Ulnar Nerve Neuropathy Research Articles

The utility of the Difference of Latency of Median and Mixed Ulnar Nerve Action Potential in Focal Ulnar Nerve Neuropathy

Several electrophysiological tests have been used to diagnose focal ulnar nerve entrapment at the elbow, including evidence of focal motor slowing at the elbow, mixed ulnar nerve potentials across the elbow and comparing the results to the contralateral side; here I am trying to diagnose focal ulnar nerve neuropathy comparing the latencies of the median and ulnar nerves across the elbow.

Delayed onset ulnar nerve neuropathy following hand injury: a case report

We present a 40-year-old man, manual worker, who sustained a right hand injury, after a fall on his outstretched hand. Initial diagnosis was isolated pisiform fracture, documented with the conventional carpal views and a conservative treatment was applied by using a cast. Three months after the trauma episode, the patient presented at hospital outpatient’s clinic with symptoms of ulnar neuropathy. The fracture had been already united, according to the signs of callus formation in plane radiographs. Nerve conduction studies confirmed the ulnar nerve’s neuropathy and a decision of surgical exploration of Guyon’s canal was made. Intraoperatively, we found that pisohamate ligament was ruptured and an acquired aberrant fibrous band was the main cause of ulnar nerve compression. The patients’ symptoms were promptly receded after the resection of the pisohamate ligament band. At one-year follow-up, no recurrence of symptoms was reported and the patient was successfully returned to his priory to injury occupation.

The pathology of the ulnar nerve in acromegaly

Acromegalic patients may complain of sensory disturbances in their hands. Cubital tunnel syndrome, the ulnar nerve neuropathy at the cubital tunnel (UCT), in acromegalic patients has never been reported. To describe and assess the prevalence of UCT in acromegalic patients and the effects of 1 year of therapy on UCT. We examined prospectively 37 acromegalic patients with no history of polyneuropathy, acute trauma at the elbow, no diabetes or hypothyroidism with clinical examination, nerve conduction studies (NCS), and high-resolution ultrasound (US). A control group was made by 50 volunteers. The local ethics committee approved the study and written informed consent was obtained from all subjects involved in the study. Clinical history, physical examination, NCS, and US were used to diagnose UCT at the beginning of the study and after 1 year. In 8 of 37 patients, a diagnosis of UCT was made at the beginning of the study reflecting a prevalence of 21%. After 1 year, 5 of 8 (62.5%) patients reported clinical and NCS improvements and evident US reduction of nerve cross-sectional area (CSA; 16.7+/-2.9 mm(2) vs 12.2+/-3.1 mm(2); P<0.001). In 3 of 8 (37.5%) patients, the UCT was unchanged. Ulnar nerve CSA was significantly increased in acromegalic patients with UCT (16.7+/-2.9 mm(2) vs 11.1+/-2.3 mm(2); P<0.047). Ulnar neuropathy could occur in acromegalic patients and can improve in 62% of cases with disease control. Due to the different management and therapeutic approach, it would be important to make differential diagnosis between cubital and carpal tunnel syndrome in acromegaly.

The clinical, electrophysiological and prognostic heterogeneity of ulnar neuropathy at the elbow

Background: Ulnar nerve neuropathy is one of the most common entrapment neuropathies and is often considered to be one entity in clinical and follow-up studies. Objective: The aim of this...

The Double Crush Syndrome: A Common Occurrence in Cyclists With Ulnar Nerve Neuropathy-A Case-Control Study

To evaluate the incidence of double crush syndrome in the upper limbs of cyclists with clinical diagnosis of ulnar nerve neuropathy. Case-control study. Outpatient clinics and university setting. Consecutive sampling of 70 cyclists (140 upper limbs) with a mean age of 36 years (+/-11.3). Seventy-two upper limbs were excluded, leaving 40 upper limbs with a clinical diagnosis of ulnar nerve neuropathy [ULNN (+)] and 28 without symptoms of ulnar nerve neuropathy [ULNN (-)]. Cyclists were examined clinically for the presence of proximal dysfunction using the following testing (independent variables): (1) thoracic outlet syndrome provocation testing: elevated arm stress test and modified Cyriax release test; (2) presence of an elevated first rib: cervical rotation lateral flexion test; and (3) presence of proximal symptoms: reports of neck pain and shoulder pain. The upper limbs of cyclists were categorized into 2 groups (dependent variable)-ULNN (+) and ULNN (-)-based on history, symptoms, motor, sensory, and provocative clinical testing. A significantly greater number of upper limbs of cyclists with ULNN (+) presented with positive provocative testing for thoracic outlet syndrome (elevated arm stress test P = 0.005; modified Cyriax release test P = 0.002) than did the upper limbs of cyclists with ULNN (-). The likelihood for the presence of neck pain, shoulder pain, and an elevated first rib was 3, 5, and 12 times greater, respectively, in the ULNN (+) than the ULNN (-) group. A statistically significant greater number of the upper limbs of cyclists with clinical diagnosis of ulnar nerve neuropathy presented with proximal dysfunctions suggestive of double crush syndrome.

