Surgery of ulnar neuropathy at the elbow: 16 cases treated by decompression without transposition

1973 ◽  
Vol 38 (6) ◽  
pp. 780-785 ◽  
Author(s):  
Donald H. Wilson ◽  
Robert Krout
Keyword(s):  
Ulnar Nerve ◽  
Nerve Palsy ◽  
Medial Epicondyle ◽  
Ulnar Neuropathy ◽  
Cubital Tunnel ◽  
Content Type ◽  
Anterior Transposition ◽  
Ulnar Nerve Palsy ◽  
Flexor Carpi Ulnaris ◽  
Fine Print

✓ The authors report 16 consecutive cases of ulnar nerve palsy at the elbow successfully relieved by simple division of the tendinous insertions of the flexor carpi ulnaris, which form the roof of the “cubital tunnel.” They believe the more complex procedures of anterior transposition of the nerve or resection of the medial epicondyle are unnecessary, and even undesirable.

Ulnar Neuropathy at the Elbow

HAND ◽  
1979 ◽  
Vol os-11 (3) ◽  
pp. 281-283 ◽  
Author(s):  
Olav Reikerås
Keyword(s):  
Ulnar Nerve ◽  
Nerve Palsy ◽  
Adult Life ◽  
Ulnar Neuropathy ◽  
Clinical Material ◽  
Duration Of Symptoms ◽  
Anterior Transposition ◽  
Ulnar Nerve Palsy ◽  
The Right

In the years 1961–1975 we have treated thirty-one men and twenty-four women for ulnar nerve palsy at Kronprinsesse Märthas Institutt. The age ranged from sixteen to seventy-eight, the majority were in mid-adult life. Thirty-four nerves on the right arm and twenty-seven on the left were operated on with anterior transposition. This clinical material has been analysed regarding aetiology and management. The neuropathy was secondary to trauma or disease at the elbow in thirty-five cases and primary with a normal elbow in twenty-six cases. At operation it was found that the neuropathy was due to fibrous compression in 36 per cent and to hypermobility in 21 per cent. In 43 per cent there were no macroscopic reasons for neuropathy. We have re-examined fifty-two patients at an average time of seven and a half years after the operation. The results were found to be excellent in 47 per cent, good in 30 per cent and poor in 23 per cent. The results were independent of duration of symptoms before the operation and independent of the surgical findings at the operation. The results were also the same whether the nerve at the transposition was put intramuscularly or just subcutanously.

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

2000 ◽  
Vol 92 (1) ◽  
pp. 52-57 ◽  
Author(s):  
Robert J. Spinner ◽  
Shawn W. O'Driscoll ◽  
Jesse B. Jupiter ◽  
Richard D. Goldner
Keyword(s):  
Ulnar Nerve ◽  
Correct Diagnosis ◽  
Medial Epicondyle ◽  
Neurological Symptoms ◽  
Ulnar Neuropathy ◽  
Content Type ◽  
Ulnar Nerve Transposition ◽  
Additional Surgery ◽  
Nerve Transposition ◽  
Fine Print

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.

scholarly journals A Neglected Markedly Displaced Medial Epicondyle Fracture with Simultaneous Ulnar Nerve Palsy in an Adolescent

2017 ◽  
Vol 9 (4) ◽  
pp. 542 ◽  
Author(s):  
Tamer Ahmed EL-Sobky ◽  
John Fathy Haleem ◽  
Hossam Moussa Sakr ◽  
Ahmad Saeed Aly
Keyword(s):  
Ulnar Nerve ◽  
Nerve Palsy ◽  
Medial Epicondyle ◽  
Ulnar Nerve Palsy ◽  
Medial Epicondyle Fracture

An elbow dislocation in a child with missed medial epicondyle fracture and late ulnar nerve palsy

2010 ◽  
Vol 19 (5) ◽  
pp. 459-461 ◽  
Author(s):  
Nor Hazla Mohamed Haflah ◽  
Sharaf Ibrahim ◽  
Jamari Sapuan ◽  
Shalimar Abdullah
Keyword(s):  
Ulnar Nerve ◽  
Nerve Palsy ◽  
Elbow Dislocation ◽  
Medial Epicondyle ◽  
Ulnar Nerve Palsy ◽  
Medial Epicondyle Fracture

