RESUMO
This study investigates the impact of the anatomical separation point of the dorsal ulnar cutaneous nerve (DUCN) on nerve conduction studies (NCS). Involving 25 subjects with DUCN NCS findings, it utilizes ultrasound to mark the DUCN's divergence from the ulnar nerve. NCS was performed at four points relative to the separation point. The findings indicate the maximal amplitudes occurred 2 cm distal to the separation point. The study suggests it is ideal when the stimulation is performed between the seperation point and 2 cm distal to it.
Assuntos
Condução Nervosa , Nervo Ulnar , Ultrassonografia , Humanos , Nervo Ulnar/diagnóstico por imagem , Nervo Ulnar/fisiologia , Condução Nervosa/fisiologia , Ultrassonografia/métodos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Idoso , Estudos de Condução NervosaRESUMO
The distinct and specialized movements performed in different sports disciplines may significantly influence nerve performance, potentially affecting nerve responses and the overall function within the respective athletic activities. The purpose of this study is to find the effect of forearm supination and pronation across the elbow joint on ulnar and median nerve conduction velocity (NCV) in throwers, archers, and non-athletes. A total of 34 participants both male and females were recruited with a body mass index (BMI) between 18.5 and 24.9 kg/m2. Nerve conduction study (NeuroStim NS2 EMG/NCV/EP System) was used for measuring ulnar and median NCV across the elbow joint at different angles with the forearm in supination and pronation. Repeated measure analysis of variance (RMANOVA) revealed that there are statistically significant differences in mean values of forearm positions, angles, nerves and groups (p < .05). This study illuminates distinctive NCV variations across diverse athletic groups during forearm supination and pronation movements. Pronation consistently exhibited faster ulnar NCV compared to the median nerve across throwers, archers, and non-athletes, while in supination specific joint positions revealed notable differences within sports groups and nerve function.
Assuntos
Antebraço , Nervo Mediano , Condução Nervosa , Pronação , Supinação , Nervo Ulnar , Humanos , Masculino , Supinação/fisiologia , Pronação/fisiologia , Feminino , Antebraço/fisiologia , Condução Nervosa/fisiologia , Nervo Mediano/fisiologia , Nervo Ulnar/fisiologia , Adulto Jovem , Adulto , Eletromiografia , AtletasRESUMO
Walter Eichler (1904-1942) performed the first in situ nerve conduction studies in humans. Eichler's work has been largely overlooked and there have been no biographical accounts written of him. His 1937 paper, Über die Ableitung der Aktionspotentiale vom menschlichen Nerven in situ (On the recording of the action potentials from human nerves in situ) was translated and reviewed. Archival material was obtained on his career that was housed predominantly at the University of Freiburg im Breisgau. He had memberships in Nazi organizations but did not appear to be politically active. During his brief career, he constructed novel equipment and established seminal principles for performing nerve conductions on humans. The authors repeated his experiment in the ulnar nerve, which duplicated Eichler's findings. His recordings were quite remarkable given advances in technology. In summary, the Eichler paper is the first study in the development of in situ clinical electroneurography in humans. Many of his procedural observations are still fundamental in the current practice of electroneurography. As best can be determined, his study in humans did not appear ethically compromised. Although Eichler's personal background remains open to question, his paper is a seminal study in the history and development of clinical electroneurography.Abbreviations: AP: Action potential; C: Capacitor; CNP: Compound nerve potential; DC: Direct current; E1: Preferred term for active electrode; E2: Preferred term for reference electrode; NSDÄB: Nationalsozialistische Deutsche NSD-Ärtzebund (National Socialist German Doctors' League; NSDAP: Nationalsozialistische Deutsche Arbeiterpartei (National Socialist German Workers' Party/ Nazi Party); SS: Schutzstaffel (Protective Echelon or Squad of the Nazi party).
