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At least 91 records · Page 5Linked to original sources
PubMed1997

[Postoperative ulnar nerve palsy of the elbow].

Ulnar nerve neuropathy of the elbow is a recognized complication of surgery involving general anesthesia. In 13 patients, aged 21-76 years, ulnar nerve palsy developed at various times and of varying degrees of severity during the postoperative period. Diagnosis was based on clinical and electrophysiological findings. 3 patients had subclinical entrapment of the ulnar nerve. All were treated conservatively by rest, splinting and physical therapy: 10 improved slowly with time and 3 were operated on, but only 1 recovered fully. Preventive measures, such as proper positioning on the operative table, use of elbow pads, avoiding adduction of the arm, pronation of the forearm and prolonged elbow flexion, may reduce the incidence of ulnar nerve palsy. Unfortunately, treatment of established lesions has yielded mixed results.

Adult↗
PubMed2001

Selective restoration of motor function in the ulnar nerve by transfer of the anterior interosseous nerve. An anatomical feasibility study.

BACKGROUND: Proximal ulnar-nerve lesions have an unfavorable prognosis. The goal of the present study was to evaluate the feasibility of selective restoration of motor function of the ulnar nerve by the transfer of the anterior interosseous nerve or one of its branches to the motor branch of the ulnar nerve. METHODS: Ten cadaveric arms were used in the present study. The ulnar nerve and its motor and sensory branches as well as the anterior interosseous nerve and its branches were dissected. The widths of the motor branch of the ulnar nerve and the anterior interosseous nerve and its motor branches as well as the relevant distances from the points of divergence were measured. The axons were counted, and the distances from the end of the main anterior interosseous nerve, its motor branches, and the motor branch of the ulnar nerve to the level of the dorsal sensory branch of the ulnar nerve were measured. RESULTS: Our results indicate that the length, width, and number of axons of the branch of the anterior interosseous nerve to the pronator quadratus make it suitable for transfer to the motor branch of the ulnar nerve. The use of the main anterior interosseous nerve or its motor branches to the flexor pollicis longus and the flexor digitorum profundus is less feasible because of the need to graft a long segment and the longer distance from the level of transfer to the motor end points. CONCLUSIONS: The findings of the present study confirm the feasibility of motor-nerve transfer for reconstruction after an injury of the ulnar nerve. Nerve-grafting would be needed for injuries distal to the level of the dorsal sensory branch of the ulnar nerve.

Arm↗
PubMed1998

Anatomy of the ulnar nerve at the elbow: potential relationship of acute ulnar neuropathy to gender differences.

Men develop perioperative ulnar neuropathies more frequently than women. To determine the role of anatomical gender differences in the development of these neuropathies, we performed several studies of the anatomy of the ulnar nerve, cubital tunnel, and elbow region. These studies included detailed dissection of male and female embalmed and unembalmed cadavers, ultrasound measurements of the tissue layers at the elbow, and measurement of various dimensions of the coronoid process of the ulna in multiple skeletal sets. No gross anatomical differences were found between genders regarding the course of the ulnar nerve through the upper limb. However, there was a strikingly larger (2-19 times greater) fat content on the medial aspect of the elbow in women compared to men, and the tubercle of the coronoid process was approximately 1.5 times larger in men (P < or = .002, rank sum test). Our finding suggest that the tubercle of the coronoid process is a likely area for external compression-induced ischemia of the ulnar nerve because the nerve and its arterial supply (the posterior ulnar recurrent artery) are covered at the tubercle only by skin, subcutaneous fat, and a very thin aponeurosis of the flexor carpi ulnaris. Importantly, this tubercle is larger and the nerve and blood vessels passing by it are less protected by subcutaneous fat in men than in women. These two anatomical differences between men and women may contribute to the increased frequency of perioperative ulnar neuropathy induced by external pressure at the medial aspect of the elbow in men.

Cadaver↗
PubMed2003

The electrodiagnosis of ulnar nerve entrapment at the elbow.

