Introduction/Purpose Surgical decompression of the ulnar nerve in the treatment of cubital tunnel syndrome is performed in close proximity to the first motor branch of the ulnar nerve to flexor carpi ulnaris (FCU). Understanding the variability of this branch is important for improving surgical interventions. The purpose of this study was to determine the location and anatomical variation of the first motor branch to flexor carpi ulnaris. Methods Embalmed cadavers were dissected to expose the ulnar nerve as it courses past the medial epicondyle of the humerus. Digital calipers were used to measure the distance between the point of origin of the first motor branch of the ulnar nerve to FCU and the most prominent aspect of the medial epicondyle. The length of the ulna was also measured and correlated with data from ulnar nerve measurements. Statistical significance was defined as a p‐value < 0.05. Outcomes Data was obtained from 113 cadaveric elbows. The location of the branch point was most consistently found (88.5% of specimens) distal to the medial epicondyle (average 19.42 mm, standard deviation 4.39, 95% confidence interval 18.54 – 20.29). In 11.5% of elbows, however, the branch point occurred proximal to the medial epicondyle (average 16.02 mm, standard deviation 4.53, 95% confidence interval 13.28 – 18.76 mm). The average distance was 18.42 mm distal to the medial epicondyle in females and 20.45 mm in males, with a statistically significant difference between genders (p‐value = 0.02). The correlation between the branch point of the first motor branch of the ulnar nerve to FCU and ulna body size was also explored. Conclusion This study has demonstrated that the first motor branch of the ulnar nerve is most consistently located 18.54 to 20.29 mm distal to the medial epicondyle. Males had a significantly greater distance from the origin of the first motor branch of the ulnar nerve to FCU from the medial epicondyle compared to females. No statistically significant correlation was found related to laterality. Additionally, the prevalence of the anatomical variant in which branching of the first motor nerve from the ulnar nerve occurs proximal to the medial epicondyle was estimated. Prior to this study, the prevalence of this variant had not been reported. Support or Funding Information The authors would like to thank Midwestern University for the use of the specimens in this study.
Glucocorticoids are not only endogenous hormones but are also administered exogenously as an anti-inflammatory and immunosuppressant for their long-term beneficial and lifesaving effects. Because of their potent anti-inflammatory property and ability to curb the cytokines, they are administered as lifesaving steroids. This property is not only made use of in the cardiovascular system but also in other major organ systems and networks. There is a fine line between their use as a protective anti-inflammatory and a steroid that could cause overuse-induced complications in major organ systems including the cardiovascular system. Studies conducted in the cardiovascular system demonstrate that glucocorticoids are required for growth and development and also for offering protection against inflammatory signals. Excess or long-term glucocorticoid administration could alter cardiac metabolism and health. The endogenous dysregulated state due to excess endogenous glucocorticoid release from the adrenals as seen with Cushing’s syndrome or excess exogenous glucocorticoid administration leading to Cushing’s-like condition show a similar impact on the cardiovascular system. This review highlights the importance of maintaining a glucocorticoid balance whether it is endogenous and exogenous in regulating cardiovascular health.
Case: A 23-year-old male patient presented with symptomatic, high-grade medial tibial plateau bone marrow edema unresponsive to conservative treatment. After the injection of intralesional viscous bone cement, the patient had resolution of his symptoms and returned to running. Conclusion:The use of intralesional viscous bone cement has grown in popularity for the treatment of bone marrow edema in individuals older than 40 years but is uncommon in younger individuals. This case demonstrates that intralesional viscous bone cement may be considered in the treatment of high-grade bone marrow edema in young, active patients who are unresponsive to extensive conservative management.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B804).
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