Efficacy of shortwave diathermy in ulnar nerve entrapment at the elbow: a double-blind randomized controlled clinical trial.

OBJECTIVE: To investigate the efficacy of shortwave diathermy in treatment of ulnar nerve entrapment at the elbow. DESIGN: The study was a double blind, randomized controlled clinical trial. SETTING, PARTICIPANTS: A total of 76 adult patients diagnosed with ulnar nerve entrapment at the elbow clinically and electrophysiologically, were randomly assigned into two groups. Patients were evaluated at baseline, after completing treatment and 1 and 3 months after treatment. Physical examination, quick-DASH (disabilities of arm, shoulder, hand) and SF-36 (short form) questionnaires for daily life activities, dynamometer for grip strength, and visual analog scale for pain were used. INTERVENTION: A total of 10 sessions of shortwave diathermy were applied to patients in treatment group as five sessions/week, 2 weeks. Control group was given placebo shortwave diathermy. Both groups were given elbow splints and informed to avoid symptom provoking activities. MAIN OUTCOME MEASURES: Visual analog scale, grip strength, SF-36, and quick-DASH results. RESULTS: Out of 76 patients, 61 of them completed the study where n = 31 for treatment group and n = 30 for control group. Mean age was 46.18 ± 13.45 years. There were 32 (52.5%) women and 29 (47.5%) men. The p values between groups 3 months after intervention for visual analog scale, quick-DASH, SF-36 questionnaire, and dynamometer were 0.669, 0.277, 0.604, and 0.126, respectively (p > 0.05). CONCLUSION: Application of shortwave diathermy to patients with ulnar nerve neuropathy at the elbow was not associated with any difference in outcome.

Unusual case of hypotenar Hammer Syndrome and carpal tunnel syndrome association.

BACKGROUND AND AIM OF THE WORK: Hypothenar Hammer Syndrome is a relatively rare disease process caused by repetitive stress or injury to the hypothenar eminence leading to chronic injury to the ulnar artery. Our study reports an unusual case. METHODS: A 57 years old Plumber presented in April 2016 with a history of constant pain and recurrent paresthesia involving the fingers of the right hand for several months, over the previous 1 year, his hand had become more intolerant of exposure to cold temperatures. Angio-RNM and electromyography were performed and showed a severe double compression of ulnar and median nerve and an ulnar artery deformity without thrombosis. Surgery was performed under sedation and axillary anesthesia. RESULTS: After surgery patient' symptoms immediately improved, and within a few months, his hand had normalized. CONCLUSION: Hypothenar Hammer Syndrome is a rare disease process which manifests in certain occupations and activities that put undue stress on the hypothenar area. Furthermore, the carpal tunnel syndrome, a pressure damage of the median nerve, caused by repetitive manual tasks with flexion and extension of wrist has been added as well as hypothenar hammer syndrome which are vascular damages of hand caused by shock-type application of force.

Intraneural microcystic lymphatic malformation of the ulnar nerve at the Guyon canal: Unusual cause of ulnar pain in a child.

We present a case of an unusual cause of ulnar pain on a 9-year-old patient. The patient had pain on the ulnar side of the wrist after a fall. MRI showed a poorly defined lesion on the ulnar nerve at Guyon's canal. The initial diagnosis was traumatic neuropathy. Following conservative treatment of symptoms for one year, the pain started again. Therefore, a new MRI was performed where progression of the lesion was observed. Excision of the lesion was performed and the specimen sent for pathologic analysis. The diagnosis was of microcystic lymphatic malformation. The patient had a satisfactory evolution, with complete resolution. This is the first description of a microcystic lymphatic malformation in an intraneuronal location.

Isolated abductor digiti minimi palsy--an unusual case of Guyon's canal compression.

