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Results for “Ulnar Neuropathies”

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At least 19 recordsLinked to original sources
PubMed1979

Surgical treatment of ulnar neuropathy.

Ulnar neuropathy is a well recognized clinical entity caused by a variety of pathological lesions around the elbow. The characteristic features include paresthesia and numbness in the little finger and medial half of the fourth digit, weakness of the small muscles of the hand innervated by the ulnar nerve, and a positive Tinel's sign. The diagnosis is confirmed by electrophysiological studies. Current methods of treatment are anterior transposition, neurolysis and medial epicondylectomy of the humerus. Forty-four patients with ulnar neuropathy are described in the present report. Most were males with a median age of 45. The left side was involved more frequently. Results of subcutaneous anterior transposition and medial epicondylectomy are presented along with a review of the literature.

Adult↗
PubMed1999

Ulnar neuropathy at the elbow.

Among the entrapment neuropathies, ulnar neuropathy at the elbow is second only to carpal tunnel syndrome in frequency; however, diagnosis and management are considerably more difficult in ulnar lesions than in carpal tunnel syndrome. Electrodiagnosis is the most important means of identifying and localizing ulnar neuropathies at the elbow, but even sophisticated techniques may sometimes fail to confirm diagnosis and localization preoperatively. Mild lesions are best managed conservatively. More severe lesions require surgical intervention. Simple decompression is now preferred over transposition in the majority of cases, but careful correlation of electrodiagnostic abnormalities and findings at surgery are necessary to ensure optimal outcome.

Decompression, Surgical↗
PubMed1991

Drivers' elbow: a cause of ulnar neuropathy.

The ulnar nerve is vulnerable to compression and vibration injury in drivers who have the shoulder abducted and elbow flexed with the arm lying against the lower edge of the window. Three cases of ulnar neuropathy at the elbow are described in vehicle drivers.

Adult↗
PubMed1993

Relative frequency of nerve conduction abnormalities at carpal tunnel and cubital tunnel in France and the United States: importance of silent neuropathies and role of ulnar neuropathy after unsuccessful carpal tunnel syndrome release.

The two most frequently diagnosed nerve compression syndromes of the upper extremities are carpal tunnel syndrome and cubital tunnel syndrome. In order to determine the relative frequencies of nerve conduction abnormalities at the carpal tunnel and cubital tunnel in France and the United States, we evaluated all patients (nFR = 882 and nUS = 818) who had nerve conduction studies of the upper extremities over a six-yearFR or three-yearUS interval. In both France and the United States, the risk of electrophysiological abnormalities was 2 to 1 for the wrist relative to the elbow. Abnormal median nerves were twice as likely to be symptomatic as were abnormal ulnar nerves (silent ulnar neuropathy). Thus, the clinical risk for carpal tunnel syndrome relative to cubital tunnel syndrome was approximately 4 to 1. In many cases of persistent hand symptoms following carpal tunnel release, the problem may actually be related to an undiagnosed ulnar nerve lesion. Thus, a complete neurophysiological evaluation of the upper extremity necessitates both median and ulnar studies.

Adolescent↗
PubMed1979

Postoperative ulnar neuropathy.

Although compressive ulnar neuropathy developing during surgical procedures under general anesthesia has been recognized, clinical and electrophysiological features of this neuropathy have been incompletely described. During the past two years, we have seen eight patients with this complication, mainly following intra-abdominal or intrathoracic operations. Neuropathy was associated with a persistent severe deficit during a mean follow-up of 23.5 months (range, six to 96 months) after operation. Electrophysiological studies verified substantial Wallerian degeneration in the majority of patients. Clinical and electrophysiological data, as well as intraoperative findings in some patients, suggest that compression occurred at the cubital tunnel. These patients with ulnar neuropathy had a particularly poor prognosis, whether treated surgically (decompression or transposition) or medically. Prevention of ulnar nerve compression during major operations therefore assumes paramount importance.

Action Potentials↗
PubMed2005

Prevalence of ulnar neuropathy in patients receiving hemodialysis.

