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.     

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.     

Ulnar nerve strains at the elbow: the effect of in situ decompression and medial epicondylectomy

Strains were measured in the ulnar nerve at the elbow in 10 unembalmed, intact cadavers by using a microstrain gauge. In each cadaver, strains in the ulnar nerve behind the medial epicondyle, occurring between 60 degrees and 140 degrees flexion, were calculated for the following 3 conditions: (1) initial strain before in situ decompression, (2) strain after in situ decompression, and (3) strain after in situ decompression plus medial epicondylectomy. The average strain for each group was compared by using the paired Students t-test with multiple comparisons. The average initial percent strain was not significantly reduced by in situ decompression alone (5.3% to 4.3%). However, the average percent strain after medial epicondylectomy and in situ decompression was -0.54%, which was a significant reduction from the initial percent strain and after decompression alone. In situ decompression of the ulnar nerve at the elbow alone does not relieve the tensile strains at the elbow, which may contribute to cubital tunnel syndrome. Medial epicondylectomy after in situ decompression eliminates ulnar nerve strains with elbow flexion.     

Severe ulnar nerve entrapment at the elbow: functional outcome after minimally invasive in situ decompression

The role of in situ decompression in patients with severe ulnar nerve compression is still controversial. Thirty patients with severe ulnar nerve compression confirmed clinically and electrophysiologically underwent simple decompression. The mean age of the patients was 58 (range 26-87) years. Through incisions ≤4?cm the nerves were fully visualized and decompressed. Outcome was measured prospectively using Modified Bishop's score (BS), grip and pinch strengths and two-point discrimination (2PD). Significant improvement in power (p?=?0.01) and pinch grip (p?=?0.001) was noted at 1 year. The grip strength continued to improve up to 1 year. According to the BS, 24 patients (80%) had good to excellent results at 1 year. Minimally invasive in situ decompression is technically simple, safe and gives good results in patients with severe nerve compression. The BS and 2PD were more reliable than grip strength in assessing these patients at follow-up.     

单纯减压对皮神经卡压作用的实验研究

目的:在大鼠皮神经卡压模型的基础上观察单纯减压术对皮神经卡压的作用,以探讨铍针治疗皮神经卡压综合征的理论依据。方法:用内径0.4 mm的硅胶管卡压大鼠双侧隐神经1周,以建立皮神经卡压模型。然后去除左侧隐神经上的硅胶管作为减压侧,保留右侧隐神经上的硅胶管作为卡压侧。将28只大鼠随机分成3组,A组(n=10):减压术后1周进行实验研究;B组(n=10):减压术后3周进行实验研究;C组(n=8):仅以硅胶管卡压隐神经1周,不进行减压。各组均进行大体形态观察、电生理学检测和组织学检测。结果:A组和B组卡压侧的组织学和电生理学改变与C组相比均明显加重,而且B组卡压侧的改变比A组卡压侧更为严重。相反A组和B组减压侧的组织学和电生理学改变与C组相比均有明显的恢复,且B组减压侧的恢复优于A组减压侧。结论:①单纯的减压术可使受压皮神经的组织学和电生理学得到较好的改善;②皮神经卡压损伤程度与卡压时间相关,卡压时间越长损伤越重,及早去除卡压因素有利于损伤神经的结构再生和功能恢复。     

Radial nerve entrapment at the elbow: surgical anatomy

The surgical anatomy of interest in the posterior interosseous nerve syndrome was studied to shed light on the ramifying pattern of the radial nerve, the number of its muscular branches and their branching levels, and to pinpoint the location of the fibrous bands that may cause radial nerve entrapment. The fibrous arch of the supinator muscle (arcade of Frohse) was found to lie 3 cm to 5 cm below Hueter's line, that of the extensor carpi radialis brevis muscle lay 0.5 cm to 1 cm proximal to the arcade of Frohse. Symptom patterns in terms of muscle weakness caused by radial nerve entrapment at different levels were also evaluated.     

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.     

Ulnar nerve palsy at the elbow after general anaesthesia

Ulnar nerve palsy is a recognized complication of general anaesthesia. Many authors have reported several series of patients and found different incidences. In this literature review, the patho-physiology of the lesion and the anatomical characteristics of the cubital tunnel at the elbow are described together with its related conditions “cubital tunnel compression syndrome” and “recurrent ulnar nerve dislocation at the elbow.” A precise and early diagnosis should be made using electromyography to determine the exact location of the lesion and the precise time-relationship of the pathology. The importance of careful positioning of the patient under anaesthesia in the prevention of ulnar nerve palsy is stressed. Unfortunately, treatment of the established lesion gives, at best, mixed results.     

