES IN ANTERIOR TRANSPOSITION

Hand Surgery ◽  
2013 ◽  
Vol 18 (03) ◽  
pp. 301-306
Author(s):  
Zhi Yang Ng ◽  
Jennifer H. Mitchell ◽  
Quentin A. Fogg ◽  
Andrew M. Hart
Keyword(s):  
Clinical Outcomes ◽  
Ulnar Nerve ◽  
Elbow Joint ◽  
Surgical Intervention ◽  
Cubital Tunnel Syndrome ◽  
Upper Extremities ◽  
Branching Pattern ◽  
Anterior Transposition ◽  
Tunnel Syndrome ◽  
Simple Decompression

Cubital tunnel syndrome is the second most common nerve entrapment neuropathy. When non-operative treatments fail, surgical intervention is indicated. Although there remains no consensus between simple decompression and anterior transposition, there is a growing recognition of improved clinical outcomes in the latter. Few details of ulnar nerve branches around the elbow are available however and their sacrifice may be necessary to facilitate anterior transposition. Therefore, ten cadaveric upper extremities were dissected to delineate the course and branching pattern of the ulnar nerve around the elbow joint; anterior transposition was also performed in the cadaveric specimens. Digital photographs of the dissection study were analyzed using the Image J package. Results show that distal ulnar nerve branches are distributed more laterally towards the olecranon and may potentially restrict transposition more than has been recognized; proximal branches may also overlap incision lines of such transposition procedures.

Role of dynamic ultrasound in assessment of the snapping elbow and distal biceps tendon injury

Ultrasound ◽  
2021 ◽  
pp. 1742271X2110572
Author(s):  
Michelle Wei Xin Ooi ◽  
Jun-Li Tham ◽  
Zeid Al-Ani
Keyword(s):  
Ulnar Nerve ◽  
Biceps Tendon ◽  
Elbow Flexion ◽  
Tendon Injury ◽  
Medial Epicondyle ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Dynamic Ultrasound ◽  
Ulnar Nerve Instability

Introduction Ultrasound is useful in assessing patients with snapping syndromes around the elbow joint. The dynamic nature of the examination allows for direct visualisation of the underlying causative factor. Topic description: We discuss the role of dynamic ultrasound in assessing various snapping syndromes around the elbow, such as ulnar nerve instability, snapping triceps and less commonly, snapping brachialis. Ultrasound is also useful in evaluating the distal biceps tendon, particularly in differentiating partial from complete tendon injury. Discussion Ulnar nerve instability and snapping triceps can be assessed via a medial approach with the transducer placed transversely between the medial epicondyle and the olecranon. In ulnar nerve instability, the nerve can be seen crossing over the medial epicondyle on elbow flexion. In snapping triceps syndrome, both the ulnar nerve and the distal triceps can be seen dislocating over the medial epicondyle. Dynamic assessment of the distal biceps tendon using a lateral approach minimises anisotropy artefact often seen on the anterior approach. Passive pronation and supination of the forearm will reveal little or no movement in a completely torn tendon whereas moving tendon fibres will be appreciated in partial tears. In a snapping brachialis, the medial portion of brachialis will be seen abnormally translocating anterolateral to the medial border of the trochlea during elbow flexion and snapping back into its normal position on elbow extension. Conclusion Dynamic ultrasound of the elbow is valuable in diagnosing patients with snapping sensations around the joint and in evaluating the integrity of the distal biceps tendon.

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