Evaluation of the ulnar nerve with shear-wave elastography: a potential sonographic method for the diagnosis of ulnar neuropathy

김수진,이근영 대한초음파의학회 2021 ULTRASONOGRAPHY Vol.40 No.3

Purpose: This study was designed to verify whether shear-wave elastography (SWE) can be used to differentiate ulnar neuropathy at the cubital tunnel from asymptomatic ulnar nerve or medial epicondylitis. An additional aim was to determine a cut-off value to identify patients with ulnar neuropathy. Methods: This study included 10 patients with ulnar neuropathy at the cubital tunnel as confirmed with electromyography (three women and seven men; mean age, 51.9 years), 10 patients with medial epicondylitis (nine women and one man; mean age, 56.1 years), and 37 patients with asymptomatic ulnar nerve and lateral epicondylitis (21 women and 16 men; mean age, 54.0 years). Each patient underwent SWE of the ulnar nerve at the cubital tunnel, distal upper arm, and proximal forearm. Results: Patients with ulnar neuropathy at the cubital tunnel exhibited significantly greater mean ulnar nerve stiffness at the cubital tunnel (66.8 kPa) than controls with medial epicondylitis (21.2 kPa, P=0.015) or lateral epicondylitis (33.9 kPa, P=0.040). No significant differences were observed between patients and controls with regard to ulnar nerve stiffness at the distal upper arm or the proximal forearm. A stiffness of 31.0 kPa provided 100% specificity, 80.0% sensitivity, 100% positive predictive value, and 83.3% negative predictive value for the differentiation between ulnar neuropathy and medial epicondylitis. Conclusion: Cubital tunnel syndrome is associated with a stiffer ulnar nerve than lateral or medial epicondylitis. SWE seems to be a new, reliable, and simple quantitative diagnostic technique to aid in the precise diagnosis of ulnar neuropathy at the cubital tunnel.

A Fusiform Epineural Ganglion Encompassing the Ulnar Nerve in the Cubital Tunnel

Soo-Min Cha(차수민),Hyun-Dae Shin(신현대),Kyung-Cheon Kim(김경천),Dong-Hun Kang(강동훈) 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.5

결절종에 의한 주관 증후군은 비교적 드물고, 대부분의 결절종은 척상완 관절의 내측에서 기원하는 경우가 많다. 저자들은 주관 내에서 방추형의 신경 외막 결절종이 척골 신경을 압박하는 매우 드문 증례를 경험하였다. 48세 남자가 약 6개월 전부터 점진적으로 악화되는 전형적인 주관 증후군의 증상을 호소하였다. 전기생리학적 검사상 압박성 척골 신경 병증 소견을 보였다. 주관 내에서 반경 1.4cm, 길이 7.2 cm의 방추형의 신경 외막 결절종이 척골 신경을 에워싸는 양상이었고 관절과의 연결은 없었다. 결절종을 절제 후 척골신경은 전방 경근 이동술을 시행하였다. 술 후 6개월에 통증, 저린감, 감각 저하는 완전히 소실되었으며 악력, 파지력, 근육 쇠약 역시 회복되었으며, 전기생리학적 검사에서 상당한 호전이 관찰되었다. Cubital tunnel syndrome, caused by a ganglion, is rare and most ganglion cysts originate from the medial aspect of the ulnohumeral joint. We present an extremely rare case of a fusiform epineural ganglion, encompassing the ulnar nerve in the cubital tunnel. A 48-yearold man complained of a 6-month history of typical cubital tunnel syndrome symptoms. Electrophysiological studies were compatible with the compressive neuropathy of the ulnar nerve. A fusiform epineural ganglion cyst (1.4 cm in diameter and 7.2 cm in length), which encompasses the ulnar nerve in the cubital tunnel, was found with no connection to the elbow joint. The ganglion cyst was excised and the ulnar nerve anterior transmuscular transposition was performed. Six months postoperatively, the patient was free of pain, tingling sensations, and numbness. In addition, his grip and pinch strength improved, the muscle wasting showed recovery, and an electrophysiological study demonstrated some improvement.

