Treatment Of Ulnar Nerve Compression Research Articles

Conservative Treatment of Ulnar Nerve Compression at the Elbow: A Systematic Review and Meta-Analysis.

Background The clinical results of conservative treatment options for ulnar compression at the elbow have not been clearly determined. The aim of this review was to evaluate available conservative treatment options and their effectiveness for ulnar nerve compression at the elbow. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, a systematic review and meta-analysis of studies was performed. Literature search was performed using Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Results Of the 1,079 retrieved studies, 20 were eligible for analysis and included 687 cases of ulnar neuropathy at the elbow. Improvement of symptoms was reported in 54% of the cases receiving a steroid/lidocaine injection (95% confidence interval [CI], 41-67) and in 89% of the cases using a splint device (95% CI, 69-99). Conclusions Conservative management seems to be effective. Both lidocaine/steroid injections and splint devices gave a statistically significant improvement of symptoms and are suitable options for patients who refuse an operative procedure or need a bridge to their surgery. Splinting is preferred over injections, as it shows a higher rate of improvement.

Unexplored parameters of ulnar nerve in the palm and its clinical implications; A cadaveric study

ObjectivesSeveral studies have been conducted on the variations and branching pattern of the ulnar nerve in the hand. There are few studies conducted on defining the distance of ulnar nerve from bony landmarks in the palm. Ulnar nerve is closely related to the pisiform and hook of hamate which act as important landmarks. MethodsThe study was conducted on 30 formalin fixed adult hand specimens in the department of Anatomy. Various measurements related to the ulnar nerve in the palm were taken using a divider and Vernier Calipers and the values were tabulated after obtaining the mean and standard deviation. ResultsThe average distance seen in the hand specimens [n = 30] from pisiform to the division of ulnar nerve into superficial and deep branch was 0.89 ± 0.25cm and the distance between pisiform bone up to the division of superficial branch of ulnar nerve into proper and common digital branches was 1.36 ± 0.59 cm. The average distance from the origin of proper digital branch of ulnar nerve to the head of fifth metacarpal bone was 5.25 ± 0.59 cm. The length of common digital branch of ulnar nerve from its origin to division into 2 sensory branches was 4.31 ± 1.09 cm. ConclusionThis study provides the metric parameters of the ulnar nerve in the hand from its significant bony landmarks which should be kept in mind during surgical procedures to minimize the incidence of injury to its branches. It would assist the orthopedic surgeon in the treatment of ulnar nerve compression in the Guyon's canal.

Ultrasound-Assisted Precise In Situ Decompression for Cubital Tunnel Syndrome.

ObjectiveTo explore the effect of locating the ulnar nerve compression sites and guiding the small incision so as to decompress the ulnar nerve in situ on the elbow by high‐frequency ultrasound before operation.MethodsA retrospective analysis was conducted on 56 patients who underwent ultrasound‐assisted in situ decompression for cubital tunnel syndrome from May 2018 to August 2019. The patients' average age was 51.13 ± 7.35 years, mean duration of symptoms was 6.51 ± 1.96 months, and mean postoperative follow‐up was 6.07 ± 0.82 months. Nine patients had Dellon's stage mild, 39 had stage moderate, and eight had stage severe. Ultrasound and electromyography were completed in all patients before operation. The presence of ulnar nerve compressive lesion, the specific location, and the reason and extent of compression were determined by ultrasound. A small incision in situ surgery was given to decompress the ulnar nerve according to the pre‐defined compressive sites.ResultsAll patients underwent in situ decompression. The compression sites around the elbow were as follows: two in the arcade of Struthers, one in the medial intermuscular septum, four in the anconeus epitrochlearis muscle, five beside the cyst of the proximal flexor carpi ulnaris (FCU), and the remaining 44 cases were all from the compression between Osborne's ligament to the two heads of the FCU. The compression localizations diagnosed by ultrasound were confirmed by operations. Preoperative ultrasound confirmed no ulnar nerve subluxation in all cases. The postoperative outcomes were satisfactory. There was no recurrence or aggravation of symptoms in this group of patients according to the modified Bishop scoring system; results showed that 43 cases were excellent, 10 were good, and three were fair.ConclusionsHigh‐frequency ultrasound can accurately and comprehensively evaluate the ulnar nerve compression and the surrounding tissues, thus providing significant guidance for the precise minimally invasive treatment of ulnar nerve compression.

