Ulnar-nerve compression syndromes at and below the wrist.
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Adult↗
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Results for “Ulnar Nerve Compression Syndromes”
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Concomitant compression of median and ulnar nerves in a hemophiliac patient: a case report.
A 15-year-old boy, with a diagnosis of hemophilia A, suffered bleeding into his left forearm 5 months before being admitted to our medical center. His neurological examination revealed a pronounced median neuropathy and a minor ulnar neuropathy on the left side. There was marked muscle atrophy on the thenar side and, to a lesser degree, on the hypothenar side and in the forearm. Electromyographic findings demonstrated an evident, nearly complete, sensorimotor axonal loss in the median nerve. Magnetic resonance imaging studies showed atrophy in muscles of the left forearm and median nerve. The patient was diagnosed as having median nerve axonotmesis and ulnar nerve neuropraxia due to compartment syndrome. In hemophiliac patients, frequent single nerve compressions (often involving the femoral nerve) can be seen. However, concomitant median and ulnar nerve injuries with differing severity are rare.
Adolescent↗
MR imaging of common entrapment neuropathies at the wrist.
MR imaging is a useful technique in the work-up of compressive neuropathies at the wrist, providing fine anatomical detail and excellent diagnostic accuracy. MR imaging, however, should be reserved for those cases in which the clinical and electrodiagnostic findings are inconclusive, the symptoms are unusually severe, or when a tumor is suspected. This article reviews the normal anatomy and the MR imaging features of the most common compressive neuropathies at the wrist: carpal and ulnar tunnel syndromes.
Carpal Tunnel Syndrome↗
Handlebar problems in bicycling.
Handlebar problems are common among serious bicyclists. Compression neuropathy, more commonly ulnar than median, is frequent but seldom produces permanent injury or deficit if promptly recognized and managed by attending to bicycle fit, energy-absorbing gloves and handlebar treatments, and cycling technique. Overuse symptoms may be seen if bicycle design and fit couple with repetitive motion to aggravate wrist tendons or connective tissues of the neck and shoulder. Mechanical and medical management are effective in relieving symptoms and preventing recurrence.
Bicycling↗
The left arm left out syndrome or left ulnar nerve compressive neuropathy.
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Aged↗
Ulnar nerve compression at the wrist. Ulnar tunnel syndrome.
Compression neuropathy of the ulnar nerve at the wrist can be caused by several lesions. The most common cause is a carpal ganglion followed by occupational repeated trauma to the hypothenar area. This process is in contrast to carpal tunnel syndrome in which the majority of the cases are idiopathic in nature with no local cause found except for synovitis of the flexor tendons. The site of the lesion will determine the clinical picture whether it is both motor and sensory abnormalities, only motor paralysis or only sensory abnormality. The latter is rare. If the abnormality is purely motor, then the compression is distal in the ulnar tunnel and the hypothenar muscles are usually spared. Carpal ganglia must be sought and removed. After an extensive search through the literature, I found only one report in which thickening of the volar carpal ligament was found to be the cause of ulnar nerve compression. I encourage the use of the term "ulnar tunnel syndrome" to discuss these lesions and the classification outlined by Shea to determine the site of the lesion. Patients with type 2 syndrome usually present late because of the lack of sensory changes. Average delay in obtaining a diagnosis of 5 months was found in my patients. The condition should be suspected if spontaneous clumsiness or awkwardness of the use of the hand occurs in a middle-aged patient.
Humans↗
[Distal ulnar nerve compression at the wrist. "Loge de Guyon" and "deep ulnar branch" syndrome (author's transl)].