Factors Influencing Outcomes after Ulnar Nerve Stability-Based Surgery for Cubital Tunnel Syndrome: A Prospective Cohort Study

최윤락,강호정,오원택,고일현,김성민 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.2

Purpose: Simple decompression of the ulnar nerve has outcomes similar to anterior transposition for cubital tunnel syndrome;however, there is no consensus on the proper technique for patients with an unstable ulnar nerve. We hypothesized that 1) simpledecompression or anterior ulnar nerve transposition, depending on nerve stability, would be effective for cubital tunnel syndromeand that 2) there would be determining factors of the clinical outcome at two years. Materials and Methods: Forty-one patients with cubital tunnel syndrome underwent simple decompression (n=30) or anteriortransposition (n=11) according to an assessment of intra-operative ulnar nerve stability. Clinical outcome was assessed using gripand pinch strength, two-point discrimination, the mean of the disabilities of arm, shoulder, and hand (DASH) survey, and themodified Bishop Scale. Results: Preoperatively, two patients were rated as mild, another 20 as moderate, and the remaining 19 as severe according to theDellon Scale. At 2 years after operation, mean grip/pinch strength increased significantly from 19.4/3.2 kg to 31.1/4.1 kg, respectively. Two-point discrimination improved from 6.0 mm to 3.2 mm. The DASH score improved from 31.0 to 14.5. All but one patientscored good or excellent according to the modified Bishop Scale. Correlations were found between the DASH score at two yearsand age, pre-operative grip strength, and two-point discrimination. Conclusion: An ulnar nerve stability-based approach to surgery selection for cubital tunnel syndrome was effective based on2-year follow-up data. Older age, worse preoperative grip strength, and worse two-point discrimination were associated with worseoutcomes at 2 years.

주관 증후군: 최근 치료 동향

허성우,이주엽 대한수부외과학회 2012 대한수부외과학회지 Vol.17 No.2

Cubital tunnel syndrome is the second most common nerve entrapment syndrome affecting the upper extremity. Surgical treatment is indicated for those who have motor weakness or when conservative measures have failed. Several different surgical techniques have been introduced, however, the optimal treatment for cubital tunnel syndrome is still under debate. In the recent years, well-performed prospective randomized studies show that there is no difference in outcome among various surgical techniques regardless of the severity and presence of subluxation. It is advised that in situ decompression is the preferred technique because it is simpler and less time consuming procedure. Although in situ decompression is effective in uncomplicated ulnar nerve subluxation, anterior transposition should be considered when the subluxation is painful or when the ulnar nerve actually snaps back and forth over the medial epicondyle. Anterior transposition of the ulnar nerve is still indicated for revision surgery, previous trauma around the elbow, distal humerus fractures, severe osteoarthritis needing medial spur excision, and severe valgus deformity of the elbow. 주관 증후군은 상지에서 수근관 증후군 다음으로 흔하게 발생하는 압박성 신경병증으로 주관절 내상과 주위에서 척골 신경이 눌려 발생한다. 다양한 수술적 치료 방법이 소개되고 있으나 어떤 수술적 방법이 가장 이상적인가에 대해서는 아직까지 논란이 있다. 최근의 전향적 무작위 연구 결과를 종합해 볼 때, 척골 신경 비전위 감압술을 시행하는 것만으로도 임상적으로 만족할 만한 결과를 얻을 수 있으며, 전방 이전술을 시행한 경우와 비교하여 결과에 차이가 없음이 밝혀지고 있다. 단, 척골 신경의아탈구나 탈구가 통증을 유발할 경우에는 척골 신경 전방 이전술을 시행하여야 하며,재수술인 경우나 주관절 내측에 외상의 과거력이 있는 경우, 원위 상완골 골절이 동반된 경우, 주관절의 심한 관절염으로 관절 절제술이 필요한 경우, 주관절의 심한 외반 변형이 있는 경우에는 척골 신경 전방 이전술이 필요하다.

주관 증후군

심경보(Gyeong-Bo Sim),김창완(Chang-Wan Kim),선지호(Ji-Ho Sun),김진삼(Jin-Sam Kim),전재명(Jae Myeung Chun),전인호(In-Ho Jeon) 대한정형외과학회 2014 대한정형외과학회지 Vol.49 No.5

주관 증후군은 주관절 내상과 주위에서 척골 신경이 눌려 발생하는 압박성 신경병증(compressive neuropathy)으로 수근관 증후군(carpal tunnel syndrome) 다음으로 상지에서 흔하게 발생한다. 척골 신경의 압박으로 인하여 초기에는 제4 수지의 척측 절반과 제5 수지의 감각저하 혹은 이상감각으로 증상이 나타나지만 병이 진행될 경우 비가역적 내재근의 근력저하 및 근위축, 제4, 5 수지의 갈퀴손 변형이 나타날 수도 있다. 치료법으로는 고전적인 척골 신경 감압술과 전방 이전술이 표준적 치료이나 최근 이전술 없이 감압술만으로도 좋은 결과를 보고하기에 수술 치료의 다양한 선택이 가능하다. 이에 저자는 주관 증후군의 원인과 임상 양상, 최근 수술적 치료에 대해 기술하고자 한다. Cubital tunnel syndrome is compressive neuropathy, entrapment of the ulnar nerve around the medial epicondyle of the elbow joint, and the second most common neuropathy after carpal tunnel syndrome. Patients complain of hypoesthesia or paresthesia in the ulnar half of the ring and small fingers early in the disease. Advanced disease is complicated by irreversible muscle weakness or atrophy and claw hand deformity of the ring and small fingers. Although traditional decompression and anterior transposition of the ulnar nerve is known as standard treatment, according to recent reports only simple decompression has a good outcome. So, variety of surgical treatment options are available. In this paper, we purpose to describe the causes, clinical features and recent surgical treatments of cubital tunnel syndrome.

