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1.
Sci Rep ; 14(1): 15595, 2024 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-38971864

RESUMO

Diabetes mellitus (DM) is a risk factor for the development of ulnar nerve entrapment (UNE). Differences in surgical outcomes for UNE between patients with and without DM have been reported, but studies on presurgical management are scarce. This study aimed to evaluate the presurgical management of UNE in patients with (DM diagnosis < 2 years of UNE diagnosis) and without DM regarding the level of care for diagnosis and the proportion that proceeds to surgery. Data from 6600 patients with UNE between 2004 and 2019 were included from the Skåne Health Care Register (SHR) and cross-linked with data from the Swedish National Diabetes Register (NDR). The group with UNE and DM was compared to the group with UNE without DM and prevalence ratios were calculated using Cox regression analysis. Patients with DM more often got their first UNE diagnosis in secondary care than in primary care (643/667, 96% vs. 5361/5786; 93%). Patients with and without DM, regardless of the type of DM, presence of retinopathy, or HbA1c levels, were surgically treated for UNE to the same extent (258/667, 39% of patients with DM vs. 2131/5786, 37% of patients without DM). The proportion of surgically treated was significantly lower among patients diagnosed with UNE in primary care compared to secondary care (59/449, 13% vs. 2330/5786, 38%). Men were more often surgically treated than women (1228/3191, 38% vs.1161/3262 36%). Patients with UNE and DM are surgically treated to the same extent as patients with UNE but without DM and are more likely to be diagnosed in specialized care.


Assuntos
Síndromes de Compressão do Nervo Ulnar , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Síndromes de Compressão do Nervo Ulnar/cirurgia , Síndromes de Compressão do Nervo Ulnar/etiologia , Idoso , Suécia/epidemiologia , Diabetes Mellitus/cirurgia , Adulto , Sistema de Registros , Nervo Ulnar/cirurgia , Fatores de Risco
2.
PLoS One ; 19(6): e0306327, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38941288

RESUMO

PURPOSE: Pain in conjunction with surgery for ulnar nerve entrapment at the elbow is seldom highlighted in the literature. This study aimed to explore patients' experiences of living with chronic pain (≥3 months duration) in conjunction with surgery for ulnar nerve entrapment at the elbow, the consequences and the coping strategies applied. MATERIAL AND METHODS: In-depth interviews were conducted with 10 participants aged 18-60 years. The narratives were analyzed using an inductive approach and content-analysis. RESULTS: The analysis revealed seven main categories: "Physical symptoms/impairments" and "Mood and emotions"comprise symptoms caused by ulnar nerve entrapment at the elbow and chronic pain; "Consequences in daily life" includes challenges and obstacles in every-day life, impact on leisure activities and social life; "Struggling with self-image" embraces experiences closely related to identity; "Coping strategies" covers adaptive resources; "Experience of relief "describes perceived improvements; "Key message for future care" comprises important aspects for healthcare providers to consider. CONCLUSIONS: The results clarify the need for healthcare personnel to adopt a biopsychosocial approach when treating patients with ulnar nerve entrapment at the elbow. Emotional symptoms and sleep disturbances should be identified and treated properly since they contribute to the heavy burden experienced by the individual.


Assuntos
Dor Crônica , Cotovelo , Pesquisa Qualitativa , Síndromes de Compressão do Nervo Ulnar , Humanos , Adulto , Feminino , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão do Nervo Ulnar/cirurgia , Adolescente , Dor Crônica/cirurgia , Dor Crônica/psicologia , Cotovelo/cirurgia , Adulto Jovem , Adaptação Psicológica , Nervo Ulnar/cirurgia
3.
BMC Musculoskelet Disord ; 25(1): 463, 2024 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-38872094