We present a case of isolated Abductor Digiti Minimi (ADM) palsy caused by an anomalous branch from the ulnar artery. Electrophysiology suggested selective involvement of the motor branch to the ADM in the Guyon's canal. Surgical exploration revealed an anomalous branch of the ulnar artery causing a pincer effect on the nerve to the ADM. Division and ligation of this branch effectively decompressed the nerve and the patient recovered satisfactorily. This report highlights the need to consider vascular aberrations as a differential diagnosis for ulnar neuropathy in Guyon's canal.

Severe ulnar nerve palsy caused by synovial chondromatosis arising from the pisotriquetral joint: a case report and review of literature.

We report here the unique case of 60-year-old man with severe ulnar nerve palsy caused by synovial chondromatosis arising from the pisotriquetral joint. At operation, the tumor entrapped the ulnar nerve proximal to the Guyon canal so that it was severely paralyzed. The ulnar neurovascular bundle could be separated safely under the microscope. To our knowledge, this type of severe neuropathy has not been reported before. Although synovial chondromatosis associated with peripheral nerve neuropathy is extremely rare, we should be aware of the existence of this type of compression neuropathy in the upper limb.

An elbow dislocation in a child with missed medial epicondyle fracture and late ulnar nerve palsy.

Elbow dislocations associated with a medial epicondyle fracture and ulnar nerve palsy are uncommon injuries. We present the case of an 11-year-old girl with an elbow dislocation treated by closed manual reduction. The medial epicondyle fracture was missed initially until she developed an ulnar nerve palsy 2 months later. Intraoperatively we discovered the bony epicondyle piercing the joint capsule and compressing the ulnar nerve. Removal of the bony fragment relieved her symptoms and she returned to normal activities at 1 year follow-up. We would like to highlight this rare occurrence and present the detailed history and management of this case.

The relationship between the pressure adjacent to the ulnar nerve and the disease causing cubital tunnel syndrome.

We investigated the relationship between cubital tunnel pressure in patients with cubital tunnel syndrome with osteoarthritis and those without osteoarthritis. We studied 31 elbows in 29 patients. We divided the patients into two groups: one associated with osteoarthritis and the other not associated with osteoarthritis. In the latter group, there was ulnar nerve subluxation in 10 elbows and cubitus valgus in 3. Cubital tunnel pressure was measured intraoperatively with a fiberoptic microtransducer. The extraneural pressure with the elbow flexed was significantly increased in patients with osteoarthritis and those without osteoarthritis. The pressure within the cubital tunnel in osteoarthritic elbows was significantly higher than that in those without osteoarthritis. Moreover, the pressure of osteoarthritic elbows significantly increased from proximally to distally within the cubital tunnel, whereas the pressure in elbows without osteoarthritis was high only proximally. Thus, cubital tunnel pressure could be a more important causative factor for cubital tunnel syndrome in the elbows with osteoarthritis than in those without osteoarthritis.

Lipofibromatous hamartoma: review of early diagnosis and treatment.

BACKGROUND: Lipofibromatous harmartoma (LFH) is a rare tumour that requires early diagnosis and treatment. To alert physicians to the possibility of this tumour, we review the epidemiologic and pathological characteristics, the presentation, diagnosis and treatment of LFH in the upper extremity. METHODS: We obtained data from a MEDLINE search of the English literature from 1966 to June 2003, using the search terms "lipofibromatous," "hamartomas of the nerve," "macrodactyly" and "intraneural lipoma." STUDY SELECTION: Articles that demonstrated institutional experience (epidemiologic, diagnostic and therapeutic, and complications) and those that provided general reviews were selected for inclusion. Of 501 identified articles, 42 fulfilled the review criteria. DATA EXTRACTION: Relevant clinical, diagnostic and therapeutic evaluations were extracted from the literature and synthesized. DATA SYNTHESIS: LFH is distinguished pathologically from other intraneural tumours by fibrofatty infiltration around the nerve fascicles. Typically, patients present either early with macrodactyly or later with a forearm mass lesion or symptoms consistent with a compressive neuropathy of the affected nerve. Although MRI is an important tool in the diagnosis of LFH, the diagnosis should be supported with a tissue biopsy. Treatment for patients with no neurologic deficit involves prophylactic decompression of affected nerves at all points of possible compression. Patients with macrodactyly may benefit from debulking, joint reconstruction or amputation. CONCLUSIONS: LFH differs from other benign nerve tumours with respect to clinical presentation, pathological characteristics, MRI features and management. Because LFH is extensive and inseparable from the nerve fascicles, excision is not recommended.