BACKGROUND: Ulnar neuropathy can cause pain, weakness, and sensory changes in the hand and can result in functional impairment. Patients with end-stage renal disease receiving hemodialysis may be predisposed to ulnar neuropathy by factors such as arm positioning during hemodialysis, underlying polyneuropathy, and upper extremity vascular access. OBJECTIVE: To determine the prevalence of clinically evident ulnar neuropathy in a cohort of 102 patients with end-stage renal disease receiving hemodialysis. DESIGN: All eligible patients in a single dialysis unit were screened for symptoms and signs of ulnar neuropathy. Those with at least 1 symptom or sign underwent nerve conduction studies to confirm the presence of ulnar neuropathy. RESULTS: Clinically evident, electrophysiologically confirmed ulnar neuropathy was present in 37 (51%) of the 73 subjects with both screening and nerve conduction study data available. The true prevalence of ulnar neuropathy in this cohort was estimated between 41% and 60%. CONCLUSIONS: There is a high prevalence of ulnar neuropathy in patients with end-stage renal disease receiving hemodialysis, which has not been previously recognized. The high prevalence of ulnar neuropathy in this population suggests that preventative efforts are indicated to prevent this functionally limiting complication.

Adult↗
PubMed2000

Changes in spinal cord excitability in patients affected by ulnar neuropathy.

OBJECTIVE: To evaluate whether ulnar neuropathy could induce changes in spinal cord and motor cortex excitability and therefore predispose to development of focal dystonia. BACKGROUND: A high incidence of ulnar neuropathy has been observed in patients with musician's cramp. Polygraphic electromyograph recordings in patients with entrapment of the ulnar nerve at the elbow have demonstrated long-duration bursts of co-contraction in antagonistic muscles, similar to those observed in focal dystonia. METHODS: All control subjects and 12 patients with ulnar neuropathy underwent an electrophysiologic protocol consisting of polygraphic recordings of a repetitive tapping task of the fourth finger, assessment of reciprocal inhibition in forearm muscles, and investigation of motor cortex excitability after paired transcranial magnetic stimulation. RESULTS: Eleven of 12 patients with ulnar neuropathy showed a loss of alternation and of well-formed bursts in both flexor and extensor muscles. Evaluation of reciprocal inhibition in these patients revealed a reduction in the amount of inhibition in the disynaptic and presynaptic phases. None of the patients presented with a clinically evident dystonia of the upper limb. The study of intracortical excitability after paired shocks did not reveal any difference in the amount of intracortical inhibition and facilitation compared with the control group. CONCLUSIONS: A peripheral nerve injury can induce a rearrangement of reciprocal inhibition circuits at the spinal cord level. These changes might predispose to the development of a focal dystonia. However, it is likely that another, yet unknown, factor is required to alter the intracortical circuits and produce a clinically evident dystonia.

Adult↗
PubMed1999

New near-nerve needle nerve conduction technique: differentiating epicondylar from cubital tunnel ulnar neuropathy.

At the elbow, the ulnar nerve is compressed most commonly either in the epicondylar groove or at the cubital tunnel. While conventional electrodiagnosis may localize an ulnar neuropathy to the elbow, separating epicondylar syndrome (tardy ulnar nerve palsy) from cubital tunnel syndrome is more difficult. We describe a new method using a near-nerve needle technique for distinguishing these two types of ulnar neuropathy at the elbow. We placed three active needle electrodes across the elbow: the first was 4 cm above, and the second and third were 1.5 cm and 6 cm below the medial epicondyle, respectively. The latter two points were chosen because of the presence of the cubital tunnel in this segment. Sensory, motor, and mixed nerve conduction studies (NCS) were performed on these two segments (elbow segment and cubital tunnel segment) in 26 normal nerves and normal data were established. We also present 7 cases of epicondylar ulnar nerve palsy and 1 case of cubital tunnel syndrome in which we were able to confirm the diagnosis with the present method. In 3 cases of epicondylar ulnar nerve palsy, the present method accurately localized the lesion when other methods failed. We believe that this method will be helpful in distinguishing cubital tunnel syndrome from epicondylar ulnar nerve palsy, especially in early ulnar neuropathy in which only sensory fibers are involved.

