Ultrasonography of the ulnar nerve in the elbow: video article.
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ABSTRACT:
SUBMITTER: Draghi F
PROVIDER: S-EPMC7441104 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Elbow arthroscopy has increased in popularity in the past 10 years for both diagnostic and therapeutic purposes. A major limiting factor faced by the elbow arthroscopist is the close proximity of the neurovasculature to the working field, with the risk of iatrogenic injury. Many arthroscopic procedures are less extensive than their open equivalents because of an inability to consistently and safely eliminate the risk of neural and vascular injury. Many open procedures in the posterior compartment of the elbow joint are not routinely performed arthroscopically. The primary reason for this restriction in arthroscopic practice is the locality of the posteromedially positioned ulnar nerve in the posterior compartment. Experience and practice with elbow arthroscopic techniques allows surgeons to expand the indications for arthroscopic treatment of an increasing number of elbow pathologies. A philosophy that is routine in open surgery when dealing with pathology that is adjacent to neurovasculature is to identify the neurovasculature and hence reduce the risk of injury. Our aim is to translate this philosophy to arthroscopy by helping define a safe technique for identifying the ulnar nerve in the posteromedial elbow gutter and allowing for a safer performance of procedures in the posteromedial region of the elbow.
| S-EPMC3678668 | biostudies-literature
Project description:Ulnar nerve entrapment can be treated by a number of surgical techniques when necessary. Endoscopic techniques have recently been developed to access the ulnar nerve by use of a minimally invasive approach. However, these techniques have been considered difficult and, many times, dangerous procedures, reserved for experienced elbow arthroscopic surgeons only. We have developed a new endoscopic approach using the da Vinci robot (Intuitive Surgical, Sunnyvale, CA) that may be easier and safer. Standardization of the technique was previously developed in cadaveric models to achieve the required safety, reliability, and organization for this procedure, and the technique was then used in a live patient. In this patient the nerve entrapment symptoms remitted after the surgical procedure. The robotic surgical procedure presented a cosmetic advantage, as well as possibly reduced scar formation. This is the first note on this surgical procedure; the procedure needs to be tested and even evolved until a state-of-the-art standard is reached.
| S-EPMC4129980 | biostudies-literature
Project description:BackgroundUlnar neuropathy at the elbow is an entrapment neuropathy, while ulnar nerve dislocation might also be involved in its incidence and severity. Wheelchair marathon athletes may be at an increased risk for Ulnar Neuropathy. However, there is a paucity of research into the prevalence of Ulnar Neuropathy and ulnar nerve dislocation in this population.ObjectiveTo investigate the prevalence of ulnar neuropathy at the elbow and ulnar nerve dislocation in wheelchair marathon athletes.ParticipantsWheelchair marathon athletes (N = 38) who participated in the 2017, 2018, and 2019 Oita International Wheelchair Marathon. 2 athletes participated only one time, 36 athletes repeatedly. Data from athletes`latest assessment were used.MethodsThe day before the race, questionnaires, physical examinations, and ultrasonography were conducted to screen for Ulnar Neuropathy in both upper limbs. Ulnar nerve dislocation was confirmed by physical examination and ultrasonography.Results11 (29%) athletes were diagnosed with Ulnar Neuropathy. There were no significant differences in age, height, weight, Body Mass Index, or history of primary illness between athletes with and without Ulnar Neuropathy. In the group without Ulnar Neuropathy, 44% of athletes reported to have been engaging in other wheelchair sports, compared to 9% in the group with Ulnar Neuropathy (p = 0.037). Ulnar nerve dislocation was diagnosed in 15 (39%) athletes by ultrasonography. Out of the 14 elbows of 11 athletes diagnosed with Ulnar Neuropathy, 9 (64%) elbows had ulnar nerve dislocation.ConclusionThe prevalence of Ulnar Neuropathy in wheelchair marathon athletes was higher than previously reported in able-bodied, non-athlete individuals and lower than in non-athletes with lower limb dysfunction. Therefore, while wheelchair sports may provide some protection against Ulnar Neuropathy, this study further supports the importance of screening for Ulnar Neuropathy, as well as for ulnar nerve dislocation as a potential risk factor for the development of Ulnar Neuropathy.
| S-EPMC7735619 | biostudies-literature
Project description:PurposeTo demonstrate usefulness of ultrasonography evaluation of the nerves of the elbow and of the structures that more frequently might cause its compression.Materials and methodsAnatomic course of nerves, muscles, tendons, fibrous structures and bursae potentially associated with nerve compression syndromes were evaluated. Informed consent was obtained from each volunteer.ResultsUlnar, median and radial nerves are always evaluable with ultrasonography as well as muscles and tendons potentially associated with nerve compression. The bursae cannot be sonographically explored unless distended by fluid.ConclusionUltrasonography is a reliable method for the evaluation of the nerves of the elbow and of the structures that might cause its compression.