Trampoline injuries

Objective: To describe the mechanism, location and types of injury for all patients treated for trampoline-associated injuries at St Olav’s University Hospital, Trondheim, Norway, from March 2001to October 2004. Materials...

Acute ulnar neuropathy at the wrist: a case report and review of the literature

Acute ulnar neuropathy at the wrist is an extremely uncommon condition, at times requiring a high index of suspicion for the diagnosis. Clinical presentations of ulnar nerve lesions at the wrist and hand show variations due to the complex anatomic course of the nerve in distal sites. We report a case of acute ulnar neuropathy at the wrist caused by a ganglion in Guyon's canal, being initially misinterpreted as flexor tenosynovitis. The accurate diagnosis of selective distal motor neuropathy of ulnar nerve was made electrophysiologically. Magnetic resonance imaging revealed a well defined soft tissue mass consistent with a ganglion, compressing the ulnar nerve in Guyon's canal. Entrapment neuropathies are one of the common conditions handled by physiatrists. Ulnar nerve lesions at the wrist should be kept in mind in the differential diagnosis of patients with wrist or hand pain. Magnetic resonance imaging is a useful method in the anatomical evaluation of acute focal neuropathies.

Intraoperative Measurement of Pressure Adjacent to the Ulnar Nerve in Patients With Cubital Tunnel Syndrome

Little is known about whether the pressure adjacent to the ulnar nerve actually is increased in patients with cubital tunnel syndrome or if it is a causative factor. We measured the pressure adjacent to the ulnar nerve in patients with cubital tunnel syndrome during surgery and verified whether or not there was an association with patient age, duration of the disease, motor nerve conduction velocity, and severity of the ulnar nerve neuropathy. Eight elbows in 8 patients with an average age of 62 years were treated surgically and the extraneural pressures within the cubital tunnel were measured during surgery by using a fiberoptic microtransducer. Pressure was measured 3 times with the elbow fully extended and then 3 times with the elbow flexed 130 degrees. The transducers were placed at 1, 2, and 3 cm distal to the proximal edge of the Osborne ligament. The severity of the neuropathy was evaluated according to Akahori's classification. The ulnar nerve palsy was graded as stage III in 5 patients and as stage IV in 3 patients. The average pressures within the cubital tunnel at 1, 2, and 3 cm distal to the proximal edge of the cubital tunnel retinaculum with the elbow flexed were 105, 29, and 18 mm Hg, respectively. The pressures at 1 and 2 cm distal to the proximal edge of the cubital tunnel retinaculum were significantly higher in elbow flexion than in elbow extension. There was also a positive correlation between the pressure and patient age but this was not significant The pressures correlated significantly with the stage of ulnar nerve neuropathy, motor nerve conduction velocity, and disease duration. The extraneural pressure within the cubital tunnel actually was increased in the patients and compression of the ulnar nerve might be a causative factor of cubital tunnel syndrome.

Pain after surgery for ulnar neuropathy at the elbow: a continuing challenge.

Fifty-eight percent of patients who had undergone surgery for ulnar neuropathy at the elbow experienced pain after surgery. Severe pain, mostly radiating from the elbow into the hand, is the main indication for subsequent surgery. During a period of 5.5 years, 25 patients underwent 28 operations for ulnar nerve entrapment at the elbow and experienced excruciating pain after surgery. Ten patients had undergone a simple decompression and 15 had undergone a nerve transposition. Seven patients underwent surgery at our hospital, whereas 18 patients underwent their primary surgery at other institutions. Various surgical techniques were used during the subsequent surgery, such as external or internal neurolysis, epineurectomy, anterior, transposition, and subsequent transfer of the nerve back into the sulcus. The average follow-up after the last procedure was 17 months (2-55 mo). All five patients with subsequent transfer of the ulnar nerve into the sulcus became pain-free, whereas only two of five patients who had secondary intramuscular transposition for subluxation became free of pain. Results after internal neurolysis were unsatisfactory. Only one of six patients was free of pain after secondary surgery. Results after three or four procedures are approximately similar to the results after the first subsequent surgery. Simple and less extensive techniques for subsequent surgery have relatively good results in this complicated condition. Although our small number of patients does not allow us to draw general conclusions, we think our report makes a contribution because of the few reports in the literature dealing with the results of subsequent surgery for ulnar nerve neuropathy.