Assuntos
Condução Nervosa , Humanos , História do Século XX , Condução Nervosa/fisiologia , Potenciais de Ação/fisiologia , Nervo Ulnar/fisiologia , Alemanha , Eletrofisiologia/história , Neurofisiologia/história , Estudos de Condução NervosaRESUMO
BACKGROUND: Little research exists on extending ex-vivo systems to large animal nerves, and to the best of our knowledge, there has yet to be a study comparing these against in-vivo data. This paper details the first ex-vivo system for large animal peripheral nerves to be compared with in-vivo results. NEW METHOD: Detailed ex-vivo and in-vivo closed-loop neuromodulation experiments were conducted on pig ulnar nerves. Temperatures from 20 °C to 37 °C were evaluated for the ex-vivo system. The data were analysed in the time and velocity domains, and a regression analysis established how evoked compound action potential amplitude and modal conduction velocity (CV) varied with temperature and time after explantation. MAIN RESULTS: Pig ulnar nerves were sustained ex-vivo up to 5 h post-explantation. CV distributions of ex-vivo and in-vivo data were compared, showing closer correspondence at 37 °C. Regression analysis results also demonstrated that modal CV and time since explantation were negatively correlated, whereas modal CV and temperature were positively correlated. COMPARISON WITH EXISTING METHODS: Previous ex-vivo systems were primarily aimed at small animal nerves, and we are not aware of an ex-vivo system to be directly compared with in-vivo data. This new approach provides a route to understand how ex-vivo systems for large animal nerves can be developed and compared with in-vivo data. CONCLUSION: The proposed ex-vivo system results were compared with those seen in-vivo, providing new insights into large animal nerve activity post-explantation. Such a system is crucial for complementing in-vivo experiments, maximising collected experimental data, and accelerating neural interface development.
Assuntos
Condução Nervosa , Nervo Ulnar , Animais , Suínos , Nervo Ulnar/fisiologia , Condução Nervosa/fisiologia , Potenciais de Ação/fisiologia , Temperatura , Estimulação Elétrica/métodosRESUMO
The monitoring of the neuromuscular blockade is critical for patient's safety during and after surgery. The monitoring of neuromuscular blockade often requires the use of Train of Four (TOF) technique. During a TOF test two electrodes are attached to the ulnar nerve, and a series of four electric pulses are applied. The electrical stimulation causes the thumb to twitch, and the amount of twitch varies depending on the amount of neuromuscular blockade in patient's system. Current medical devices used to assist anesthesiologists to perform TOF monitoring often require free hand movement and do not provide accurate or reliable results. The goal of this work is to design, prototype and test a new medical device that provides reliable TOF results when thumb movement is restricted. A medical device that uses a pressurized catheter balloon to detect the response thumb twitch of the TOF test is created. An analytical model, numerical study, and mechanical finger testing were employed to create an optimum design. The design is tested through a pilot human subjects study. No significant correlation is reported with subjects' properties, including hand size.
Assuntos
Bloqueio Neuromuscular , Fármacos Neuromusculares não Despolarizantes , Humanos , Monitoração Neuromuscular/métodos , Nervo Ulnar/fisiologia , Estimulação ElétricaRESUMO
Electro-physiological diagnosis of mild Carpal Tunnel Syndrome (CTS) based on traditional median motor and sensory studies are often inconclusive. Therefore, we wanted to investigate the utility of Median-to-Ulnar Sensory Conduction studies in diagnosis of mild CTS. Data from Nerve conduction study (NCS) of 82 cases with symptoms suggestive of CTS from September 2017 to October 2020 attending electrophysiology department of Mount Adora Hospital, Sylhet, Bangladesh was selected for study. About 54(66.0%) out of 82 symptomatic patients were diagnosed as CTS by the conventional method, and 28(34.0%) patients required further investigation as their test report were found to be inconclusive. combining methods showed 70(85.37%) were found to be positive and 12(14.63%) were negative in comparison study. Thus, it can be concluded that those patients found to be negative in conventional methods; comparison method is an option for diagnostic confirmation.
Assuntos
Síndrome do Túnel Carpal , Humanos , Síndrome do Túnel Carpal/diagnóstico , Nervo Mediano , Estudos de Condução Nervosa , Nervo Ulnar/fisiologia , Condução Nervosa/fisiologia , BangladeshRESUMO
BACKGROUND: The distinction between sensory neuronopathies (SN), which is by definition purely sensory, and sensory polyneuropathies (SP) and sensory multineuropathies (SM) is important for etiologic investigation and prognosis estimation. However, this task is often challenging in clinical practice. We hypothesize that F-wave assessment might be helpful, since it is able to detect subtle signs of motor involvement, which are found in SP and SM, but not in SN. OBJECTIVE: The aim of the present study was to determine whether F-waves are useful to distinguish SN from SP and SM. METHODS: We selected 21 patients with SP (12 diabetes mellitus, 4 transthyretin familial amyloid polyneuropathy, 4 others), 22 with SM (22 leprosy), and 26 with SN (13 immune-mediated, 10 idiopathic, 3 others) according to clinical-electrophysiological-etiological criteria. For every subject, we collected data on height and performed 20 supramaximal distal stimuli in median, ulnar, peroneal, and tibial nerves, bilaterally, to record F-waves. Latencies (minimum and mean) and persistences were compared across groups using the Kruskal-Wallis and Bonferroni tests. P-values < 0.05 were considered significant. RESULTS: All groups were age, gender, and height-matched. Overall, there were no significant between-group differences regarding F-wave latencies. In contrast, F-wave persistence was able to stratify the groups. Peroneal F-wave persistence was higher, bilaterally, in the SN group compared to SM and SP (p < 0.05). In addition, F-waves persistence of the ulnar and tibial nerves was also helpful to separate SN from SP (p < 0.05). CONCLUSION: F-wave persistence of the peroneal nerves might be an additional and useful diagnostic tool to differentiate peripheral sensory syndromes.
