Brachialis insertion measurement: an anatomic cadaver study for plate fixation of the coronoid process fracture

Detailed assessment of the proximity of the brachialis insertion to the anterior bundle of the medial collateral ligament and its potential influence on plate application for the treatment of the coronoid process fracture has not been reported previously. The purpose of this study was to describe the anatomic interval used for coronoid plate and the measurement of the brachialis insertion to confirm partial release of the insertion site may be required during plate fixation of the coronoid process fracture. After eight fresh-frozen cadaveric elbows were dissected, the interval between the brachialis insertion and the attachment of the anterior bundle of medial collateral ligament was identified, and the gross morphological characteristics of the brachialis insertion were also recorded. The average width of the interval was 4.14 mm, and the brachialis was found to be consisted of a superficial head and a deep head, and insertion of the deep head was composed of three units: a medial aponeurosis, a lateral aponeurosis, and muscle fibers inserted directly into the ulna. The interval between the brachialis insertion and the attachment of the anterior bundle of medial collateral ligament can be used for placement of the coronoid plate regardless of the plate type. Partial release of the brachialis insertion is necessary during the operation, while the width of the plate is larger than that of the interval. This study may provide some useful information on plate application for the treatment of the coronoid process fracture.     

经皮电刺激内关穴监测拇内收肌神经肌肉阻滞的准确性

目的 评价经皮电刺激内关穴监测拇内收肌神经肌肉阻滞的准确性.方法 择期全麻下拟行腹部手术患者35例,年龄40～60岁,ASAⅠ～Ⅲ级,体重指数≤35 kg/m2.麻醉诱导完毕后所有患者行气管插管后机械通气,记录神经肌肉阻滞监测仪经内关穴与经尺神经监测的刺激强度和传感器的增益值;术中单次静脉注射阿曲库铵0.5 mg/kg,采用神经肌肉阻滞监测仪经内关穴与经尺神经监测的阿曲库铵起效时间、TOF比值(T4/T1比值)恢复至25%、90%的时间.结果 经皮电刺激尺神经和内关穴所得的电流强度及传感器的增益值差异无统计学意义(P>0.05);经皮电刺激尺神经和内关穴监测的阿曲库铵起效时间、TOF比值恢复至25%、90%的时间差异无统计学意义(P>0.05).结论 肌松监测仪的电极置于内关穴部位可准确地监测神经肌肉阻滞程度.     

Risk factors for ulnar nerve compression at the elbow: a case control study

Summary Background. Ulnar nerve compression at the elbow is frequently encountered as the second most common compression neuropathy in the arm. As dexterity may be severely affected, the disease entity can seriously interfere with daily life and work. However, epidemiological research considering the risk factors is rarely performed. This study intended to investigate whether potential risk factors based on historical belief contribute to the development of ulnar nerve compression at the elbow. Method. A hospital based case control study was performed of patients that underwent surgical treatment for ulnar nerve compression at the elbow at the neurosurgical department from June 2004 until June 2005. Controls were those patients treated for a cervical or lumbar herniated disc. The main outcome measure was the presence of ulnar nerve compression at the elbow proven clinically, and electrodiagnostically. Results. 110 patients with ulnar nerve lesions and 192 controls were identified. Smoking, education level and related working experience were identified as risk factors. Conversely, gender, BMI, alcohol consumption, trauma to the elbow, diabetes mellitus, and hypertension are not risk factors for the development of ulnar nerve compression at the elbow. Conclusion. Risk factors are clearly defined. In the past many factors have been described, but mostly in surgical series. This study concludes that gender, previous fracture of the elbow and BMI are not predictive factors for ulnar entrapment neuropathy. However, education and working experience are closely correlated with this entity.     

Ulnar nerve impairment at the wrist does not contribute to extramedian sensory symptoms in carpal tunnel syndrome

ObjectiveExtramedian spread of sensory symptoms is frequent in carpal tunnel syndrome (CTS) but its mechanisms are unclear. We explored the possible role of subtle ulnar nerve abnormalities in the pathogenesis of extramedian symptoms.MethodsWe recruited 350 CTS patients. After selection, 143 patients (225 hands) were included. The hand symptoms distribution was graded with a diagram into median (MED) and extramedian (EXTRAMED) pattern. We tested the correlation of ulnar nerve conduction measures with the distribution and the severity of symptoms involving the ulnar territory. The clinical significance of ulnar nerve conduction findings was explored with quantitative sensory testing (QST).ResultsEXTRAMED distribution was found in 38.7% of hands. The ulnar neurographic measures were within normal values. Ulnar nerve sensory measures were significantly better in EXTRAMED vs MED hands and not significantly correlated to ulnar symptoms severity. Ulnar and median nerve sensory measures were significantly correlated. QST showed normal function of ulnar nerve Aβ-fibers.ConclusionsUlnar nerve sensory abnormalities do not contribute to the spread of sensory symptoms into the ulnar territory.SignificanceOur data favour the hypothesis that spinal and supraspinal neuroplastic changes may underlie extramedian spread of symptoms in CTS.     