The Ulnar Nerve at the Elbow and its Local Branching: An Anatomic Study

2001 ◽  
Vol 26 (2) ◽  
pp. 142-144 ◽  
Author(s):  
M. H. GONZALEZ ◽  
P. LOTFI ◽  
A. BENDRE ◽  
Y. MANDELBROYT ◽  
N. LIESKA
Keyword(s):  
Ulnar Nerve ◽  
Significant Variation ◽  
Medial Epicondyle ◽  
Nerve Compression ◽  
Cubital Tunnel ◽  
Anatomic Study ◽  
Local Branching ◽  
Flexor Carpi Ulnaris

Thirty nine cadaver elbows were dissected and the branching of the ulnar nerve, as well as the cubital tunnel and adjacent potential sites of nerve compression were studied. An arcade of Struthers was present in 26 specimens and Osborne’s ligament was present in all specimens. A discrete flexor pronator aponeurosis overlying the ulnar nerve was present in 17 specimens. An average of one (range, 0–3) capsular nerve branches were noted. These originated an average 7 mm proximal (range, 45 mm proximal to 24 mm distal) to the medial epicondyle. An average of three (range, 1–6) motor branches to the flexor carpi ulnaris muscle were noted, and one of these originated proximal to the medial epicondyle in two specimens. Significant variation was noted in the capsular and motor branching of the ulnar nerve. Care must be taken to identify the motor branches of the ulnar nerve when performing a transposition.

scholarly journals The 7 Structures Distal to the Elbow That Are Critical to Successful Anterior Transposition of the Ulnar Nerve

Hand ◽  
2018 ◽  
Vol 14 (6) ◽  
pp. 776-781 ◽  
Author(s):  
John M. Felder ◽  
Susan E. Mackinnon ◽  
Megan M. Patterson
Keyword(s):  
Ulnar Nerve ◽  
Ulnar Artery ◽  
Cubital Tunnel Syndrome ◽  
Medial Epicondyle ◽  
Cubital Tunnel ◽  
Anterior Transposition ◽  
Straight Line ◽  
Tunnel Syndrome ◽  
Poor Outcomes ◽  
Flexor Digitorum

Background: Ulnar nerve transposition (UNT) surgery is performed for the treatment of cubital tunnel syndrome. Improperly performed UNT can create iatrogenic pain and neuropathy. The aim of this study is to identify anatomical structures distal to the medial epicondyle that should be recognized by all surgeons performing UNT to prevent postoperative neuropathy. Methods: Ten cadaveric specimens were dissected with attention to the ulnar nerve. Intramuscular UNT surgery was simulated in each. Distal to the medial epicondyle, any anatomical structure prohibiting transposition of the ulnar nerve to a straight-line course across the flexor-pronator mass was noted and its distance from the medial epicondyle was measured. Results: Seven structures were found distal to the medial epicondyle whose recognition is critical to ensuring a successful anterior transposition of the ulnar nerve: (1) Branches of the medial antebrachial cutaneous (MABC) nerve; (2) Osborne’s fascia; (3) branches from the ulnar nerve to the flexor carpi ulnaris (FCU); (4) crossing vascular branches from the ulnar artery to the FCU; (5) the distal medial intermuscular septum between the FCU and flexor digitorum superficialis (FDS); (6) the combined muscular origins of the flexor-pronator muscles; and (7) the investing fascia of the FDS. Measurements are given for each structure. Conclusions: Poor outcomes and unnecessary revision surgeries for cubital tunnel syndrome can be avoided with intraoperative attention to 7 structures distal to the medial epicondyle. Surgeons should expect to dissect up to 12 cm distal to the medial epicondyle to adequately address these and prevent kinking of the nerve in transposition.

