Ulnar Nerve

The outcomes of 55 cases of cubital tunnel syndrome treated by a partial frontal epicondylectomy are presented at a mean follow-up of 38 months follow-up. According to McGowan classification, 25 cases were grade I (45%), 12 grade II (22%) and 18 grade III (33%). The results (Wilson and Krout classification) were excellent or good in 41 patients (75%), fair in nine patients and unchanged in five, without any worsening or recurrence. Total relief was reported in 80% of grade I, 75% of grade II and 66% of grade III patients. Seven painful scars and one persistent 15° elbow extension deficit were the only complications. The satisfaction rate was 93%. This technique preserves bony protection, the blood supply and gliding tissues for the nerve and nerve recovery were comparable to other surgical procedures. Residual pain at the osteotomy site was not a serious problem.

OBJECT Surgical transposition of the ulnar nerve to alleviate entrapment may cause otherwise normal structures to become new sources of nerve compression. Recurrent or persistent neuropathy after anterior transposition is commonly attributable to a new distal compression. The authors sought to clarify the anatomical relationship of the ulnar nerve to the common aponeurosis of the humeral head of the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) muscles following anterior transposition of the nerve. METHODS The intermuscular septa of the proximal forearm were explored in 26 fresh cadaveric specimens. The fibrous septa and common aponeurotic insertions of the flexor-pronator muscle mass were evaluated in relation to the ulnar nerve, with particular attention to the effect of transposition upon the nerve in this region. RESULTS An intermuscular aponeurosis associated with the FCU and FDS muscles was present in all specimens. Transposition consistently resulted in ...

To investigate the sonographic characteristics of the normal ulnar nerve in the cubital tunnel, as well as any differences related to age, sex, and dominant arm. Two hundred twelve elbows in healthy volunteers were evaluated sonographically. The cross-sectional area (CSA) of the ulnar nerve within the cubital tunnel was measured with the elbow in extension and in flexion. The presence and number of fascicles was determined. The displacement of the ulnar nerve out of the cubital tunnel in full elbow flexion was also investigated. The mean +/- SD CSA of the ulnar nerve was 6.6 +/- 1.7 mm(2) (6.7 +/- 1.8 mm(2) in men and 6.5 +/- 1.7 mm(2) in women). The mean CSA of the ulnar nerve was highest for subjects aged 50-59 years, and lowest for subjects aged 30-39 years. Forty-two of 212 (19.8%) ulnar nerves had 2 fascicles, and 5 (2.4%) had 3 fascicles. The remaining 165 (77.8%) nerves had 1 fascicle. During elbow flexion, 49 of 212 (23.1%) ulnar nerves showed subluxation, and 18 (8.5%) were dislocated. There were differences in the CSA of the ulnar nerve between some age groups, but there was no variation with sex or handedness. Sonography can evaluate the morphologic changes of the nerve during flexion of the elbow.

Numerous neurological diseases are accompanied by atrophy of the intrinsic muscles of the hand. Muscle strength testing of these muscles is frequently used for clinical decision making. Traditionally, these strength measurements have focused on manual muscle testing (MMT) or on grip and pinch strength dynamometry. We have developed a hand-held dynamometer, the Rotterdam Intrinsic Hand Myometer (RIHM), to measure this

The superficial location of critical structures, including tendons, nerves and vessels, in the volar surface of the wrist makes them vulnerable to penetrating trauma. Extensive injuries to these structures are described as "spaghetti wrist". The main objective of this study was to report functional outcome in spaghetti-wrist injuries. The records of patients presenting to our clinic with extensive volar wrist injuries between January 2016 and January 2019 were reviewed retrospectively. Age, gender, comorbidities, date of injury, injury mechanism, affected hand and transected structures were noted. Tendon function, opposition, intrinsic hand function, deformity and sensitivity were evaluated following the Noaman report. The Michigan Hand Outcomes Questionnaire (MHOQ) was used to evaluate hand-specific outcomes. Twenty patients were included. Mean age was 32.7 years (range, 18-47 years). Mean follow-up was 21.9 months (range, 12-50 months). Mean number of injured structures was 11.9 (range, 10-16 structures) per patient. Physiotherapy duration had an effect on postoperative outcome in all six MHOQ domains (r = 0.821, p = 0.00001). However, no significant difference in overall hand function was found according to the number of injured structures (r = -0.105, p = 0.661). Precise initial evaluation, meticulous surgical treatment within 24 h and early physical therapy are essential after spaghetti-wrist injury. Good functional results are associated with prolonged physical therapy, but not with the number of structures injured.

