Objective To investigate the clinical therapeutic effect of the ulnar neurolysis and nerve anterior transposition with an immediate range of motionfor the cubital tunnel syndrome in the aged. Methods Forty-three patients (24males and 19 females, aged 60-81 years, averaged 67) admitted for the cubital tunnel syndrome from January 1999 to December 2004 were randomly divided into 2groups: Group A (n=20) and Group B (n=23), with an illness course of 2-10 months. All the patients underwent the ulnar neurolysis and the nerve anterior transposition. After operation the patients’ elbows in group A were immobilized with the plaster slab for an external fixation for 3 weeks; the patients’ elbows in group B did not use the external fixation, but began an immediate range of motion on the 2nd day after operation. The Bishop scoring system was used to evaluate the patients’ functional recovery in the 2 groups. Results The follow-up for 1-5 years showed that the ulnar nerve function of all the patients were improved but no significant differences were found between the 2 groups (P＞0.05). The patients in Group A returned to daily activities or work at 45.2±5.1 days, but the patients in Group B required 15.5±3.8 days, with a significant difference between the 2 groups (P＜0.05). According to Bishop scoring system, the resutls were excellent in 14 cases, good in 4 cases, fair in 1 case and poor in 1 case in Group A, and 16, 4, 2 and 1 respectively in Group B. There was no significant difference between the two groups(P＞0.05). Conclusion The ulnar neurolysis and nerve anterior transposition with an immediate range of motion for the cubital tunnel syndrome can promote the ulnar function recovery of the oldaged patients. They can return to their daily activities or work at a more rapid speed when their elbows are mobilized immediately after operation.
Objective To investigate the blood supply of the ulnar nerve in the elbow region and to design the procedure of anterior transposition of ulnar nerve accompanied with arteries for cubital tunnel syndrome.Methods The vascularity of the ulnar nerve was observed and measured in20adult cadaver upper limb specimens. And the clinical surgical procedure was imitated in 3 adult cadaver upper limb specimens. Results There were three major arteries to supply the ulnar nerve at the elbow region: the superior ulnar collateral artery, the inferior ulnar collateral artery and the posterior ulnar recurrent artery. The distances from arterial origin to the medial epicondyle were 14.2±0.9, 4.2±0.6 and 4.8±1.1 cm respectively. And the total length of the vessels travelling alone with the ulnar nerve were 15.0±1.3,5.1±0.3 and 5.6±0.9 cm. The external diameter of the arteries at the beginning spot were 1.5±0.5, 1.2±0.3 and 1.4±0.5 mm respectively. The perpendicular distance of the three arteries were 1.2±0.5,2.7±0.9 and 1.3±0.5 cm respectively.Conclusion It is feasible to perform anterior transposition of the ulnar nerve accompanied with arteries for cubital tunnel syndrome. And the procedure preserves the blood supply of the ulnar nerve following transposition.
Objective To investigate the relationship between the elbow flexion angle and the cubital tunnel pressure in patients with cubital tunnel syndrome. Methods Between June 2010 and June 2011, 63 patients with cubital tunnel syndrome were treated. There were 47 males and 16 females with an average age of 59 years (range, 31-80 years). The lesion was at left side in 18 cases and at right side in 45 cases. During anterior transposition of ulnar nerve, the cubital tunnel pressure values were measured at full elbow extension, elbow flexion of 30, 60, and 90°, and full elbow flexion with microsensor. The elbow flexion angle-cubital tunnel pressure curve was drawn. Results The cubital tunnel pressure increased smoothly with increased elbow flexion angle when the elbow flexed less than 60°, and the pressure increased sharply when the elbow flexed more than 90°. The cubital tunnel pressure values were (0.13 ± 0.15), (1.75 ± 0.30), (2.62 ± 0.34), (5.78 ± 0.47), and (11.40 ± 0.62) kPa, respectively at full elbow extension, elbow flexion of 30, 60, and 90°, and full elbow flexion, showing significant differences among different angles (P lt; 0.05). Conclusion The cubital tunnel pressure will increase sharply when the elbow flexes more than 90°, which leads to the chronic ischemic damage to ulnar nerve. Long-term ischemic damage will induce cubital tunnel syndrome.
