Nerve For Cubital Tunnel Syndrome Research Articles

Die endoskopische Dekompression des Nervus ulnaris bei Kubitaltunnelsyndrom

Long endoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome (sulcus ulnaris syndrome) with direct visualization and minimal incision. Every cubital tunnel syndrome including a posttraumatic or arthrotic etiology, cubitus valgus, nerve dislocation, or other causes. Revision surgery after primary endoscopic decompression. Relative: irritation of the ulnar nerve by recurrent luxation. Relative: previous open primary surgery. Minimal longitudinal incision in the retrocondylar groove. The Osborne ligament is opened and the ulnar nerve identified. Dissection of a subcutaneous tunnel in the direction of the nerve. Decompression of the ulnar nerve by opening the muscle fascia proximally and distally while preserving all sensory nerves. Afterwards, the submuscular membrane with its fibrous bands between flexor carpi ulnaris and the nerve is opened while preserving all motor branches of the ulnar nerve. Bulky, slightly compressive dressing of the entire upper extremity to prevent excessive motion in 20 degrees elbow flexion for 3 days. Then, free motion is allowed during the day. At night, the arm should be kept in near extension for 14 days. Muscular atrophy prior to surgery should imply focused physiotherapy for ulnaris-innervated muscles 8 weeks postoperatively. 52 patients were operated using this method. 53% felt an immediate improvement right after surgery. 47 patients (90%) were available for reexamination after 8 months. Two-point discrimination, grip and pinch strength, and nerve conduction velocity had improved significantly to normal levels. Results, measured with the modified Bishop Rating System, were excellent in 66%, good in 32%, and fair in 2%. There were no poor results. Patients with advanced stages of disease also achieved good results.

Comparative Clinical Outcomes of Submuscular and Subcutaneous Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome

To determine retrospectively whether the technique of ulnar nerve transposition (subcutaneous versus submuscular) is associated with clinical sensory and motor recovery in cubital tunnel syndrome, and whether recovery is influenced by prognostic factors such as preoperative McGowan stage, age, and duration of symptoms. Twenty-five patients (average age, 53 years; follow-up, 7 years) with cubital tunnel syndrome had submuscular transposition, and 24 patients (average age, 46 years; follow-up, 3 years) were treated by subcutaneous transposition. There were 11 McGowan stage II and 14 stage III patients in the submuscular group and 14 stage II and 10 stage III patients in the subcutaneous group. Preoperatively, all patients presented with diminished 2-point discrimination. Postoperative sensory and motor recovery was evaluated clinically. There was no significant difference between subjective results in the submuscular and subcutaneous groups: 20 of 25 patients in the submuscular group versus 17 of 24 patients in the subcutaneous group were clearly improved, and 3 of 25 patients in the submuscular group versus 6 of 24 patients in the subcutaneous group partially improved. The logistic multivariate regression analysis indicated that sensory and motor function were both significantly improved following both surgical techniques. Sensory function recovered (2-point discrimination <6 mm) in 17 of 25 patients in the submuscular group and in 17 of 24 patients in the subcutaneous group, and motor function recovered (intrinsic strength grade 5) in 19 of 25 patients in the submuscular group and in 19 of 24 patients in the subcutaneous group. Symptoms lasting more than 6 months were associated with a poor prognosis. Sensory and motor recovery for patients with McGowan stages II and III of cubital tunnel syndrome were similar following submuscular and subcutaneous transposition techniques, and patients with symptoms lasting longer than 6 months had a worse prognosis regardless of surgical technique.