ANTECEDENTES: A distinção entre neuronopatias sensitivas (SN) e polineuropatias sensitivas (SP) e multineuropatias sensitivas (SM) é importante para a investigação etiológica e para o prognóstico. Contudo, esta tarefa é desafiadora na prática clínica. Hipotetizou-se que a avaliação das ondas-F pode ser útil, por ser capaz de detectar envolvimento motor nas SP e SM, mas não nas SN. OBJETIVO: Determinar se as ondas-F podem ajudar a distinguir entre SN, SP e SM. MéTODOS: Selecionou-se 21 pacientes com SP (12 diabetes mellitus, 4 ATTR-FAP e 4 com outras neuropatias), 22 com SM (22 hanseníases) e 26 com SN (13 imunomediadas, 10 idiopáticas e 3 com outras neuronopatias), de acordo com critérios clínicos, etiológicos e eletrofisiológicos. Para cada indivíduo, foi aferida a altura e foram aplicados 20 estímulos distais supramáximos nos nervos mediano, ulnar, fibular e tibial, bilateralmente, para registrar as ondas-F. Uma comparação foi feita, por grupo, das latências (mínimas e médias) e persistências pelos testes Kruskal-Wallis e Bonferroni. Valores de p < 0.05 foram considerados estatisticamente significativos. RESULTADOS: Todos os grupos foram pareados por idade, sexo e altura. Não houve diferença estatística significativa entre os grupos quanto às latências das ondas-F. A persistência da onda-F foi capaz de estratificar os grupos, sendo as dos nervos fibulares bilateralmente maiores no grupo SN que nos grupos SM e SP (p < 0.05). Adicionalmente, a persistência das ondas-F dos nervos ulnares e tibiais também foi útil para distinguir SN de SP (p < 0.05). CONCLUSãO: A persistência das ondas-F dos nervos fibulares pode ser uma ferramenta adicional e útil para diferenciar síndromes sensitivas periféricas.
Assuntos
Condução Nervosa , Polineuropatias , Humanos , Condução Nervosa/fisiologia , Nervo Mediano , Nervo Ulnar/fisiologia , Nervo Tibial , Nervo Fibular , Síndrome , Nervos Periféricos/fisiologiaRESUMO
Errors of touch localization after hand nerve injuries are common, and their measurement is important for evaluating functional recovery. Available empirical accounts have significant methodological limitations, however, and a quantitatively rigorous and detailed description of touch localization in nerve injury is lacking. Here, we develop a new method of measuring touch localization and evaluate its value for use in nerve injury. Eighteen patients with transection injuries to the median/ulnar nerves and 33 healthy controls were examined. The hand was blocked from the participant's view and points were marked on the volar surface using an ultraviolet (UV) pen. These points served as targets for touch stimulation. Two photographs were taken, one with and one without UV lighting, rendering targets seen and unseen, respectively. The experimenter used the photograph with visible targets to register their locations, and participants reported the felt position of each stimulation on the photograph with unseen targets. The error of localization and its directional components were measured, separate from misreferrals-errors made across digits, or from a digit to the palm. Nerve injury was found to significantly increase the error of localization. These effects were specific to the territory of the repaired nerve and showed considerable variability at the individual level, with some patients showing no evidence of impairment. A few patients also made abnormally high numbers of misreferrals, and the pattern of misreferrals in patients differed from that observed in healthy controls.NEW & NOTEWORTHY We provide a more rigorous and comprehensive account of touch localization in nerve injury than previously available. Our results show that touch localization is significantly impaired following median/ulnar nerve transection injuries and that these impairments are specific to the territory of the repaired nerve(s), vary considerably between patients, and can involve frequent errors spanning between digits.