Purpose The gold standard of neuromuscular monitoring is mechanomyography (MMG). Phonomyography (PMG) and kinemyography (KMG) are new methods of neuromuscular monitoring. In this study, all three methods were compared to determine neuromuscular blockade at the adductor pollicis muscle. Methods In 14 patients, phonomyography was recorded via a microphone taped to the thenar region. A standard mechanomyographic device was applied to the same thumb, and attached to the force transducer. On the contralateral side, a NMT-Mechanosensorê probe was attached to the thumb and forefinger (KMG). After induction of general anaesthesia, the ulnar nerves were stimulated supramaximally using superficial electrodes at the wrists using train-of-four (TOF) stimulation every 12 sec. Onset and recovery indices measured by the three methods after mivacurium 0.2 mg·kg-1 iv were compared using ANOVA-multiple group comparisons. Agreement between methods was determined using Lin’s concordance correlation coefficient. Results Onset time and peak effect measured via MMG and PMG were similar. Recovery times from neuromuscular blockade (NMB) as measured via the three methods were not different. Agreement between PMG and MMG was excellent for onset and offset of NMB but unsatisfactory for peak effect. Agreement between MMG and KMG was satisfactory for TOF 0.25 and 0.50, and excellent for TOF 0.75 and 0.90 (onset and peak effect not determined for KMG). Agreement between PMG and KMG was satisfactory for TOF 0.25, 0.50 and 0.75, and excellent for TOF 0.90. Conclusion Mechanomyography, PMG and KMG show satisfactory agreement for determination of recovery of NMB for clinical purposes. Objectif La référence en monitorage neuromusculaire est la mécanomyographie (MMG). La phonomyographie (PMG) et la cinémyographie (CMG) sont de nouvelles méthodes. Nous comparons les trois méthodes pour qualifier le blocage neuromusculaire à ľadducteur du pouce. Méthode La phonomyographie a été enregistrée par un microphone fixé à la région thénar chez 14 patients. Un appareil de mécanographie standard, au même pouce, a été fixé au transducteur de force. Au côté opposé, une sonde de NMTMechanosensorê a été fixée au pouce et à ľindex (CMG). Après ľinduction de ľanesthésie, les nerfs cubitaux ont reçu une stimulation supramaximale, utilisant un train-de-quatre (TDQ) toutes les 12 sec, produite par des électrodes superficielles aux poignets. Les indices du début et de la fin du bloc, mesurés par les trois méthodes après ľadministration iv de 0,2 mg·kg-1 de mivacurium, ont été comparés par une analyse ANOVA de groupes multiples. La concordance entre les méthodes a été déterminée par le coefficient de concordance et de corrélation de Lin. Résultats Les temps du début et de ľeffet maximal du blocage neuromusculaire (BNM) étaient similaires par MMG et PMG. Les temps de récupération du BNM ont été similaires avec les trois méthodes. La concordance entre la PMG et la MMG a été excellente pour le début et la fin du BNM, mais insatisfaisante pour ľeffet maximal. La concordance entre la MMG et la CMG a été satisfaisante pour les TDQ 0,25 et 0,50, et excellente pour les TDQ 0,75 et 0,90 (début et effet maximal non déterminés pour le CMG). La concordance entre la PMG et la CMG a été satisfaisante pour les TDQ 0,25, 0,50 et 0,75 et excellente pour le TDQ 0,90. Conclusion La MMG, la PMG et la CMG affichent une concordance satisfaisante pour la détermination de la récupération après un BNM réalisé pour des objectifs cliniques.

A man with multifocal acquired demyelinating sensory and motor neuropathy (MADSAM), or Lewis-Sumner syndrome, presented with a progressive left lumbosacral plexus lesion resembling a neurofibroma. After 7 years he developed a left ulnar nerve lesion with conduction block in its upper segment. Treatment with intravenous immunoglobulin improved the symptoms and signs of both lesions. We conclude that inflammatory neuropathy must be considered in the differential diagnosis of peripheral nerve tumors, and that unifocal lesions may precede multifocal involvement in MADSAM by several years. In addition, we discuss the clinical features in 9 patients attending a specialist peripheral nerve clinic and review the literature.

In normal subjects, the application of heterotopic painful stimuli induces simultaneous and parallel decrease in the sensation of pain and of the spinal nociceptive flexion (RIII) reflex evoked by electrical stimulation of the sural nerve. This inhibition of the RIII reflex is absent in tetraplegic patients with clinically complete spinal cord transections and can be triggered only from the analgesic hand in patients with Wallenberg's syndrome. These findings suggest that the inhibitory phenomena observed in normal subjects are likely to be examples of diffuse noxious inhibitory controls (DNICs), being sustained by a loop involving supraspinal structures, the ascending part of which is localized in the spinoreticular tract. We now report an exceptional case of a patient with Brown-Séquard syndrome due to a 4-year-old spinal cord lesion (left side, T-6 level) produced by a knife-wound in the back. Nociceptive flexion (RIII) reflexes elicited by stimulation of cutaneous afferents in the ulnar and sural nerves were studied in the upper and lower limbs by recording from the biceps brachialis and biceps femoris muscles, respectively. For each limb, the RIII reflex threshold was determined. The reflex was then elicited regularly by stimuli of 1.2 times threshold before, during, and after periods of nociceptive electrical conditioning stimulation (15 mA; 4Hz; 1 min) applied successively to the other three limbs. Inhibitions of around 90% followed by after effects (2–3 min) were observed in all situations except that (1) no inhibition could be obtained when the conditioning stimuli were applied to the lower right limb (contralateral to the spinal lesion) and (2) the RIII reflex in the lower left limb was completely insensitive to any of the conditioning stimuli. These results suggest that in humans (1) the ascending part of the loop subserving DNICs is completely crossed at the spinal level and (2) the descending part is confined to the white matter ipsilateral to the limb being tested.

Recurrent compression of the ulnar nerve in the cubital tunnel is a difficult problem and many solutions have been tried with variable success. Autologous vein graft wrapping is an alternative technique and it is recommended for the treatment of recalcitrant ulnar nerve compression in which 2 or more previous surgical procedures have failed to resolve the problem. Seventeen patients with recurrent cubital tunnel syndrome were treated with autologous saphenous vein wrapping. These patients had previously undergone simple decompression, decompression combined with medial epicondylectomy, anterior submuscular, or intramuscular transposition with internal neurolysis and had persistence of symptoms. Each patient underwent both subjective and objective evaluation. Our clinical results on 17 patients have been encouraging. All patients reported significant pain relief, while improvements in grip strength and 2-point discrimination were also observed. There were no complications, other than...

Purpose: One of the consequences of median and ulnar nerve trauma is delayed return to work. The aim of this study was to determine return to work (RTW) and risk factors for delayed RTW in addition to time off work (TOW). Differences among median, ulnar, and combined median-ulnar nerve injuries were examined. Method: In this study 96 patients who were