Electrodiagnostic testing in hand surgery

General techniques of electrodiagnostic examination, how such examination can predict the pathophysiology of nerve injury, and specific techniques and findings of the major entrapments such as carpal tunnel syndrome and ulnar nerve neuropathy are described in detail. Additional disease states that relate to hand surgery, such as anterior interosseous syndrome, brachial plexopathy, radiculopathy, polyneuropathy, and the nebulous entity of thoracic outlet syndrome are discussed.

神経内ガングリオンによる尺骨神経麻すいの一例

We experienced a case of ulnar nerve neuropathy caused by an itraneural ganglion of the ulnar nerve.A 57 year-old man, who is a carpenter, felt numbness of his left ring and little finger. He had sensory disturbance in the ulnar nerve area and decrease of hand grip strength. At surgery, a ganglion was located under the epineurium and we were only able to remove the epineurium. After one and half years, has no symptoms.Electromyography and magnetic resonance imaging were most useful for the preoperative diagosis.

The drop-out splint: An alternative to the conservative management of ulnar nerve entrapment at the elbow

U lnar nerve entrapment at the elbow involves a compression neuropathy of the ulnar nerve as it courses along the medial head of the triceps, through the postcondylar groove behind the medial epicondyle and through the cubital tunnel. Numerous etiological factors have been identified that contribute to ulnar nerve neuropathy at the elbow. These factors include bony trauma, ganglia, soft tissue tumors, foreign bodies, congenital abnormalities, and cubitus valgus of developmental or traumatic origin. Toxic, metabolic, and nutritional changes secondary to diabetes, alcoholism, and vitamin deficiencies have also been identified as causative factors, as have habitual subluxation of the ulnar nerve and various anatomic sites of entrapment. 13 These sites include the arcade of Struthers, the medial head of the triceps, the aponeurosis of the flexor carpi ulnaris, and the cubital tunnel. 4 Individuals with ulnar nerve entrapment at the elbow typically present with complaints of radiating pain accompanied by paresthesias in the ulnar nerve distribution of the forearm and hand . Muscle-wasting of the ulnar-innervated intrinsics may be observed, although this is usually an indication of more prolonged or severe compression. Clinical signs include the presence of a positive percussion test (Tinel's sign), which is indicative of localized nerve irritability. A positive elbow-flexion test results in symptoms of pain, numbness, and tingling secbndary to the mechanical and pathophysiological events that occur during elbow flexion. 5 Both subjective symptoms and objective clinical signs may suggest the presence of an ulnar nerve entrapment syndrome. Electrodi-

Compressive Neuropathies of the Median and Radial Nerves at the Elbow

Compressive neuropathies of the median and radial nerves in the region of the elbow are a frequent cause of pain and weakness as well as sensory complaints. The problems associated with these neuropathies can be as severe and disabling as the more commonly encountered ulnar nerve neuropathies discussed elsewhere in this issue. Regardless of the nerve that is compressed, prompt recognition of the problem and the specific site of compression are important in order to institute effective treatment and limit, if not totally eliminate, permanent sequelae. Diagnosis and treatment are presented.

Ulnar compression neuropathy secondary to the anconeus epitrochlearis muscle

The treatment of the five arms of four patients with ulnar neuropathy at the elbow and an associated anconeus epitrochlearis muscle is presented. Two of these patients had unilateral involvement, one had bilateral neuropathy and bilateral anconeus epitrochlearis muscles, and one had bilateral symptoms, with an anconeus epitrochlearis muscle on the side that was treated by operation. All patients were treated with excision of the anconeus epitrochlearis muscle and cubital tunnel release without anterior transposition of the nerve. All five arms were clinically normal at follow-up 16 to 29 months after operation. Postoperative electrodiagnostic studies on four arms at an average of 9 months after operation showed marked improvement in conduction velocities across the elbow. We recommend simple excision of the anomalous anconeus epitrochlearis muscle when no other cause of ulnar nerve neuropathy at the elbow is identified. Anterior transposition of the nerve seems unnecessary.