Occurrence of nerve entrapment lesion in chronic inflammatory demyelinating polyneuropathy.

OBJECTIVE: To evaluate the occurrence of nerve entrapment syndrome in chronic inflammatory demyelinating polyneuropathy (CIDP). METHODS: We retrospectively evaluated neurophysiologic results of 41 (25 male and 16 female, mean age 49.8, range 11-87) patients with CIDP. We evaluated the frequency of focal neurophysiologic lesion at entrapment site distinguishing two kinds of lesion: (a) true entrapment; and (b) false entrapment on the basis of nerve conduction results. RESULTS: Occurrence of focal aggression within the entrapment site is similar to that out of the entrapment site in all examined nerves. CONCLUSIONS: The entrapment sites are not an elective zone of focal autoimmune aggression in CIDP. Therefore, in CIDP patients a true entrapment, neurophysiologically demonstrated, could be a concomitant pathology and if a severe and persistent entrapment worsens functional deficit and symptoms, a surgical decompression could be useful.

Ulnar nerve entrapment at wrist associated with carpal tunnel syndrome.

In this study, ulnar nerve entrapments at the wrist were investigated using nerve conduction studies in cases with established diagnosis of carpal tunnel syndrome (CTS). Cases with cervical radiculopathy and polyneuropathy as well as patients with ulnar nerve entrapment at elbow were excluded from the study. Fifty-three cases (46 females, seven males) whose ages ranged between 20 and 72 years (mean: 49.31 +/- 13.78) were evaluated. Among 53 cases, 12 (22.6%) bilateral and 41 (77.3%) unilateral CTS were detected. Totally 65 wrists evaluated and prolongation of median nerve wrist-3rd digit distal sensory latencies (DSL; N: 59; 90.7%) and wrist-abductor pollicis brevis distal motor latencies (N: 48; 73.8%) were seen. In six wrists, diagnoses were established with the detection of an increase in the differences between wrist-4th digit DSL of median and ulnar nerve. This test was used if other test results were in normal limits. Prolongation of ulnar nerve wrist-5th digit DSL were found in 12 wrists (18.4%) in cases with CTS. Among these 12 wrists mild (N: 2), moderate (N: 7) and severe (N: 3) CTS were detected. Ulnar nerve motor conduction studies provided normal results. In conclusion, we are in the opinion that for the detection of associated ulnar nerve wrist entrapments, ulnar nerve conduction studies paying special attention to DSL convey importance in established cases with CTS.

Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow.

BACKGROUND: In the absence of a randomized, prospective study comparing different surgical approaches for decompression of the ulnar nerve at the elbow, the choice of an approach relies on the individual surgeon's training and experience. The present report describes the results of a prospective, long-term evaluation of the musculofascial lengthening technique in a large series of patients. In these patients, the degree of ulnar nerve compression was staged with use of a numerical grading system that included measures of both motor and sensory function. METHODS: From 1985 through 1991, 121 consecutive patients (161 extremities) in whom the ulnar nerve was entrapped at the elbow were treated with surgical decompression with use of a musculofascial lengthening technique. In addition to the patient history and physical examination, measurements of sensory and motor function were obtained prospectively to permit staging of the severity of the compression by means of a grading scale. The preoperative and postoperative scores on this scale were evaluated. The mean duration of follow-up after surgery was 45.6 months. RESULTS: On the basis of traditional criteria, 105 limbs (65%) had an excellent result; thirty-seven (23%), a good result; six (4%), a fair result; twelve (7.5%), a failure; and one (0.5%), a recurrence. There was significant improvement in ulnar nerve function in terms of both the sensory (p < 0.001) and motor (p < 0.001) components of the grading scale. Comparisons of clinical subgroups revealed significant improvement in patients with diabetes, those with a Workers' Compensation claim, and those who had a severe degree of compression rather than a mild degree of compression. CONCLUSION: Surgical decompression of ulnar nerve entrapment at the elbow by means of a musculofascial lengthening technique was associated with an 88% rate of good to excellent results. The results of the present study demonstrate the feasibility of performing a statistical analysis of surgical results by using a numerical grading system to stage the degree of nerve compression. This method may be used to study different surgical techniques for the treatment of this common nerve compression syndrome.