| S-EPMC3771565 | biostudies-literature
Project description:IntroductionHigh resolution ultrasonography (US) has been used for diagnosis and evaluation of entrapment peripheral neuropathy. Ulnar neuropathy at the elbow (UNE) is the second most common focal entrapment neuropathy. The ulnar nerve tends to move to the anteromedial side and sometimes subluxates or dislocates over the medial epicondyle as the elbow is flexed. Dislocation of the ulnar nerve during elbow flexion may contribute to friction injury. We aimed to investigate the effects which the dislocation of ulnar nerve at the elbow could have on the electrophysiologic pathology of UNE.MaterialsWe retrospectively reviewed 71 arms of UNE. The demographic data, electrodiagnosis findings and US findings of ulnar nerve were analyzed. We classified the electrodiagnosis findings of UNE into three pathologic types; demyelinating, sensory axonal loss, and mixed sensorimotor axonal loss. The arms were grouped into non-dislocation, partial dislocation, and complete dislocation groups according to the findings of nerve dislocation in US examination. We compared the electrodiagnosis findings, ulnar nerve cross sectional areas in US and electrodiagnosis pathology types among the groups.ResultsA total of 18 (25.3%) arms showed partial dislocation, and 15 (21.1%) arms showed complete dislocation of ulnar nerve in US. In the comparison of electrodiagnosis findings, the partial and complete dislocation groups showed significantly slower conduction velocities and lower amplitudes than non-dislocation group in motor conduction study. In the sensory conduction study, the conduction velocity was significantly slower in partial dislocation group and the amplitude was significantly lower in complete dislocation group than non-dislocation group. In the comparison of US findings, patients in partial and complete dislocation groups showed significantly larger cross sectional areas of the ulnar nerve. The comparison of electrodiagnosis pathologic types among the groups revealed that there were significantly larger proportions of the axonal loss (sensory axonal loss or mixed sensorimotor axonal loss) in partial and complete dislocation groups than non-dislocation group.ConclusionThe ulnar nerve dislocation could influence on the more severe damage of the ulnar nerve in patients with UNE. It might be important to evaluate the dislocation of the ulnar nerve using US in diagnosing ulnar neuropathy for predicting the prognosis and determining the treatment direction of UNE.
| S-EPMC6532616 | biostudies-literature
Project description:PurposeFollowing medial epicondyle fractures, a subset of pediatric patients has persistent limitations in elbow motion. This study soughted to understand the patient characteristics of this group and to assess the effectiveness of intensive therapy and ulnar nerve transposition in improving elbow range of motion and patient-reported outcomes.MethodsA cohort of 31 pediatric patients with stiffness after elbow trauma was narrowed to 8 pediatric patients (7 female) ranging in age from 9 to 14 years, who were diagnosed with medial epicondyle fractures and underwent intensive therapy and ulnar nerve transposition with or without elbow joint release. We collected demographic and objective data as well as subjective data including Patient-Reported Outcome Measurement Information System (PROMIS) scores before and after ulnar nerve transposition.ResultsFollowing initial intensive therapy, elbow range of motion improved by an average of 56°, and 7 of the 8 patients reached a functional motion arc of 100°. Subsequently, following ulnar nerve surgery with or without elbow release, motion improved by an average of 22°, and 5 of the 8 patients demonstrated improvement from this intervention. Surgery led to improvements in subjective outcomes with an improvement in PROMIS mobility scores by an average of 9 points, pain interference by 6 points, and upper extremity scores by 3 points. Based on a previously determined minimally important difference of three points, these indicate significant clinical improvements.ConclusionsA subset of pediatric patients with persistent stiffness following medial epicondyle fractures may benefit from additional interventions, including intensive therapy, transposition of the ulnar nerve, and open capsular release. However, not all patients were improved after ulnar nerve surgery, and the identification and treatment of ulnar nerve irritability may not fully resolve preoperative symptoms in all patients.Type of study/level of evidenceTherapeutic IV.