Trends in the Surgical Treatment of Cubital Tunnel Syndrome: An Analysis of the National Survey of Ambulatory Surgery Database

To ascertain trends in the surgical treatment of ulnar nerve compression at the elbow within the United States. We analyzed the National Survey of Ambulatory Surgery to study trends in the treatment of cubital tunnel syndrome from 1994 to 2006. The National Survey of Ambulatory Surgery provides a comprehensive overview of ambulatory surgical procedures performed in the United States. Patients identified in the database with surgically treated cubital tunnel syndrome were verified by members of our research staff and compiled into these 3 groups: decompression, transposition, and other. The data were then statistically analyzed for trends in treatment, utilization, and demographics. A total of 52,133 surgical procedures were recorded in the National Survey of Ambulatory Surgery for the treatment of ulnar nerve compression in 2006. This represents an increase from 26,283 in 1994 and 35,406 in 1996. In the 11 years from 1996 to 2006, the total surgical procedures on the ulnar nerve increased by 47%. Transposition went from 49% of all cubital tunnel procedures in the 1990s to 38% in 2006. In 2006, women were much more likely to have a simple decompression (70%) than a transposition or other technique. Decompression had a mean surgical time of 48 minutes, and transposition had a mean surgical time of 59 minutes. The percentage of transpositions used in the treatment of cubital syndrome has decreased to 37% in the last survey. Possible reasons include expanded indications or changing surgical preferences. Prognostic II.

Ulnar nerve transposition using a mini-invasive approach: case series of 30 patients

The treatment of ulnar nerve compression at the elbow remains controversial. No single technique has yet proven its superiority. We describe a technique combining the advantages of the mini-invasive approach with those of transposition. We present the results of 30 patients, of mean age 52 years, who underwent anterior subcutaneous transposition of the ulnar nerve using a mini-invasive approach with a follow-up of more than six months. The incision measures 3 cm. The results were evaluated by measuring pain intensity, quick disabilities of the arm shoulder and hand (DASH), grip strength and pinch, and McGowan score, pre- and post-operatively. All parameters were improved post-operative. The mean pain score went from 5.5 to 4, the quick DASH from 48 to 38, mean grip strength from 28 to 31 kg, and mean pinch strength from 4.7 to 6.4 kg. The McGowan score was also improved; pre-operatively, there were 16 patients at stage III, seven patients stage II, seven patients stage I, and post-operatively there was one patient stage III, three patients stage II, 16 patients stage I, and 10 patients stage 0. Analysis of our series shows that a 3 cm incision without endoscopy allows subcutanous transposition, with results at least as good as those with other techniques. The advantages of our technique are that it is easy, has a limited approach, preserves blood supply, allows placement of the nerve in a favourable environment, and decreases nerve stretching during elbow flexion.

Morphology of the Cubital Tunnel: An Anatomical and Biomechanical Study With Implications for Treatment of Ulnar Nerve Compression

