Pisiform-hamate synostosis with ulnar neuropathy. Case report

Entrapment of the ulnar nerve at the wrist is rare compared with the more commun site at the elbow. This condition was secondary to reccurent blunt trauma, ganglion cyst, vasculitic disorders, and fibrous bands. Compression of the ulnar nerve caused by pisiform-hamate coalition is rare entity. One case of this condition is reported.     

Surgical treatment of ulnar neuropathy.

Ulnar neuropathy is a well recognized clinical entity caused by a variety of pathological lesions around the elbow. The characteristic features include paresthesia and numbness in the little finger and medial half of the fourth digit, weakness of the small muscles of the hand innervated by the ulnar nerve, and a positive Tinel's sign. The diagnosis is confirmed by electrophysiological studies. Current methods of treatment are anterior transposition, neurolysis and medial epicondylectomy of the humerus. Forty-four patients with ulnar neuropathy are described in the present report. Most were males with a median age of 45. The left side was involved more frequently. Results of subcutaneous anterior transposition and medial epicondylectomy are presented along with a review of the literature.     

Nonfamilial hyperphosphatemic tumoral calcinosis with ulnar neuropathy

We present a case of multiple large juxta-articular painless masses involving both the elbows and right hip in a 27-year old south Asian male who presented with ulnar neuropathy and constitutional symptoms. Radiology, blood investigations and biopsy confirmed it to be hyperphosphatemic tumoral calcinosis. Patient was also diagnosed with an extremely rare association, testicular microlithiasis. Complete surgical excision with low phosphate diet resulted in complete neurological recovery and no recurrence at 30 months. Tumoral calcinosis should be considered in the differential diagnosis of a case with multiple, symptomatic juxta-articular masses.     

Distal ulnar neuropathy. Clinical and electrophysiologic aspects

Nine patients with distal ulnar neuropathy were studied. Weakness of the hand muscles was the only abnormality in six patients; abnormal sensation was present in two patients. The cause was known in seven patients: chronic "occupational" nerve compression occurred in three meat packers and two long-distance bicyclists--acute blunt trauma to the palm of the hand in two patients. Our study indicates that electromyographic abnormalities in distal ulnar neuropathy are more variable than reported. The electromyographic findings indicated predominant axonal degeneration of motor nerve fibers, contrasting also to electromyographic abnormalities seen in entrapment neuropathies. The reasons for these differences are discussed.     

Pressures recorded in ulnar neuropathy

The pressure between the ulnar nerve and the arcade bridging the two heads of the flexor carpi ulnaris muscle was recorded peroperatively in ten patients with electrophysiologically confirmed ulnar neuropathy at the elbow. At rest, with the elbow extended, pressures ranged from 0 to 19 mm Hg but increased in flexion and during isometric contraction of the flexor carpi ulnaris muscle to maximal values above 200 mm Hg.     

Pressures recorded in ulnar neuropathy

The pressure between the ulnar nerve and the arcade bridging the two heads of the flexor carpiulnaris muscle was recorded peroperatively in ten patients with electrophysiologically confirmed ulnar neuropathy at the elbow. At rest, with the elbow extended, pressures ranged from 0 to 19 mm Hg but increased in flexion and during isometric contraction of the flexor carpi ulnaris muscle to maximal values above 200 mm Hg.     

Reoperation in high ulnar neuropathy

Twenty-two reoperations were done on 16 arms in 14 patients who had previously been unsuccessfully treated by neurolysis for cubital tunnel syndrome. For the first reoperation subcutaneous transposition was chosen for 10 arms, and submuscular transposition for six. The symptoms were cured or improved in seven arms, eight were unchanged and one was made worse. In six arms in which first neurolysis and then subcutaneous transposition had been unsuccessful, submuscular transposition was carried out. Five patients were improved or cured, and the symptoms were unchanged in one. Reoperation after ulnar neurolysis therefore gave satisfactory results in about half the cases. Submuscular transposition carried out as a second reoperation may be useful in cases in which subcutaneous transposition had not been successful.     

Recurrent ulnar nerve dislocation at the elbow. Report of a non-traumatic case with ulnar entrapment neuropathy

An unusual case of habitual recurrent ulnar nerve dislocation at the elbow is described. The case was complicated by non-traumatic ulnar entrapment neuropathy interfering with the patient's profession as a musician (cello).     

Pressures recorded in ulnar neuropathy

The pressure between the ulnar nerve and the arcade bridging the two heads of the flexor carpiulnaris muscle was recorded peroperatively in ten patients with electrophysiologically confirmed ulnar neuropathy at the elbow. At rest, with the elbow extended, pressures ranged from 0 to 19 mm Hg but increased in flexion and during isometric contraction of the flexor carpi ulnaris muscle to maximal values above 200 mm Hg.     

Drivers' elbow: a cause of ulnar neuropathy.

The ulnar nerve is vulnerable to compression and vibration injury in drivers who have the shoulder abducted and elbow flexed with the arm lying against the lower edge of the window. Three cases of ulnar neuropathy at the elbow are described in vehicle drivers.     