Intermediate and long-term outcomes following simple decompression of the ulnar nerve at the elbow

INTRODUCTION: There is currently little consensus regarding the appropriate surgical approach to treatment of cubital tunnel syndrome (CubTS), and few studies have reported long-term follow-up of patients who have received surgical treatment for ulnar nerve compression at the elbow. METHOD: Seventy-four patients with a total of 102 cases of CubTS treated with simple decompression of the ulnar nerve were examined 1.0-12.4 years postoperatively. Ulnar nerve conduction studies (slowest conducting 5 cm segment of ulnar nerve motor fibers measured at the elbow) were performed both pre- and postoperatively. The primary clinical outcome was percentage relief of symptoms, divided into "excellent" outcome group or less (> or = 90% improvement or < 90% improvement). RESULTS: Ulnar nerve conduction improved pre- to postoperatively, but clinical improvement was not related to changes in velocity. Women reported greater clinical improvement than men, and weight gain in men (but not women) predicted less improvement. Relief of cubital tunnel symptoms was greatest for those arms receiving carpal tunnel release surgery simultaneous or subsequent to cubital tunnel release. DISCUSSION: Simple decompression may offer excellent intermediate and long-term relief of symptoms associated with CubTS. Although improvement in ulnar motor nerve conduction velocity occurs following treatment of CubTS, it may not be a consistent marker of perceived symptom relief. Finally, these findings suggest that less complete relief of symptoms following ulnar nerve decompression may be related to unrecognized carpal tunnel syndrome or weight gain.     

Surgical treatment for ulnar nerve entrapment at the elbow

The outcomes of 81 operations were assessed for the treatment of ulnar nerve entrapment at the elbow performed on 55 males (bilateral operations in one) and 25 females during the period from January 1995 to December 2000. Before operation, neurophysiological examination was performed in all patients. Simple ulnar nerve decompression or anterior transposition of the ulnar nerve (subcutaneous or intramuscular) was performed with or without the operating microscope. Nine patients were lost to follow up. The outcome was excellent or good in 63 of 72 cases, no change in eight cases, and poor in one case. The outcomes of procedures performed with the operating microscope tended to be superior.     

Electrophysiological diagnosis in ulnar nerve entrapment at elbow

Using "inching technique" we recorded antidromic sensory nerve action potentials from the little finger and compound muscle action potentials from the abductor digiti minimi, first dorsal interosseous and flexor carpi ulnaris muscles in 30 entrapped ulnar nerves. In cubital tunnel syndrome, localized conduction delay occurred most commonly at a point 2 to 4 cm distal to the medial epicondyle. In other ulnar neuropathies, with the exception of cubitus valgus deformity, conduction block or delay was noted at a site just distal to the medial epicondyle. These conduction abnormalities were most commonly observed in the abductor digiti minimi and first dorsal interosseous. In contrast, conduction abnormality in tardy palsy secondary to the valgus deformity reflected mainly in the flexor carpi ulnaris. This method provides useful information in diagnosing the early involvement and precise localization of nerve entrapment, and differentiation of cubital tunnel syndrome from other ulnar nerve entrapment.     

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).     

Endoscopic decompression of the ulnar nerve at the elbow

PURPOSE: The ideal operative treatment for cubital tunnel syndrome, the second most common form of peripheral compression neuropathy, remains controversial. We therefore reviewed our series of endoscopically assisted ulnar nerve decompression at the elbow to determine the effectiveness of the procedure, which was intended to minimize perioperative morbidity and scar discomfort. METHODS: In 36 patients (ages 22-76 years) with clinical McGowan grade I (4 patients), II (21 patients), and III (11 patients) and electrophysiologic signs of cubital tunnel syndrome (35 primary, 1 recurrent), 20 cm of the ulnar nerve was released through a 3.5-cm-long skin incision above the medial epicondyle. A 4-mm, 30 degrees standard endoscope and custom-made guiding-dissecting tool were utilized during the procedure, and the mean postoperative follow-up examination was 14 months (range 6-19). RESULTS: No macroscopically visible nerves and vessels were injured during the procedure. The only postoperative complication was hematoma in one patient that resolved after conservative management. One case was converted from endoscopic to open because of a ganglion that surrounded the nerve in the forearm. There was no scar discomfort (ie, painful neuroma, impaired sensibility, or burning sensation) or elbow extension deficit after surgery, and surgical wounds all healed within a week. Outcomes were excellent in 21 of 36 cases and good in 12 of 36 cases. All patients improved electrophysiologically after surgery, were satisfied with the procedure, returned to full activities within 3 weeks, and would have the procedure again. CONCLUSIONS: By using a safe and reliable endoscopic technique characterized by a short incision, minimum soft tissue dissection, and early postoperative mobilization, we were able to preserve the benefits of conventional approaches (namely, complete release and good visualization), while avoiding problems such as painful scarring and elbow contracture.