Regional Ulnar Nerve Strain Following Decompression and Anterior Subcutaneous Transposition in Patients With Cubital Tunnel Syndrome

Foran, Ian M.; Vaz, Kenneth; Sikora‐Klak, Jakub; Ward, Samuel R.; Hentzen, Eric R.; Shah, Sameer B.

doi:10.1016/j.jhsa.2016.07.095

Cited by 16 publications

(15 citation statements)

References 26 publications

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“…The observed homogenization of strain distributions after decompressing the mesoneurium (Fig. E and F) is consistent with a similar redistribution observed in rat sciatic nerves and in patients with cubital tunnel syndrome after circumferential decompression . The concurrent reduction in strain, also noted by Foran et al ., is likely due to the longitudinal relocation of the strain to proximal or distal regions that could not be visualized.…”

Section: Discussionsupporting

confidence: 89%

“…1E and F) is consistent with a similar redistribution observed in rat sciatic nerves and in patients with cubital tunnel syndrome after circumferential decompression. 24,29 The concurrent reduction in strain, also noted by Foran et al, 24 is likely due to the longitudinal relocation of the strain to proximal or distal regions that could not be visualized. Alternatively, although we did not observe obvious subluxation of the nerve during joint manipulation, reduced strain may also reflect subtle alterations to the nerve course through its bed.…”

Section: Mesoneurial Effects On Epineurial Strain Distributionmentioning

confidence: 86%

“…Epineurial strain was measured based on methods previously used in rat sciatic nerves and in the human upper extremity (see additional details in Methods and Fig. S1 in the Supplementary Material online).…”

Section: Methodsmentioning

confidence: 99%

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Decoupled epineurial and axonal deformation in mouse median and ulnar nerves

et al. 2019

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Introduction Peripheral nerves accommodate mechanical loads during joint movement. Hypothesized protective features include increased nerve compliance near joints and axonal undulation. How axons perceive nerve deformation is poorly understood. We tested whether nerves increase local axonal undulation in regions of high epineurial strain to protect nerve fibers from strain‐induced damage. Methods Regional epineurial strain was measured near the elbow in median and ulnar nerves of mice expressing axonal fluorescence before and after decompression. Regional axonal tortuosity was quantified under confocal microscopy. Results Nerves showed higher epineurial strain just distal to the medial epicondyle; these differences were eliminated after decompression. Axonal tortuosity also varied regionally; however, unlike in the epineurium, it was greater in proximal regions. Discussion In this study we have proposed a neuromechanical model whereby axons can unravel along their entire length due to looser mechanical coupling to the peri/epineurium. Our findings have major implications for understanding nerve biomechanics and dysfunction. Muscle Nerve 59:619–619, 2019

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Section: Discussionsupporting

confidence: 89%

Section: Mesoneurial Effects On Epineurial Strain Distributionmentioning

confidence: 86%

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Decoupled epineurial and axonal deformation in mouse median and ulnar nerves

et al. 2019

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“…Using a tissue marking pen, five epineurial markers were placed along the exposed nerve, with the most proximal marker at the level of the quadratus femoris muscle and most distal marker at the level of the trifurcation (Figure 1). The region between the first and third marker was designated as “mid-femoral,” while the region between the third and fifth marker was defined as “distal-femoral.” Strain across the entire exposed region (mean strain), maximum strain between any two adjacent markers, and regional nerve strain in the mid-femoral and distal-femoral regions were calculated, using methods similar to those previously published (Abe et al., 2005; Foran et al., 2016; Mahan et al., 2015; Phillips et al., 2004; Schuind et al., 1995). Briefly, strain was measured based on the marker-to-marker distance in a configuration with the knee extended to 0° and the ankle maximally dorsiflexed (nerve stretched) relative to a configuration with the knee flexed to 90° and ankle maximally plantarflexed (nerve relaxed).…”

