Ulnar Nerve Neuritis Research Articles

A COMPARATIVE STUDY OF MEDIAL EPICONDYLECTOMY VERSUS ANTERIOR TRANSPOSITION IN THE MANAGEMENT OF ULNAR NEUROPATHY, AT ELBOW IN HANSEN’S DISEASE

Objective: The objective of the study is to know the better results after medial epicondylectomy with regards to sensory recovery and patient satisfaction. Methods: We operated on a total of 36 patients of Hansen’s disease suffering from ulnar nerve neuritis at the elbow from 1999 to 2003. They were alternately operated either by epicondylectomy or anterior transposition by the same unit. All these patients had either completed MDT or were on MDT for a minimum of 2 months before surgery. Results: The mean age of the patient was 28.6 years (range 15–45 years). The average follow-up was 3.2 years (range 1–5 years). The male-to-female ratio was 7: 4. The patients who were operated on within 4 months of the onset of symptoms showed a satisfaction rate of 70% as compared to 50% in patients who were operated on after 4 months of the onset of symptoms. Conclusion: Our study showed better results after medial epicondylectomy with regard to sensory recovery and patient satisfaction. There was no statistically significant difference in motor power recovery and post-operative pain, among both procedures none of the procedures had any significant effect on elbow function or stability.

Adolescent medial epicondyle trash lesion clinic radiological evaluation and treatment

<p class="abstract">Elbow injures in children accounts for 10% of all fractures, ranges from simple sprain to elbow fracture dislocation. Ligamentous injury accounts for 2-3% only and are mostly sports related seen in overhead athletes. Trash lesions (the radiological appearances seemed harmless) around the elbow are reported in children under 10 years which are high energy trauma with initial normal looking X-rays. These are osteochondral or physical injures presenting with soft tissue swelling without any fractures. A high index of suspicion, early additional imaging such as MRI, CT scan, ultrasound examination and aggressive surgical care are usually necessary for prompt diagnosis and successful treatment of these injuries before complications arise. We presented a case of an elbow injury in a 15 year old girl, following a fall on her outstretched hand with initial normal findings in her X-rays. 3 months following the injury she had persisting pain and instability with ulnar nerve impingement symptoms. Her elbow CT scan, nerve conduction study confirmed the avulsion fracture of medial epicondyle with ulnar nerve neuritis and cubital tunnel syndrome. Valgus stress test proved the extent of additional medial instability. Medial epicondyle avulsion fractures are always challenging for fixation. The retracting UCL forces prevents healing and were prone for failure with non-operative splinting once instability is defined. Attempted fixation can also result in failure of fixation. Our case study highlights the possibility of such trash lesion in adolescent and also the modified technique of ulnar collateral ligament (UCL) reconstruction in a cost effective manner.</p>

Cubital tunnel syndrome: a surgical modification to in situ decompression to improve results

BackgroundThe gold standard for surgical treatment of cubital tunnel syndrome is in situ decompression. However, this procedure does not come without complications. Subluxation of the ulnar nerve and ulnar nerve neuritis from adhesion formation remain 2 potential complications after this procedure. It has been shown in the literature that young, active, male patients are most likely to have these complications postoperatively. We have developed a modification to in situ decompression by developing a fascial turnover flap and using a porcine submucosa extracellular matrix (Axogen) to help reduce both ulnar nerve subluxation and adhesion formation postoperatively.MethodsThirteen patients underwent cubital tunnel surgery by the highlighted technique to prevent postoperative ulnar nerve subluxation and adhesion formation. Patient outcomes including elbow range of motion, functional status, paresthesia, and grip strength were recorded.ResultsOf the 13 patients, 10 had excellent results, 1 had a good result, and 2 required revision with anterior transposition of the nerve. The mean Mayo Elbow Performance Score of the 11 patients not needing revision was 92.7.ConclusionThe described surgical technique provides surgeons with the ability to directly decompress the ulnar nerve while decreasing postoperative complications such as instability and adhesion formation.

Evaluation of grip strength in hook of hamate fractures treated with osteosynthesis. Is this surgical treatment necessary?

ObjectiveThe aim of this study was to evaluate the outcomes of open reduction and internal fixation (ORIF) in hamate hook fractures and review the literature on this surgical procedure. MethodsWe report the outcomes of ORIF of hamate hook fractures in 13 consecutive patients (12 men and 1 woman; mean age: 32 years (range, 22–48 years)). In eight patients (61%) the fracture was associated with ulnar nerve neuritis in Guyon's canal. We assessed the following clinical data: age, sex, mechanism of injury, side of the injured hand and associated lesions, fracture classification, average time from injury to correct diagnosis, surgical technique, complications, and length of follow-up.All patients underwent radiological imaging, including standard radiographs in two planes (anteroposterior and lateral projections), and a CT study. Functional outcomes evaluated were pain, range of motion, grip strength, Disabilities of the arm, shoulder and hand (DASH) and Mayo wrist score. ResultsThe mean follow-up was 36 months (range, 12–144 months). All 13 cases were treated with ORIF of the hook of the hamate. Mean VAS pain score was 5 preoperatively (4–9) and 1 (0–2) postoperatively. All patients returned to pre-injury level and only one patient felt pain on activity. Preoperative modified Mayo wrist score was 51 and the postoperative value was 94. All outcomes scores improved significantly from preoperative values. The patients who participated in sports postoperatively were able to do so at or near pre-injury levels. Postoperative average range of wrist motion was 76° in extension, 71° in flexion, 14° in ulnar deviation, and 21° in radial deviation.Mean grip strength in the hand with the hook fracture was 58 kg compared with 53 Kg in the unaffected hand. All patients returned to their pre-injury level of functioning after 10–12 weeks and there were no complications. Analysis of grip strength revealed values comparable with the unaffected hand. ConclusionORIF of hamate hook fractures is a safe and effective technique to restore normal grip strength and return to pre-injury level. In cases of ulnar nerve neuritis, neurolysis of the deep palmar branch is mandatory. Level of evidenceLevel IV, Therapeutic study.