The distal non-traumatic ulnar nerve compression syndrome can be dividded into two types: -i) the proximal (paralytic) type caused by compression in the "Loge de Guyon", with involvement of both the superficial sensory and the deep branch, including the motor branch to the hypothenar muscles, and, ii) the distal, more common, purely motor type (the deep ulnar branch syndrome) with paresis of the interossei and the adductor pollicis, and less commonly of the hypothenar muscles. Whereas the proximal type has various causes, particularly pressure and occupational trauma, the distal type is almost exclusively the result of extra-neural ganglion cysts. An accurate diagnosis is made possible by electromyography and nerve conduction studies. The sensory nerve action potentials, distal motor latency to the hypothenar and adductor pollicis muscles, and the corresponding muscle action potentials after nerve stimulation are pathologically altered, according to the type of lesion. Although spontaneous recovery may occur, operation is the treatment of choice, provided that simple pressure palsy is eliminated.
Action Potentials↗
Intercondylar fractures of the distal humerus: routine anterior subcutaneous transposition of the ulnar nerve in a posterior operative approach.
Intercondylar fractures of the distal humerus in adults are rare and notoriously difficult to treat. The goals of open reduction are to preserve the articular surface and restore elbow function. We treated 20 patients by open reduction with dual-plate internal fixation and routine anterior subcutaneous transposition of the ulnar nerve. The follow-up period ranged from 15 to 35 months. The fractures were classified according to Muller's system. The results were evaluated using the Cassebaum rating system and subjective functional status. Excellent or good results were achieved in 15 elbows (75%), two had a fair result, and three, poor. A clearer understanding of fracture patterns, rigid dual-plate internal fixation, and early rehabilitation are needed to improve the results from this vexing injury. We recommended routine ulnar nerve anterior subcutaneous transposition using a posterior approach. Compared with published reports, our preliminary results demonstrated no postoperative ulnar nerve compression syndrome at follow-up. Routine anterior subcutaneous transposition of the ulnar nerve to avoid the postoperative ulnar nerve compression syndrome is required.
Adult↗
Metaphrase: an aid to the clinical conceptualization and formalization of patient problems in healthcare enterprises.
Patient descriptors, or "problems," such as "brain metastases of melanoma" are an effective way for caregivers to describe patients. But most problems, e.g., "cubital tunnel syndrome" or "ulnar nerve compression," found in problem lists in an Electronic Medical Record (EMR) are not comparable computationally--in general, a computer cannot determine whether they describe the same or a related problem, or whether the user would have preferred "ulnar nerve compression syndrome." Metaphrase is a scalable, middleware component designed to be accessed from problem-manager applications in EMR systems. In response to caregivers' informal descriptors it suggests potentially equivalent, authoritative, and more formally comparable descriptors. Metaphrase contains a clinical subset of the 1997 UMLS Metathesaurus and some 10,000 "problems" from the Mayo Clinic and Harvard Beth Israel Hospital. Word and term completion, spelling correction, and semantic navigation, all combine to ease the burden of problem conceptualization, entry and formalization.
Humans↗
Bilateral anomalous course of the ulnar nerve at the wrist causing ulnar and median nerve compression syndrome. Case report.
The case of a patient with a bilateral compression syndrome of the ulnar and median nerves at the wrist is described. Both ulnar nerves, which were surgically explored at different times, followed an anomalous course and passed into the canalis carpi side by side with the median nerve. This variation in the course of the ulnar nerve is extremely rare and causes a unique syndrome with characteristic electromyographic patterns.
Adult↗
[Carpal tunnel syndrome of the median nerve and compression syndrome of the ulnar nerve in the wrist joint].
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Carpal Tunnel Syndrome↗
The external compression syndrome of the ulnar nerve at the cubital tunnel.