Survey of hand symptoms in pregnancy.

In a study of 1216 pregnancies, 427 (35%) patients reported hand symptoms. Symptoms of the same quality and distribution were reported by 40 (30%) of 132 control subjects within the previous year, and although invariably mild, these symptoms suggest that pregnancy may aggravate a pre-existing condition. Fewer than 20% of the 427 affected patients described a classic median-nerve symptom distribution (carpal tunnel syndrome), while 12% of patients described an ulnar-nerve distribution, which is thought to represent a genuine and previously underestimated occurrence of ulnar-nerve neuropathy in pregnancy. In 69% of patients, hand symptoms were generalized. Most symptoms were bilateral, commenced in the third trimester and resolved soon after delivery. There was a significant correlation of hand symptoms in pregnancy with the presence of preeclampsia, tight rings, the weight at confinement, the birth weight and a history of premenstrual bloating. Operative intervention was not required for any patient.

Characterized dispersive wave-form of evoked compound muscle action potential in the localized ulnar nerve neuropathy.

Disorder of the ulnar nerve with continuity around the elbow is known to be a neuropathy produced by long lasting compression, friction or traction. Forty-four patients with clinical diagnosis of ulnar nerve neuropathy were examined by means of motor nerve conduction study and induced electromyography. Compound muscle action potentials (CMAPs) from hand muscle were evoked by stimulating many points proximal and distal to the elbow and analysis of CMAP was performed. In mild grade of nerve lesion, dispersive wave-form with the extension of its duration was elicited by only stimulating proximal points to the elbow. It was also found that conduction velocity is delayed only over the short distance across the elbow. Thus an initial stage of nerve lesion has a tendency of dysfunctioning of conductivity restricted in only affected portion. CMAP patterns are classified into four groups in comparison with the progress of clinical signs of the disease. This classification can be utilized for the evaluation of the progress of ulnar nerve lesion.

L'atteinte des fibres motrices dans le syndrome du nerf cubital au coude

In order to improve the diagnosis of the ulnar nerve neuropathy at the elbow, we have retrospectively analysed the data obtained in the course of the electrophysiological examinations of the ulnar nerve motor component in three groups of adult subjects of both sexes (210 control subjects; 111 patients with more or less marked clinical symptoms suggestive of ulnar nerve neuropathy; 21 patients who after our investigation have undergone an operation for an ulnar nerve neuropathy at the elbow). The comparison of the data obtained in the three groups permits us to propose the following parameters as signs of ulnar neuropathy at the elbow: the proximal conduction time (stimulation in the axilla) greater than or equal to 12 msec for males and greater than or equal to 11 msec for females; motor conduction velocity of ulnar motor nerve fibers at the arm comprise in the range of normal values and similar to that measured on the contralateral ulnar nerve; conduction velocity of ulnar nerve motor fibers when it is measured on all the length of the upper limb less than 45 m/sec-1 (males) or less than 50 m/sec-1 (females).

神経内ガングリオンによる尺骨神経麻ひの２例

We report two cases of ulnar nerve neuropathy caused by an intraneural ganglion of the cubital tunnel. At operation these ganglions were located between the nerve fibers and had a stalk extending to the medial joint capsule of the elbow. The stalk and cyst were removed under the operating microscope and King's method was done. Two cases' progress was very good. The microscopic specimens from the excised tumor were that of a ganglion. We discuss about the origin of ganglion, whether it is an intraneural or extraneural cyst.

Distal Ulnar Neuropathy in Meat Packers

Distal ulnar neuropathy at the wrist level was observed in three meat packers. The diagnosis was confirmed electromyographically, by follow-up, and with surgical exploration. Compression neuropathy of the distal ulnar nerve has been a well-recognized occupational hazard and is cause by chronic and repeated compression of the ulnar nerve at the level of Guyon's canal; pathogenetic mechanisms differ from those observed in the more common carpal tunnel syndrome.

Professional Golfers and the Price They Pay.

In brief Professional golfers' injuries are usually related to their swings. A wide variety of acute and chronic injuries have been reported, including carpal fractures, ulnar and median nerve neuropathies, tendinitis, skin rashes, and eye injuries. There have been two deaths. In this study questionnaires were mailed to 500 professional golfers, and 226 were returned. During their careers 103 men and 87 women were injured, an average of two injuries per player. The left wrist, lower back, and left hand were most commonly injured. Repetitive practice swings caused the most injuries in both men and women.