Adult↗
PubMed1998

Three ulnar nerve conduction studies in patients with ulnar neuropathy at the elbow.

OBJECTIVE: Ulnar neuropathy at the elbow is often difficult to localize by standard electrophysiologic testing. This study compared three ulnar nerve conduction studies to determine which was more sensitive in localizing ulnar neuropathy at the elbow. METHODS: Motor studies to the first dorsal interosseous and the abductor digiti quinti and a mixed ulnar nerve sensory study across the elbow. RESULTS: Motor studies to the first dorsal interosseous and abductor digiti quinti were abnormal in 81% and 71% of patients, respectively. The ulnar mixed sensory study across the elbow was abnormal in 57%. In 38%, all three tests were abnormal. CONCLUSION: Motor studies were more sensitive than the ulnar mixed sensory study across the elbow in localizing ulnar neuropathy of the elbow.

Adult↗
PubMed1995

Comparison of the flexed and extended elbow positions in localizing ulnar neuropathy at the elbow.

Electrophysiologic localization of ulnar neuropathy at the elbow often depends on demonstration of segmental slowing. Based on normative data obtained from 50 control subjects, we compared the utility of flexed and extended elbow positions in demonstrating focal slowing at the elbow as compared to the forearm segment in patients with ulnar neuropathy. We studied 35 patients with ulnar neuropathy with definite electrophysiologic localization to the elbow segment defined by conduction block across the elbow segment or by focal slowing demonstrated either in the flexed or extended position. Applying cutoff values from the control group, all 35 patients demonstrated focal slowing at the elbow in the flexed position, whereas only 5 of 35 (14%) patients did so in the extended position. We conclude that the flexed elbow position is more sensitive than the extended position in localizing ulnar neuropathy at the elbow and should be the preferred method when performing ulnar motor conduction studies.

Adult↗
PubMed1992

Early postoperative ulnar neuropathies following coronary artery bypass surgery.

Ulnar neuropathies following surgery are common. However, they often go undetected during the early postoperative period, because the patient may be unaware of symptoms related to the neuropathy. Nerve conduction studies are useful in localizing the lesion, but are usually employed only in cases developing signs and symptoms. We undertook this study to determine the incidence, time of onset, and outcome of clinical and subclinical ulnar neuropathies. Electrophysiological studies were carried out preoperatively, immediately following surgery, and 4 to 6 weeks postoperatively in 20 coronary artery bypass patients. Conduction velocity across the elbow was reduced in 3 limbs (8%) postoperatively, all of which were detected immediately following surgery. One patient developed conduction block and weakness in ulnar supplied intrinsic hand muscles. Denervation was seen in 2 cases and, in 1 case (5%), a right brachial plexus injury was clinically evident 5 days following surgery. All newly developing ulnar neuropathies were asymptomatic, with most recovering to their preoperative electrophysiological status at follow-up.

Brachial Plexus↗
PubMed2003

Perioperative ulnar neuropathies: a medicolegal review.

BACKGROUND: Perioperative ulnar neuropathies have long been attributed to inappropriate arm positioning and padding during operations and have resulted in many lawsuits. METHODS: A recent Canadian lawsuit is described and the literature regarding perioperative ulnar and other focal neuropathies reviewed. RESULTS: The evidence strongly suggests that ulnar nerve damage is usually sustained in the postoperative rather than the intraoperative period. There is no evidence that positioning or padding of the arm during the operation prevents perioperative ulnar neuropathies. CONCLUSIONS: There should generally be no basis for a claim against medical or nursing staff or hospitals when an ulnar neuropathy develops following anesthesia and surgery.

Aged↗
PubMed2005

[Comparison of mixed latency of ulnar and median nerve between wrist and elbow as diagnostic test of ulnar neuropathy in elbow].

