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A rare case of neurilemmoma of the deep branch of the ulnar nerve presented as ulnar nerve compression syndrome. This tumour was arising from the deep branch at the wrist just distal to the ulnar tunnel. By its proximity to the sensory division, it led to sensory symptoms in the ulnar two digits. Certain features of this case, which are uncommon are discussed.
Distal entrapment of the ulnar nerve at the wrist and hand (Guyon's syndrome) is a relatively uncommon condition. It may present with a confusing permutation of sensory and motor symptoms, depending on which branches of the ulnar nerve are involved Electrodiagnostic test procedures are often helpful in sorting out this quandary. Electrophysiologic studies that include electrical stimulation of the nerve at the palm, in addition to stimulation of the ulnar nerve at other locations, are useful in demonstrating the focal nerve conduction abnormality that is involved in the entrapment. Sensory and motor recordings from palmar stimulation of the ulnar nerve are not technically difficult procedures, and can be performed routinely.
Ulnar nerve injuries are common in young people. When there is a delay in the diagnosis and surgical management, the results are usually poor and can be permanent. Nerve grafting procedures were carried out in 85 patients with ulnar nerve injuries and 30 patients with both ulnar and median nerve injuries between 1981 and 1992. The patients could be divided into three categories according to the level of the trauma. Group A with injuries in the carpal area consisted of 43 cases with ulnar nerve injuries and 30 cases with both ulnar and median nerve injuries. Group B comprised 25 patients with ulnar nerve injuries in the area of elbow due to bone fractures. Group C comprised 18 patients with ulnar nerve injuries in the upper arm area. The quality of the functional results was closely related to the age of patients with better results in younger people and to early post-traumatic management of the injury. This was particularly notable in group C where, although there was high nerve damage, young patients and patients with early treatment generally had a better response than patients with lower ulnar nerve lesions. In contrast, we found that in cases of delay in surgical procedures for mixed nerve damage, the response was poor.
Seven patients with tardy ulnar nerve palsy from a posttraumatic cubitus varus deformity were reviewed retrospectively. The severity of symptoms was grade I in 3 patients and grade II in 4 patients according to McGowan's classification. The mean internal rotation angle was 30.7 degrees (range, 25 degrees -45 degrees ). The most prominent feature was dislocation of the nerve anterior to the medial epicondyle and entrapment of the nerve by the fibrous band of the flexor carpi ulnaris muscle. Of these 7 patients, 4 were treated by 3-dimensional osteotomy with ulnar nerve transposition, and 3 were treated by anterior transposition of the ulnar nerve. All patients improved clinically, and there was no significant difference between anterior transposition of the nerve in the group with osteotomy and the group without osteotomy. Ulnar nerve instability due to internal rotation deformity and distal entrapment was considered to be the main cause of neuropathy.
We carried out a prospective randomised study comparing medial epicondylectomy with anterior transposition for the treatment of ulnar neuropathy at the elbow. The mean follow-up period was 4.5 years and we assessed the patients neurologically and orthopaedically. Neither procedure appeared to have a significant effect on elbow function. Our study showed better results after medial epicondylectomy; in particular patient satisfaction was higher than after ulnar nerve transposition. There were no significant differences in motor power or nerve-conduction rates and sensory fibres appeared to be more vulnerable to devascularisation.
A ganglion at the cubital tunnel is a rare cause of ulnar nerve compression. Wrong or late diagnosis may be common. In one of the two described cases the diagnosis was made promptly, so that the early operation was followed by full restitution. In the other patient, at first the site of compression was supposed to be at the wrist. Only at the second operation was the ganglion in the cubital tunnel detected and removed. The result was unsatisfactory because motor loss was permanent.
In view of the Lack of theoretical information, end-to-side neurorrhaphy is a frequent object of experimental interest. End-to-side neurorrhaphy is based on collateral sprouting of an intact axon. The quantitative assessment of collateral sprouts sent by an intact motor and sensory axon was the goal of the present study. End-to-side neurorrhaphy of the distal stump of transected musculocutaneous nerve (MCN) with intact ulnar nerve (UN) was performed in a rat model. Collateral sprouts were quantitatively evaluated by counting of motoneurons and DRG neurons following their retrograde labeling by Fluoro-Ruby and Fluoro-Emerald applied to the UN and MCN, respectively. The results suggest a comparable capacity of both intact sensory and motor axons to send collateral sprouts into a denervated nerve stump. The ratio of sensory/motor neurons, the axons of which reinnervated distal MCN stumps, was very similar to that of intact UN (6.500 and 6.747, respectively), but different from intact MCN (5.029). This suggests that the pruning process occurred to balance the collateral sprouts at a ratio of sensory/motor neurons for the donor UN, but not according to the number of sensory and motor bands of Bungner available in the distal stump of the MCN. The present experimental study confirms end-to-side neurorrhaphy as a suitable method of nerve reconstruction.
