Conservative treatment using a newly designed custom-made wrist splint for ulnocarpal abutment syndrome.

BACKGROUND: Immobilization of the wrist joint with a splint is an established approach for ulnar-sided pain due to ulnocarpal abutment syndrome. However, patients have a tendency to stop wearing the splints because of its inconvenience and there have been no reports based on splint therapy. OBJECTIVE: We investigated the usefulness of a newly designed custom-made aluminum splint for ulnar-sided wrist pain. STUDY DESIGN: This was a cohort study of the aluminum splint therapy for the patients who had been primarily treated with a conventional splint but ceased to use it because of the inconvenience in activities of daily living. METHODS: The subjects included 10 female patients (mean age = 44.2 years). The outcome was assessed using the visual analogue scale score for pain, the disabilities of the arm, shoulder and hand score, range of motion of the wrist, and the grip strength. The mean follow-up period after wearing the aluminum splint was 8.8 months. RESULTS: All parameters, including the visual analogue scale pain and disabilities of the arm, shoulder and hand scores, improved significantly (p < 0.05) following use of the aluminum splint relative to the pretreatment scores. Seven patients continued to use the aluminum splint, and three of the seven had complete remission from related pain. CONCLUSION: Constant use of the aluminum splint during the study period was associated with improvement in the ulnar-sided wrist pain scores, which reconfirmed that increased adherence to splint use in daily activities is an important intentional behavioral strategy. CLINICAL RELEVANCE: Although the custom splint is effective for alleviation of wrist pain in ulnocarpal abutment syndrome, continuity of splint use is a key element of conservative treatment. This study showed that a splint that patients were willing to wear in their daily life was a useful device for alleviation of pain.

Mobilização do osso pisiforme no tratamento da neuropraxia do nervo ulnar no canal de Guyon: relato de caso / Pisiform bone mobilization for treating ulnar nerve neuropraxia at Guyon's canal: case report

As neuropraxias do nervo ulnar são lesões bastante freqüentes que provocam efeitos deletérios, como diminuição de força muscular e parestesias; geralmente ocorrem no nível do epicôndilo medial e do túnel ulnar (canal de Guyon). São escassos os relatos referentes a técnicas de terapia manual para compressões do nervo ulnar no canal de Guyon. Este trabalho relata o uso da técnica de mobilização do pisiforme na compressão do nervo ulnar no canal de Guyon de um homem que sofreu luxação do punho direito aos 8 anos e, aos 25, queixava-se de um deficit para adução do dedo mínimo, que atrapalhava a realização de algumas atividades de vida diária. O paciente foi submetido a uma única sessão de mobilização articular do pisiforme. Após a aplicação da técnica, o sinal positivo do teste foi eliminado, restabelecendo-se a função de adução do 5o dedo. Embora carecendo de maior fundamentação teórica, pode-se afirmar que a técnica usada, de mobilização articular do osso pisiforme, é eficaz para melhora do quadro de paresia por neuropraxia do nervo ulnar no canal de Guyon...

A common ulnar nerve neuropraxia is lesion that may result in muscle strength decrease and/or paresthesia; it usually takes place at medial epicondylelevel and the ulnar tunnel (Guyon’s canal). Studies on manual therapy techniques for ulnar nerve compression in Guyon’s canal are scarce. This paper reports the use of a technique of pisiform bone mobilization for relieving ulnar nerve compression in Guyon’s canal, in a man who had suffered a luxation of the right wrist at the age of 8 and, at 25, complained of adduction deficit of the fifth finger that interfered in his daily life activities. He was submitted to one session of pisiform mobilization; after the session, the positive test sign was eliminated, thus restoring the fifth finger function. Though lacking further grounding, it may be said that the technique used, of mobilizing the pisiform bone joint, is effective to restore normal function after ulnar nerve compression at the Guyon’s canal...

Ulnar nerve compression neuropathy at Guyon's canal caused by crutch walking: case report with ultrasonographic nerve imaging.

This report is the first account of Guyon's syndrome after the bilateral use of forearm crutches. Crutch palsy is usually neuropraxic in nature and associated with clinical and electrophysiologic recovery of nerve function, especially if patients are instructed to not bear excessive weight on the wrist. The present case history follows this pattern. In establishing the diagnosis of a focal compression neuropathy, a combination of clinical assessment and neurophysiologic studies are typically used. This report describes the additional application of ultrasound imaging to verify the diagnosis and to track changes in the appearance of the nerve during follow-up.

Neurolysis of the ulnar nerve for neuropathy following total elbow replacement.

Ulnar neuropathy presents as a complication in 5% to 10% of total elbow replacements, but subsequent ulnar neurolysis is rarely performed. Little information is available on the surgical management of persistent ulnar neuropathy after elbow replacement. We describe our experience with the surgical management of this problem. Of 1607 total elbow replacements performed at our institution between January 1969 and December 2004, eight patients (0.5%) had a further operation for persistent or progressive ulnar neuropathy. At a mean follow-up of 9.2 years (3.1 to 21.7) six were clinically improved and satisfied with their outcome, although, only four had complete recovery. When transposition was performed on a previously untransposed nerve the rate of recovery was 75%, but this was reduced to 25% if the nerve had been transposed at the time of the replacement.

Severe ulnar neuropathy after subcutaneous transposition in a collegiate tennis player.