The purpose of this study is to provide a thorough understanding of the anatomy of the cubital tunnel and to outline specific anatomical parameters of the cubital tunnel retinaculum (CuTR) that might aid in the management of ulnar nerve problems. The hypotheses of this study are (1) that the nerve elongates with elbow flexion and (2) that the cross-sectional area of the cubital tunnel is inversely proportional to the degree of elbow flexion. Eleven fresh-frozen cadaver arms were dissected at the medial elbow. The CuTR was identified, and its thickness was measured. After excising the CuTR, we measured the elongation of the anterior and posterior aspects of the ulnar nerve, as well as the length of the CuTR origin/insertion, at increasing intervals of elbow flexion (15°, 30°, 45°, 90°, 120°, and 135°). Using 3-dimensional digitization technology, the surface of the cubital tunnel was recorded at 4 positions of elbow flexion (15°, 45°, 90°, and 135°) and analyzed to define the tunnel geometry. The CuTR origin-to-insertion length and the ulnar nerve length both increased significantly with increasing flexion angle. Both lengths at 90°, 120°, and 135° of elbow flexion were greater than at 15° or 30°. The cubital tunnel area was significantly less at 135° compared to either 45° or 90° of flexion. There was a linear relationship between the cubital tunnel area of the different arms with the corresponding nerve cross-sectional area when measured at the level of the epicondyle and when the arm was at 90° of elbow flexion. The CuTR begins to stretch at 60° of flexion and continues to stretch with increasing flexion. Similarly, the ulnar nerve is more taut in flexion. The area within the cubital tunnel decreases beyond 90° of elbow flexion. Understanding the dynamic anatomical relationships of the cubital tunnel might help in the safe treatment of cubital tunnel syndrome when using minimally invasive techniques and instrumentation.

Sindrome compressiva del nervo ulnare al gomito e al polso

The aim of this article is to underline the main anatomic, aetiopatogenetic, diagnostic and surgical aspects of ulnar nerve compression syndrome at the elbow and wrist level. Knowledge of these aspects provides useful guidelines for a prompt diagnosis, choosing the most appropriate surgical procedure for treatment. A good clinical examination is the only and most relevant tool for reaching a correct diagnosis of the compression point, that can be confirmed and completed by imaging, also useful in the pre-operative planning. Comprehension of aetiology and pathology of ulnar nerve compression is very important to evaluate, in the surgical treatment of ulnar nerve compression at the elbow, the necessity of a simple decompression or of a transposition of the nerve; on the other hand it is really necessary also in the diagnosis and treatment of the isolated or associated compression of the deep distal motor branch at the hand level.

Comparative study of surgical treatment of ulnar nerve compression at the elbow

The optimal surgical treatment for cubital tunnel syndrome remains unclear. We aim to evaluate the long-term outcome of surgical treatment by comparing the results of the different methods proposed. We retrospectively reviewed 113 patients in whom 3 different surgical methods were used for cubital tunnel syndrome treatment. In situ decompression, partial epicondylectomy, and anterior subcutaneous transposition were performed from 1997 to 2007. Results were graded as excellent in 51 patients (45%), good in 34 (30%), fair in 8 (7%), and poor in 20 (18%). When we compared the results among the different surgical procedures, good and excellent results were achieved in 26 of 31 patients (84%) treated with in situ decompression, 36 of 45 (80%) treated with release and partial medial epicondylectomy, and 23 of 37 (62%) treated with release and anterior subcutaneous transposition of the nerve. Our results indicate that in situ decompression and partial epicondylectomy both represent efficient and safe methods for cubital tunnel syndrome management. In patients in whom anterior subcutaneous transposition was performed, although they had a significant improvement of their clinical signs and symptoms, they had an inferior outcome when compared with patients treated with the other 2 methods.

Treatment of Ulnar Nerve Compression at the Elbow

Treatment of Ulnar Nerve Compression at the Elbow

Anterior Transposition Compared with Simple Decompression for Treatment of Cubital Tunnel Syndrome

