Ulnar nerve entrapment neuropathy in the forearm

A 74-year-old male attorney developed rapidly progressive weakness of the fourth and fifth digits of the right hand with impairment of his grip and ability to perform cursive writing. Lancinating pain occurred spontaneously and was triggered by pressure along the ulnar border of the forearm about 5 cm proximal to the wrist crease. Nerve conduction studies revealed a complete electrical block to stimulation at a point 5 cm proximal to the wrist crease when recording from the abductor digiti minimi. Distal to this point, responses of normal amplitude and latency were recorded. Surgical exploration disclosed two fibrovascular bands coursing from the ulnar artery to the distal belly of the flexor carpi ulnaris, entrapping and grooving the ulnar nerve. Release of these bands resulted in reversal of the electrical block, complete relief of pain, and a full neurologic recovery during the ensuing six months.     

Entrapment of the median nerve and flexor pollicis longus tendon in an epiphyseal fracture-dislocation of the distal radioulnar joint: a case report

A 10-year-old boy sustained a severe distal radius and ulna epiphyseal fracture-dislocation, Salter type II, with entrapment of the median nerve and the flexor pollicis longus tendon. Nerve function was intact before reduction and is normal 1 year after open reduction.     

Reconstruction of the unstable proximal interphalangeal joint: The double superficialis tenodesis

A technique is described for reconstructing the unstable proximal interphalangeal joint where there has been a break in continuity of both the volar plate and the collateral ligament. Both slips of the superficialis are used. They are divided proximally and tenodesed in appropriate positions on the proximal phalanx.     

The pronator quadratus in motions and in stabilization of the radius and ulna at the distal radioulnar joint.

Based upon the findings of dissections of 15 forearms and clinical observations in patients with disturbed architecture of the distal radioulnar joint, the pronator quadratus was found to be composed of two heads. A superficial head originated from the ulna and passed transversely to its insertion into the radius. It averaged 5.1 cm. in length, 4.5 cm. in width, 0.2 cm. in thickness, with a cross-sectional area of 0.95 cm.2 and a contractile volume of 2.6 cm.3. The deep head ran obliquely from a more proximal origin on the ulna to a distal insertion on the radius, with an average length of 4.0 cm., average width of 3.2 cm., and a thickness of 0.4 cm. Its average cross-sectional area was 1.64 cm.2 and its contractile volume 2.5 cm.3. A group of fibers occasionally was noted deep to both heads, running at right angles to them and paralleling the direction of the fibers of the interosseous membrane. The superficial head initiates pronation while the deep head coapts the joint surfaces and stabilizes the joint.     

Chronic fracture-subluxation of the proximal interphalangeal joint

Reported methods of treatment of chronic fracture-subluxations of the proximal interphalangeal joint require wide dissection and prolonged immobilization and often result in limited motion. Open reduction with minimal dissection, immobilization for 11 days to allow soft-tissue healing, and the early institution of active flexion exercises protected by an extension block splint was done in four patients. The long-term results demonstrate restoration of a stable joint with satisfactory motion and minimal subjective complaints.