Ulnar nerve entrapment at the elbow by persistent epitrochleoanconeus muscle

1981 ◽  
Vol 55 (5) ◽  
pp. 830-831 ◽  
Author(s):  
Lucido Gessini ◽  
Bruno Jandolo ◽  
Alberto Pietrangeli ◽  
Emanuele Occhipinti
Keyword(s):  
Ulnar Nerve ◽  
Nerve Entrapment ◽  
Cubital Tunnel ◽  
Content Type ◽  
Ulnar Nerve Entrapment ◽  
Anomalous Muscle ◽  
Fine Print

✓ A case of ulnar nerve entrapment in the cubital tunnel by persistent epitrochleoanconeus muscle is reported. The anatomy of the anomalous muscle is outlined, and previous cases are briefly summarized.

Surgical management of ulnar nerve compression at the elbow: an analysis of the literature

1998 ◽  
Vol 89 (5) ◽  
pp. 722-727 ◽  
Author(s):  
Ronald H. M. A. Bartels ◽  
Thomas Menovsky ◽  
Jacobus J. Van Overbeeke ◽  
Wim I. M. Verhagen
Keyword(s):  
Ulnar Nerve ◽  
Operative Treatment ◽  
Postoperative Rehabilitation ◽  
Content Type ◽  
Ulnar Nerve Compression ◽  
Anterior Transposition ◽  
Significant Difference ◽  
Preoperative Status ◽  
Simple Decompression ◽  
Fine Print

Object. Surgical treatment for cubital ulnar nerve compresson includes medial epicondylectomy, simple decompression, or anterior transposition (subcutaneous, intramuscular, or submuscular). There is a dearth of prospective randomized studies on which to base guidelines for choosing one operative treatment over another. The authors review the literature on this subject and present their findings. Methods. The authors reviewed the literature from January 1970 to July 1997. Two authors decided independently whether an article should be included for review based on previously formulated inclusion and exclusion criteria. In addition to demographic information, data concerning preoperative status and outcome were extracted. For statistical analyses chi-square and Kruskal—Wallis tests were performed. Irrespective of their preoperative status, patients with simple decompression had the best outcome, whereas those with anterior subcutaneous and submuscular transposition had the worst. If outcome was related to the patient's preoperative status, a significant difference was not found among the various groups for those patients with a preoperative McGowan Grade 2. However, for those with McGowan Grade 3 (severe) symptoms, patients with anterior intramuscular transposition had the best outcome followed by those with simple decompression and anterior submuscular transposition. Statistical analysis was not possible for patients with McGowan Grade 1 because of the small numbers of patients in several treatment modality groups. Conclusions. Formulating a uniform guideline for operative treatment is not possible based on the results of this study. However, the authors believe that support is given to their policy, which is primarily to perform a simple decompression. Its surgical simplicity with preservation of the anatomy, especially the vascularization, and the possibility of rapid postoperative rehabilitation are also taken into consideration. If subluxation is found intraoperatively, anterior transposition is proposed.

scholarly journals Acute handlebar syndrome: Two extremes of a challenging diagnosis

2020 ◽  
Vol 11 ◽  
pp. 366
Author(s):  
Fabio Veiga de Castro Sparapani ◽  
Marcela Fernandes ◽  
Leonardo Favi Bocca ◽  
Luis Renato Nakachima ◽  
Sergio Cavalheiro
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Ulnar Nerve ◽  
Functional Recovery ◽  
Short Distance ◽  
Nerve Palsy ◽  
Ulnar Neuropathy ◽  
Case Description ◽  
Ulnar Nerve Palsy ◽  
Repetitive Trauma

Background: Ulnar nerve mononeuropathy diagnosis can be challenging depending on where neural lesion is present. Repetitive trauma during cycling is a rare cause of ulnar neuropathy. Case Description: We describe two patients who developed the handlebar syndrome, an ulnar nerve palsy at Guyon’s canal after cycling. The first patient had the syndrome after a short-distance ride and she was treated surgically, while the second patient developed the classical syndrome after a long ride and received conservative treatment. Surgical treatment of the first patient led to functional recovery. Conclusion: Handlebar syndrome is a neuropathy caused by extrinsic repetitive compression of ulnar nerve at wrist. Increasing incidence of this disease can be expected after increasing popularity of cycling sports. Avoid of repetitive trauma is the main management goal, with surgical treatment reserved for failure of conservative treatment.

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