Assuntos
Percepção do Tato , Tato , Humanos , Tato/fisiologia , Mãos/inervação , Nervo Mediano , Nervo Ulnar/fisiologiaRESUMO
As per existing guidelines, the distance between stimulator and recording electrodes in nerve conduction studies (NCS) should be the same (fixed) in all the subjects, i.e., it should not be based on anatomical landmarks. However, there are no studies comparing fixed distance recordings with landmark based NCS. We postulated that hand length can influence the NCS parameters in fixed distance recordings and this can be nullified using landmark based recordings. To test this theory, we performed NCS in 48 normal subjects as per standard guidelines (standard protocol) and then compared it to NCS with ulnar styloid as the landmark (modified protocol). NCS were performed on median and ulnar nerves of the right upper limb. Three motor NCS parameters including distal latency, compound muscle action potential (CMAP) amplitudes and nerve conduction velocities were measured. Sensory nerve action potential (SNAP) amplitudes and conduction velocities were the two sensory parameters measured. On analysis, ulnar motor conduction velocity was the only parameter affected by hand length in both standard and modified protocols. Modified protocol did not have any additional advantage to the standard protocol advised by NDTF. We conclude that the NDTF guidelines are therefore reasonable when considering the effects of hand length. Possible reasons for this result including anatomical and anthropometric explanations are discussed.
Assuntos
Estudos de Condução Nervosa , Condução Nervosa , Humanos , Potenciais de Ação/fisiologia , Condução Nervosa/fisiologia , Mãos , Nervo Ulnar/fisiologia , Nervo MedianoRESUMO
INTRODUCTION/AIMS: Switching between different types of electrodes during motor and sensory nerve conduction studies adds time to a study. We investigated the use of disposable disc electrodes (DDE) used for motor nerve conduction studies to record the antidromic sensory nerve action potential (SNAP) in median, ulnar and radial sensory nerve conduction studies. METHODS: The SNAP was recorded using four different electrode types: reusable ring, reusable bar, disposable ring, and DDE in a random rotating order. Studies were performed in healthy subjects. Other than being an adult with no history of neuromuscular disease, there were no exclusion criteria. RESULTS: We studied 20 subjects (11 females, 9 males; age 41.1 ± 15.7 y). The SNAP waveforms recorded by all four electrode types were similar. There was no statistically significant difference in the onset latency, peak latency (PL), negative peak amplitude (NPA), peak to peak amplitude, or conduction velocity. In individual nerve recordings, the absolute PL difference between reusable ring electrodes (our current standard) and DDE was less than 0.2 ms in 58 of 60 (97%) nerves. The mean absolute NPA difference was 3.1 µV (standard deviation = 2.85 µV). Recordings with NPA difference >5 µV also had high NPA and/or had large artifacts. DISCUSSION: DDE may be used for performing motor and sensory nerve conduction studies. This can reduce the time required for electrodiagnostic testing.
Assuntos
Potenciais Evocados , Condução Nervosa , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Potenciais de Ação/fisiologia , Eletrodos , Potenciais Evocados/fisiologia , Nervo Mediano , Condução Nervosa/fisiologia , Tempo de Reação/fisiologia , Nervo Ulnar/fisiologiaRESUMO
OBJECTIVE: Complex regional pain syndrome (CRPS) can be distinguished as type I without and type II with electrophysiological evidence of major nerve lesion. The pathophysiology of both subgroups is still under investigation. The aim of this research is to demonstrate the nerve morphology and electrophysiology in CRPS type I patients. MATERIALS AND METHODS: Bilateral median and ulnar nerve cross-sectional areas were evaluated with ultrasound and also median and ulnar nerve conduction studies of both hands were performed. Cross-sectional areas of median and ulnar nerves and nerve conduction studies in healthy controls were also obtained and compared with the patients. RESULTS: Twenty-five male patients and 11 healthy male controls were enrolled in the study. The mean age of the patients was 24.08 ± 5.50 years and controls was 23.18 ± 5.09 (p > 0.05). Compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) amplitudes of the diseased side were found significantly lower than the healthy side (p < 0.05). Both median and ulnar nerve distal motor latency values were significantly higher in the patient group (p < 0.05). There was no significant difference in the median and ulnar nerve cross-sectional area when compared with the opposite extremity and healthy volunteers. CONCLUSION: The lower SNAP and CMAP amplitudes of the median and ulnar nerves compared to the healthy side and the prolongation of the affected side median and ulnar nerve distal motor latencies of the affected individuals may indicate axonal involvement in patients with CRPS type 1. Decreased CMAP amplitudes may also indicate muscle atrophy due to a decrease in the number of functional motor units.