Ergebnisse der endoskopischen Dekompression des Nervus ulnaris bei Kubitaltunnelsyndrom

Aim of this study was to evaluate our own results after endoscopic decompression of the ulnar nerve in cubital tunnel syndrome (CuTS) and to compare them with those in the literature. Between April 2005 and April 2006 52 patients with clinically and neurologically verified CuTS received an endoscopic decompression of the ulnar nerve. Patients with concomitant pathology or recurrent disease were excluded. Pre- and postoperatively, the history was taken and an extensive clinical examination was carried out. Grip strength and pinch strength were measured, as was the static two-point discrimination. All ulnar nerve-innervated muscles were tested for their neurological muscle power. Tinel's sign, Froment's sign and the elbow flexion test were examined. Nerve subluxation was documented. All patients underwent nerve conduction studies with documentation of the velocity distal and proximal of the cubital tunnel. 47 patients (90%) were available for re-evaluation after eight months. The results were evaluated using the Dellon classification and the modified Bishop rating system. According to the Dellon classification 10 patients had mild, 21 moderate and 16 severe CuTS. Statistical significance was verified using the Wilcoxon test. All operations, as described by Hoffmann and Siemionow, were performed only by the author. In 94% of the followed patients sensibility was normalised. Grip strength improved from 75% of the contralateral side to 94%. The proximal nerve conduction velocity improved significantly postoperatively. According to the modified Bishop rating system 31 patients (66%) had an excellent, 15 patients (32%) a good and 1 patient (2%) a fair result. There were no poor results. On average, patients reached 7.7 points on the Bishop scale; those patients with stage Dellon III alone reached 7.5 points. Complications included subcutaneous harmless haematomas in 4% of all cases and a laceration of a single motor branch of the ulnar nerve innervating the flexor carpi ulnaris in two patients with restitutio ad integrum. In this study endoscopic decompression of the ulnar nerve in CuTS proved to be a patient-oriented and excellent method with very good, reproducible results, even in Dellon III patients.

Comparative Clinical Outcomes of Submuscular and Subcutaneous Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome

Comparative Clinical Outcomes of Submuscular and Subcutaneous Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome

Ultrasonographic measurements in cubital tunnel syndrome

The cubital tunnel is the most common site of ulnar nerve entrapment. Previous ultrasound studies have demonstrated enlargement of the ulnar nerve in cubital tunnel syndrome but did not report on the cubital tunnel itself. Twenty-two individuals with cubital tunnel syndrome were evaluated with nerve conduction studies and ultrasound. The ultrasound measurement that most strongly correlated with conduction velocity was the ratio of ulnar nerve to cubital tunnel cross-sectional area with the elbow flexed. Measurement of this ratio may improve the diagnostic accuracy of ultrasound in cubital tunnel syndrome, although further investigation is needed.

Simple Decompression of the Ulnar Nerve for Cubital Tunnel Syndrome

Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper extremity. Although many different operative techniques have been introduced, none of them have been proven superior to others. Simple cubital tunnel decompression has numerous advantages, including simplicity and safety. We present our experience of treating cubital tunnel syndrome with simple decompression in 15 patients. According to Dellon's criteria, one patient was classified as grade 1, eight as grade 2, and six as grade 3. Preoperative electrodiagnostic studies were performed in all patients and 7 of them were rechecked postoperatively. Five patients of 15 underwent simple decompression using a small skin incision (2 cm or less). Preoperative mean value of motor conduction velocity (MCV) within the segment (above the elbow-below the elbow) was 41.8+/-15.2 m/s and this result showed a decrease compared to the result of MCV in the below the elbow-wrist segment (57.8+/-6.9 m/s) with statistical significance (p<0.05). Postoperative mean values of MCV were improved in 6 of 7 patients from 39.8+/-12.1 m/s to 47.8+/-12.1 m/s (p<0.05). After an average follow-up of 4.8+/-5.3 months, 14 patients of 15 (93%) reported good or excellent clinical outcomes according to a modified Bishop scoring system. Five patients who had been treated using a small skin incision achieved good or excellent outcomes. There were no complications, recurrences, or subluxation of the ulnar nerve. Simple decompression of the ulnar nerve is an effective and successful minimally invasive technique for patients with cubital tunnel syndrome.