There is currently no consensus on the optimal operative treatment for cubital tunnel syndrome. The objective of this meta-analysis of randomized, controlled trials was to evaluate the efficacy of simple decompression compared with that of anterior transposition of the ulnar nerve in the treatment of this condition. Multiple databases were searched for randomized, controlled trials on the outcome of operative treatment of cubital tunnel syndrome in patients who had not previously sustained trauma or undergone a surgical procedure involving the elbow. Two reviewers abstracted baseline characteristics, clinical scores, and motor nerve-conduction velocities independently. Data were pooled across studies, standard mean differences in effect sizes weighted by study sample size were calculated, and heterogeneity across studies was assessed. We identified four randomized, controlled trials comparing simple decompression with anterior ulnar nerve transposition (two submuscular and two subcutaneous). In three studies that included a total of 261 patients, a clinical scoring system was used as the primary clinical outcome. There were no significant differences between simple decompression and anterior transposition in terms of the clinical scores in those studies (standard mean difference in effect size = -0.04 [95% confidence interval = -0.36 to 0.28], p = 0.81). We did not find significant heterogeneity across these studies (I(2) = 34.2%, p = 0.22). Two reports, on a total of 100 patients, presented postoperative motor nerve-conduction velocities; they showed no significant differences between the procedures (standard mean difference in effect size = 0.24 [95% confidence interval -0.15 to 0.63] in favor of simple decompression, p = 0.23; I(2) = 0%, p = 0.9). The results of this meta-analysis suggest that there is no difference in motor nerve-conduction velocities or clinical outcome scores between simple decompression and ulnar nerve transposition for the treatment of ulnar nerve compression at the elbow in patients with no prior traumatic injuries or surgical procedures involving the affected elbow. Confidence intervals around the points of estimate were narrow, which probably exclude the possibility of clinically meaningful differences. These data suggest that simple decompression of the ulnar nerve is a reasonable alternative to anterior transposition for the surgical management of ulnar nerve compression at the elbow.

History of the surgical treatment of ulnar nerve compression at the elbow.

Surgery to achieve ulnar nerve decompression at the elbow has been performed for nearly 2 centuries. Several methods have been developed, some of which have been abandoned. Historical insight improves understanding of current techniques and provides the basis for the development of new methods. Which treatment method is best is the topic of ongoing debate. The literature was reviewed using the MEDLINE database. Standard textbooks and retrieved articles were checked for missing references. For older articles, the bibliographies of books and theses were consulted. When I was unsuccessful in finding information in standard biographies of authors of milestone publications, I contacted the hospitals or institutions in which these individuals worked or are currently working. A systematic chronological overview of the surgical treatment of ulnar nerve compression at the elbow is presented, with special attention to people who described a treatment method for the first time. This article is the first in the literature to provide information about and photographs of nearly all of the people who were important in the development of the surgical treatment of compression of the ulnar nerve at the elbow.

History of the Surgical Treatment of Ulnar Nerve Compression at the Elbow

History of the Surgical Treatment of Ulnar Nerve Compression at the Elbow

Diagnosis and Treatment of Ulnar Nerve Compression at the Elbow

Diagnosis and Treatment of Ulnar Nerve Compression at the Elbow

MODIFIED IN SITU DECOMPRESSION OF THE ULNAR NERVE AT THE ELBOW

Controversy continues to surround the treatment of ulnar nerve compression at the elbow in the cubital tunnel. By performing extensive segmental electrodiagnostic studies of the ulnar nerve through the cubital tunnel, accuracy of diagnosis is improved. In those patients with documented compression where the ulnar nerve enters the flexor carpi radialis, decompression of this area alone yields excellent results with rapid recovery.

Medial epicondylectomy for the treatment of ulnar nerve compression at the elbow

Decompression of the ulnar nerve at the elbow with medial epicondylectomy was done in 43 patients and reviewed with an average follow-up of 2.3 years. Eight were graded as excellent, 23 as good, 9 as fair, and 3 as poor results. A special emphasis was placed on analysis of the potential disadvantages of medial epicondylectomy including bone tenderness at the osteotomy site, vulnerability of the ulnar nerve, ulnar collateral ligament instability, and weakness from disruption of the flexor pronator origin. Clinical assessment of strength including quantitative measurement of pinch strength, grip strength and endurance, and testing of forearm muscles did not show these potential disadvantages to be significant problems.