Assuntos
Distrofia Simpática Reflexa , Nervo Ulnar , Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Nervo Ulnar/diagnóstico por imagem , Nervo Ulnar/fisiologia , Condução Nervosa/fisiologia , Distrofia Simpática Reflexa/diagnóstico , Extremidade Superior , Axônios , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/fisiologiaRESUMO
PURPOSE: The use of a peripheral nerve stimulator to assess the level of neuromuscular blockade tasks the anesthesia clinician with subjectively assessing the response to neurostimulation. In contrast, objective neuromuscular monitors provide quantitative information. The purpose of this study was to compare subjective evaluations from a peripheral nerve stimulator with objective measurements of neurostimulation responses from a quantitative monitor. METHODS: Patients were enrolled preoperatively, and intraoperative neuromuscular blockade management was at the discretion of the anesthesiologist. Electromyography electrodes were placed over the dominant or nondominant arm in a randomized fashion. Following onset of nondepolarizing neuromuscular blockade, the ulnar nerve was stimulated, the response was measured with electromyography, and anesthesia clinicians, who were blinded to the objective measurements, subjectively (visually) evaluated the response to neurostimulation. RESULTS: Fifty patients were enrolled and 666 neurostimulations were performed at 333 different time points. Anesthesia clinicians subjectively overestimated the response of the adductor pollicis muscle following neurostimulation of the ulnar nerve 155/333 (47%) of the time when compared with objective electromyographic measurements. When subjective evaluations and objective measurements differed to any degree, subjective evaluations were higher than objective measurements 155/166 (92%) of the time (95% CI, 87 to 95; P < 0.001), representing significant evidence that subjective evaluation overestimates the response to train-of-four stimulation. CONCLUSIONS: Subjective observations of a "twitch" do not consistently correspond to objective measurements of neuromuscular blockade with electromyography. Subjective evaluation overestimates the response to neurostimulation and may be unreliable for determining the depth of block or confirming adequate recovery.
RéSUMé: OBJECTIF: Lors de l'utilisation d'un stimulateur nerveux périphérique pour évaluer le niveau de bloc neuromusculaire, le clinicien en anesthésie doit évaluer de manière subjective la réponse à la neurostimulation. Les moniteurs neuromusculaires objectifs fournissent quant à eux des informations quantitatives. L'objectif de cette étude était de comparer les évaluations subjectives d'un stimulateur nerveux périphérique avec des mesures objectives des réponses de neurostimulation provenant d'un moniteur quantitatif. MéTHODE: Les patients ont été recrutés avant leur opération, et la gestion du bloc neuromusculaire peropératoire était à la discrétion de l'anesthésiologiste. Des électrodes d'électromyographie ont été placées sur le bras dominant ou non dominant de manière aléatoire. Après l'amorce du bloc neuromusculaire non dépolarisant, le nerf cubital a été stimulé, la réponse a été mesurée par électromyographie, et les cliniciens en anesthésie, qui n'avaient pas accès aux mesures objectives, ont évalué subjectivement (visuellement) la réponse à la neurostimulation. RéSULTATS: Cinquante patients ont été recrutés et 666 neurostimulations ont été réalisées à 333 moments différents. Les cliniciens en anesthésie ont subjectivement surestimé la réponse du muscle adducteur du pouce après neurostimulation du nerf cubital 155/333 (47 %) fois par rapport aux mesures électromyographiques objectives. Lorsque les évaluations subjectives et les mesures objectives différaient à quelque degré que ce soit, les évaluations subjectives étaient plus élevées que les mesures objectives 155/166 (92 %) du temps (IC 95 %, 87 à 95; P < 0,001), ce qui représente une preuve significative que l'évaluation subjective surestime la réponse à la stimulation par train-de-quatre. CONCLUSION: Les observations subjectives d'une « contraction ¼ ne correspondent pas systématiquement aux mesures objectives d'un bloc neuromusculaire telles qu'obtenues par électromyographie. L'évaluation subjective surestime la réponse à la neurostimulation et pourrait ne pas être fiable pour déterminer la profondeur du bloc ou confirmer une récupération adéquate.