Comparative study between minimal medial epicondylectomy and anterior subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome

The purpose of this study was to review the results of 2 surgical methods for treating cubital tunnel syndrome. From 1994 to 2001, minimal medial epicondylectomy was performed on 22 elbows, and anterior subcutaneous transposition of the ulnar nerve was done on 34 elbows. In the group treated by medial epicondylectomy, 9 of the results (41%) were excellent, 10 (45%) were good, 2 (9%) were fair, and 1 result (5%) was poor. In the group treated by anterior subcutaneous transposition of ulnar nerve, 14 of the results (41%) were excellent, 13 (38%) were good, 6 (18%) were fair, and 1 result (3%) was poor. No significant difference was found between the 2 groups (P < .05). Both methods can be used for the treatment of cubital tunnel syndrome with a high rate of satisfaction.

Simple Decompression Did Not Differ from Simple Decompression Plus Anterior Transposition of the Nerve for Cubital Tunnel Syndrome

Simple Decompression Did Not Differ from Simple Decompression Plus Anterior Transposition of the Nerve for Cubital Tunnel Syndrome

Surgical Treatment of Cubital Tunnel Syndrome with Subcutaneous Anterior Transposition of the Ulnar Nerve

Purpose : To evaluate the surgical outcomes and the clinical factors affecting the results of subcutaneous anterior transposition of the ulnar nerve in cubital tunnel syndrome. Materials and Methods : Eighteen patients diagnosed as having cubital tunnel syndrome and treated by subcutaneous anterior transposition of ulnar nerve were investigated retrospectively. According to preoperative Dellon's staging, 2 patients (11%) were in mild stage, 5 (28%) in moderate and 11 (61%) in severe. Results were evaluated using Dellon's staging and Mowlavi’s classification. Results : According to Mowlavi's outcome status, 2 patients (11%) showed total relief, 10 (56%) improvement, 5 (28%) no change and 1 (6%) was worse, therefore the results were satisfactory in 12 patients (67%). Patients with less severe symptoms received surgery within a year of symptom onset and showed better results. Conclusion : The result of subcutaneous anterior transposition of ulnar nerve in cubital tunnel syndrome is comparable to that of other surgical methods, but it is easier technically. Better results may be anticipated when surgery is performed within a year of symptom onset.

Diagnostic ultrasonography of the ulnar nerve in cubital tunnel syndrome

Thirty-two elbows in 31 patients diagnosed as having cubital tunnel syndrome underwent ultrasonographic examination to assess morphological changes in the ulnar nerve and its surrounding tissues. On longitudinal images, the site of constriction due to the fibrous band and proximal swelling of the nerve were observed by ultrasonography and were confirmed intraoperatively. On axial images, the lengths of the major axis [7.2 (SD 1.6) mm] and the minor axis [3.7 (0.9) mm] of the nerve at the medial epicondyle were greater than those in normal subjects. There was a correlation between the stage of ulnar nerve palsy and the diameter of the major axis. Preoperatively, ganglia were detected by ultrasonography in the cubital tunnel in three cases and an anconeus epitrochlearis muscle in two.

Diagnostic Ultrasonography of the Ulnar Nerve in Cubital Tunnel Syndrome

Thirty-two elbows in 31 patients diagnosed as having cubital tunnel syndrome underwent ultrasonographic examination to assess morphological changes in the ulnar nerve and its surrounding tissues. On longitudinal images, the site of constriction due to the fibrous band and proximal swelling of the nerve were observed by ultrasonography and were confirmed intraoperatively. On axial images, the lengths of the major axis [7.2 (SD 1.6) mm] and the minor axis [3.7 (0.9) mm] of the nerve at the medial epicondyle were greater than those in normal subjects. There was a correlation between the stage of ulnar nerve palsy and the diameter of the major axis. Preoperatively, ganglia were detected by ultrasonography in the cubital tunnel in three cases and an anconeus epitrochlearis muscle in two.