INTRODUCTION: Conventional electrodiagnosis of ulnar neuropathy at the elbow is based on abnormalities in motor conduction across the elbow. However, sensory symptoms are predominant, and an accurate determination of the length of the nerve in this segment is difficult to obtain. OBJECTIVE: We present an electrodiagnostic technique which helps to avoid these difficulties. MATERIAL AND METHODS: We compared the mixed latency of ulnar and median nerve between wrist and above the elbow in 172 symptomatic and 407 asymptomatic ulnar nerves. RESULTS: We determined that a difference of the mixed latency of ulnar and median nerve between wrist and above the elbow equal or higher than 1 ms had a sensitivity of 87% to an specificity of 91% for the diagnosis of ulnar neuropathy at the elbow. Moreover, a difference between both arms equal to or higher than 0.3 ms had a sensitivity of 80% and specificity of 91 %. If both conditions are present, the test is very specific (98%). CONCLUSIONS: The measurement of the difference in mixed latency between ulnar and median nerves from wrist to above the elbow is a valuable tool for evaluating patients with suspected ulnar neuropathy at the elbow without motor involvement.

Action Potentials↗
PubMed1999

Ulnar neuropathy in surgical patients.

BACKGROUND: The goal of this project was to study the frequency and natural history of perioperative ulnar neuropathy. METHODS: A prospective evaluation of ulnar neuropathy in 1,502 adult patients undergoing noncardiac surgical procedures was performed. Patients were assessed with a standard questionnaire and neurologic examination before surgery, daily during hospitalization in the first week after surgery, and by telephone if they were discharged before 1 postoperative week. Patients in whom ulnar neuropathy developed were followed for 2 yr. RESULTS: Ulnar neuropathy developed in seven patients (0.5%; 95% confidence interval, 0.2% to 1.0%). Six of the seven patients were men. Symptoms of ulnar neuropathy began 2-7 days after surgery. Manifestations were mild and confined to sensory deficits in six patients. Symptoms resolved in four patients within 6 weeks. The remaining three patients had residual symptoms 2 yr later. CONCLUSIONS: In this surgical population, ulnar neuropathy was an infrequent complication. It occurred primarily in men who were 50-75 yr old and was not symptomatic until several days after surgery. Gender-dependent differences in the anatomy of the ulnar nerve and related structures at the elbow may serve as risk factors for ulnar neuropathy in patients having surgery.

Aged↗
PubMed1994

Ulnar neuropathy. Incidence, outcome, and risk factors in sedated or anesthetized patients.

BACKGROUND: Ulnar neuropathy is well-recognized as a potential complication of procedures performed on anesthetized patients. However, reported outcomes and risk factors for this problem are based on small series and anecdotes. METHODS: We retrospectively reviewed the perioperative courses of 1,129,692 consecutive patients who underwent diagnostic and noncardiac surgical procedures with concurrent anesthetic management at the Mayo Clinic from 1957 through 1991 (inclusive). The medical diagnoses of patients who had these procedures were scanned for 26 diagnoses associated with neuropathy. Persistent neuropathy of an ulnar nerve was defined as a sensory or motor deficit of greater than 3 months' duration. Risk factors anecdotally associated with persistent neuropathy were analyzed by comparing patients with an ulnar neuropathy with control subjects in a 1:3 case-control study. RESULTS: Persistent ulnar neuropathies were identified in 414 patients, a rate of 1 per 2,729 patients. Of these, 38 (9%) patients had bilateral neuropathies. Approximately equal numbers of the neuropathies included sensory loss only or mixed sensory and motor loss. Initial symptoms form most neuropathies were noted more than 24 h after the procedure. Factors associated with persistent ulnar neuropathy included male gender and a duration of hospitalization of more than 14 days (P < 0.01). Neuropathy was more likely to develop in very thin and obese patients than in patients with average body habitus. Neither the type of anesthetic technique nor the patient position was found to be associated with this neuropathy. Of the 382 patients who survived the 1st postoperative yr, 53% regained complete motor function and sensation and were asymptomatic. Of those with neuropathies persisting for more than 1 yr, most had moderate or greater disability from pain or weakness. CONCLUSIONS: These data suggest that perioperative ulnar neuropathies are associated with factors other than general anesthesia and intraoperative positioning. Men at the extremes of body habitus who have prolonged hospitalizations are particularly susceptible to development of ulnar neuropathies.