Assessment of Rotational Instability with Disruption of the Accessory Collateral Ligament of the Thumb MCP Joint: A Biomechanical Study

OBJECTIVES: The objective of this paper was to biomechanically investigate rotational stability of the thumb after ulnar collateral ligament (UCL) and accessory collateral ligament (ACL) disruption and repair at the metacarpal joint of the thumb. METHODS: Twelve fresh frozen adult cadaveric thumbs were used. The torsion test was performed under constant rotation of 1/s through 30 arc of metacarpal phalangeal (MCP) joint. The torsional resistance was determined for four categories: first no intervention of the UCL structures (control), next with the proper UCL cut at the distal insertion, then with the additional ACL ligament cut, and lastly with the repair of only the proper UCL. The decrease on the amount of torsional rigidity for each of the last three categories was determined and compared. Each thumb was used as its own control. Significance of the differences in each test categories was statistically determined. RESULTS: After the proper UCL was cut, the torsional rigidity of the MCP joint was reduced 35.18 +/- 17.56% (p < 0.001). When, additionally, the ACL was cut, the torsional rigidity of the MCP joint was further reduced to 49.34 +/- 16.82% (P < 0.001). After repair of only the proper UCL, the torsional rigidity of the MCP joint improved, but still showed a considerable reduction from controls. The amount of reduction was not consistent among specimens and was 13.52 +/- 16.40%. CONCLUSIONS: The ACL ligament is a contributor of rotary stability as well as a provider of lateral stability. Leaving the ruptured ACL unrepaired causes some residual rotating instability and that may lead to future rotational instability of the MCP joint.     

Hypothenar hammer syndrome: case reports and brief review

Patients with hand and finger pain regularly present to primary care practices. Although a well-known clinical entity to specialists, hypothenar hammer syndrome is an uncommon vascular overuse syndrome that may not be familiar to primary care practices. It is caused by trauma to the palmar portion of the ulnar artery, usually as a result of occupational or sports activities which involve repetitively striking objects with the heel of the hand. In this report we describe two representative cases as well as discuss clinical features, pathogenesis, diagnosis, imaging and management.     

对中重度肘管综合征治疗方式的探讨

目的 通过对中、重度肘管综合征的分度及手术效果分析寻找最佳治疗方法。方法 根据３４例中、重度肘管综合征在手术中发现尺神经的变性程度分为２组。Ⅰ组：尺神经无明显神经瘤样变，采用前置术加神经鞘膜内注射确炎舒松－Ａ。Ⅱ组：尺神经在肘管内有明显神经瘤样变，采用前置术、束间松解术、神经周转放置确炎舒松－Ａ。结果 术后平均随访２２．２个月。按２０００年手外科学会周围神经功能评定试用标准评价，Ⅰ组１４例，功能恢     

带伴行血管尺神经前置术的解剖学研究

目的观察肘部尺神经的血液供应,设计带伴行血管尺神经前置的手术方法。方法取20侧防腐成人上肢标本,观测肘部尺神经血供来源和血管起始处外径、血管起始处至肱骨内上髁距离、血管起始处至尺神经垂直距离及尺神经伴行长度。另采用3侧防腐成人上肢标本模拟临床手术,设计带伴行血管尺神经前置术。结果肘部尺神经血供有3个来源,分别是尺侧上副动脉、尺侧下副动脉和尺侧返动脉后支。3条动脉从起始处至肱骨内上髁的距离分别是14.2±0.9、4.2±0.6和4.8±1.1cm;尺神经伴行长度分别是15.0±1.3、5.1±0.3和5.6±0.9cm;血管起始处外径分别是1.5±0.5、1.2±0.3和1.4±0.5mm;血管起始处至尺神经垂直距离分别是1.2±0.5、2.7±0.9和1.3±0.5cm。结论带伴行血管尺神经前置术治疗肘管综合征是可行的,且最大程度保留了肘部尺神经血供。     

肘管综合征的临床病因学探讨及神经电生理检查

目的 探讨肘管综合征的发病原因，评价尺神经传导速度(NCV)检查在术前诊断肘管综合征的临床价值。方法 对临床上伴有尺神经分布区受损症状及体征的患者，进行尺神经感觉神经传导速度(SCV)及运动神经传导速度(MCV)分段测定，并对这些患者进行尺神经前移术治疗。结果 共有21例(22肢)行尺神经传导速度分段测定并手术治疗。尺神经SCV测定，14例(14肢)异常，其中12例未引出电位；MCV肘上至肘下段测定，20例(21肢)减慢。手术证实尺神经受压原因为：韧带、肌腱及骨质增生压迫尺神经15肢，粘连2肢，扩张静脉及静脉丛压迫3肢，囊性肿物压迫2肢。结论 本组肘管综合征发病原因，除文献报道的常见病因外，还有其他少见原因，包括充盈的静脉丛，粗大静脉，囊肿压迫尺神经等。尺神经肘段运动神经传导速度减慢对肘管综合征有一定诊断价值。