Assuntos
Bloqueio Neuromuscular , Nervo Ulnar , Humanos , Estimulação Elétrica , Eletromiografia , Músculo Esquelético/inervação , Músculo Esquelético/fisiologia , Estudos Prospectivos , Nervo Ulnar/fisiologiaRESUMO
The disappointing outcomes of conventional nerve repair or grafting procedures for proximal ulnar nerve injuries have led the scientific community to search for better alternatives. The pronator quadratus branch of the anterior interosseous nerve has been transferred to the distal ulnar motor branch in a reverse end-to-side fashion with encouraging results. This transfer is now becoming commonly used as an adjunct to cubital tunnel decompression in patients with compressive ulnar neuropathy, underscoring the need for this knowledge transfer to the neurosurgical community. However, the mechanism of recovery after these transfers is not understood completely. We have reviewed the existing preclinical and clinical literature relevant to this transfer to summarize the current level of understanding of the underlying mechanisms, define the indications for performing this transfer in the clinic, and identify the complications and best practices with respect to the operative technique. We have also attempted to identify the major deficiencies in our current level of understanding of the recovery process to propose directions for future research.
Assuntos
Transferência de Nervo , Nervo Ulnar , Humanos , Nervo Ulnar/cirurgia , Nervo Ulnar/fisiologia , Transferência de Nervo/métodos , Procedimentos Neurocirúrgicos , Músculo Esquelético/inervaçãoRESUMO
Ultrasound (US) is commonly used to evaluate ulnar nerve instability (UNI) and snapping of the medial head of the triceps brachii muscle (ST). We aimed to determine the diagnostic accuracy of US in evaluating UNI, through cadaveric dissection, and to evaluate the US features and relationships of UNI and ST according to elbow flexion. Dynamic US was performed with elbow extension, 90° flexion, and full flexion positions on 18 elbows from 9 fresh cadavers. UNI was classified into N (normal), S (subluxation), and D (dislocation) types. On US exams, the following findings and parameters were evaluated: the presence of UNI and ST; the horizontal distance from the apex of the medial epicondyle (ME) to the margins of the UN and medial head of the triceps brachii muscle (ME_UN and ME_TB, respectively); cross-sectional area and flattening ratio (FR) of UN. After US, all cadavers were dissected to expose the UN and TB, and elbow flexion and extension were simulated to confirm UNI and ST. The gross anatomic findings of UNI and ST were consistent with the US findings. In extension and 90° flexion positions, all cases were type N. In full flexion position, types N and S occurred in 10 (56%) and 8 (44%) elbows, respectively. FR and ME_UN in 90° flexion position, FR, ME_UN, and ME_TB in full flexion position differed significantly between types S and N. Positive correlations were found between ME_UN and ME_TB in 90° flexion and full flexion positions. Dynamic US accurately assessed UNI and ST. UNI was positively correlated to medial TB movement.
Assuntos
Articulação do Cotovelo , Luxações Articulares , Humanos , Cotovelo , Nervo Ulnar/fisiologia , Braço , CadáverRESUMO
PURPOSE: Cubital tunnel syndrome is the second most common upper-extremity compressive neuropathy, and persistent symptoms can necessitate operative treatment. Surgical options include simple decompression and ulnar nerve transposition. The cause of wound dehiscence after surgery is not well known, and the factors leading to the development of these complications have not been previously described. METHODS: Patients undergoing ulnar nerve surgery from January 1, 2016, to December 31, 2019, were retrospectively evaluated for the development of wound dehiscence within 3 months of surgery. There were 295 patients identified who underwent transposition and 1,106 patients who underwent simple decompression. Patient demographics and past medical history were collected to evaluate the risk factors for the development of wound dehiscence. RESULTS: The overall rate of wound dehiscence following surgery was 2.5%. In the simple decompression group, the rate of wound dehiscence was 2.7% (30/1,106), which occurred a mean of 21 days (range, 2-57 days) following surgery. In the transposition group, the rate of wound dehiscence was 1.7% (5/295), which occurred a mean of 20 days (range, 12-32 days) following surgery. The difference in rates of dehiscence between the decompression and transposition groups was not significant. Five patients in the simple decompression group