RESUMO

BACKGROUND: Double crush syndrome refers to a nerve in the proximal region being compressed, affecting its proximal segment. Instances of this syndrome involving ulnar and cubital canals during ulnar neuropathy are rare. Diagnosis solely through clinical examination is challenging. Although electromyography (EMG) and nerve conduction studies (NCS) can confirm neuropathy, they do not incorporate inching tests at the wrist, hindering diagnosis confirmation. We recently encountered eight cases of suspected double compression of ulnar nerve, reporting these cases along with a literature review. METHODS: The study included 5 males and 2 females, averaging 45.6 years old. Among them, 4 had trauma history, and preoperative McGowan stages varied. Ulnar neuropathy was confirmed in 7 cases at both cubital and ulnar canal locations. Surgery was performed for 4 cases, while conservative treatment continued for 3 cases. RESULTS: In 4 cases with wrist involvement, 2 showed ulnar nerve compression by a fibrous band, and 1 had nodular hyperplasia. Another case displayed ulnar nerve swelling with muscle covering. Among the 4 surgery cases, 2 improved from preoperative McGowan stage IIB to postoperative stage 0, with significant improvement in subjective satisfaction. The remaining 2 cases improved from stage IIB to IIA, respectively, with moderate improvement in subjective satisfaction. In the 3 cases receiving conservative treatment, satisfaction was significant in 1 case and moderate in 2 cases. Overall, there was improvement in hand function across all 7 cases. CONCLUSION: Typical outpatient examinations make it difficult to clearly differentiate the two sites, and EMG tests may not confirm diagnosis. Therefore, if a surgeon lacks suspicion of this condition, diagnosis becomes even more challenging. In cases with less than expected postoperative improvement in clinical symptoms of cubital tunnel syndrome, consideration of double crush syndrome is warranted. Additional tests and detailed EMG tests, including inching tests at the wrist, may be necessary. We aim to raise awareness double crush syndrome with ulnar nerve, reporting a total of 7 cases to support this concept.


Assuntos
Eletromiografia , Síndromes de Compressão do Nervo Ulnar , Nervo Ulnar , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Síndromes de Compressão do Nervo Ulnar/cirurgia , Síndromes de Compressão do Nervo Ulnar/diagnóstico , Síndromes de Compressão do Nervo Ulnar/etiologia , Síndromes de Compressão do Nervo Ulnar/fisiopatologia , Nervo Ulnar/cirurgia , Nervo Ulnar/fisiopatologia , Síndrome de Esmagamento/cirurgia , Síndrome de Esmagamento/diagnóstico , Síndrome de Esmagamento/complicações , Síndrome de Esmagamento/fisiopatologia , Punho/inervação , Condução Nervosa/fisiologia , Cotovelo/inervação , Cotovelo/cirurgia , Resultado do Tratamento , Idoso
4.
J Hand Surg Eur Vol ; 49(6): 712-720, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38641934

RESUMO

Peripheral nerve injuries present a complex clinical challenge, requiring a nuanced approach in surgical management. The consequences of injury vary, with sometimes severe disability, and a risk of lifelong pain for the individual. For late management, the choice of surgical techniques available range from neurolysis and nerve grafting to tendon and nerve transfers. The choice of technique utilized demands an in-depth understanding of the anatomy, patient demographics and the time elapsed since injury for optimized outcomes. This paper focuses on injuries to the radial, median and ulnar nerves, outlining the authors' approach to these injuries.Level of evidence: IV.


Assuntos
Traumatismos dos Nervos Periféricos , Extremidade Superior , Humanos , Traumatismos dos Nervos Periféricos/cirurgia , Extremidade Superior/inervação , Extremidade Superior/lesões , Extremidade Superior/cirurgia , Nervo Ulnar/lesões , Nervo Ulnar/cirurgia , Tempo para o Tratamento , Nervo Mediano/lesões , Nervo Mediano/cirurgia , Nervo Radial/lesões , Nervo Radial/cirurgia , Procedimentos Neurocirúrgicos/métodos
5.
Microsurgery ; 44(4): e31178, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38661385

RESUMO

BACKGROUND: Transfer of the fascicle carrying the flexor carpi ulnaris (FCU) branch of the ulnar nerve (UN) to the biceps/brachialis muscle branch of the musculocutaneous nerve (Oberlin's procedure), is a mainstay technique for elbow flexion restoration in patients with upper brachial plexus injury. Despite its widespread use, there are few studies regarding the anatomic location of the donor fascicle for Oberlin's procedure. Our report aims to analyze the anatomical variability of this fascicle within the UN, while obtaining quantifiable, objective data with intraoperative neuromonitoring (IONM) for donor fascicle selection. METHODS: We performed a retrospective review of patients at our institution who underwent an Oberlin's procedure from September 2019 to July 2023. We used IONM for donor fascicle selection (greatest FCU muscle and least intrinsic hand muscle activation). We prospectively obtained demographic and electrophysiological data, as well as anatomical location of donor fascicles and post-surgical morbidities. Surgeon's perception of FCU/intrinsic muscle contraction was compared to objective muscle amplitude during IONM. RESULTS: Eight patients were included, with a mean age of 30.5 years and an injury-to-surgery interval of 4 months. Donor fascicle was located anterior in two cases, posterior in two, radial in two and ulnar in two patients. Correlation between surgeon's perception and IONM findings were consistent in six (75%) cases. No long term motor or sensory deficits were registered. CONCLUSIONS: Fascicle anatomy within the UN at the proximal arm is highly variable. The use of IONM can aid in optimizing donor fascicle selection for Oberlin's procedure.


