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At least 73 records · Page 4Linked to original sources
PubMed1992

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↗
PubMed2002

Strain in the median and ulnar nerves during upper-extremity positioning.

The purpose of this study was to quantify the strain of the median nerve and the ulnar nerve throughout upper-extremity positioning sequences used by clinicians to evaluate nerve dysfunction. A microstrain gauge was used to quantify strain and digital calipers were used to assess nerve excursion in 4, fresh, intact cadavers. Data analysis of noncontinuous motion trials showed that the median nerve tension test caused a maximum summative strain in the median nerve at the carpal tunnel of 7.6%, with the largest increase in strain during elbow extension (3.5%). Components of the median nerve tension test decreased strain in the ulnar nerve at the cubital tunnel. The ulnar-nerve tension test caused a maximum summative strain in the ulnar nerve of 2.1%, with the largest increase in strain during shoulder abduction (0.9%). Some components of the ulnar-nerve tension test decreased strain in the median nerve. These cadaver findings lend support to the use of upper-extremity positioning sequences in the clinic to induce nerve strain during evaluation of nerve dysfunction.

Adult↗
PubMed1996

Unusual cause of ulnar nerve palsy.

An ulnar nerve palsy occurring as the result of an elbow dislocation is well recognized. An unusual case of an elbow dislocation with concomitant radial head fracture and ulnar nerve palsy caused by the radial head lying in the medial epicondylar groove is presented.

Adult↗
PubMed2006

A novel endoscopic technique in treating single nerve entrapment syndromes with special attention to ulnar nerve transposition and tarsal tunnel release: clinical application.

OBJECTIVE: To describe a simple retractor integrated endoscopic technique for treating idiopathic solitary compression neuropathies with special attention to the anterior transposition of the ulnar nerve and tarsal tunnel release, and to present the clinical results. METHODS: Eleven patients with ulnar sulcus syndrome, eight with tarsal tunnel syndrome, and one with meralgia paraesthetica (seven females and 13 males; age range, 12-64 yr) were treated with endoscopic anterior ulnar nerve transposition and in situ decompression of the tibial (eight patients) and lateral femoral cutaneous nerves (one patient), respectively. The selection criteria were: classical nerve compression symptoms, failed conservative treatment, abnormal electrophysiology, and a nonviolated anatomic region. The degree of nerve compression (after Dellon) was rated as moderate in five out of 20 patients and as severe in 15 out of 20 patients. Electrophysiological studies were conducted independently by physicians specializing in these techniques. Postoperative recovery was evaluated according to the nine-point Bishop rating system. RESULTS: Of the 11 patients with anterior ulnar nerve transposition, seven scored excellent, three scored good, and one scored fair (mean follow-up, 15.5 mo; range, 6-27 mo). Five patients with tarsal tunnel release scored excellent and three scored good (mean follow-up, 10.1 mo; range, 3-24 mo). The patient with meralgia paraesthetica showed an excellent score at 28 months after surgery. There were no technical or postoperative complications. None of the operations had to be converted to open surgery. CONCLUSION: We describe a new endoscopic technique for transposing the ulnar nerve and decompressing the tibial nerve. This technique could be extrapolated to release other single nerve entrapments. The simplicity of the technique, and our preliminary clinical results, may encourage other groups to adapt this method.

Adolescent↗
PubMed2004

The V-sling: a modified medial intermuscular septal sling for anterior transposition of the ulnar nerve.

Subcutaneous anterior ulnar nerve transposition has been advocated by many surgeons as simple and effective. Techniques to maintain the nerve anterior to the medial epicondyle include subcutaneous pocket, subcutaneous-fascia tunnel, and fascial and fasciodermal sling. We describe a modified technique that uses the medial intermuscular septum as a sling to allow a more gentle transition of the ulnar nerve as it enters into the flexor carpi ulnaris muscle belly.

Adult↗
PubMed2003

Morphologic and functional study of rat median nerve repair by terminolateral neurorrhaphy of the ulnar nerve.

While it has been shown that terminolateral (end-to-side) neurorrhaphy leads to successful functional motor reinnervation of the peripheral territories belonging to the severed nerve, data on the morphology of terminolateral sprouting and on the voluntary control of the motor function restored by terminolateral neurorrhaphy are still partial. In this study, the severed rat median nerve was sutured in an end-to-side fashion to the intact ulnar nerve. The progression of recovery of the flexion of the fingers was assessed by means of the grasping test. Seven months after surgery, the rats were sacrificed, and morphologic and morphometric analysis was performed on the regenerated median nerve and on the donor ulnar nerve. Results of the functional assessment showed that voluntary motor control of the muscles innervated by the median nerve was partially and progressively recovered by terminolateral neurorrhaphy, with a mean strength in the flexion of the fingers that reached about 20 percent of normal before sacrifice. Morphologic and morphometric analysis showed that nerve-fiber regeneration occurred in all repaired median nerves. Signs of nerve fiber atrophy were detected in the ulnar nerve distal to the point of suture, suggesting the possible occurrence of secondary damage to the donor nerve after terminolateral neurorrhaphy that should be taken into consideration in a clinical perspective.