Section: Methodsmentioning

confidence: 99%

“…Several studies have speculated that the paraneurium may guide the trajectory of peripheral nerves and facilitate low-friction nerve “gliding” (Butler, 2000; Mazal and Millesi, 2005; Millesi et al., 1995; Smith, 1966). Bolstering this possibility is evidence that the pathologic counterpart of the paraneurium – paraneurial adhesions – contributes to entrapment neuropathies by abnormally tethering the nerve to surrounding structures, resulting in impingement, traction, and supraphysiologic strain (Abe et al., 2005; Foran et al., 2016; Ochi et al., 2014; Topp and Boyd, 2006). As adhesions are believed to increase the risk for recurrent entrapment (Botte et al., 1996; McCall et al., 2001; Steyers, 2002), the mainstay of surgical management of these syndromes involves decompression or neural transposition, with the intent of relieving traction on the nerve (Foran et al., 2016; Millesi et al., 1993).…”

Section: Introductionmentioning

confidence: 99%

Native paraneurial tissue and paraneurial adhesions alter nerve strain distribution in rat sciatic nerves

Foran

Hussey

Patel

et al. 2017

J Hand Surg Eur Vol

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Paraneurial adhesions have been implicated in the pathological progression of entrapment neuropathies. Surgical decompression of adhesions is often performed, with the intent of restoring nerve kinematics. The normal counterpart of adhesions, native paraneurium, is also thought to influence nerve deformation and mobility. However, influences of native or abnormal paraneurial structures on nerve kinematics have not been investigated. We measured regional strains in rat sciatic nerves before and immediately after decompression of native paraneurial tissue, and before and after decompression of abnormal paraneurial adhesions, which formed within 6 weeks of the initial decompression. Strain was significantly higher in the distal-femoral than in the mid-femoral region of the nerve before either decompression. Decompression of native and abnormal paraneurial tissue removed this regional strain difference. Paraneurial tissues appear to play a major role in distributing peripheral nerve strain. Normal nerve strain distributions may be reconstituted following decompression, even in the presence of paraneurial adhesions.

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Cubital tunnel perfusion in different postures—An anatomical investigation

Rossmann

Heber

et al. 2021

Muscle and Nerve

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Introduction/Aims: For cubital tunnel syndrome, the avoidance of predisposing arm positions and the use of elbow splints are common conservative treatment options.The rationale is to prevent excessive stretching and compression of the nerve in the cubital tunnel, as this mechanical stress impedes intraneural perfusion. Data regarding those upper extremity postures to avoid, or whether elbow flexion alone is detrimental, are inconsistent. This study aimed to assess perfusion and size changes of the cubital tunnel during different postures in an experimental cadaver setup.Methods: Axillary arteries in 30 upper extremities of fresh cadavers were injected with ultrasound contrast agent. High-resolution ultrasound of the cubital tunnel was performed during five different arm postures that gradually increased tension on the ulnar nerve and caused cubital tunnel narrowing. Contrast enhancement within the tunnel was measured to quantify perfusion. Cubital tunnel crosssectional area was measured to detect compression.Results: Increasing tension significantly reduced perfusion. When isolated, neither shoulder elevation, elbow flexion, pronation, nor extension of wrist and fingers impaired perfusion. However, combining two or more of these postures led to significant decreases. Significant narrowing of the cubital tunnel was seen in full elbow flexion and shoulder elevation.Discussion: Combinations of some upper extremity joint positions reduce nerve perfusion, but isolated elbow flexion does not have a significant impact. We hypothesize that elbow splints alone may not influence cubital tunnel perfusion but may only prevent direct compression of the ulnar nerve. Advising patients about upper extremity postures that should be avoided may be more effective.

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Regional Ulnar Nerve Strain Following Decompression and Anterior Subcutaneous Transposition in Patients With Cubital Tunnel Syndrome

Cited by 16 publications

References 26 publications

Decoupled epineurial and axonal deformation in mouse median and ulnar nerves

Decoupled epineurial and axonal deformation in mouse median and ulnar nerves

Native paraneurial tissue and paraneurial adhesions alter nerve strain distribution in rat sciatic nerves

Cubital tunnel perfusion in different postures—An anatomical investigation

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