Changes in Interstitial Pressure and Cross-Sectional Area of the Cubital Tunnel and of the Ulnar Nerve with Flexion of the Elbow. An Experimental Study in Human Cadavera*

Gelberman, Richard H.; Yamaguchi, Ken; Hollstien, Steven B.; Winn, Steven; Heidenreich, Fred P.; Bindra, Ranjna; Hsieh, Paul A.; Silva, Matthew J.

doi:10.2106/00004623-199804000-00005

Cited by 273 publications

(164 citation statements)

References 13 publications

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“…The transducer was placed proximal to the medial epicondyle and affixed to the nerve with metal pins, as an in line pull is necessary for accurate device measurement. The elbows were then placed at 50°o f flexion to initiate testing as previously described [17]. A strain transducer was placed on the neutral axis of the ulnar nerve (DVRT; Microstrain Co. Williston, VT) [4].…”

Section: Methodsmentioning

confidence: 99%

The Effect of Operative Technique on Ulnar Nerve Strain following Surgery for Cubital Tunnel Syndrome

Mitchell

Dunn

Kusnezov

et al. 2015

Hand (New York, N,Y.)

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Background The aim of this study is to compare the amount of strain on the ulnar nerve based on elbow position after in situ release, subcutaneous transposition, submuscular transposition, and medial epicondylectomy. Methods Six matched cadaver upper extremity pairs underwent ulnar nerve decompression, transposition in a sequential fashion, while five elbows underwent medial epicondylectomy. A differential variable reluctance transducer (DVRT) was placed in the ulnar nerve. An in situ release, a subcutaneous transposition, and a submuscular transposition were performed sequentially with the strain being measured after each procedure in neutral, full elbow flexion, and extension positions. The strain was then averaged and compared for each procedure. Five cadavers underwent medial epicondylectomy and were similarly tested. Results After the in situ release, there was no statistically significant change in strain in either flexion or extension. After a subcutaneous transposition, there was a statistically significant decrease in strain in full elbow flexion but not in extension. Similarly after a submuscular transposition, there was a statistically significant decrease in strain in full flexion but not in extension. There was not a statistically significant change in strain with medial epicondylectomy.Conclusion An in situ release of the ulnar nerve at the elbow may relieve pressure on the nerve but does not address the problem of strain which may be the underlying pathology in many cases of ulnar neuropathy at the elbow (UNE). Transposition of the ulnar nerve anterior to the medial epicondyle addresses the problem of strain on the ulnar nerve. In addition, it does not create an increased strain on the ulnar nerve with elbow extension.

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Section: Methodsmentioning

confidence: 99%

The Effect of Operative Technique on Ulnar Nerve Strain following Surgery for Cubital Tunnel Syndrome

Mitchell

Dunn

Kusnezov

et al. 2015

Hand (New York, N,Y.)

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“…All individuals were examined in a seated position with a 45º flexed elbow as described by Gelberman et al (1998) and Marques et al (2003). The ulnar nerves were scanned from the axilla to the hand along the transverse and longitudinal axes.…”

Section: Patients Materials and Methodsmentioning

confidence: 99%

New sonographic measures of peripheral nerves: a tool for the diagnosis of peripheral nerve involvement in leprosy

Frade

Nogueira-Barbosa

Lugão

et al. 2013

Mem. Inst. Oswaldo Cruz

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“…Proponents of simple decompression in the absence of an anatomical lesion argue that transposition of ulnar nerve involves an unnecessary risk of nerve injury or devascularization, and extensive dissection. In turn, proponents of anterior transposition argue that dynamic compression of the nerve with elbow flexion can only be properly resolved by this technique [14,15,23,24].…”

Section: Resultsmentioning

confidence: 99%

Comparative Study of Outcome of Simple Decompression Versus Anterior Transposition of Ulnar Nerve in the Treatment of Cubital Tunnel Syndrome

Tawfik¹,

Khedr²,

Sakr³

2017

Natl. j. health sci.

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Background: Cubital tunnel syndrome (CuTS) is the second most common entrapment neuropathy in the upper limb, after the entrapment of the median nerve in the carpal tunnel. Different techniques of nerve decompression have been described, however, the idyllic surgical treatment and technique for CuTS remain controversial.Objective: Our aim is to compare the outcome of simple decompression with anterior subcutaneous transposition of ulnar nerve in the treatment of CuTS. Methods:The study included 20 patients that were surgically treated in the Neurosurgery department at Gamal Abdel Nasser Hospital -General Authority for Health Insurance between August 2014 and February 2015. These patients were randomly distributed into two equal groups, each consisting of 10 cases. In the first group, only simple decompression was performed while in the second group, anterior subcutaneous transposition was supplemented. All cases were followed for at least 6 months.Results: Seventy percent of the patients were females and the mean age was 45.35 ± 14.62. The duration of symptoms before surgery varied from 4 months to 2 years. Occupational repetitive elbow flexion and extension was the most common contributing factor. Seven out of ten patients, in the simple decompression group, showed clinical and electrophysiological improvement at 6 months interval. While in the second group, only six patients showed improvement 6 months after surgery. The difference was found to be statistically insignificant. There was no significant effect of the duration of symptoms or co-morbidities on the outcome. Conclusion:Long term follow up revealed no significant difference between simple decompression and anterior subcutaneous transposition. Simple decompression of the ulnar nerve, in our experience, is an effective and less invasive technique for patients with cubital tunnel syndrome.

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Changes in Interstitial Pressure and Cross-Sectional Area of the Cubital Tunnel and of the Ulnar Nerve with Flexion of the Elbow. An Experimental Study in Human Cadavera*

Cited by 273 publications

References 13 publications

The Effect of Operative Technique on Ulnar Nerve Strain following Surgery for Cubital Tunnel Syndrome

The Effect of Operative Technique on Ulnar Nerve Strain following Surgery for Cubital Tunnel Syndrome

New sonographic measures of peripheral nerves: a tool for the diagnosis of peripheral nerve involvement in leprosy

Comparative Study of Outcome of Simple Decompression Versus Anterior Transposition of Ulnar Nerve in the Treatment of Cubital Tunnel Syndrome

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