Assuntos
Monitorização Neurofisiológica Intraoperatória , Transferência de Nervo , Nervo Ulnar , Humanos , Estudos Retrospectivos , Adulto , Masculino , Feminino , Nervo Ulnar/cirurgia , Nervo Ulnar/anatomia & histologia , Transferência de Nervo/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Plexo Braquial/anatomia & histologia , Plexo Braquial/cirurgia , Plexo Braquial/lesões , Músculo Esquelético , Adulto Jovem , Neuropatias do Plexo Braquial/cirurgia , Pessoa de Meia-Idade
6.
Acta Orthop Belg ; 90(1): 63-66, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38669651

RESUMO

Ulnar nerve release is often performed under general anaesthesia. Wide Awake Local Anaesthesia No Tourniquet (WALANT) is a new anaesthetic method increasingly used by hand surgeons in an outpatient setting. It has advantages such as the possibility to shift surgical interventions out of the regular surgical theatre settings into an outpatient clinical setting, no risk of complications or side effects resulting from regional and general anesthesia and decreased costs. The use of WALANT has not been investigated extensively in elbow surgery. This study aims to evaluate clinical outcomes after ulnar nerve release under WALANT 27 patients with ulnar nerve release for cubital tunnel syndrome were included. The primary outcome was the presence of (remaining) symptoms after ulnar nerve release. Data was extracted from medical records. 13 out of 27 patients had (mild) remaining symptoms after ulnar nerve release, and 1 complication (superficial wound infection) was seen. Ulnar nerve release under WALANT is safe and effective in patients with primary ulnar nerve entrapment that have failed conservative therapy.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Anestesia Local , Anestésicos Locais , Síndrome do Túnel Ulnar , Humanos , Anestesia Local/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Síndrome do Túnel Ulnar/cirurgia , Adulto , Procedimentos Cirúrgicos Ambulatórios/métodos , Anestésicos Locais/administração & dosagem , Idoso , Nervo Ulnar/cirurgia , Torniquetes , Resultado do Tratamento , Estudos Retrospectivos
7.
J Hand Surg Am ; 49(4): 346-353, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38323947

RESUMO

PURPOSE: Microsuture neurorrhaphy is technically challenging and has inherent drawbacks. This study evaluated the potential of a novel, sutureless nerve coaptation device to improve efficiency and precision. METHODS: Twelve surgeons participated in this study-six attending hand/microsurgeons and six trainees (orthopedic and plastic surgery residents or hand surgery fellows). Twenty-four cadaver arm specimens were used, and nerve repairs were performed at six sites in each specimen-the median and ulnar nerves in the proximal forearm, the median and ulnar nerves in the distal forearm, and the common digital nerves to the second and third web spaces. Each study participant performed nerve repairs at all six injury locations in two different cadaver arms (n = 12 total repairs for each participating surgeon). The nerve repairs were timed, tested for tensile strength, and graded for alignment and technical repair quality. RESULTS: A substantial reduction in time was required to perform repairs with the novel coaptation device (1.6 ± 0.8 minutes) compared with microsuture (7.2 ± 3.6 minutes). Device repairs were judged clinically acceptable (scoring "Excellent" or "Good" by most of the expert panel) in 97% of the repairs; the percentage of suture repairs receiving Excellent/Good scores by most of the expert panel was 69.4% for attending surgeons and 36.1% for trainees. The device repairs exhibited a higher average peak tensile force (7.0 ± 3.6 N) compared with suture repairs (2.6 ± 1.6 N). CONCLUSIONS: Nerve repairs performed with a novel repair device were performed faster and with higher technical precision than those performed using microsutures. Device repairs had substantially greater tensile strength than microsuture repairs. CLINICAL RELEVANCE: The evaluated novel nerve repair device may improve surgical efficiency and nerve repair quality.