Adult↗
PubMed2006

Utility of magnetic resonance imaging in diagnosing ulnar neuropathy at the elbow.

OBJECTIVE: Magnetic resonance imaging (MRI) of the ulnar nerve is being increasingly employed in the diagnosis of ulnar neuropathy at the elbow (UNE). Our aims were to: (i) assess the sensitivity of MRI in diagnosing UNE, especially in cases where neurophysiologic studies were non-localizing, (ii) determine the spectrum of MRI abnormalities in patients presenting with symptoms and signs of ulnar neuropathy, (iii) assess whether MRI findings differ between grades of UNE severity, and (iv) to see if MRI findings give an input into the pathological mechanisms of UNE. METHODS: Clinical, neurophysiologic, and radiologic (MRI) records were reviewed in 52 patients with symptoms and signs of ulnar neuropathy. Ulnar nerve MRI studies were assessed by an unblinded observer. RESULTS: The sensitivity of MRI at diagnosing UNE was higher than conventional nerve conduction studies, 90 versus 65%, respectively. In patients with non-localizing neurophysiologic studies (n=19), MRI disclosed changes consistent with UNE in 16 (84%) cases. The most frequent MRI findings included a combination of high signal intensity and nerve enlargement (63%), followed by nerve compression (27%) and isolated high signal intensity (23%), and isolated nerve enlargement (2%). There was no significant difference between patients with localizing and non-localizing neurophysiologic testing. Lastly, there were no differences between different grades of UNE, suggesting that UNE may be a neurophysiologically heterogeneous disorder. CONCLUSIONS: MRI studies proved to be more sensitive than conventional nerve conduction studies at diagnosing UNE. In addition, the MRI studies were highly sensitive in patients with non-localizing UNE. SIGNIFICANCE: Our study shows that MRI of the ulnar nerve should be used in patients with clinical features of UNE especially in those with non-localizing neurophysiologic testing.

Adolescent↗
PubMed1982

Simple decompression and occasional microsurgical epineurolysis under local anesthesia as treatment for ulnar neuropathy at the elbow.

Decompression of the ulnar nerve in the cubital tunnel will reverse ulnar neuropathy at the elbow in most patients. We believe that operating under local anesthesia has allowed us to identify those few patients who will not respond to simple decompressive surgery. Among the 20 cases of ulnar neuropathy managed in this fashion, intraoperative motor-sensory improvement occurred after simple decompressive surgery in 16. Four patients who failed to improve after cubital tunnel decompression underwent microsurgical epineurolysis immediately thereafter, under the same local anesthetic, with prompt improvement. Local anesthesia and microsurgical epineurolysis seem to be useful adjuncts to simple decompressive surgery for ulnar neuropathy.

Female↗
PubMed1991

Ulnar neuropathy caused by an accessory abductor digiti minimi muscle.

Peripheral neuropathies of the ulnar nerve at various locations in the upper extremity are common, but compression of the ulnar nerve at the level of the wrist due to an anomalous muscle is rare, though reported in the literature. Three cases of an abnormal abductor digiti minimi origin were first reported by Wood in 1868, but no mention was made of an associated ulnar neuropathy. To data, there have been 8 reported cases of an anomalous abductor digiti minimi, with sensory or motor abnormalities of the ulnar nerve the most common presentation. This case report describes a patient who had subjective paresthesiae in the ulnar nerve distribution for 2 years. He was found, at exploration, to have an anomalous muscle belly originating proximally from the deep forearm fascia with insertion into the abductor digiti minimi. We present the case, discuss the spectrum of compression neuropathies of the ulnar nerve at the wrist, and a review of the occurrence of anomalous muscles responsible.

Adult↗