Preliminary Study on the Lesion Location and Prognosis of Cubital Tunnel Syndrome by Motor Nerve Conduction Studies

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.

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

Neurosurgery ◽

10.1227/01.neu.0000115152.78918.61 ◽

2004 ◽

Vol 54 (4) ◽

pp. 891-896 ◽

Cited By ~ 25

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

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P963: The application values of short-segment nerve conduction studies in the cubital tunnel syndrome

Clinical Neurophysiology ◽

10.1016/s1388-2457(14)50997-2 ◽

2014 ◽

Vol 125 ◽

pp. S303-S304

Author(s):

Z. Jia ◽

P. Tao ◽

T. Wang ◽

Z. Liu ◽

S. Xin ◽

...

Keyword(s):

Nerve Conduction ◽

Cubital Tunnel Syndrome ◽

Nerve Conduction Studies ◽

Cubital Tunnel ◽

Short Segment ◽

Tunnel Syndrome

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

Hand ◽

10.1177/1558944718762566 ◽

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.

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Nerve Conduction Studies in Surgical Cubital Tunnel Syndrome Patients

Hand ◽

10.1177/1558944719840750 ◽

2019 ◽

pp. 155894471984075

Author(s):

Daniel J. Shubert ◽

Joseph Prud’homme ◽

Shafic Sraj

Keyword(s):

Nerve Conduction ◽

Cubital Tunnel Syndrome ◽

Nerve Conduction Studies ◽

Cubital Tunnel ◽

Tunnel Syndrome

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Q&A: Rating Multiple Pelvic Fractures

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2015.marapr02 ◽

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.

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Carpal tunnel syndrome in the elderly: nerve conduction parameters

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2010000100019 ◽

2010 ◽

Vol 68 (1) ◽

pp. 87-92 ◽

Cited By ~ 1

Author(s):

Thiago Guimarães Naves ◽

João Aris Kouyoumdjian

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Motor Nerve ◽

The Elderly ◽

Nerve Conduction Studies ◽

Motor Nerve Conduction ◽

Latency Difference ◽

Upper Limits ◽

Tunnel Syndrome

OBJECTIVE: To establish nerve conduction parameters for carpal tunnel syndrome (CTS) electrodiagnosis in the elderly. METHOD: Thirty healthy subjects (65-86 years), 9 male and 21 female, were studied. Routine median and ulnar sensory and motor nerve conduction studies, median mixed palmar latency, comparative latency techniques median to ulnar (sensory, mixed and motor lumbrical-interossei), median to radial (sensory), and combined sensory index (CSI) were performed in both hands. RESULTS: The upper limits of normality (97.5%) were: median sensory distal latency 3.80 ms (14 cm); median motor distal latency 4.30 ms (8 cm); median palmar latency 2.45 ms (8 cm); lumbrical-interossei latency difference 0.60 ms (8 cm); comparative median to radial 0.95 ms (10 cm); comparative median to ulnar 0.95 ms (14 cm); comparative palmar median to ulnar 0.50 ms (8 cm); and CSI 2.20 ms. Sensory and mixed latencies were measured at peak. CONCLUSION: Our results establish new nerve conduction parameters for mild CTS electrodiagnosis in the elderly and will be helpful to reduce the number of false positive cases in this age.

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