Assuntos
Mãos , Nervos Periféricos , Humanos , Nervos Periféricos/cirurgia , Mãos/cirurgia , Nervo Ulnar/cirurgia , Braço , Cadáver , Técnicas de Sutura
8.
Handchir Mikrochir Plast Chir ; 56(1): 101-105, 2024 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-38359863

RESUMO

INTRODUCTION: A supracondylar process is a bony spur on the distal anteromedial surface of the humerus, and it is considered an anatomical variant with a prevalence of 0.4-2.7% according to anatomical studies. In almost all cases, it is associated with a fibrous, sometimes ossified ligament, which extends from the supracondylar process to the medial epicondyle. This ligament is known in the literature as the ligament of Struthers, named after the Scottish anatomist who first described it in detail in 1854. In rare cases, the supracondylar process can be a clinically relevant finding as a cause of nerve compression syndrome. The median and ulnar nerve can be trapped by the ring-shaped structure formed by the ligament of Struthers and the supracondylar process. CASE REPORT: A 59-year-old patient with symptoms of a cubital tunnel syndrome and additional ipsilateral sensory deficits in his thumb was referred to our clinic. Electroneurography showed no signs of an additional carpal tunnel syndrome. Preoperative x-ray and CT scans of the upper arm revealed a supracondylar process, which led us to suspect an associated entrapment of the median nerve. An MRI scan of the upper arm showed a ligament of Struthers and signs of a related median nerve compression as we initially assumed. We performed a surgical decompression of the median nerve in the distal upper arm and of the ulnar nerve in the cubital tunnel. Intraoperatively, there was evidence of compression of the median nerve due to the supracondylar process and the ligament of Struthers. The latter was cleaved and then resected along with the supracondylar process. Three months after surgery, the patient had no motor or sensory deficits. SUMMARY: The ring-shaped structure formed by the supracondylar process and ligament of Struthers represents a rare cause of compression syndrome of the median and ulnar nerve. Its incidence remains unknown so far. This anatomical variant should be considered a differential diagnosis in case of possibly related nerve entrapment symptoms after ruling out other, more frequent nerve compression causes. Moreover, the supracondylar process should be completely resected including the periosteum during surgery to minimise the risk of recurrence.


Assuntos
Síndrome do Túnel Carpal , Síndromes de Compressão Nervosa , Humanos , Pessoa de Meia-Idade , Nervo Mediano/cirurgia , Ligamentos/cirurgia , Úmero/diagnóstico por imagem , Úmero/cirurgia , Úmero/inervação , Braço , Nervo Ulnar/cirurgia , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/cirurgia , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/cirurgia
9.
JBJS Case Connect ; 14(1)2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38207087

RESUMO

CASES: We present 2 cases of median nerve reconstruction using distal nerve transfers after resection of unusual benign median nerve tumors. Critical sensation was restored in case 1 by transferring the fourth common digital nerve to first web digital nerves. Thumb opposition was regained by transferring the abductor digiti minimi ulnar motor nerve branch to the recurrent median motor nerve branch. Critical sensation was restored in case 2 by transferring the long finger ulnar digital nerve to the index finger radial digital nerve. CONCLUSION: Distal nerve transfers, even with short grafts, are reliable median nerve deficit treatments, sparing the need for larger autologous nerve grafts and late tendon opponensplasties.


Assuntos
Nervo Mediano , Transferência de Nervo , Humanos , Nervo Mediano/cirurgia , Dedos/cirurgia , Dedos/inervação , Nervo Ulnar/cirurgia , Nervo Radial/cirurgia
10.
Bone Joint J ; 106-B(2): 212-218, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38295855

RESUMO

Aims: Medial humeral epicondyle fractures (MHEFs) are common elbow fractures in children. Open reduction should be performed in patients with MHEF who have entrapped intra-articular fragments as well as displacement. However, following open reduction, transposition of the ulnar nerve is disputed. The aim of this study is to evaluate the need for ulnar nerve exploration and transposition. Methods: This was a retrospective cohort study. The clinical data of patients who underwent surgical treatment of MHEF in our hospital from January 2015 to January 2022 were collected. The patients were allocated to either transposition or non-transposition groups. Data for sex, age, cause of fracture, duration of follow-up, Papavasiliou and Crawford classification, injury-to-surgery time, preoperative ulnar nerve symptoms, intraoperative exploration of ulnar nerve injury, surgical incision length, intraoperative blood loss, postoperative ulnar nerve symptoms, complications, persistent ulnar neuropathy, and elbow joint function were analyzed. Binary logistic regression analysis was used for statistical analysis. Results: A total of 124 patients were followed up, 50 in the ulnar nerve transposition group and 74 in the non-transposition group. There were significant differences in ulnar nerve injury (p = 0.009), incision length (p < 0.001), and blood loss (p = 0.003) between the two groups. Binary logistic regression analysis revealed that preoperative ulnar nerve symptoms (p = 0.012) were risk factors for postoperative ulnar nerve symptoms. In addition, ulnar nerve transposition did not affect the occurrence of postoperative ulnar nerve symptoms (p = 0.468). Conclusion: Ulnar nerve transposition did not improve clinical outcomes. It is recommended that the ulnar nerve should not be transposed when treating MHEF operatively.