Entrapment of the ulnar nerve at the elbow is the second most common focal peripheral neuropathy. Recent advances have facilitated the electrodiagnosis of this common nerve entrapment. The goals of electrodiagnosis are to localize ulnar nerve dysfunction, confirm that the disturbance is confined to the ulnar nerve, and assess the severity of ulnar nerve dysfunction. The goal of this review is to highlight the important advances in anatomy, neurophysiology and methodology that impact upon the electrodiagnosis of entrapment of the ulnar nerve at the elbow, illustrate the limits of electrodiagnosis, and discuss methodological issues that may be the subject of further study. Careful attention to elbow position, temperature, and conservative estimates of conduction block should be part of common practice. Awareness of anatomical variations in structural anatomy, anomalous innervation and fascicular arrangement of ulnar nerve fibers are required to interpret electrodiagnostic studies accurately. The most reliable finding is slowing of the ulnar across-elbow motor nerve conduction velocity to less than 50 m/sec while recording from the abductor digiti minimi muscle, and should be carefully interpreted in the presence of a polyneuropathy or other neurogenic process. Alternative techniques such as relative ulnar slowing in different ulnar nerve segments, use of alternative muscles, sensory and mixed nerve techniques provide complementary information, and like all nerve conduction studies are highly operator-dependent and should be used on a case by case basis. Recent studies have focused the electromyographer's attention on the use of shorter across-elbow segments (2-5 cm). This may offer a reasonable trade-off between sensitivity and measurement error and may result in improved electrodiagnosis.

Animals↗
PubMed1985

Digital nerve grafting using the dorsal sensory branch of the ulnar nerve.

The dorsal sensory branch of the ulnar nerve has been found to have the appropriate size and sufficient length for use as a digital nerve graft. This donor nerve was utilised fifteen times in twelve patients for the bridging of defects in thirteen digital nerves of the fingers. After an average follow-up of 23.2 months, only one patient failed to achieve any two point discrimination in the area supplied by the involved digital nerve. The other eleven patients had an average two point discrimination of 9.5 mm with a range of 5 to 18 mm. Painful neuroma formation or loss of hand function related to the use of the dorsal sensory branch of the ulnar nerve as a donor for digital nerve grafts was not encountered.

Adolescent↗
PubMed1977

[Functional mechanisms of the proximal ulnar nerve compression syndrome].

The proximal ulnar compression syndrome when it is not a result of trauma, tumors, inflammatory and degenerative processes, inborn deformations or external pressure, is caused by two mechansims, namely the pinching of the ulnar nerve between the proximal edge of the ligamentous and muscular coverings of the cubital tunnel and of the exit of the nerve from the tunnel under the tendinous arch of the flexor carpi ulnaris. The compression itself is dependent upon the possibility of subluxation of the ulnar nerve. Therapy should consists not only in "decompression", but also in a simultaneous anterior transposition of the ulnar nerve.

Elbow↗
PubMed1991

[Isolated compression of the dorsal branch of the ulnar nerve].

The dorsal branch of the ulnar nerve was dissected in 20 upper extremities. The nerve arises from the ulnar aspect of the ulnar nerve at an average distance of 8.5 centimeters from the proximal border of the pisiforme. It courses deep to the palmar carpal ligament and pierces the ligament dorsal to the tendon of the flexor carpi ulnaris, becoming subcutaneous. The palmar carpal ligament has been found to be a cause of isolated entrapment of the dorsal branch of the ulnar nerve. A report of eleven operative cases is presented.

Adult↗
PubMed2004

Refinements in the technique of 'awake' electrical nerve stimulation in the management of chronic low ulnar nerve injuries.

The standard technique in the management of chronic low ulnar nerve injuries includes excision of the neuroma and reconstruction using sural nerve grafts in the fully anaesthetised patient. It has been shown that using this standard technique, disappointing results may be observed and that significant improvement in results could be obtained if intra-operative matching of sensory and motor fascicles is performed. This study reports on eight patients with chronic ulnar nerve injuries managed using the technique of electrical fascicular orientation and sural nerve grafting. In all patients, intra-operative electrical stimulation of the fascicles in the proximal stump was done in the awake state. Several refinements in technique are described including detailing pre-operative patient education, anaesthetic considerations and in the technique of nerve dissection. Assessment was done using a sensory grading system mainly based on static two-point discrimination and a motor grading system based on intrinsic muscle function and key pinch power. At final follow up satisfactory sensory (S3+ or S4) and motor (M3 or M4) recovery was obtained in almost all cases. It was concluded that intra-operative electrical fascicular orientation was reliable and that our refinements in the technique ensured better communication with the patient during surgery, resulted in a smoother awakening without apprehension, and provided an easier nerve dissection with preservation of the blood supply of the distal nerve segment.

