Compression neuropathy of the median nerve caused by a loose body in the elbow

We present a case of median nerve compression at the elbow associated with an intra-capsular loose body cured by arthroscopic removal of the loose body. This is a rare but eminently treatable cause of median nerve compression.     

Ulnar nerve entrapment neuropathy at the elbow: simple decompression

Ulnar nerve entrapment neuropathy at the elbow, or the cubital tunnel syndrome, is frequently encountered in neurosurgical practice as the second most common peripheral nerve entrapment after carpal tunnel syndrome. Patients typically present with weakness or atrophy of the hand as well as paresthesias in the ulnar nerve distribution. The diagnosis can be confirmed with a careful clinical examination and electrophysiological studies. Patients who have failed conservative therapy are considered for surgery. Although a number of surgical options are available, simple decompression of the ulnar nerve can achieve satisfactory results with appropriate patient selection. We describe the relevant anatomy and surgical techniques for simple in situ decompression of the ulnar nerve at the elbow.     

Compression of the ulnar (cubital) nerve at the wrist by a supernumerary muscle

The authors report a case of anomaly of the flexor digiti minimi muscle, which extended into the forearm to be inserted 10 centimetres proximal to the carpal flexion crease on flexor carpi radialis. This anomaly was responsible for ulnar nerve compression when grasping objects with the hand. Cases of ulnar nerve compression at the wrist appear to be rare and the great majority of cases are secondary. Anatomical variants of muscles and nerves at the wrist are not exceptional, hence the importance of systematically looking for such anomalies in patients with ulnar nerve compression at the wrist. Excision of the muscle anomaly eliminated nerve compression and the associated symptoms.     

Ulnar nerve decompression with medial epicondylectomy for neuropathy at the elbow.

Ulnar nerve decompression with medial epicondylectomy was performed in 66 elbows between 1966 and 1986 for compressive ulnar neuropathy at the elbow. This study is an updated review that adds 36 cases to a previously published report on 30 cases. These elbows were graded preoperatively and postoperatively using McGowan's grading system. Eighty-three percent improved one or two grades, and 11% improved subjectively although they showed no objective improvement, 3% noted no change, and 3% were subjectively worse. One early case sustained damage to the ulnar collateral ligament with resultant instability. No other complications occurred. The best results were seen in the Grade I and II lesions, whereas those with Grade III lesions were the least predictable. The procedure is technically uncomplicated with minimal morbidity and reliable results.     

Focal hand dystonia in a patient with ulnar nerve neuropathy at the elbow

We describe a patient who presented with dystonia of her small finger secondary to entrapment neuropathy of the ulnar nerve at the elbow. Pre operative electrophysiological studies suggested that the locus of entrapment was located proximal to the medial epicondyle. This was confirmed intraoperatively by the presence of a thickened and prominent arcade of Struthers. Surgical decompression resulted in a rapid and dramatic improvement of the dystonic pattern as well as an improvement in nerve conduction. A review of literature has not revealed any other reports of such a clear cut association between ulnar nerve entrapment and non task-specific focal hand dystonia.     

Compression neuropathy of the radial palmar thumb nerve

Compression neuropathy of a single digital nerve is a rare entity. We report the case of a patient with numbness in the distribution of the radial digital nerve of the thumb caused by the use of a walking stick. The nerve was compressed between the handle of the stick, the loop and the radial sesamoid bone of the first metacarpophalangeal joint. The site of the lesion was confirmed by electrophysiologic examination. Orthodromic recording of the sensory response from the radial palmar digital nerve of the thumb documented a complete absence of nerve action potential whereas the ulnar digital thumb nerve showed a normal response. Sensory function was restored when a padded ski glove was used to protect the area of the metacarpophalangeal joint whilst using the stick.     

Anterior submuscular transposition of the ulnar nerve. For post-operative focal neuropathy at the elbow

Outcome studies of revision surgical treatment for recurrent or persistent neuropathy of the ulnar nerve at the elbow are relatively rare and none involves patient self-assessment. In this study of 40 patients (41 elbows), a clear discrepancy is shown between clinical assessment and the patient's own view. From clinical assessment, 20% of patients had an excellent result, whereas only one (2.5%) patient self-reported a complete cure. More reports using patient self-assessment and validated scores are required.     

Ulnar nerve decompression at the cubital tunnel.