Diagnosis of the cubital tunnel external compression syndrome, and subsequent avoidance of further external pressure, minimizes the possibility of progressive crippling of the hand. The usual clinical features are local tenderness over the cubital tunnel, often accompanied by distal paresthesias, and neurological deficit in the ulnar nerve distribution with sparing of the flexor digitorum profundus and flexor carpi ulnaris muscles; the elbow flexion test, described by the author, awaits evaluation in the diagnosis of the syndrome. Clinicians and others concerned with positioning patients on the operating room table or caring for patients in the ward should be aware of the syndrome. Avoidance of a position of the elbow which predisposes to external compression of the cubital tunnel is mandatory and active elbow movement should be encouraged in bedridden and chair-bound patients. Surgical treatment is sometimes indicated, at least to halt progression of the palsy. A classification of the cubital tunnel syndrome is proposed: physiological, acute and subacute due to external pressure (both forming the cubital tunnel external compression syndrome) and chronic (space-occupying lesions and loss of volume due to lateral shift of the ulnar as a consequence of childhood injury to the capitular epiphysis). Nerve conduction studies may be helpful in the diagnosis of the doubtful cubital tunnel syndrome, particularly when there is definite impairment of power or sensation in the hand.
Acute Disease↗
[Narrow tunnel and compression syndromes of the hand].
In osteofibrous channels of the hand a disproportion of capacity and contents may cause either a restriction of the gliding of the tendon or a lesion of nerves by pressure. During a 5 year period 362 narrow pass and compression syndromes were operated. Trigger fingers were most frequent with 224 cases, followed by 85 de Quervain's diseases, 49 carpal tunnel syndromes and 4 ulnar nerve compression syndromes. These diseases can be operated in a bloodless field and under regional anaesthesia, mostly under outpatient conditions. The manifold reasons of compression syndromes call for differentiated operative procedures.
Adult↗
Compartment syndromes in the forearm.
This paper has been written in response to a reader's set of questions: "Do compartment syndromes in the forearm exist? "I am also curious about the effects of nerve compression syndromes in the forearm. "What are the signs and symptoms of ulnar nerve compression and where is Guyon's canal? "What are the signs of posterior interosseus nerve compression syndrome?" The author emphasises that the answers are based on his experience as a plastic surgeon and could vary according to the experience of the surgeon consulted.
Acute Disease↗
Entrapment neuropathies of the upper extremities.
The three syndromes described in this article were chosen from about a dozen nerve-compression disorders that affect the arm from scapula to digits. They illustrate the range of problems encountered. None of the other syndromes are as common, and in some instances (pronator syndrome and anterior interosseous syndrome), localized inflammation is at least as common a cause of neuropathy as is compression. Some syndromes of nerve compression have important implications for musicians, athletes, and those who place stress on the upper limbs through heavy or repeated use. Well-designed prospective trials are clearly needed to expand our knowledge of the prevention and treatment of the entrapment neuropathies. Much more needs to be known about the long-term natural history of these disorders, since prevention is usually possible.
Arm↗
Entrapment neuropathies: clinical overview.
Causes include congenital defects, trauma, and inflammation. Some forms are overdiagnosed, particularly carpal tunnel syndrome. Others--such as thoracic outlet syndrome and anterior interosseous nerve syndrome--are rare. Diagnosis and management are relatively straightforward in most cases, but much remains to be learned about the natural course and prevention of these disorders.
Carpal Tunnel Syndrome↗
[Anatomic variants as a rare cause of distal ulnar nerve compression].
A case of anatomical variation of the course and branching of the ulnar nerve causing a nerve compression syndrome at the wrist joint is described. Decompression and transposition as well as tenotomy of the flexor carpi ulnaris were carried out, followed by improvement in neurological findings and complaints.
Adult↗
[Long-term results after neurolysis and palmar transposition of the ulnar nerve].
We reviewed 41 patients with 43 proximal ulnar nerve compression syndromes. The usual procedure was neurolysis of the ulnar nerve und subcutaneous transposition. The average follow-up period was 5 1/2 years (15 1/4 years to 3 months). The M/F ratio is 2.4:1. Most of the patients are hard manual workers, the dominant arm is most often affected, and 60% have some form of an injury in their history. About half of the patients followed-up have extensive relief of pain, loss of sensibility and weakness of the hand. But only 8 patients feel to have a perfect result. A few do complain of some tenderness in the scar region, some sensibility loss and a Tinel sign along the anterior route of the transposed nerve. Regaining of strength last months or even years. There is a general tendency to better final results in younger patients.
Adolescent↗