MR anatomy and pathology of the ulnar nerve involving the cubital tunnel and Guyon’s canal

Shen, Luyao; Masih, Sulabha; Patel, Dakshesh B.; Matcuk, George R.

doi:10.1016/j.clinimag.2015.11.008

Cited by 27 publications

(37 citation statements)

References 27 publications

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“…Although this diagnosis is usually confirmed by EDX, US due to recent implementation of high-frequency transducers enabling high-resolution images of peripheral nerves is emerging as a complementary method to evaluate patients with compressive neuropathies, e.g. UNE [ 5 , 7 , 15 , 17 , 22 – 25 , 44 , 45 ]. The hallmark sonographic features of entrapment neuropathy include enlargement of the nerve, its hypoechoic swelling proximal to the compression site, loss of normal fascicular pattern and, not infrequently, oedema of adjacent soft tissues [ 7 , 13 , 20 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…The ulnar nerve may be compressed at the cubital tunnel inlet by the medial intermuscular septum and an aponeurotic band referred to as the arcade of Struthers. Moreover, the nerve may be entrapped in the tunnel by the Osborne's band, a retinaculum that extends from the medial epicondyle to the olecranon, and by the aponeurosis of the flexor carpi ulnaris (FCU); this is postulated to be the most common site of the entrapment [ 5 – 7 ]. Finally, the ulnar nerve may be compressed distally, at the tunnel outlet, by the two heads of the FCU muscle [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Ulnar neuropathy may also result from habitual elbow flexion, acute or repetitive trauma, excessive strain, presence of mass-like lesions, degenerative arthritis and snapping triceps syndrome. The list of intrinsic aetiological factors includes diseases of the thyroid, diabetes mellitus, alcohol abuse, rheumatoid arthritis and other systemic inflammatory diseases, to mention a few [ 5 , 7 , 9 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…According to many authors, electrodiagnostic studies constitute an essential component of the evaluation, as they can be used to confirm the diagnosis and to assess the severity of nerve damage. Additional tests, such as ultrasonography (US), plain film radiography and magnetic resonance imaging (MRI), are recommended in patients with vague clinical presentation or during preoperative work-up [ 1 , 5 – 7 , 13 – 25 ]. Based on published evidence we can expect that also diffusion tensor imaging may be soon added to the peripheral nerve assessment armamentarium [ 26 – 31 ].…”

Section: Introductionmentioning

confidence: 99%

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Shear-wave elastography: a new potential method to diagnose ulnar neuropathy at the elbow

Paluch¹,

Noszczyk²,

Nitek³

et al. 2018

Eur Radiol

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ObjectivesThe primary aim of this study was to verify if shear-wave elastography (SWE) can be used to diagnose ulnar neuropathy at the elbow (UNE). The secondary objective was to compare the cross-sectional areas (CSA) of the ulnar nerve in the cubital tunnel and to determine a cut-off value for this parameter accurately identifying persons with UNE.MethodsThe study included 34 patients with UNE (mean age, 59.35 years) and 38 healthy controls (mean age, 57.42 years). Each participant was subjected to SWE of the ulnar nerve at three levels: in the cubital tunnel (CT) and at the distal arm (DA) and mid-arm (MA). The CSA of the ulnar nerve in the cubital tunnel was estimated by means of ultrasonographic imaging.ResultsPatients with UNE presented with significantly greater ulnar nerve stiffness in the cubital tunnel than the controls (mean, 96.38 kPa vs. 33.08 kPa, p < 0.001). Ulnar nerve stiffness of 61 kPa, CT to DA stiffness ratio equal 1.68, and CT to MA stiffness ratio of 1.75 provided 100% specificity, sensitivity, positive and negative predictive value in the detection of UNE. Mean CSA of the ulnar nerve in the cubital tunnel turned out to be significantly larger in patients with UNE than in healthy controls (p < 0.001). A weak positive correlation was found in the UNE group between the ulnar nerve CSA and stiffness (R = 0.31, p = 0.008).ConclusionsSWE seems to be a promising, reliable and simple quantitative adjunct test to support the diagnosis of UNE.Key Points• SWE enables reliable detection of cubital tunnel syndrome• Significant increase of entrapped ulnar nerve stiffness is observed in UNE• SWE is a perspective screening tool for early detection of compressive neuropathies

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Shear-wave elastography: a new potential method to diagnose ulnar neuropathy at the elbow

Paluch¹,

Noszczyk²,

Nitek³

et al. 2018

Eur Radiol

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show abstract

“…Should this indeed have been the case, some of the patients might have been untreatable or should have undergone surgery sooner after the onset of complaints. Technical developments in nerve ultrasound 4 or MRI 16 might be helpful in further selecting patients for surgery, but studies on this subject have yet to be done. The modest results of ASTAFNUE should be mentioned when counseling patients with FNUE to manage their expectations.…”

Section: Discussionmentioning

confidence: 99%

Anterior subcutaneous transposition for persistent ulnar neuropathy after neurolysis

Gent¹,

Datema

Groen³

et al. 2017

FOC

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OBJECTIVE Little is known about optimal treatment if neurolysis for ulnar nerve entrapment at the elbow fails. The authors evaluated the clinical outcome of patients who underwent anterior subcutaneous transposition after failure of neurolysis of ulnar nerve entrapment (ASTAFNUE). METHODS A consecutive series of patients who underwent ASTAFNUE performed by a single surgeon between 2009 and 2014 was analyzed retrospectively. Preoperative and postoperative complaints in the following 3 clinical modalities were compared: pain and/or tingling, weakness, and numbness. Six-point satisfaction scores were determined on the basis of data from systematic telephonic surveys. RESULTS Twenty-six patients were included. The median age was 56 years (range 22–79 years). The median duration of complaints before ASTAFNUE was 23 months (range 8–78 months). The median interval between neurolysis and ASTAFNUE was 11 months (range 5–34 months). At presentation, 88% of the patients were experiencing pain and/or tingling, 46% had weakness, and 50% had numbness of the fourth and fifth fingers. Pain and/or tingling improved in 35%, motor function in 23%, and sensory disturbances in 19% of all the patients. Improvement in at least 1 of the 3 clinical modalities was found in 58%. However, a deterioration in 1 of the 3 modalities was noted in 46% of the patients. On the patient-satisfaction scale, 62% reported a good or excellent outcome. Patients with a good/excellent outcome were a median of 11 years younger than patients with a fair/poor outcome. No other factor was significantly related to satisfaction score. CONCLUSIONS A majority of the patients were satisfied after ASTAFNUE, even though their symptoms only partly resolved or even deteriorated. Older age is a risk factor for a poor outcome. Other factors that affect outcome might play a role, but they remain unidentified. One of these factors might be earlier surgical intervention. The modest results of ASTAFNUE should be mentioned when counseling patients after failure of neurolysis of ulnar nerve entrapment to manage their expectations. Patients, especially those who are elderly, might even consider not undergoing a secondary procedure. A randomized trial that includes a conservative treatment group and groups undergoing one of the several possible surgical procedures is needed to find the definitive answer for this clinical problem.

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Diagnostic Testing: Alternative Modalities

Fowler

Chenoweth

2019

Cubital Tunnel Syndrome

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MR anatomy and pathology of the ulnar nerve involving the cubital tunnel and Guyon’s canal

Cited by 27 publications

References 27 publications

Shear-wave elastography: a new potential method to diagnose ulnar neuropathy at the elbow

Shear-wave elastography: a new potential method to diagnose ulnar neuropathy at the elbow

Anterior subcutaneous transposition for persistent ulnar neuropathy after neurolysis

Diagnostic Testing: Alternative Modalities

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