The surgical treatment of the ulnar nerve entrapment neuropathy at the elbow is controversial. None of the presently advocated procedures (simple decompression of the ulnar nerve, medial epicondylectomy, subcutaneous or submuscular anterior transposition of the ulnar nerve) has proven optimal regarding long-term results. We studied the outcome in 79 patients whose ulnar nerve had been operated on for the first time, either by simple decompression (31 cases) or by submuscular anterior transposition (48 cases). The mean follow-up was 76 months. Patients were classified according to McGowan pre- and postoperatively; we also applied a more detailed scoring system of our own. Preoperatively, the patients were distributed almost equally between the three McGowan classes. Postoperatively, about one out of three patients in both treatment groups experienced a distinct improvement, i.e. was upgraded to a better McGowan class. Using our own scoring system, the overall rate of objective improvement was 73% after transposition and 55% after simple decompression. Irrespective of the surgical method, roughly 90% of the patients considered their postoperative condition to be improved. However, one specific group of patients (people with habitual ulnar luxation or subluxation of the ulnar nerve) experienced a distinctly better result when treated by anterior transposition than by simple decompression. Our results show that simple decompression of the ulnar nerve can be recommended in all patients without cubital (sub)luxation of the nerve, whereas people with a tendency of cubital (sub)luxation of the ulnar nerve should be treated by submuscular anterior transposition.
Compression of the median nerve and the nerve due to the anatomical anomaly processus supracondyloidea humeri is a rare condition. A case of combined median and ulnar nerve compression is described. Diagnostics and treatment are discussed in the light of the present case history and those described in the literature. The conclusion is that the treatment should be superiosteal resection of the process together with the origin of the pronator teres muscle.
The introductory part deals with a great community impact of ulnar nerve damage and its high incidence. From peripheral nerves, this ulnar is the most frequently exposed to injuries and impresses. The impressory damage occurs mainly in elbow region. Anatomic peculiarities of ulnar nerve are scrutinized concerning with more connective tissue presence on its cutting section comparably to the other upper limb nerves. Frequent innervative deviations are referred to especially in ulnar and median nerve regions in the course of ulnar nerve branching. Also three types of anastomoses are listed between the both nerves which are important as to the clinical pattern in damages and for electrophysiologic diagnosing. From the clinical tests, those of rare use are emphasized (test of crossed fingers, palmaris brevis sign, Mumenthaler's sign, ulnar test). The last part deals in detail with anatomic, functional and clinical problems of ulnar nerve in elbow area. Its biomechanic relations in the cubital tunnel are elucidated as well as etiopathogenetic factors of neural damage in this area (traction and compressive theories and hypermobility of the nerve etc.). The most frequent causes of ulnar injuries are reviewed. The present work is of introductory value for those dealing mainly with electrophysiologic problems of both sensitive and motoric neural injuries varying in the intensity, location and diagnosis.
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UNLABELLED: This article presents a case of ulnar nerve compression at the Guyon's canal caused by a true aneurysm of the ulnar artery secondary to blunt trauma. The duration of follow-up was one year. SETTING: Hospitalized care. A 27-year-old man who worked in an office fell on to a gravel path landing on his out-stretched right hand. Decompression of the ulnar nerve was made by simple ligation of the damaged artery and resection of aneurysm. MEASURES: Histological examination. The sensory symptoms disappeared two days after the operation. At one year after surgery, the patient was completely asymptomatic. There was no residual cold intolerance. Simple ligation of the damaged artery and resection of aneurysm resulted satisfactory. It seemed to be a safe method in this case. Ulnar nerve compression due to a true aneurysm of the ulnar artery in the Guyon's canal is rarely described in the literature.
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Explore the source record for details and available documents.
Ulnar nerve entrapment can be divided into compression at the elbow and the wrist. Etiologies range from direct trauma to metabolic derangements. Guidelines for diagnosis at each site have been presented. Surgical release at the elbow begin at the mid arm where the nerve passes from the anterior to the posterior compartment through the intermuscular septum and extends into the proximal forearm, where it dives down under the heads of the flexor carpi ulnaris. Surgical release at the wrist involves deroofing the canal of Guyon. The authors' preferred methods of release at each site are given along with a description of positive care.
Leprosy is one of the most common diseases of peripheral nerves in the world. In Brazil it is particularly frequent, being a major health problem. In tuberculoid leprosy the ulnar nerve is the most common affected nerve. Sometimes there are no skin changes. In these cases in spite of nerve thickening only the nerve biopsy is capable to make a specific diagnosis. We performed a biopsy in the dorsal sensory branch of the ulnar nerve in the hand in 17 patients with ulnar palsy with thickening of the nerve in the elbow, without skin changes. The pathological findings consisted mainly of: loss of fibers (14 cases), inflammatory infiltration (13), fibrosis (12), demyelination and remyelination (9), presence of granuloma (6) and presence of bacilli (5 cases). We conclude that in case of ulnar nerve palsy in leprosy without skin changes, the biopsy of the dorsal sensory branch of this nerve in the hand is a good procedure for the diagnosis of leprosy.
PURPOSE: Ulnar nerve palsy is an unusual complication of postvitrectomy positioning. METHOD: We report two such cases. RESULTS: Both patients developed ulnar nerve palsy after maintaining a face-down position for 2 to 4 weeks after vitrectomy with intraocular perfluoro-octane. The neuropathy resolved in one patient after he was instructed to avoid prolonged pressure on his flexed elbows, whereas the other patient ultimately required surgical decompression of the nerve at the elbow. CONCLUSION: Ulnar nerve palsy can result from postvitrectomy positioning associated with prolonged direct pressure on the ulnar nerve or compression of the ulnar nerve via flexion of the elbow.