Assuntos
Fraturas do Úmero , Nervo Ulnar , Criança , Humanos , Nervo Ulnar/cirurgia , Estudos Retrospectivos , Fraturas do Úmero/cirurgia , Cotovelo , Úmero , Resultado do Tratamento
11.
J Shoulder Elbow Surg ; 33(5): 1092-1103, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38286182

RESUMO

BACKGROUND: Ulnar neuropathy at the elbow caused by heterotopic ossification (HO) is a rare condition. This retrospective study aims to report on 32 consecutive cases of ulnar nerve encasement caused by elbow HO and evaluate long-term outcomes of operative management and a standardized postoperative rehabilitation regimen. METHODS: A retrospective case series was conducted on 32 elbows (27 patients) that underwent operative management of bony ulnar nerve encasement. All procedures were performed in the inpatient setting at an Academic Level 1 Trauma Center from September 1999 to July 2021 by one of 3 fellowship-trained shoulder and elbow. Postoperatively, all patients received formal physical therapy, HO prophylaxis (30 received indomethacin, 2 received radiation), and a structured continuous passive motion machine regimen. Patient demographics, age, gender, type of injury, history of tobacco use, and medical comorbidities were obtained to include in the analysis. Long-term follow-up examinations were performed to evaluate elbow flexion-extension arc of motion, Mayo Elbow Performance Score, and visual analog scale pain scores. RESULTS: Thirty-two elbows with complete bony ulnar nerve encasement secondary to HO were identified (14 from burns, 15 from trauma, 3 closed head injuries). Following surgery, the mean flexion-extension arc of motion improved significantly, increasing from 21° to 100° at long-term follow-up (average 8.7 years, range 2-17 years), with statistically significant improvements in preoperative vs. long-term postoperative elbow extension (P < .001), flexion (P < .001), and total arc of motion (P < .001). There was a statistically significant improvement in pre- vs. postprocedure ulnar nerve function, as demonstrated by a decrease in average McGowan grade (1.2-0.7; P = .002). Additionally, 63% of patients with preoperative ulnar neuropathy symptoms (20/32) had either complete resolution or subjective improvement after surgery. The mean time from injury to surgery was 518 days (range 65-943 days). Age, gender, time to surgery, and medical comorbidities were not associated with outcomes. The complication rate was 9% (3/32). Patients had an average flexion-extension arc of motion of 97° and average Mayo Elbow Performance Score of 80 ("good") at long-term follow-up. CONCLUSIONS: The combination of operative management, postoperative HO prophylaxis, and a regimented rehabilitation program has proven to be a durable solution for treating and ensuring good long-term functional outcomes for patients with elbow HO and bony ulnar nerve encasement. This treatment approach leads to superior range of motion, improved or resolved ulnar neuropathy, and good to excellent long-term functional outcomes.


Assuntos
Articulação do Cotovelo , Ossificação Heterotópica , Neuropatias Ulnares , Humanos , Cotovelo/cirurgia , Nervo Ulnar/cirurgia , Estudos Retrospectivos , Articulação do Cotovelo/cirurgia , Neuropatias Ulnares/etiologia , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/cirurgia , Ossificação Heterotópica/diagnóstico , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
12.
J Shoulder Elbow Surg ; 33(5): 1185-1199, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38072032