Objective To investigate the methods and outcome of endoscopic ulnar neurolysis and minimal medial epicondylectomy in treatment of cubital tunnel syndrome with ulnar nerve subluxation. Methods Between June 2004 and June 2009, 11 cases of cubital tunnel syndrome with ulnar nerve subluxation were treated with endoscopic ulnar neurolysis andminimal medial epicondylectomy. There were 7 males and 4 females with an average age of 36 years (range, 18-47 years). All cases had numbness in l ittle finger and ring finger. The disease duration varied from 3 to 18 months (7 months on average). Nine cases had atrophy in the first dorsal interosseous muscle and hypothenar muscles. The preoperative electromyography showed that the ulnar nerve conduction velocity (NCV) were slowed down at elbow, which was (27.0 ± 1.5) m/s. Results All incisions healed by first intention, and no compl ication occurred. Eleven cases were followed up 6-37 months (19 months on average). All cases had normal sensation after 1 month of operation. The muscle strength was obviously improved in 11 cases after 3 months postoperatively (grade 4 in 7 cases and grade 3-4 in 4 cases). The postoperative electromyography showed that the NCV was obviously improved, which was (43.5 ± 9.5) m/s, showing significant difference when compared with preoperative one (P lt; 0.05). According to Amadio’ efficacy appraisal standard, the results were excellent in 7 cases and good in 4 cases. Conclusion The method of endoscopic ulnar neurolysis and minimal medial epicondylectomy has the advantages of safety, convenient manipulation, small incision, and early recovery for cubital tunnel syndrome with ulnar nerve subluxation.
ObjectiveTo summarize the clinical research progress of surgical procedures for cubital tunnel syndrome. MethodsThe related literature on surgical procedures for cubital tunnel syndrome was summarized and analyzed. ResultsMultiple surgical procedures have been applied to treat cubital tunnel syndrome, including simple decompression, subcutaneous transposition, submuscular transposition, medial epicondylectomy, intramuscular transposition, and ulnar groove plasty. Each procedure has its own advantages and disadvantages. With the development of minimally invasive surgical technique, endoscope-assisted surgery has been gradually applied to treat cubital tunnel syndrome. ConclusionOptimal surgical procedure remains controversial and individualized treatment decision based on patient's clinical conditions is recommended.
Objective To report the operation method and the cl inical effect of decompression and anterior transposition of the ulnar nerve with inferior ulnar collateral artery for cubital tunnel syndrome. Methods From September 2005 to May 2006, 25 cases of cubital tunnel syndrome were treated by the method of decompression and anterior transposition of the ulnar nerve with inferior ulnar collateral artery. There were 19 males and 6 females with an average of 60 years (20-72 years). The disease course was 2 months to 3 years (mean 6.7 months). The causes were ostesarthritis in 23 cases, cubital tunnel cyst in 1 case and ulnar nerve ol isthy in 1 case. According to Pasque grading system for cubital tunnel syndrome, 19 cases were graded as good and 6 cases were graded as poor. Electrophysiological examination showed the motor nerve conduction velocity of the ulnar nerve around the elbow joint was less than 42 m/s. Results All wounds healed by first intention and no operative compl ications and recurrences occurred. All patients were followed up for one year to two and half years (13.9 months on average). According to Pasque grading system for cubital tunnel syndrome, 15 cases were graded as excellent, 9 cases as good and 1 case as fair. The excellent and good rate was 96%, indicating a significant difference compared with the results before operation (P lt; 0.05). Electrophysiological examination showed the motor nerve conduction velocity of the ulnar nerve around the elbow joint was more than 42 m/s. Conclusion The method of decompression and anterior transposition of the ulnar nerve with inferior ulnar collateral artery is safe and effective for the treatment of cubital tunnel syndrome.