Entrapment neuropathy of the ulnar nerve

Ulnar nerve entrapment is the second most common nerve entrapment syndrome of the upper extremity. Although it may occur at any location along the length of the nerve, it is most common in the cubital tunnel. Ulnar nerve entrapment produces numbness in the ring and little fingers and weakness of the intrinsic muscles in the hand. Patient presentation and symptoms vary according to the site of entrapment. Treatment options are often determined by the site of pathology. Many patients benefit from nonsurgical treatment (eg, physical therapy, bracing, injection). When these methods fail or when sensory or motor impairment progresses, surgical release of the nerve at the site of entrapment should be considered. Surgical release may be done alone or with nerve transposition at the elbow. Most patients report symptomatic relief following surgery.     

The cubital tunnel and ulnar neuropathy

The anatomy of the cubital tunnel and its relationship to ulnar nerve compression is not well documented. In 27 cadaver elbows the proximal edge of the roof of the cubital tunnel was formed by a fibrous band that we call the cubital tunnel retinaculum (CTR). The band is about 4 mm wide, extending from the medial epicondyle to the olecranon, and perpendicular to the flexor carpi ulnaris aponeurosis. Variations in the CTR were classified into four types. In type 0 (n = 1) the CTR was absent. In type Ia (n = 17), the retinaculum was lax in extension and taut in full flexion. In type Ib (n = 6) it was tight in positions short of full flexion (90 degrees to 120 degrees). In type II (n = 3) it was replaced by a muscle, the anconeus epitrochlearis. The CTR appears to be a remnant of the anconeus epitrochlearis muscle and its function is to hold the ulnar nerve in position. Variations in the anatomy of the CTR may explain certain types of ulnar neuropathy. Its absence (type 0 CTR) permits ulnar nerve displacement. Type Ia is normal and does not cause ulnar neuropathy. Type Ib can cause dynamic nerve compression with elbow flexion. Type II may be associated with static compression due to the bulk of the anconeus epitrochlearis muscle.     

Postoperative ulnar neuropathy after kidney transplantation

Postoperative ulnar neuropathy as a result of mechanical trauma at the elbow was observed in eight patients undergoing renal transplantation. In five cases this occurred on arms that were adducted during the operation and in which an arteriovenous shunt was present. In four cases (one patient had the lesion bilaterally) the other, abducted arm was affected. Analysis of possible causes revealed no single factor responsible for the condition. Factors that most likely contributed were: pressure on the adducted arm by the combined weights of patient and surgeon, blood pressure monitoring with a cuff compressing the cubital fossa, venous congestion by the arteriovenous shunt, and subclinical uraemic polyneuropathy. Although no single factor could be identified protection of the adducted arms with a hard plastic cover and placement of the blood pressure cuff as proximally as possible on the abducted arms provided a successful solution to the problem.     

Traumatic ulnar neuropathy from jet injection: case report.

The usefulness and relative safety of the technique of jet injection, mainly used in mass immunization, have been well established. A patient who developed a traumatic ulnar neuroma at the site of jet injection of swine flu vaccine is reported. This unusual and previously unreported complication of this procedure is thought to have occurred because of the patient's extremely small size and small muscles.     

Surgical approaches for nonneurogenic elbow heterotopic ossification with ulnar neuropathy

BACKGROUND: Few reports are available concerning elbow heterotopic ossification (HO) and its optimal management in nonneurologic or nonburn patients after repetitive elbow manipulation. The unique anatomic relationship of the ulnar nerve at the elbow renders it rather vulnerable to injury when elbow HO occurs medially or posteromedially and extends into the vicinity of the cubital tunnel. METHODS: A total of 16 consecutive patients without neurologic injury were diagnosed with heterotopic ossification formation in the elbow and referred to the Upper Extremity Unit of Chang Gung Memorial Hospital. All 16 patients were diagnosed with ulnar palsy, and 14 were found to have sensory dysfunction and muscle wasting for an average of 5.2 months. RESULTS: Fourteen of 16 patients achieved functional range of motion or more after surgery. The final gain in range of motion averaged 80.3 degrees. All except one had complete neurologic recovery postoperatively. The patient who had ulnar palsy for 1 year presurgery did not achieve any neurologic recovery. CONCLUSION: Forceful and repetitive manipulation may add further damage to an already stiffened elbow and should be avoided in an elbow after immobilization or surgery. Early surgical resection of HO and ulnar nerve decompression followed by gentle and aggressive physical therapy terminate the vicious cycle and yield encouraging results.     

Ulnar neuropathy in the distal ulnar tunnel

A brief anatomical review of the ulnar nerve and areas of ulnar nerve entrapment is discussed. The importance of the dorsal cutaneous nerve is presented with regard to localizing a lesion to the ulnar nerve in the forearm. A classification system is described for ulnar entrapment that occurs distal to the wrist. The case of a nine-year-old girl with a fibrous entrapment of the ulnar nerve in the distal ulnar tunnel is presented. The clinical and diagnostic procedures required for localizing the level of the ulnar nerve entrapment are described, along with the operative findings of this case report. J Orthop Sports Phys Ther 1991;13(1):6-10.