Adolescent↗
PubMed2002

An improved approach to the evaluation of the deep motor branch of the ulnar nerve.

The detection of ulnar nerve lesions at Guyon's canal requires evaluation of the distal ulnar sensory and distal motor latency to the abductor digiti minimi (ADM). In addition precision in the measurement of distal motor latencies (DL) to the first dorsal interosseous (1DI) muscle and response amplitude is necessary. This study examines a standardized technique assessing distal ulnar nerve conduction aimed to provide a more sensitive evaluation of these lesions. Fifty normals and eighteen subjects with hand symptoms were assessed to determine DL to the ADM and 1DI and response amplitudes. These standard values were then compared to values obtained from clinically proven cases of distal ulnar lesions over the previous 2 years. The main outcome measures were elimination of premotor potentials and prolongation of 1DI DL. The results revealed that the standardized technique consistently eliminates premotor potentials (PMP) and provides a significantly narrowed range of normal DL values. This enhanced precision allows for more accurate normative values, making recognition of more subtle lesions possible. Normative data compared to values from a 2 year chart review of distal ulnar lesions shows predictive trends toward prolonged 1DI DL and diminution of 1DI amplitudes (AMP).

Adult↗
PubMed1987

Characterized dispersive wave-form of evoked compound muscle action potential in the localized ulnar nerve neuropathy.

Disorder of the ulnar nerve with continuity around the elbow is known to be a neuropathy produced by long lasting compression, friction or traction. Forty-four patients with clinical diagnosis of ulnar nerve neuropathy were examined by means of motor nerve conduction study and induced electromyography. Compound muscle action potentials (CMAPs) from hand muscle were evoked by stimulating many points proximal and distal to the elbow and analysis of CMAP was performed. In mild grade of nerve lesion, dispersive wave-form with the extension of its duration was elicited by only stimulating proximal points to the elbow. It was also found that conduction velocity is delayed only over the short distance across the elbow. Thus an initial stage of nerve lesion has a tendency of dysfunctioning of conductivity restricted in only affected portion. CMAP patterns are classified into four groups in comparison with the progress of clinical signs of the disease. This classification can be utilized for the evaluation of the progress of ulnar nerve lesion.

Adolescent↗
PubMed1993

Sensory nerve findings by tactile stimulation of median and ulnar nerves in healthy subjects of different ages.

We studied orthodromic sensory conduction velocity along the distal and proximal segments of the median and ulnar nerves by tactile stimulation of the distal phalanx of the 3rd and 5th digits in 44 healthy subjects divided into 2 age groups: from 16 to 35 years and from 63 to 81 years. In the same nerves, we used selective electrical stimulation of the corresponding digital nerves to obtain sensory potentials. In both groups, responses to tactile stimuli had a longer latency and smaller amplitude than those to electrical stimulation, and they were distributed in a series of 6-7 main deflections, apparently regardless of whether the recording site was distal or proximal. Moreover, irrespective of the nerve and of subject age, conduction velocity along both the digit-wrist and the wrist-elbow nerve segments was significantly slower with tactile stimuli than with electrical stimuli. However, independently of the stimulus used, conduction velocity along the proximal nerve segment was significantly faster than that measured along the digit-wrist nerve segment. In both the median and ulnar nerves, maximum potential amplitude, cumulative area and conduction velocity were significantly reduced in the older age group. This finding could reflect the smaller number of Meissner's corpuscles in older subjects, and the loss of large nerve fibres in individuals over 60.