We report the case of an "overhead" athlete (a collegiate tennis player) who developed severe ulnar neuropathy after anterior subcutaneous transposition and placement of a fasciodermal sling. Treatment consisted of opening the sling, excising suture material, releasing all other areas of potential compression, and performing anterior submuscular transposition of the ulnar nerve deep to the flexor muscle group. Two years after surgery, subjective symptoms were significantly improved, though the patient continued to experience mild medial-side elbow discomfort and intermittent paresthesia along the ulnar nerve distribution. Pain relief achieved without full sensory and motor recovery is consistent with results reported elsewhere. In short, extreme care must be taken when creating a fasciodermal sling during anterior subcutaneous transposition of the ulnar nerve.

[The effect of pharmacopuncture on the blood biochemical indices of patients with tunnel syndromes of the hands]. / Vliianie farmakopunktury na biokhimicheskie pokazateli krovi bol'nykh s tunnel'nymi sindromami ruk.

Concentrations of serotonin, beta-endorphine, myoglobin, basic myelin protein were measured in blood of patients with tunnel hand syndromes treated by actovegin or physiological solution pharmacopuncture and acupuncture to the same acupuncture points (AP). The above biochemical indices showed similar changes in pharmacopuncture with actovegin and the solution. These changes were different in acupuncture. This indicates specificity of AP stimulation by introduction of fluid, but not specificity of drug effects.

Rehabilitation after subcutaneous transposition of the ulnar nerve: immediate versus delayed mobilization.

We studied 36 patients who had clinical signs and symptoms consistent with cubital tunnel syndrome and in whom nonoperative management failed. These patients underwent anterior subcutaneous transposition of the ulnar nerve followed by either immediate (20 patients) or delayed (16 patients) mobilization. All patients were evaluated with an outcomes assessment questionnaire, and 35 of the 36 were given repeat physical examinations. After surgery, there were no significant differences between the two groups in pain relief, weakness, or patient satisfaction (71% of the immediate mobilization group and 74% of the delayed group) were satisfied. Secondary quantitative outcomes such as grip strength, lateral pinch, or two-point discrimination were also not significantly different between the groups. Both groups had a statistically significant improvement in first dorsal interosseous and adductor pollicis muscle strength. In the immediate mobilization group, however, patients returned to work and resumed activities of daily living earlier (median 1 month) than patients in the delayed mobilization group (median 2.75 months). Therefore, we conclude that anterior subcutaneous transposition provides a high degree of satisfaction and relief of symptoms regardless of when mobilization is initiated. However, immediately mobilizing the patient significantly influenced how early the patient returned to work and resumed activities of daily living.

The role of splinting and rehabilitation in the treatment of carpal and cubital tunnel syndromes.

Successful treatment of patients suffering from carpal or cubital tunnel syndrome requires a skilled collaborative effort by the physician, therapist, and patient. Unfortunately, many factors influence an individual's recovery and outcome. As medical professionals, we must educate the patient, examine the physical and environmental factors involved in each case, and design unique treatment plans in each instance.

[Entrapment of the ulnar nerve at the elbow caused by repetitive movements: description of a clinical case]. / Intrappolamento del nervo ulnare al gomito da movimenti ripetitivi: descrizione di un caso clinico.

The paper describes a case of ulnar neuropathy in a man who made household fittings and toys using bamboo. Several years after starting the job he showed symptoms and physical signs of ulnar nerve entrapment at the elbow, which were confirmed by electrophysiological findings. Job analysis revealed biomechanical risk factors consisting of a high repetition of forceful flexion and extension of the elbow, wrist and fingers without sufficient rest periods. Chronic musculoskeletal overuse gradually leads to tendon and nerve disorders. The ulnar neuropathy described can be classed under cumulative occupational trauma, which is the most important cause of musculoskeletal disorders among the working population.

Outcome study of ulnar nerve compression at the elbow treated with simple decompression and an early programme of physical therapy.

Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper limb. This paper presents the experience of treating cubital tunnel syndrome with simple decompression in 131 patients (164 ulnar nerves) over the past 12 years. 85% of these patients had mild or moderate ulnar nerve disease. In 146/164 ulnar nerves (89%), simple decompression resulted in good or excellent immediate post-operative relief of symptoms. After an average follow-up of 4.3 years (range, 0.8-12.0 years), 130/164 (79%) still reported good or excellent relief. The independent predictors of a better long-term outcome were absence of post-operative subluxation, greater body weight, normal pre-operative two-point discrimination (2-PD), and a more recent date of operation. A physical therapy rehabilitation program generally began on the day after surgery. Active participation in this predicted a rapid return to work or activities of daily living. The average time to return to work with simple decompression was 20 workdays.

Early versus late range of motion following cubital tunnel surgery.

The purpose of this study was to evaluate the effects of early versus late range of motion exercises following cubital tunnel release and medial epicondylectomy. Fifty-seven consecutive cases were studied and divided into two groups. Physical therapy consisting of active and passive range of motion exercises was started 14 days postoperatively for the first group and 3 days postoperatively for the second group. Fifty-two percent of the patients in group 1 sustained flexion contractures of more than 5 degrees compared with only 4% of the patients in group 2. Early initiation of therapy did not adversely affect the grip strength and/or other functions of the upper extremity, and the patients in group 2 returned to work sooner than the patients in group 1 (in fact, in half the time). Institution of range of motion exercises immediately postoperatively is more effective in preventing flexion contractures of the elbow than is delayed treatment.