Shoulder position increases ulnar nerve strain at the elbow of patients with cubital tunnel syndrome

Ochi, Kensuke; Homma, Yukio; Horiuchi, Kiyomi; Iwamoto, Takuji; Morisawa, Yasushi; Sato, Kazuki

doi:10.1016/j.jse.2015.01.014

Cited by 9 publications

(5 citation statements)

References 21 publications

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“…Previous studies have shown that strain in the median and ulnar nerves increases during shoulder elevation. 31 , 32 One possible explanation for the improved shoulder ROM is the reduced irritability of the median and ulnar nerves after surgical decompression, which in turn allowed the nerves to withstand traction better.…”

Section: Discussionmentioning

confidence: 99%

“Idiopathic” Shoulder Pain and Dysfunction from Carpal Tunnel Syndrome and Cubital Tunnel Syndrome

Hagiwara

Nakamura

Sonoki

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: As a referral center for chronic pain, we see many patients with “idiopathic” shoulder pain and limited range of motion. The combination of mild or subclinical carpal tunnel syndrome and cubital tunnel syndrome may be an underrecognized etiology of symptoms in such patients. Here, we report our treatment algorithm and results for such patients. Methods: Of patients with a chief complaint of shoulder pain, we identified 56 consecutive patients who had pain or tingling with median nerve compression at the proximal wrist crease and positive Tinel’s around the cubital tunnel. They were first provided a night-time wrist orthosis. If still symptomatic, nerve blocks were given to median and ulnar nerves under ultrasound guidance. If symptoms recurred after nerve blocks, nerve conduction studies and surgical release of affected nerves were performed. Results: Six patients had 60% or more pain relief with orthosis (mean 4.7 ± 0.8 (SD) to 2.2 ± 0.8). Twenty-three patients had nerve blocks and had persistent pain relief (6.0 ± 1.7 to 2.1 ± 1.9) and significant shoulder motion improvement. Twenty-seven patients only had temporal relief and required surgery but postoperatively had persistent pain relief (6.2 ± 2.0 to 1.2 ± 1.0) and improved shoulder motion. qDASH improved from 33.4 ± 20.1 preoperatively to 12.2 ± 7.4 postoperatively. Conclusions: All patients had substantial improvement in shoulder pain and motion with compressive neuropathy treatments. Targeted physical examination can identify these patients, who can have significant improvement with appropriate diagnosis and treatment. The study sheds light on an underrecognized cause of shoulder dysfunction.

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Section: Discussionmentioning

confidence: 99%

“Idiopathic” Shoulder Pain and Dysfunction from Carpal Tunnel Syndrome and Cubital Tunnel Syndrome

Hagiwara

Nakamura

Sonoki

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…These were supplied by Dissect (Birmingham, UK). Similar to other studies, [7,15,[22][23][24] two 4-0 proline sutures were placed proximal to the cubital tunnel into the epineurium to avoid injuring the nerve or leaving it susceptible to tearing. Epineurial elongation was used as a measure of intraneural elongation of the ulnar nerve.…”

Section: Strain Measurementmentioning

confidence: 96%

“…Epineurial elongation was used as a measure of intraneural elongation of the ulnar nerve. [7,15,22,25] Sutures were placed approximately 2 cm apart, with the arm placed in the neutral position (shoulder abduction 90° and elbow at maximum extension). Surgical reference rulers were pinned onto the surrounding tissue to allow subsequent calibration.…”

Section: Strain Measurementmentioning

confidence: 99%

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The effect of shoulder abduction and medial epicondylectomy on ulnar nerve strain: A preliminary study

Barberio¹,

Chaudhry²,

Power³

et al. 2019

J Musculoskelet Surg Res

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The primary aim was to determine whether a dynamic suture marker method of measuring ulnar nerve strain yields comparable results to strain gauges. The secondary aim was to assess the effect of elbow flexion, shoulder abduction and medial epicondylectomy on strain. Methods: In four embalmed elbows, ulnar nerve strain was measured using suture markers during elbow flexion and shoulder abduction before and after medial epicondylectomy. Linear regression analysis and Wilcoxon signed-rank test were used to analyse the results. Results: Ulnar nerve strain increased in direct proportion to elbow flexion angle before and after medial epicondylectomy, with one exception. At 90° shoulder abduction, strain was 0%-17%. Strain was greatest at 90° and least at 110° before and after medial epicondylectomy, P > 0.05. The effect of medial epicondylectomy varied. Strain was reduced at 90° by 5%, at 110° by 0% and at 120° by 1%; P > 0.05. Conclusions: The suture marker method yielded comparable results to strain gauges. Both shoulder abduction and medial epicondylectomy did not have statistically significant effects on ulnar nerve strain. However, only four embalmed elbows were studied in this preliminary study, so a large difference would be needed to produce a significant change. The finding that medial epicondylectomy fails to reduce strain raises questions about its role in treating cubital tunnel syndrome and highlights the need for further research. The authors believe that the technique described for dynamic strain assessment is applicable in an in vivo setting and therefore, should be used to compare strain properties of cadaveric and in vivo nerves.

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“…The ulnar nerve originates from the ulnar sulcus and enters the cubital tunnel posterior to the medial epicondyle and medial to the olecranon and runs between the ulnar and humeral heads of flexor carpi ulnaris [4]. Previous studies demonstrated that soft tissues, such as retinaculum, fibrous band, and anconeus, cause ulnar nerve compression [1,3,5,6], whereas other studies showed that the bony structure [7][8][9] causes strain of the ulnar nerve that runs directly behind the medial epicondyle constituting the boundary of the cubital tunnel during elbow flexion [10]. However, no studies on the association of the shape of the bony structure with CuTS symptoms have been conducted.…”

Section: Introductionmentioning

confidence: 99%

Validity of computed tomographic measurements and morphological comparison of cubital tunnel in idiopathic cubital tunnel syndrome

Lee

Hwang

Choy

2020

BMC Musculoskelet Disord

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Background: Ulnar neuropathy is a common reason for referral to hand surgeons, and 10 to 30% of cubital tunnel syndrome (CuTS) is idiopathic. We hypothesized that the cause of idiopathic CuTS is in the bony structure. Methods: We analyzed 79 elbows (39 idiopathic CuTS and 40 without CuTS symptom) using computed tomography and Materialize Mimics software to compare the differences between the two groups. We proposed a new bony cubital tunnel with a new boundary that could play a role in ulnar nerve compression symptom. Results: The mean cubital tunnel volume was 1245.6 mm 3 in all patients, 1180.6 mm 3 in CuTS patients, and 1282.3 mm 3 in the control group. A significant difference (p = 0.015) between two groups was found. Bony cubital tunnel cross-sectional area, cubital tunnel depth, and cubital tunnel angle also showed significant differences. Conclusion: The shape of the bony cubital tunnel is an important cause of CuTS, and the normal variation of the volume and cross-sectional area of the cubital tunnel and cubital tunnel angle could influence the occurrence of idiopathic CuTS.

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Shoulder position increases ulnar nerve strain at the elbow of patients with cubital tunnel syndrome

Cited by 9 publications

References 21 publications

“Idiopathic” Shoulder Pain and Dysfunction from Carpal Tunnel Syndrome and Cubital Tunnel Syndrome

“Idiopathic” Shoulder Pain and Dysfunction from Carpal Tunnel Syndrome and Cubital Tunnel Syndrome

The effect of shoulder abduction and medial epicondylectomy on ulnar nerve strain: A preliminary study

Validity of computed tomographic measurements and morphological comparison of cubital tunnel in idiopathic cubital tunnel syndrome

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