Animals↗
PubMed1987

Validity of nerve conduction velocity studies after anterior transposition of the ulnar nerve.

To determine which anatomic position and marking techniques are valid for postoperative electrodiagnostic testing, ten patients were studied during anterior transposition of the ulnar nerve. Variables included skin and ulnar nerve distances measured anterior and posterior to the medial humeral epicondyle, and ulnar nerve conduction velocities over these distances, with the elbow flexed and extended, and with the ulnar nerve in the pretransposition and posttransposition location. The results of the study confirm that ulnar nerve conduction velocity is recorded as faster with elbow flexion preoperatively and elbow extension postoperatively when the skin measurement used for the distance is kept constant. Postoperatively, the most valid measurement of ulnar nerve conduction velocity was a skin distance that was posterior to the medial humeral epicondyle with the elbow extended.

Humans↗
PubMed2001

Anatomic basis of vascularized ulnar nerve graft by the pedicle of the superior collateral ulnar artery.

OBJECTIVE: To investigate the anatomic basis of vascularized ulnar nerve graft by the pedicle of the superior collateral ulnar artery (SCUA). METHODS: Twenty-two fresh cadaver upper extremities injected i ntra-arterially with latex were dissected to study the extrinsic blood supply of the ulnar nerve. Other 6 fresh upper extremities were used to analyze the blood supply range of SCUA inside the ulnar nerve by microangiographic and histological methods. RESULTS: The ulnar nerve was supplied by a branch of the lateral thoracic artery or directly by the axillary artery in the axillary section, by b ranches of SCUA in the upper arm, and by branches from the anastomosis of the collateral arteries and the posterior branch of the recurrent ulnar artery in the elbow. SCUA could supply the whole ulnar nerve from the axilla to the wrist. CONCLUSIONS: The ulnar nerve can be used as a vascularized nerve graft by the pedicle of SCUA in treatment of brachial plexus roots avulsion by C7 transfer from healthy side.

Humans↗
PubMed1998

Three ulnar nerve conduction studies in patients with ulnar neuropathy at the elbow.

OBJECTIVE: Ulnar neuropathy at the elbow is often difficult to localize by standard electrophysiologic testing. This study compared three ulnar nerve conduction studies to determine which was more sensitive in localizing ulnar neuropathy at the elbow. METHODS: Motor studies to the first dorsal interosseous and the abductor digiti quinti and a mixed ulnar nerve sensory study across the elbow. RESULTS: Motor studies to the first dorsal interosseous and abductor digiti quinti were abnormal in 81% and 71% of patients, respectively. The ulnar mixed sensory study across the elbow was abnormal in 57%. In 38%, all three tests were abnormal. CONCLUSION: Motor studies were more sensitive than the ulnar mixed sensory study across the elbow in localizing ulnar neuropathy of the elbow.

Adult↗
PubMed1997

Biomechanical effects of operative nerve mobilization and transposition in a canine ulnar nerve model.

The purpose of this study was to evaluate the effects that operative mobilization and transposition of the ulnar nerve have on both neural excursion and mechanical properties. Twelve dogs underwent ulnar nerve transposition and postoperative casting. Four animals were killed at 3 weeks and four animals were killed at 6 weeks. Four animals had their casts removed at 3 weeks, were allowed to ambulate, and were killed at 6 weeks. Operated and contralateral control nerves were compared. Neural excursion was measured near the elbow and 12 cm proximally. The nerves were harvested and their mechanical properties determined. Repeated measures analysis of variance revealed significant differences in longitudinal excursion between control and experimental groups at both sites. Ultimate strain, ultimate strength, and modulus were significantly reduced in the experimental groups. No differences were seen in cross-sectional area or stiffness between control and experimental groups. Analysis revealed no independent effect of the rehabilitation method. Results of this study indicate that significant changes in neural excursion, ultimate strain, ultimate strength, and modulus occur following ulnar nerve mobilization and transposition and that these changes persist throughout the early postoperative period.

Analysis of Variance↗
PubMed1987

[Distribution of motor nerve conduction velocities in the ulnar nerve--a control study, its clinical application and limitations].

The goal of measuring the conduction velocity of a peripheral nerve is to describe the distribution of conduction velocities (DCV) of each nerve fiber in a nerve bundle examined. The author devised a fully automatized method to describe the DCV of a nerve bundle with a signal processor. The principle of the method is nerve impulse collision method which was devised by Hopf in 1963. DCV of the ulnar nerve innervating the first dorsal interosseous muscle from the elbow to the wrist was examined in sixty five normal subjects without any evidence of peripheral nerve problems, in ninety seven patients with diabetes mellitus (DM) and in five normal subjects whose forearm was cooled. Maximum conduction velocity at the same region was measured by using conventional method and compared to the DCV. In control group, there was very mild influence of aging on the peak velocity of DCV but there was no statistically significant deference of mean DCV pattern between any decade of age. In this group a bimodal distribution of velocities was demonstrated. It is assumed that the distribution represents populations of motor fibers innervating the fast and the slow twitch muscle fibers in this muscle. Those results in patients with DM and those normal subjects with their forearm was cooled were controversial. In patients with DM the peak velocity of DCV and its density has positive correlation, in contrast those cold injury group has negative correlation. It might be represents that the pathological condition of large fiber loss in the former group and small fiber damage in the latter group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

Superficial anterior transposition of the ulnar nerve at the elbow for ulnar neuritis.