RESUMO

BACKGROUND: Elbow medial ulnar collateral ligament (mUCL) injuries have become increasingly common, leading to a higher number of mUCL reconstructions (UCLR). Various techniques and graft choices have been reported. The purpose of this study was to evaluate the prevalence of each available graft choice, the surgical techniques most utilized, and the reported complications associated with each surgical method. METHODS: A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysesguidelines. We queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify all articles that included UCLR between January 2002 and October 2022. We included all studies that referenced UCLR graft choice, surgical technique, and/or ulnar nerve transposition. Studies were evaluated in a narrative fashion to assess demographics and report current trends in utilization and complications of UCLR as they pertain to graft choice and surgical techniques over the past 20 years. Where possible, we stratified based on graft and technique. RESULTS: Forty-seven articles were included, reporting on 6671 elbows. The cohort was 98% male, had a weighted mean age of 21 years and follow-up of 53 months. There were 6146 UCLRs (92%) performed with an autograft and 152 (2.3%) that utilized an allograft, while 373 (5.6%) were from mixed cohorts of autograft and allograft. Palmaris longus autograft was the most utilized mUCL graft choice (64%). The most utilized surgical configuration was the figure-of-8 (68%). Specifically, the most common techniques were the modified Jobe technique (37%), followed by American Sports Medicine Institute (ASMI) (22%), and the docking (22%) technique. A concomitant ulnar nerve transposition was performed in 44% of all patients, with 1.9% of these patients experiencing persistent ulnar nerve symptoms after ulnar nerve transposition. Of the total cohort, 14% experienced postoperative ulnar neuritis with no prior preoperative ulnar nerve symptoms. Further, meta-analysis revealed a significantly greater revision rate with the use of allografts compared to autograft and mixed cohorts (2.6% vs. 1.8% and 1.9%, P = .003). CONCLUSIONS: Most surgeons performed UCLR with palmaris autograft utilizing a figure-of-8 graft configuration, specifically with the modified Jobe technique. The overall rate of allograft use was 2.3%, much lower than expected. The revision rate for UCLR with allograft appears to be greater compared to UCLR with autograft, although this may be secondary to limited allograft literature.


Assuntos
Beisebol , Ligamento Colateral Ulnar , Ligamentos Colaterais , Articulação do Cotovelo , Reconstrução do Ligamento Colateral Ulnar , Neuropatias Ulnares , Humanos , Masculino , Adulto Jovem , Adulto , Feminino , Reconstrução do Ligamento Colateral Ulnar/métodos , Cotovelo/cirurgia , Ligamento Colateral Ulnar/cirurgia , Ligamento Colateral Ulnar/lesões , Nervo Ulnar/cirurgia , Neuropatias Ulnares/etiologia , Articulação do Cotovelo/cirurgia , Ligamentos Colaterais/cirurgia , Ligamentos Colaterais/lesões , Beisebol/lesões
13.
Neurol Res ; 46(2): 125-131, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37729085

RESUMO

BACKGROUND: The polarity of nerve grafts does not interfere with axon growth. Our goal was to investigate whether axons can regenerate in a retrograde fashion within sensory pathways and then extend into motor pathways, leading to muscle reinnervation. METHODS: Fifty-four rats were randomized into four groups. In Group 1, the ulnar nerve was connected end-to-end to the superficial radial nerve after neurectomy of the radial nerve in the axilla. In Group 2, the ulnar nerve was connected end-to-end to the radial nerve distal to the humerus; the radial nerve then was divided in the axilla. In Group 3, the radial nerve was divided in the axilla, but no nerve reconstruction was performed. In Group 4, the radial nerve was crushed in the axilla. Over 6 months, we behaviorally assessed the recovery of toe spread in the right operated-upon forepaw by lifting the rat by its tail and lowering it onto a flat surface. Six months after surgery, rats underwent reoperation, nerve transfers were tested electrophysiologically, and the posterior interosseous nerve (PIN) was removed for histological evaluation. RESULTS: Rats in the crush group recovered toe spread between 5 and 8 days after surgery. Rats with nerve transfers demonstrated electrophysiological and histological findings of nerve regeneration but no behavioral recovery. CONCLUSIONS: Ulnar nerve axons regrew into the superficial radial nerve and then into the PIN to reinnervate the extensor digitorum communis. We were unable to demonstrate behavioral recovery because rats cannot readapt to cross-nerve transfer.


Assuntos
Neurônios Motores , Nervos Periféricos , Ratos , Animais , Neurônios Motores/fisiologia , Nervos Periféricos/cirurgia , Regeneração Nervosa/fisiologia , Nervo Ulnar/cirurgia , Axônios/fisiologia , Vias Eferentes
14.
Hand Surg Rehabil ; 43(1): 101614, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37935334

RESUMO

OBJECTIVE: Recurrence after primary ulnar tunnel syndrome surgery is observed in 1.4%-25% of patients. However, the outcome of revision surgery is uncertain and limited. This study aimed to assess the clinical and functional outcomes of neurolysis combined with anterior subcutaneous transposition in cases of recurrence. PATIENTS AND METHODS: This retrospective single-center study included patients who were operated on for iterative ulnar tunnel syndrome at the elbow between January 1996 and December 2020, with a minimum follow-up of 24 months. Demographic data, pre- and post-operative clinical evaluations, surgical details, and satisfaction levels were collected. RESULTS: Twenty-eight patients were reviewed. Mean follow-up was 11.7 years (range, 2.1-26.4 years). The secondary procedure led to significant improvement in mean Quick-DASH score, from 25.3 (range, 11-50) to 20.0 (range, 11-49) (p = 0.023), with a satisfaction rate of 78.5%. Symptoms of pain (p = 0.033), amyotrophy (p = 0.013), hypoesthesia (p < 0.01), and paresthesia (p < 0.001) also showed significant improvement. There were 7 cases of failure (25.0%). CONCLUSION: The combination of neurolysis and anterior subcutaneous transposition was a reliable technique, improving clinical outcome in recurrent ulnar tunnel syndrome after previous surgery. LEVEL OF EVIDENCE: IV - retrospective study.