| S-EPMC10721539 | biostudies-literature
Project description:Patient characteristics and predictive factors for outcomes were analysed in 202 cases undergoing simple decompression, primary subcutaneous transposition, or secondary subcutaneous transposition for ulnar nerve compression at the elbow at a tertiary referral hospital. Data from medical charts and a survey were evaluated. The mean patient age was 49 years with revision surgery cases being significantly younger. Sixty-one percent of cases were female, and 31% were smokers. The comorbidity was extensive, including other nerve compression lesions as well as neck and shoulder problems. Overall, 53% reported being pleased with the result of surgery and 57% of the cases rated function as better or completely recovered after surgery. The median postoperative DASH (Disabilities of the Arm, Shoulder and Hand) score was 26 (IQR 11-49), which is in accordance with unpublished national data. No significant differences in DASH scores were found between surgical groups, but a higher preoperative McGowan grade was significantly associated with a poorer postoperative DASH score. Women scored greater disability postoperatively than men. There was a significantly increased risk of complications, which was doubled for smokers, following primary and secondary transposition compared to simple decompression. Surgical cases with ulnar nerve compression treated at a tertiary referral hospital constitute a heterogeneous group with great comorbidity and frequent concomitant nerve compression lesions. We suggest simple decompression as the procedure of first choice. Transposition can be used in selected cases or when simple decompression fails. All patients should be strongly recommended to stop smoking considering the remarkably increased risk for complications among smokers.
| S-EPMC6948284 | biostudies-literature
Project description:Cervical pathology may contribute to residual problems after surgery for ulnar nerve compression. We aimed to evaluate the presence of pathological conditions in spinal cord and cervical spinal nerve roots in patients surgically treated for ulnar nerve compression at elbow. In a cohort of patients, surgically treated for ulnar nerve compression at elbow, magnetic resonance images (MRI; performed 3 years pre/postoperatively) were evaluated by a neuroradiologist blinded to patient characteristics and outcome of surgery. Cervical conditions were assessed and related to patient characteristics, preoperative McGowan grade, and outcome. Among 62 patients (45 unilaterally and 17 bilaterally), only one had spinal nerve root affection of nerve roots contributing to the ulnar nerve (C8-Th1). About half of the patients, mainly those at higher age, had alterations affecting C3-C7 spinal nerve roots at both surgically treated and contralateral, non-surgically treated, sides. Only few other changes were observed at cervical levels. A high McGowan grading was related to a high frequency of spinal nerve root affection. Smokers were more frequently observed among those with spinal nerve root affection at C3-C7 levels at surgically treated side. Residual problems, expressed as patient dissatisfaction and DASH score ≥40, were common. Spinal nerve roots, contributing to the ulnar nerve, are rarely affected in surgically treated patients with ulnar nerve compression at elbow even though pathology is often observed at other cervical levels. Pathology is often detected at other cervical spinal nerve root levels at surgically treated and contralateral sides, particularly among older patients, smokers, and in conjunction with worse preoperative McGowan grade. No relation between cervical pathology and outcome of ulnar nerve surgery is seen.
| S-EPMC9790900 | biostudies-literature
Project description:Direct posterior and posterolateral portals are the standard portals used in posterior elbow arthroscopy. A posteromedial portal in the elbow is not recommended because of its proximity to the ulnar nerve. However, iatrogenic injuries to the ulnar nerve have been reported after elbow arthroscopy using the standard posterior portals, especially in posteromedial elbow joint pathologies. We present a surgical technique applicable to posteromedial elbow pathology by using ultrasound-assisted posteromedial portal placement of the elbow joint. Through this technique, the position of the ulnar nerve is identified prior to portal creation and the instruments are introduced from an ulnar to radial direction, thus avoiding ulnar nerve injury.
| S-EPMC5621707 | biostudies-other
Project description:BackgroundTardy ulnar nerve palsy is the development of late onset ulnar nerve dysfunction and is usually treated by open anterior transposition of ulnar nerve. Open technique is done using a longitudinal incision about 6-8 inch. in length with chances of development of medial antebrachial cutaneous nerve neuromas.PurposeIn this study, we describe the technique of Endoscopic Anterior Transposition of Ulnar Nerve (EATUN procedure) to treat tardy ulnar nerve palsy and analyze the results.MethodsSeven patients diagnosed to have tardy ulnar nerve palsy was treated by EATUN. The humerus-elbow-wrist angle (HEW), pre- and post-operative intrinsic muscle power and sensory assessment, Dellon scores, and the Q-DASH was analyzed.ResultsThe minimum follow-up was 12 months (Mean 27.4 months, Range 12-36 months). Improvement in Dellon and Q-DASH scores following EATUN procedure was statistically significant. There was objective improvement of intrinsic muscle power and sensation on follow-up, though not statistically significant. No instance of neuroma of the medial cutaneous nerve of forearm was noted.ConclusionsThe endoscopic anterior transposition of the ulnar nerve is a good option in surgical management of tardy ulnar nerve palsy.Level of evidenceTherapeutic Level IV.Supplementary informationThe online version contains supplementary material available at 10.1007/s43465-021-00366-w.
| S-EPMC8046855 | biostudies-literature