To explore related factors of cubital tunnel syndrome caused by cubitus valgus deformity so as to provide theoretical basis for the cl inical treatment. Methods Between June 2002 and September 2008, 40 patients with cubital tunnel syndrome caused by cubitus valgus deformity underwent anterior subcutaneous ulnar transposition. Related factors wasanalysed through logistic regression analysis using scoring standard recommended by Yokohama City University. Results All 40 patients were followed up 27.5 months on average (range, 12-75 months). The duration of cubitus valgus deformity, cubitus valgus deformity angle, and the duration of paraesthesia and muscular atrophy were identified as related factors for ulnar neuropathy and the odds ratios were 1.005 (P=0.045), 9.374 (P=0.000), and 4.358 (P=0.010), respectively. The related prognosis factors were duration of paraesthesia and muscular atrophy, deformity angle, and age at surgery, with odds ratios of 8.489 (P=0.000), 2.802 (P=0.030), and 4.611 (P=0.031), respectively. Conclusion Related factors for ulnar neuropathy are durations of cubitus valgus deformity, cubitus valgus deformity angle, and duration of paraesthesia and muscular atrophy. Related factors for prognosis include age at surgery, cubitus valgus deformity angle, and duration of muscular atrophy. Early anterior subcutaneous ulnar transposition should be performed in patients with cubital tunnel syndrome caused by cubitus valgus deformity
ObjectiveTo study the effectiveness of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle in the treatment of severe cubital tunnel syndrome. MethodsBetween March 2006 and May 2015, 22 cases (23 hands) of severe cubital tunnel syndrome were treated by use of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle. There were 15 males and 7 females, aged 45-60 years (mean, 55 years). The causes were valgus deformity of elbow joint in 12 cases, ulnar nerve subluxation in 4 cases, and osteoarthritis in 6 cases. The disease duration was 10 months to 3 years (mean, 17 months). According to Akahori classification, 14 cases were rated as type 4 and 9 cases as type 5. The ring/little finger's numbness, hand intrinsic muscle atrophy, recovery of thumb adduction function, and improvement of claw hand deformity were observed after operation. Thumb and index finger's pinch strength was measured by use of pinch device; postoperative hand function was evaluated by the standards of Chinese Medical Society of Hand Surgery of upper limb assessment protocol. ResultsAll incisions healed well and all cases were successfully followed up 8 to 24 months (mean, 14 months). Numbness of ring/little finger was significantly reduced at 1 day after operation in 10 hands; numbness disappeared completely at 1 month after operation in 12 hands; mild numbness remained at 14 months after operation in 11 hands. At last follow-up, hand intrinsic muscle atrophy partially improved (+++) in 1 hand, no improvement in 22 hands; improvement of claw hand deformity was achieved in 17 hands, no improvement in 6 hands; pinch strength of thumb and index finger was significantly improved to (5.07±1.11) kg from preoperative (2.91±0.63) kg (t=-12.340, P=0.032). At last follow-up, the results were excellent in 11 hands, good in 8 hands, fair in 3 hands, and poor in 1 hand, and the excellent and good rate was 82.6%. ConclusionAnterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle is a simple, effective, and reliable surgical treatment for severe cubital tunnel syndrome.
Objective To discuss the curative effect of expanding ulnar nerve groove and interfascicular neurolysis under microscope in treating severe cubital tunnel syndrome (Cub Ts), and to compare with that of the forward moving of ulnar nerve and interfascicular neurolysis under microscope to find out the best way to treat severe Cub Ts. Methods From December 2002 to January 2007, 22 severe Cub Ts cases were treated with expansion of ulnar nerve groove and interfascicular neurolysis under microscope (treatment group), and other 22 cases were treated with forward moving of ulnar nerve and interfascicular neurolysis under microscope (control group). In treatment group, there were 17 males and 5 females, aged 21-66 years (mean 43.8 years). Pathogenic causes were elbow arthritis in 17 cases, ulnar nerve dislocation in 3 cases and elbow ectroption in 2 cases. The locations were left elbow in 8 cases and right elbow in 14 cases. Thecourse of disease was 6-69 months. In control group, there were 18 males and 4 females, aged 20-64 years (mean 42.1 years). Pathogenic causes were elbow in arthritis 16 cases, ulnar nerve dislocation in 3 cases, elbow ectroption in 1 case and narrowing and shallowing of ulnar nerve groove caused by abnormal heal ing of medial condyle fracture in 1 case. The locations were left elbow in 7 cases and right elbow in 15 cases. The course of disease was 5-67 months. Results For all patients of both groups, the wound healed by first intention, and all were followed up for 12-45 months. In treatment group, the numbness in l ittle finger was obviously rel ieved, or disappeared in 22 cases 1 day after operation. In control group, the numbness in l ittle finger was obviously rel ieved or disappeared in 22 cases 3-5 days after operation. EMG showed that conduction speed of ulnar nerve was normal. Evaluated by upper l imbs function standard of China Medical Association, Surgery Association and Lascar grades, the results were excellent in 21 cases and good in 1 case in treatment group; whilet excellent in 19 cases, good in 2 cases and fair in 1 case in control group. There was significant difference between treatment group and control group (P lt; 0.01). Conclusion Either expansion of ulnar nerve groove and interfascicular neurolysis or forward moving of ulnar nerve and interfascicular neurolysis is an effective method to treat severe Cub Ts, but the former is better than the latter.