Management of distal humerus fracture is not always a surgeon's nightmare!

Aim: To evaluate the functional outcome of distal humerus intercondylar fracture treated by open reduction and internal fixation. Methods: The prospective study of 42 patients with intercondylar humerus fracture treated at Sri Ramachandra Medical Centre between March 2010 and March 2014. The inclusion criteria were age above 19 years, Type C fractures of the distal humerus and closed fracture's. The exclusion criteria were extraarticular fractures of the distal humerus, unicondylar with intercondylar extension and open fractures. The rating system of the Mayo elbow functional scoring system was used. The patients were followed for a minimum of 1-year. Results: In 42 patients, 26 were males and 16 were females. In our series, we had 81% excellent/good results, 19% fair/poor result. We had complications in 7 patients. Two patients had early Kirschner-wire back out. One patient had an infection, and 4 patients had ulnar nerve neuritis. Conclusion: Meticulous surgical technique, stable internal skeletal fixation, and early controlled postoperative mobilization are critical factors for a successful outcome. Trans-olecranon approach with the patient in lateral position offers excellent exposure of the articular surface. Arc of motion was more important than the total range of motion. The clinical evaluation did not always correlate with the follow-up radiograph.

A paradigm shift in the surgical reconstruction of extra-articular distal humeral fractures: Single-column plating

ObjectivesThe study aimed (1) to examine if there are equivalent results in terms of union, alignment and elbow functionally comparing single- to dual-column plating of AO/OTA 13A2 and A3 distal humeral fractures and (2) if there are more implant-related complications in patients managed with bicolumnar plating compared to single-column plate fixation. DesignThis was a multi-centred retrospective comparative study. SettingThe study was conducted at two academic level 1 trauma centres. Patients/participantsA total of 105 patients were identified to have surgical management of extra-articular distal humeral fractures Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 13A2 and AO/OTA 13A3). InterventionPatients were treated with traditional dual-column plating or a single-column posterolateral small-fragment pre-contoured locking plate used as a neutralisation device with at least five screws in the short distal segment. Main outcome measurementsThe patients’ elbow functionality was assessed in terms of range of motion, union and alignment. In addition, the rate of complications between the groups including radial nerve palsy, implant-related complications (painful prominence and/or ulnar nerve neuritis) and elbow stiffness were compared. ResultsPatients treated with single-column plating had similar union rates and alignment. However, single-column plating resulted in a significantly better range of motion with less complications. ConclusionsThe current study suggests that exposure/instrumentation of only the lateral column is a reliable and preferred technique. This technique allows for comparable union rates and alignment with increased elbow functionality and decreased number of complications.

Comparison of the intramedullary nail and low-profile plate for unstable metacarpal neck fractures

BackgroundThere is no robust evidence for the best treatment practice for metacarpal neck fractures. The purpose of this comparative study was to investigate whether the intramedullary nail or low-profile plate allows for good clinical and radiological results for displaced metacarpal neck fractures. MethodsWe prospectively reviewed 30 patients with a displaced metacarpal neck fracture who underwent surgery: 15 with intramedullary nails and 15 with low-profile plates. Radiographic and clinical outcomes of both groups were compared. Objective findings of range of finger motion and grip strength were assessed at 3, 6, and 12months postoperatively. ResultsThere was no non-union, and postoperative complications included extensor tendon rupture in one and transient ulnar nerve neuritis in two. Radiological parameters after the fracture healing were comparable between the two groups. Postoperative range of finger motion was better in patients with the intramedullary nail, and acquired grip strength in the low-profile plate group was superior to that in the intramedullary nail group. ConclusionsThe current results indicate that both procedures are highly effective in maintaining fracture restorations. Plate fixation provides earlier recovery of powerful hand function, and intramedullary nailing allows a wide range of finger motion.

Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients

Distal humeral fractures are difficult to treat. In the elderly population, the problems are compounded by osteoporosis and gross comminution. Open reduction and internal fixation for such fractures is sometimes difficult and may be associated with poor results. Total elbow arthroplasty has been suggested as a last-ditch effort to salvage functional use for such difficult fractures in the elderly. We followed seven patients (seven elbows) with a mean age of 81.7 years at the time of injury. Open reduction and internal fixation was considered a difficult option for these fractures. They were treated with a total elbow arthroplasty using the semi-constrained Coonrad–Morrey elbow replacement prosthesis. The duration of follow up at present is between 2 and 4 years. At the latest follow up the mean arc of flexion is 20–130°. Six patients have no pain while one complains of mild pain. All elbows are stable. The Mayo elbow performance score for five elbows is excellent and two scored good. All but one patient are satisfied with the result. One patient developed superficial wound infection which resolved after antibiotic therapy. One patient has developed post-operative triceps weakness. There have been no cases of deep infection, ulnar nerve neuritis or component failure. The rarity of this procedure suggests its very narrow spectrum of indication. We feel that the short-term results do suggest an important role for semi-constrained total elbow arthroplasty in managing carefully selected comminuted distal humeral fractures in the elderly, especially those that cannot be treated by conventional open reduction and internal fixation.

Hypoplasia of bilateral humeral trochlea associated with unilateral ulnar nerve neuritis. A case report

On this paper the authors document a case of unilateral ulnar neuropathy that developed in a 56-year-old Japanese man who had bilateral hypoplasia of humeral trochlea and severe degenerative changes in the both elbow joints. The patient is the oldest in the reported cases. Pathomechanism of the nerve paresis in this peculiar condition is discussed.

Les névrites cubitales de la maladie de Hansen. Résultats de cinquante neurolyses au bras et au coude

Fifty cases of ulnar nerve neuritis in Hansen disease are reported. The authors analyse the type of lesion, the clinical feature, the treatment, and the results of neurolysis. Many points are emphasized: the requirement to an association antileprosy, chemotherapy and corticotherapy with a careful neurolysis; pain and paresthesia were relieved immediately after neurolysis, recovery within two years after neurolysis; the amount of recovery was directly related to the extent and stage of involvement of the nerve; and thus the sooner procedure give the best result.

Hypoplasia of the trochlea and the medial epicondyle of the humerus associated with ulnar neuropathy. Report of two cases.

The Journal of Bone and Joint Surgery. British volumeVol. 60-B, No. 2 ArticlesFree AccessHypoplasia of the trochlea and the medial epicondyle of the humerus associated with ulnar neuropathy. Report of two casesY Murakami, Y KomiyamaY MurakamiSearch for more papers by this author, Y KomiyamaSearch for more papers by this authorPublished Online:1 May 1978https://doi.org/10.1302/0301-620X.60B2.659470AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByCubital tunnel syndrome in Noonan syndrome secondary to hypoplasia of the humeral trochlea19 August 2020 | SAGE Open Medical Case Reports, Vol. 8Tardy Ulnar Nerve PalsyJournal of the American Academy of Orthopaedic Surgeons, Vol. 27, No. 19Congenital Abnormalities of the ElbowFracturas del extremo distal del húmero en niñosEMC - Aparato Locomotor, Vol. 49, No. 4Nerve Compression/Entrapment Sites of the Upper LimbDynamic analysis of the ulnar nerve in the cubital tunnel using ultrasonographyJournal of Shoulder and Elbow Surgery, Vol. 23, No. 7Congenital Abnormalities of the ElbowOlecranon AplasiaOrthopedics, Vol. 27, No. 7Journal of Pediatric Orthopedics, Vol. 22, No. 2Trochlear Deformity Occurring After Distal Humeral Fractures: Magnetic Resonance Imaging and Its Natural ProgressionJournal of Pediatric Orthopaedics, Vol. 22, No. 2Hypoplasia of bilateral humeral trochlea associated with unilateral ulnar nerve palsy: A case reportJournal of Shoulder and Elbow Surgery, Vol. 9, No. 3Cubitus Varus Associated With Dislocation of Both the Medial Portion of the Triceps and the Ulnar NerveThe Journal of Hand Surgery, Vol. 24, No. 4PROXIMAL ULNAR NERVE COMPRESSIONHand Clinics, Vol. 8, No. 2Hypoplasia of the humeral trochleaThe Journal of Hand Surgery, Vol. 15, No. 6Ulnar neuropathy at the elbow: Results of medial epicondylectomyThe Journal of Hand Surgery, Vol. 14, No. 2Hypoplasia of bilateral humeral trochlea associated with unilateral ulnar nerve neuritis. A case reportAnnales de Chirurgie de la Main, Vol. 7, No. 1Humerus Vol. 60-B, No. 2 Metrics Downloaded 36 times History Published online 1 May 1978 Published in print 1 May 1978 InformationCopyright © 1978, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

An unusual cause of ulnar nerve palsy associated with Colles's fracture

An unusual case of traumatic neuritis of ulnar nerve associated with Colles's fracture is described. The ulnar nerve had the abnormal course in the lower forearm and wrist. The fracture of the styloid process of the ulna was responsible for the traumatic neuritis of the ulnar nerve.

Diagnosis and Treatment of the Delayed Ulnar Nerve Neuritis

Diagnosis and Treatment of the Delayed Ulnar Nerve Neuritis