Assuntos
Síndrome do Túnel Ulnar , Humanos , Síndrome do Túnel Ulnar/cirurgia , Nervo Ulnar/cirurgia , Estudos Retrospectivos , Descompressão Cirúrgica/métodos , Procedimentos Neurocirúrgicos
15.
J Hand Surg Eur Vol ; 49(2): 250-256, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-37747704

RESUMO

Extensive microsurgical neurolysis followed by free gracilis muscle flap coverage can be performed as a last resort for patients with persistent neuropathic pain of the ulnar nerve. All patients who had this surgery between 2015 and 2021 were identified. Data were collected from the medical records of 21 patients and patient-reported outcomes were collected from 18 patients, with a minimum follow-up of 12 months. The median visual analogue pain score decreased significantly 8 months postoperatively from 8.0 to 6.0 and stabilized to 5.4 at the 3-year follow-up. Health-related quality-of-life scores remained diminished compared to normative data. In the treatment of therapy-resistant neuropathic pain of the ulnar nerve, extensive neurolysis with a subsequent free gracilis muscle flap coverage shows a promising reduction of pain that persists at long-term follow-up.Level of evidence: IV.


Assuntos
Músculo Grácil , Neuralgia , Humanos , Nervo Ulnar/cirurgia , Neuralgia/cirurgia , Retalhos Cirúrgicos , Medidas de Resultados Relatados pelo Paciente
16.
J Hand Surg Am ; 49(2): 124-140, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38108682

RESUMO

PURPOSE: Controversy exists regarding the best option for revision surgery in refractory cubital tunnel syndrome (CuTS). The purpose of this systematic review was to evaluate the effectiveness of revision surgery and determine the optimal surgical approach for patients requiring revision surgery for CuTS. METHODS: A literature search was conducted. Characteristics of the included studies were summarized descriptively. The risk ratio between patient-reported preoperative and postoperative outcomes relating to pain, motor, and sensory deficits was calculated. A meta-regression analysis was performed to evaluate the postoperative symptom improvements based on the type of secondary surgery. Random-effects meta-analysis and descriptive statistics were used when appropriate. RESULTS: A total of 471 patients were evaluated in 20 studies. In total, 254 (53.9%) male and 217 (46.1%) female patients, with an average age of 49.2 ± 14.1 years, were included in this study. Pain was the most common symptom (n = 346, 81.6%), followed by sensory and motor dysfunction in 342 (80.6%) and 223 (52.6%) patients, respectively. Meta-analysis comparing preoperative and postoperative symptoms between patients who had submuscular transposition (SMT), subcutaneous transposition (SCT), and neurolysis showed that a significant subgroup difference exists between the types of revision surgery in sensory and motor improvements. Meta-regression showed that SMT was associated with better outcomes compared with SCT in motor and sensory improvements. CONCLUSIONS: Revision surgery for CuTS can be useful for addressing recurrent and persistent symptoms. Compared with neurolysis and SCT, SMT seems to be the superior option for revision surgery, demonstrating substantial improvement in all symptom domains. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Assuntos
Síndrome do Túnel Ulnar , Nervo Ulnar , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Nervo Ulnar/cirurgia , Síndrome do Túnel Ulnar/cirurgia , Síndrome do Túnel Ulnar/diagnóstico , Procedimentos Neurocirúrgicos/métodos , Descompressão Cirúrgica/métodos , Dor , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos
17.
Clin Neurol Neurosurg ; 236: 108078, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38103390