[Treatment of piso-triquetral pain by excision of the pisiform: report of fifteen cases]. / Traitement des douleurs piso-triquétrales par exérèse du pisiforme: à propos de 15 cas.

INTRODUCTION: Piso-triquetral joint could be painful and pisiformectomy can be the best procedure if conservative treatment have failed. The aim of this retrospective study was to evaluate clinical and functional results of pisiformectomy. MATERIAL AND METHOD: Thirteen patients with pisiformectomy were included in this retrospective study, 2 of them have bilateral procedure (n = 15). An ulnar neuropathy was associated in four cases. The average follow-up was 31.5 month. Professional traumatic injuries were the most common etiology. Surgical procedure was the same for all patients. Patients were reviewed clinically and subjective results were evaluated with an analogic scale (Eva). RESULTS: No postoperative complications were found. At the maximal follow-up, result was excellent for 12 cases, good for 2 cases and fair for one case. Analogic evaluation pain at maximal follow-up was 0.8 points compared to 6.4 points preoperatively (p < 0.001). Wrist range of motion was improved. DISCUSSION: Etiologies of piso-triquetral disorders were large and dominated by traumatic or microtraumatic injuries. Pisiformectomy is the best procedure if conservative treatment have failed. There is no place for piso-triquetral arthrodesis considering pisiformectomy's good results. Nevertheless, it's important to know that piso-triqueral disorder could be included in an authentic loco-regional disorder.

[Ulnar nerve compression and pseudoarthrosis of the medial metacarpal bases]. / Compression du nerf ulnaire et pseudarthrose des bases métacarpiennes médiales.

A case of compression of the deep branch of the ulnar nerve associated with pseudarthrosis of the base of the fifth metacarpal and the upper shaft of the fourth metacarpal is reported. The delayed procedure consisted in volar decompression of the ulnar nerve by dividing the pisi-hamate ligament and plating and grafting of both fractures. The patient achieved marked improvement four weeks post-operatively and had complete functional recovery at follow-up of 16 years after injury without narrowing of the hamato-metacarpal joint despite synostosis of the bases of the medial metacarpals.

Quantificação do grau de melhora da força de preensão palmar em pacientes portadores de hanseníase submetidos a neurólise dos nervos ulnar e mediano: relato de um caso / Quantification of the degree of improvement of the hold force to palmar in carrying patients of hanseníase submitted neurólise of the nerves to ulnar and medium: story of a case

O presente trabalho teve como objetivo quantificar o grau de melhora da força de preensão palmar nos pacientes hansenianos com sequelas da mão. Trata-se de um estudo de caso com um paciente portador de hanseníase e o instrumento utilizado na coleta de dados foi o dinamômetro Jamar que esteve auxiliando o estudo antes e depois da neurólise dos nervos ulnar e mediano. Conclui-se com este estudo que o dinamômetro Jamar é um instrumento confiável e seguro para detectar a perda da força de preensão palmar de uma pessoa e, para precisão dos resultados, padroniza-se a manopla do aparelho na posição 2 e a posição do paciente, sempre alternando os membros com intervalo de um minuto para evitar fadiga muscular. A neurólise é eficaz para liberar o nervo e, após este procedimento cirúrgico, utiliza-se tala gessada no membro e, posteriormente inicia-se a reabilitação. É através da Fisioterapia que o paciente consegue maior recuparação e mobilidade do membro afetado