Effect of Partial, Distal Epicondylectomy on Reduction of Ulnar Nerve Strain: A Cadaver Study

Çirpar, Meriç; Türker, Mehmet; Yalçınozan, Mehmet; Eke, Murat; Sahin, Feyzi

doi:10.1016/j.jhsa.2012.12.033

Cited by 8 publications

(19 citation statements)

References 19 publications

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“…Originally, it was thought to be due to a compressive or entrapment neuropathy [3][4][5]. However, more recently, it has been thought to be due to nerve strain [2,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Towards viscoelastic characterisation of the human ulnar nerve: An early assessment using embalmed cadavers

Barberio

Chaudhry

Power

et al. 2019

Medical Engineering & Physics

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Cubital tunnel syndrome is the most prevalent neuropathy of the ulnar nerve and its aetiology is controversial. Potential replacement materials should display similar viscoelastic properties. The purpose of this study was to assess the feasibility and merit of quantifying the frequency-dependent viscoelastic properties of proximal and distal sections of the human ulnar nerve. Four ulnar nerves (n = 4) were dissected from the elbows of human cadavers and sectioned at the level of the cubital tunnel into proximal and distal sections. These eight sections of the ulnar nerve were sinusoidally loaded to induce stresses between 0.05-0.27 MPa and the viscoelastic properties were measured between 0.5-24 Hz using Dynamic Mechanical Analysis. The nerves were found to exhibit frequency-dependent viscoelastic behaviour throughout this frequency range. The median storage moduli of the proximal nerves ranged between 7.03 and 8.18 MPa, and 8.85 to 10.19 MPa for distal nerves, over the frequency-sweep tested. The median loss moduli of the proximal nerves ranged between 0.46 and 0.81 MPa and between 0.51-0.80 MPa for distal nerves. Ulnar nerves display frequency dependency viscoelasticity. Such characterisation is feasible with potential applications to suitable nerve grafts.

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“…Originally, it was thought to be due to a compressive or entrapment neuropathy [3][4][5]. However, more recently, it has been thought to be due to nerve strain [2,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Towards viscoelastic characterisation of the human ulnar nerve: An early assessment using embalmed cadavers

Barberio

Chaudhry

Power

et al. 2019

Medical Engineering & Physics

View full text Add to dashboard Cite

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“…Thus, the clinical difference we observed may be related with paresthesia, tenderness over the medial epicondyle and painful subluxation of the ulnar nerve encountered in PMe patients. The persistence of paresthesia may be due to limited effect of partial epicondylectomy on ulnar nerve strain as shown by Cirpar [11] and Mitchell. [27] In this study, we used quantitative parameters of SWM test, grip strength and pinch strengths to objectively evaluate the difference between distal and partial ME techniques.…”

Section: Discussionmentioning

confidence: 97%

“…[25,26] Medial epicondylectomy has been shown to decrease ulnar nerve strain at the elbow which is accepted as a cause of CuTS. [3,11,27] To address the tethering effect of this anatomical structure on ulnar nerve, different types of medial epicondylectomy techniques have been described with satisfactory clinical results. [2,[5][6][7] Distal medial epicondylectomy was reported as a modification of PMe with encouraging preliminary clinical results.…”

Section: Discussionmentioning

confidence: 99%

“…[2,[5][6][7] Distal medial epicondylectomy was reported as a modification of PMe with encouraging preliminary clinical results. [2,11] In this study, we aimed to clinically compare DMe with the widely applied PMe technique described by Kaempffe and Farbach. [6] There are studies reporting on the clinical comparison of different types of medial epicondylectomy techniques in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…[6,9,10] Distal medial epicondylectomy (DMe) was reported as a modification of partial medial epicondylectomy (PMe) which creates a significant change in ulnar nerve strain with encouraging preliminary clinical results. [2,11] In this study, we aimed to compare PMe and DMe in terms of sensory and motor improvements, functional results and complications.…”

Section: Comparison Of Two Medial Epicondylectomy Techniques In Cubitmentioning

confidence: 99%

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Comparison of two medial epicondylectomy techniques in cubital tunnel syndrome

Çirpar

Ozuak

Oktaş

et al. 2017

Eklem Hastalik Cerrahisi

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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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Effect of Partial, Distal Epicondylectomy on Reduction of Ulnar Nerve Strain: A Cadaver Study

Cited by 8 publications

References 19 publications

Towards viscoelastic characterisation of the human ulnar nerve: An early assessment using embalmed cadavers

Towards viscoelastic characterisation of the human ulnar nerve: An early assessment using embalmed cadavers

Comparison of two medial epicondylectomy techniques in cubital tunnel syndrome

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

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