A limited surgical decompression of the ulnar nerve within the cubital tunnel by incision of the arcuate ligament was effective in relieving pain and dysesthesia in 22 of 27 patients. No patient had any apparent muscle weakness or atrophy preoperatively. Twenty-five patients had evidence of compression of the ulnar nerve within the cubital tunnel at surgery, as noted by narrowing, hyperemia, or attachment of adhesions to the nerve. Three of four patients who had a subsequent anterior transposition obtained partial relief of symptoms.     

Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel

PURPOSE: Ulnar neuropathy at the cubital tunnel (UCT) is diagnosed on the basis of history, physical examination, and nerve conduction studies (NCSs); however, the wide spectrum of findings often makes the diagnosis difficult. The purpose of this study was to document the ultrasonographic differences in ulnar nerve size between patients with UCT and control subjects, and to correlate those differences with clinical examination findings and NCS abnormalities, thereby testing the validity of ultrasound (US) as an additional adjunct diagnostic modality for UCT. METHODS: Fifteen elbows in 14 patients with symptoms, clinical examination, and NCS findings consistent with UCT had US of the ulnar nerve. Patients were excluded if they had a history of polyneuropathy, acute trauma involving the upper extremity, previous trauma in the region of the elbow (including previous surgery), or brachial plexus injury. The control group consisted of 60 elbows from 30 normal volunteers that also had US. Maximal cross-sectional areas (CSAs) were measured and compared for the 2 groups and a correlation analysis was performed between nerve size and NCS findings. RESULTS: The average CSA of the ulnar nerve was 0.065 cm(2) in the control group, whereas in the UCT group it was 0.19 cm(2), indicating a significant statistical difference in ulnar nerve size between the 2 groups. The Pearson correlation coefficient between motor nerve conduction velocity of the ulnar nerve and the CSA was 0.80. CONCLUSIONS: High-resolution US is a noninvasive, safe, and reliable modality for imaging the ulnar nerve at the elbow and it may provide a valuable adjunct to NCS in the diagnosis of UCT.     

Compression syndromes of the radial nerve in the area of the elbow and lateral elbow pain

Preoperative, intraoperative, and postoperative findings are described and discussed with reference to 93 operations for entrapment syndromes of the radial nerve in the cubital region. Reference is also made to the importance of this pathological pattern in the context of the whole complex of "lateral elbow pain".     

Frontal partial epicondylectomy for release of the ulnar nerve at the elbow]

The author reports about an original technique of release of the ulnar nerve in the elbow by frontal partial epicondylectomy. In our opinion, this technique has the advantage of leaving a natural protection for the ulnar nerve when leaning on the internal aspect of the elbow. After summing up the various elements of ulnar nerve compression in the elbow and the various surgical techniques to remove compression, we describe in detail the surgical technique that we propose. The series is reported and the results are presented. These results are comparable to those of other published series and seem to depend mainly on the stage of nerve compression.     

Compression neuropathy of the radial nerve as a complication of elbow arthroscopy: A case report and review of the literature

Arthroscopic surgery of the elbow was performed in a 14-year-old male athlete for diagnosis and treatment of osteochondritis dissecans of the capitellum. Anterolateral and anteromedial portals were used in accordance with described technique. Postsurgical examination revealed an immediate and complete palsy of the posterior interosseous nerve. This complication was attributed to the manipulation of the arthroscope and instrumentation in close proximity to the radial nerve. Neuromuscular function returned to normal over a 6-month period. This case demonstrates the importance of portal placement and instrument manipulation in arthroscopic evaluation and treatment of the elbow. Further study is necessary to develop technical and procedural improvements to assure safe and effective arthroscopic treatment.     

Neurolysis of the ulnar nerve for neuropathy following total elbow replacement

Ulnar neuropathy presents as a complication in 5% to 10% of total elbow replacements, but subsequent ulnar neurolysis is rarely performed. Little information is available on the surgical management of persistent ulnar neuropathy after elbow replacement. We describe our experience with the surgical management of this problem. Of 1607 total elbow replacements performed at our institution between January 1969 and December 2004, eight patients (0.5%) had a further operation for persistent or progressive ulnar neuropathy. At a mean follow-up of 9.2 years (3.1 to 21.7) six were clinically improved and satisfied with their outcome, although, only four had complete recovery. When transposition was performed on a previously untransposed nerve the rate of recovery was 75%, but this was reduced to 25% if the nerve had been transposed at the time of the replacement.