and 1 patient in the transposition group required a secondary surgery for closure of the wound. Age, body mass index, smoking status, and medical comorbidities were not found to contribute to the development of wound dehiscence. CONCLUSIONS: Wound dehiscence can occur following both simple decompression and transposition, even after postoperative evaluation demonstrates a healed wound. Surgeons should be aware of this possibility and specifically counsel patients about remaining cautious with, and protective of, their wound for several weeks after surgery. Dehiscence may be related to suboptimal vascularity in the soft tissue envelope in the posteromedial elbow. When it occurs, dehiscence can generally be treated by allowing healing by secondary intention. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Assuntos
Síndrome do Túnel Ulnar , Cotovelo , Humanos , Estudos Retrospectivos , Cotovelo/cirurgia , Descompressão Cirúrgica/efeitos adversos , Nervo Ulnar/cirurgia , Nervo Ulnar/fisiologia , Síndrome do Túnel Ulnar/cirurgia , Síndrome do Túnel Ulnar/diagnóstico , Complicações Pós-Operatórias/cirurgia , Resultado do TratamentoRESUMO
PURPOSE: The cardinal symptoms of carpal tunnel syndrome (CTS) include pain in the affected hand(s). The median/second lumbrical nerve (Med2ndL) seems relatively preserved in severe CTS, with previous small studies suggesting its value in electromyogram to localize a median neuropathy to the wrist when both initial routine sensory and thenar motor responses are absent. METHODS: This is a retrospective analysis of 208 hands in 183 patients with electrophysiologically markedly severe CTS (absent routine sensory and thenar motor median responses) who underwent stimulation of both the Med2ndL and ulnar/second dorsal interosseous (Uln2ndDIn) motor nerves. A Med2ndL distal latency of ≥ 0.5 milliseconds when compared with the Uln2ndDIn supported the diagnosis of CTS. The presence or absence of hand pain was recorded if these data were available. RESULTS: Some 83.7% of hands (172/208) in 183 patients with markedly severe CTS had preservation of the Med2ndL meeting criteria for CTS. In those with pain data available, 77.1% (81/105) of hands had no pain. Of those 105 hands, 87 had preservation of the Med2ndL with 79.3% (69/87) demonstrating no pain. CONCLUSIONS: This is a large study that demonstrates the relative preservation of the Med2ndL response in markedly severe CTS. Assessment of the Med2ndL should be considered to electrophysiologically support CTS when routine sensory and thenar motor responses are absent. In addition, most patients with electrophysiologically markedly severe CTS had no pain.
Assuntos
Síndrome do Túnel Carpal , Humanos , Síndrome do Túnel Carpal/diagnóstico , Estudos Retrospectivos , Condução Nervosa/fisiologia , Nervo Ulnar/fisiologia , Nervo MedianoRESUMO
PURPOSE: The second palmar interosseous muscle is innervated solely by the ulnar nerve, and second palmar interosseous pinch (2IP) strength may be a good indicator of ulnar nerve motor function. The goal of this study was to describe the 2IP test and establish its normative values, stratified by age, sex, and dominance. METHODS: Volunteers were recruited to participate in this study at various community locations. Patients over the age of 18 years were eligible for this study. Demographic information on all subjects was collected. The volunteers were asked to pinch a hydraulic pinch gauge between the index and middle finger proximal phalanges with the proximal and distal interphalangeal joints flexed and without recruiting the thumb. Three 2IP measurements were taken for each hand. Descriptive statistics and analysis of covariance were performed to determine the effect of age, sex, dominance, and side on 2IP. We analyzed the 2IP strength using the 2IP test across 3 trials to determine whether it was affected by repeated testing. RESULTS: Two hundred thirty-eight patients met the inclusion criteria (45 ± 21 years, 55% women, 87% right-hand dominant). There was no statistically significant difference between dominant and nondominant hands or among the 3 trials. There was a statistically significant correlation between age and 2IP strength ranging between 0.32 and 0.44 kg. Age and sex showed a statistically significant association with 2IP strength, with patients of older age and women having weaker 2IP. CONCLUSIONS: We determined normative values for 2IP strength using a sample from a normal population. More studies are needed to validate these results. CLINICAL RELEVANCE: Second interosseous pinch strength may be a useful tool to assess ulnar nerve function.