Simple decompression of the ulnar nerve in cubital tunnel syndrome

Simple decompression of the ulnar nerve in cubital tunnel syndrome

Functional outcome of anterior transposition of the vascularized ulnar nerve for cubital 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.

Cubital tunnel syndrome: diagnosis by high-resolution ultrasonography.

The purpose of this study was to evaluate the morphologic changes in the ulnar nerve in cubital tunnel syndrome with high-resolution ultrasonography. The mean values of the short axis (cm) x long axis (cm) at the arm, epicondyle, and forearm levels were 0.057 +/- 0.01, 0.068 +/- 0.019, and 0.062 +/- 0.01 in control group; 0.069 +/- 0.04, 0.139 +/- 0.06, and 0.066 +/- 0.023 in the symptomatic side in patients with cubital tunnel syndrome; and 0.063 +/- 0.029, 0.068 +/- 0.029, and 0.057 +/- 0.012 in the normal side in patients with cubital tunnel syndrome. No significant difference was found in the area (short axis x long axis) of the ulnar nerve at the arm, epicondyle and forearm levels between the left and right ulnar nerve in the control group and between the control group and the normal side in symptomatic patients. However, the mean value of the area of the ulnar nerve at the epicondyle level in symptomatic patients was significantly larger than that of the control group and that of the contralateral side in patients, and the P value was less than 0.001. High resolution ultrasonography can detect morphologic changes in the ulnar nerve accurately, and it could therefore be useful as a screening and even follow-up modality in patients with cubital tunnel syndrome.

Anterior intramuscular transposition of the ulnar nerve for cubital tunnel syndrome

Forty-five sequential cubital tunnel releases with anterior transposition of the ulnar nerve in an intramuscular fashion were performed over a 4-year period. All patients had a positive Tinel's sign at the cubital tunnel and reported numbness and tingling in the ring and small finger of the affected arm. Thirty-three cases had preoperative electrodiagnostic studies performed. Twenty-three cases had positive electromyographic and nerve conduction velocity findings for cubital tunnel syndrome, whereas 10 cases had normal electromyographic and nerve conduction velocity studies. Twenty-four cases were covered by Workers' Compensation insurance. The average age of the patients was 40 years, with an average duration of symptoms of 22 weeks. Average follow-up examination was 15 months, with all patients being reexamined and completing a symptom outcome questionnaire. No significant differences between preoperative electrodiagnostic status could be demonstrated with regard to final symptom outcome. Patients with improved results from a symptom status were younger and had cubital tunnel syndrome of shorter duration. A trend toward poor results in patients with Workers' Compensation was noted, although this was not statistically significant. Overall, 87% of the patients had resolved or improved symptoms after cubital tunnel release with the anterior intramuscular transposition technique.

Anterior submuscular transposition of the ulnar nerve for cubital tunnel syndrome

48 patients with 50 involved limbs were retrospectively analyzed to determine factors influencing the outcome of surgical treatment for cubital tunnel syndrome. All patients were treated by anterior submuscular transposition of the ulnar nerve with Z-lengthening of the flexor-pronator origin. There were 24 men and 24 women with an average age of 42 years +/- 16.4 years (range, 5-75 years). The average follow-up time was 58 months (range, 12-156 months). A grading system was used pre- and post-operatively based on the severity of subjective complaints and objective findings. 92% of the patients were satisfied, or satisfied with some reservations, and only 8% were dissatisfied. All patients had either fair or poor pre-operative grades. 84% had excellent or good post-operative grades and only 16% had fair grades. There were no recurrences or poor post-operative grades in our series. Workers' compensation status had no statistically significant adverse effect on post-operative patient satisfaction or post-operative grade. Anterior submuscular transposition of the ulnar nerve in this series provided satisfactory subjective outcome, relief of symptoms and adequate decompression of the ulnar nerve at the elbow.