RESUMO

BACKGROUND: Ulnar nerve entrapment at the elbow (UNE) is the second most prevalent entrapment neuropathy after carpal tunnel syndrome. The objective of this study was to evaluate the expert opinion of different surgical disciplines regarding the need for electrodiagnostic or ultrasound confirmation of UNE and, if so, which test was preferred for confirmation. METHODS: A questionnaire was sent to all neurosurgeons and plastic or hand surgeons in the Netherlands to evaluate the current practice in planning surgical treatment of UNE. RESULTS: The response rate was 36.4 % (134 out of 368). 94 % of surgeons reported that > 95 % of their patients had EDX or ultrasound studies before surgery. 80.6 % of all surgeons who responded reported that they seldom operated on UNE without electrodiagnostic confirmation. Hand surgeons (25.9 %) were more willing to operate on clinically diagnosed UNE without EDX than neurosurgeons (9.4 %) CONCLUSIONS: Dutch surgeons prefer diagnostic confirmation of UNE either by ultrasound or EDX, with a preference for EDX and the vast majority of operated patients do have either EDX or ultrasound or both before surgery. Compared to neurosurgeons, hand surgeons are more willing to operate on patients with clinically defined UNE but normal electrodiagnostic studies.


Assuntos
Cirurgiões , Síndromes de Compressão do Nervo Ulnar , Neuropatias Ulnares , Humanos , Eletrodiagnóstico , Países Baixos , Cotovelo/inervação , Nervo Ulnar/diagnóstico por imagem , Nervo Ulnar/cirurgia , Condução Nervosa/fisiologia
18.
Georgian Med News ; (343): 50-52, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-38096515

RESUMO

Cubital tunnel syndrome is the second most common neuropathy of the upper extremity. Cubital tunnel syndrome caused by intraneural ganglion cysts is rare in clinical practice. We present the case of a 71-year-old male patient with a 4-month history of cubital tunnel syndrome of the left elbow due to an intraneural ganglion cyst. After revision of the ulnar nerve and resection of the intraneural cyst nearly complete recovery was achieved within a 5 month follow-up but some sensory deficits of the fifth fingertip. We recommend preoperative ultrasound examination of the cubital tunnel even in cases with clear diagnosis. Ganglion cyst as a cause of cubital tunnel is rare but needs to be diagnosed and treated as soon as possible to prevent irreversible complications.


Assuntos
Síndrome do Túnel Ulnar , Cistos Glanglionares , Masculino , Humanos , Idoso , Síndrome do Túnel Ulnar/diagnóstico por imagem , Síndrome do Túnel Ulnar/etiologia , Nervo Ulnar/diagnóstico por imagem , Nervo Ulnar/cirurgia , Cistos Glanglionares/diagnóstico , Cistos Glanglionares/diagnóstico por imagem , Descompressão Cirúrgica
19.
JBJS Case Connect ; 13(4)2023 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-37976383

RESUMO

CASE: We present a 28-year-old woman with long-standing left ulnar wrist pain. Physical examination revealed severe tenderness over the pisiform; imaging findings were normal. Surgical exploration revealed compression of an aberrant branch, likely Kaplan's accessory branch, around the pisiform. Complete symptom relief was achieved after nerve decompression. CONCLUSION: Clinical symptoms associated with Kaplan's accessory branch are rare, indicating that many branches may be asymptomatic or overlooked despite the presence of symptoms. Kaplan's accessory branch should be considered as a potential differential diagnosis for refractory ulnar wrist pain.


Assuntos
Dor Intratável , Pisciforme , Piramidal , Feminino , Humanos , Adulto , Nervo Ulnar/diagnóstico por imagem , Nervo Ulnar/cirurgia , Punho/diagnóstico por imagem
20.
BMJ Case Rep ; 16(11)2023 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-38000811

RESUMO

Epithelioid malignant peripheral nerve sheath tumour (EMPNST) is a rare histological subtype of malignant peripheral nerve sheath tumour (MPNST), accounting for 5% to 17% of MPNSTs. The clinical and MRI findings of EMPNST mimic those of nerve abscesses, similar to the presentation in Hansen's disease. We present one such case with this kind of diagnostic dilemma. Intraoperative findings suggest a tumour changed the course of management subsequently. The development of neurological deficits postoperatively after tumour resection was a reconstructive challenge. To provide motor power and sensation through a procedure that provides a complete functional outcome for a young patient, distal nerve transfers were chosen. This provided an improvement in the quality of life and hastened the neurological recovery of the involved limb. Level of evidence: V.


Assuntos
Neoplasias de Bainha Neural , Neurofibrossarcoma , Neoplasias Cutâneas , Humanos , Neoplasias de Bainha Neural/diagnóstico , Neoplasias de Bainha Neural/cirurgia , Neoplasias de Bainha Neural/patologia , Cotovelo/patologia , Nervo Ulnar/cirurgia , Nervo Ulnar/patologia , Qualidade de Vida
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