Assuntos
Mãos , Força Muscular , Músculo Esquelético , Nervo Ulnar , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mãos/inervação , Músculo Esquelético/inervação , Músculo Esquelético/fisiologia , Valores de Referência , Nervo Ulnar/fisiologia , Idoso , Voluntários , Força Muscular/fisiologiaRESUMO
PURPOSE: Patients with severe ulnar neuropathy at the elbow frequently experience suboptimal surgical outcomes. Clinical symptoms alone may not accurately represent the severity of underlying nerve injury, calling for objective assessment tools, such as electrodiagnostic studies. The goal of our study was to determine whether specific electrodiagnostic parameters can be used to predict the outcomes after in situ decompression of the ulnar nerve. METHODS: This prospective study enrolled consecutive patients aged ≥18 years diagnosed with ulnar neuropathy at the elbow. Patients completed a baseline battery of motor, sensory, functional, and electrodiagnostic tests before undergoing in situ decompression of the ulnar nerve. They were reassessed at 6 weeks, 3 months, 6 months, and 12 months after surgery. Forty-two patients completed at least 2 follow-up assessments and were included in the study. RESULTS: When controlling for other electrodiagnostic measurements and demographic factors, none of the electrodiagnostic parameters were predictive of outcomes at 12 months after surgery. Patients with decreased compound muscle action potential amplitudes demonstrated slower trends of recovery in grip strength, pinch strength, and overall scores on the Michigan Hand Outcomes Questionnaire as well as its function, work, and activities of daily living subscales, Disabilities of the Arm, Shoulder, and Hand questionnaire, and the Carpal Tunnel Questionnaire. Decreased motor nerve conduction velocity was predictive of slower recovery of 2-point discrimination and pinch strength. CONCLUSIONS: Compound muscle action potential amplitude, but not other conventional electrodiagnostic parameters, was predictive of functional outcomes after in situ decompression of the ulnar nerve. This parameter should play a role in determining the timing and prognosis of treatment for ulnar neuropathy at the elbow. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
Assuntos
Nervo Ulnar , Neuropatias Ulnares , Humanos , Adolescente , Adulto , Nervo Ulnar/fisiologia , Atividades Cotidianas , Estudos Prospectivos , Neuropatias Ulnares/diagnóstico , Neuropatias Ulnares/cirurgia , Descompressão CirúrgicaRESUMO
BACKGROUND: Various electrodiagnostic tests are employed for diagnosis of carpal tunnel syndrome reporting wide range of sensitivity and specificity for each test in clinical practice. Therefore, the aim of our study is to assess the sensitivity of electrodiagnostic tests used in our set up for the diagnosis of carpal tunnel syndrome. METHODS: This cross-sectional study consisted of 21 patients suspected with carpal tunnel syndrome who were referred to neurophysiology lab for electrodiagnostic evaluation and 21 age-group gender matched healthy controls. Digit 4, lumbrical versus ulnar interossei latencies and conventional nerve conduction variables were recorded. A p value of less than 0.05 was considered significant. RESULTS: The sensitivity of median versus ulnar digit 4 sensory latency difference was the highest (72.72 %) whereas the conduction velocity of median nerve was the lowest (45.45%). The lumbrical versus ulnar interossei latency difference was significant between groups; however the sensitivity was only 51.52%. The conduction velocity of median nerve was relatively slower in the suspected cases than controls (49.67±13.75 vs. 60.90 ±6.70; p=0.007). The distal sensory latency of median nerve was significant between groups (3.47 ±0.58 vs. 2.16±0.25; p=0.03). The distal and proximal latencies of motor median nerve were significant between suspected cases and controls (4.70±1.82 vs. 2.75±0.38; p=<0.001). CONCLUSIONS: The sensitivity of median versus ulnar digit 4 sensory latency difference was the highest in our set up therefore, addition of this test with conventional method can be helpful in achieving a higher diagnosis rate.
Assuntos
Síndrome do Túnel Carpal , Humanos , Síndrome do Túnel Carpal/diagnóstico , Estudos Transversais , Nervo Ulnar/fisiologia , Nepal , Nervo Mediano/fisiologiaRESUMO
Ultrasound imaging (US) is increasingly being used in the diagnosis of entrapment neuropathies. The aim of the current study was to evaluate changes in stiffness (shear modulus), cross-sectional area (CSA), and trace length (TRACE) of the ulnar nerve in patients with cubital tunnel syndrome (CuTS), with shear wave elastography (SWE). A total of 31 patients with CuTS were included. CSA, shear modulus, and TRACE examinations were performed in the SWE mode in four positions of the elbow: full extension, 45° flexion, 90° flexion, and maximum flexion. There were significant side-to-side differences in the ulnar nerve elasticity value at 45°, 90°, and maximal elbow flexion (all, p < 0.001) but not at elbow extension (p = 0.36). There were significant side-to-side differences in the ulnar nerve CSA value at each elbow position (all, p < 0.001). There were significant side-to-side differences in the ulnar nerve trace value at each elbow position (all, p < 0.001). The symptomatic ulnar nerve in patients with CuTS exhibited greater stiffness (shear modulus), CSA, and TRACE values, compared with the asymptomatic side. US examinations (shear modulus, CSA, and TRACE evaluation) of the ulnar nerve can be helpful in supporting and supplementing the diagnosis in patients with CuTS.