Adolescent↗
PubMed1999

Anatomical and functional connectivity of the transected ulnar nerve after intercostal neurotization in cats.

OBJECT: Acute transfer of three intercostal nerves to the ulnar nerve was performed in cats for histological and clinical evaluation of a distal muscle reinnervation. METHODS: Infraclavicular intercostal-ulnar communications were created after dividing the motor branches of the upper intercostal nerves in 14 adult cats. Reinnervation of distal forelimb muscles in the ulnar territory was assessed by electromyographic (EMG) studies and motor function rating each month until 18 months postsurgery. In five of these treated animals, and in tour controls, horseradish peroxidase (HRP) was applied to the ulnar or intercostal nerves to study the amount and distribution of retrograde motor neuron labeling in the spinal cord. Also, samples of reinnervated muscles and neurotized ulnar nerves were processed to assess regeneration. Simple ulnar transection without reconstruction led to permanent atrophy of ulnar muscles, lack of recovery according to EMG or clinical studies, and disappearance of the ulnar motor neuron pool. In contrast, ulnar neurotization with the intercostal nerves led to a high rate of functional recovery, which began 5 months postsurgery, and progressed from muscle activity synchronized with ventilatory movements to spontaneous movements that were independent of respiration. This recovery was accompanied by substantial retrograde labeling of intercostal motor neurons after HRP application in the ulnar nerve. Cell counts showed that practically the whole motor neuron pool of the involved intercostal nerves contributed to reinnervation of the transected ulnar nerve. CONCLUSIONS: These findings demonstrate that the use of intercostal nerves to neurotize long brachial plexus nerves can achieve long-lasting and successful reinnervation of distal forelimb muscles.

Animals↗
PubMedDate not supplied

A study of the sympathetic skin response and sensory nerve action potential after median and ulnar nerve repair.

The purpose of this study was to compare SSR with sensory nerve action potential (SNAP) responses in regeneration of injured peripheral nerves after nerve repair. We studied 10 male patients with a mean age of 26.7 years. All the patients had complete laceration of median or ulnar nerves. The patients were followed up at least for six months. SSR and SNAP assessment were performed every one to two months. Normal hands were used as controls. SSR was positive after 15.8 +/- 9.4 weeks (mean +/- 2 SD) and SNAP after 27.8 +/- 12.9 weeks (mean +/- 2 SD). The difference was statistically significant (P value < 0.001). This can be due to more rapid growth of sympathetic unmyelinated fibers relative to sensory myelinated fibers. This study also shows that recovery of the sudomotor activity following nerve repair is satisfactory in general and SSR can be used as a useful and sensitive method in the evaluation of sudomotor nerve regeneration.

Action Potentials↗
PubMed1985

Surface recording of orthodromic sensory nerve action potentials in median and ulnar nerves in normal subjects.

Reference values of sensory nerve compound action potentials (CAP) were established in 50 healthy subjects by examination with surface electrodes placed in a transverse and a longitudinal position at the wrist. Longitudinal electrodes record potentials of larger amplitude and shorter duration than transversally recorded CAPs. Both amplitude and duration were increased by an increase of interelectrode distance. The use of amplitude and duration as variables is encouraged by the well-defined biologic variation obtained when fixed interelectrode distance is used and when values are corrected for age and temperature. The strong correlation between amplitude and duration might indicate that the decrease of amplitude with age is caused by the reduction of conduction velocity rather than axonal loss. The ulnar nerve CAPs differ from those of the median nerve mostly with regard to influence of age and temperature. The reasons for this are discussed.

Action Potentials↗
PubMed1980

Crossed fingers and other tests of ulnar nerve motor function.

All tests for ulnar nerve motor function require demonstration and explanation if they are to be carried out reliably. The tests used most commonly may be difficult to elicit, particularly in children or in the presence of an acute injury. The authors have found that the ability to cross the middle over the index finger is a reliable test of ulnar nerve function. This maneuver of "crossing the fingers" is in common usage from childhood on as a good luck sign and is elicited easily in the presence of an intact ulnar nerve. An annotated table is included of other tests that may be useful in evaluating ulnar nerve integrity.

Adult↗