Superficial anterior transposition of the ulnar nerve at the elbow was carried out for ulnar neuritis in 18 extremities. Epineural neurolysis and superficial stabilization by suture of the epineurium to the fascia were performed in all cases. The procedure, as described, prevents muscle scarring, kinking of the nerve over the intermuscular septum, and fascial sling. It does not require muscular dissection and allows rapid return to occupational and athletic activity. Our 83% good or excellent results compares favorably with other series in the literature.

Adolescent↗
PubMed2000

Unrecognized dislocation of the medial portion of the triceps: another cause of failed ulnar nerve transposition.

OBJECT: Failed surgical treatment for ulnar neuropathy or neuritis due to dislocation of the ulnar nerve presents diagnostic and therapeutic challenges. The authors of this paper will establish unrecognized dislocation (snapping) of the medial portion of the triceps as a preventable cause of failed ulnar nerve transposition. METHODS: Fifteen patients had persistent, painful snapping at the medial elbow after ulnar nerve transposition, which had been performed for documented ulnar nerve dislocation with or without ulnar neuropathy. The snapping was caused by a previously unrecognized dislocation of the medial portion of triceps over the medial epicondyle. Seven of the 15 patients also had persistent ulnar nerve symptoms. The correct diagnosis of snapping triceps was delayed for an average of 22 months after the initial ulnar nerve transposition. An additional surgical procedure was performed in nine of the 15 cases and, in part, consisted of lateral transposition or excision of the offending snapping medial portion of the triceps. Of the four patients in this group who had persistent neurological symptoms, submuscular transposition was performed in the two with more severe symptoms and treatment of the triceps alone was performed in the two with milder neurological symptoms. Excellent results were achieved in all surgically treated patients. Six patients declined additional surgery and experienced persistent snapping and/or ulnar nerve symptoms. CONCLUSIONS: Failure to recognize that dislocation of both the medial portion of the triceps and the ulnar nerve can exist concurrently may result in persistent snapping, elbow pain, and even ulnar nerve symptoms after a technically successful ulnar nerve transposition.

Adolescent↗
PubMed1980

[The ulnar nerve compression syndrome].

The ulnar nerve has to bear a large amount of compression, especially in the cubital tunnel, which can be deducted from the topographic relation of this nerve to the elbow. Apart from tightness of the tunnel, intraarticular changes can also cause compression of the nerve. A further narrow tunnel in the course of the ulnar nerve is the "loge de GUYON", situated in the hypothenar region. A careful neurological examination of sensory and motor signs as well as an accurate electromyographical examination differentiate compression syndromes from other neuropathies. Two unusual cases of a functional cubital tunnel syndrome are demonstrated: their cause was primarily a chondromatosis of the elbow joint in one case a functional vasal compression in the other case.

Elbow↗
PubMed1987

Compound nerve action potentials from the median and ulnar nerves.

The compound nerve action potentials from mixed motor/sensory (MNAP) and sensory (SNAP) nerve stimulation in the median and ulnar nerves were recorded in both arms of 20 able-bodied subjects. Intranerve and internerve peak-to-peak amplitudes were compared. An SNAP/MNAP amplitude ratio greater than 0.25 exceeded the mean by 2SD. The fastest, intermediate, and slowest conduction velocities were calculated from chosen points on the biphasic waveform. An intermediate MNAP conduction velocity for the median and ulnar nerves of less than 49.5m/sec exceeded more than 2SD below the mean. Likewise, an intermediate SNAP conduction velocity of less than 45.5m/sec exceeded 2SD below the mean. Median MNAP latency across the carpal tunnel was 1.0 +/- 0.3 and ulnar MNAP conduction velocity across the elbow was 59.7 +/- 3.8m/sec. This technique may supplement traditional electrodiagnostic studies in evaluating upper extremity neuropathies.

Action Potentials↗
PubMed1973

Differential sensitivity of motor and sensory fibres in human ulnar nerve.

The human ulnar nerve has been stimulated with square-wave pulses of various fixed durations. Measurements were made of the growth of hand myograms compared with elbow neurograms and of hand myograms compared with finger neurograms, for fixed durations of pulses and increasing strength. The effect of blocking sensory action potentials with stimuli of various durations has been investigated, as well as the blocking of action potentials in motor nerve fibres by voluntary activity. It is concluded that pulses of long duration (1 msec or more) selectively stimulate sensory fibres at threshold, whereas short duration pulses (less than 200 μsec) selectively stimulate motor fibres.

Action Potentials↗