척골신경병증

권봉철 대한의사협회 2017 대한의사협회지 Vol.60 No.12

Cubital tunnel syndrome is the second most common compressive neuropathy. Its diagnosis is largely based on clinical findings. It has been well known that patients with mild to moderate grade of cubital tunnel syndrome have a high chance of spontaneous resolution, while those with severe degree do not. Thus, the former is treated with conservative methods initially, and the latter is indicated for surgical intervention. There are three types of surgical techniques for cubital tunnel syndrome. Of these, in-situ decompression technique has been gaining popularity as it is simpler and shows similar efficacy with less complications compared to other techniques. In this review, we deal with current concepts of the cubital tunnel syndrome pertaining to the primary clinical practice.

Identification of Double Compression Lesion of Ulnar Nerve after Cubital Tunnel Release

곽호일,김준엽,유정현,김주학,손동욱,조재호 대한수부외과학회 2015 대한수부외과학회지 Vol.20 No.3

The double compression syndrome of the ulnar nerve is a rare condition. Herin, we experienced double compression of ulnar nerve at cubital tunnel and Guyon’s canal by re-evaluation after surgical decompression of cubital tunnel. We might suspect the double compression lesion in cases of worsening of symptom or nerve conduction velocity findings in a relative short duration of symptom as in our case. Meticulous physical examination might be needed to detect the Guyon’s canal syndrome as a comorbidity in the treatment of cubital tunnel syndrome and re-evaluation for dual compression might be recommended if the resolution of symptom was not achieved after surgical decompression of single nerve lesion.

A Fusiform Epineural Ganglion Encompassing the Ulnar Nerve in the Cubital Tunnel

차수민,신현대,김경천,강동훈 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.5

Cubital tunnel syndrome, caused by a ganglion, is rare and most ganglion cysts originate from the medial aspect of the ulnohumeral joint. We present an extremely rare case of a fusiform epineural ganglion, encompassing the ulnar nerve in the cubital tunnel. A 48-year-old man complained of a 6-month history of typical cubital tunnel syndrome symptoms. Electrophysiological studies were compatible with the compressive neuropathy of the ulnar nerve. A fusiform epineural ganglion cyst (1.4 cm in diameter and 7.2 cm in length), which encompasses the ulnar nerve in the cubital tunnel, was found with no connection to the elbow joint. The ganglion cyst was excised and the ulnar nerve anterior transmuscular transposition was performed. Six months postoperatively, the patient was free of pain, tingling sensations, and numbness. In addition, his grip and pinch strength improved, the muscle wasting showed recovery, and an electrophysiological study demonstrated some improvement.

Cubital tunnel syndrome associated with previous ganglion cyst excision in the elbow: a case report

Woojin Shin,Taebyeong Kang,Jeongwoon Han 대한견주관절학회 2024 대한견주관절의학회지 Vol.27 No.1

Cubital tunnel syndrome refers to compression neuropathy caused by pressure on the ulnar nerve pathway around the elbow. A 63-year-old male patient visited the clinic complaining of decreased sensation and weakness in his left ring finger and little finger, stating that the symptoms first began 6 months prior. He had undergone surgery to remove a ganglion cyst from his left elbow joint about 5 years prior in Mongolia. Magnetic resonance imaging revealed a cystic mass located at the previous surgical site, which was compressing the ulnar nerve within the cubital tunnel. Ulnar nerve decompression and anterior transposition were performed, and the cystic mass was excised. Upon pathological examination, the mass was diagnosed as a ganglion cyst. The patient’s symptoms including sensory dysfunction and weakness improved over the 1-year follow-up period. This report describes a rare case of ganglion cyst recurrence compressing the ulnar nerve in the cubital tunnel after previous ganglion cyst excision.

Simple Decompression of the Ulnar Nerve for Cubital Tunnel Syndrome

Cho, Yong-Jun,Cho, Sung-Min,Sheen, Seung-Hoon,Choi, Jong-Hun,Huh, Dong-Hwa,Song, Joon-Ho The Korean Neurosurgical Society 2007 Journal of Korean neurosurgical society Vol.42 No.5

Objective : Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper extremity. Although many different operative techniques have been introduced, none of them have been proven superior to others. Simple cubital tunnel decompression has numerous advantages, including simplicity and safety. We present our experience of treating cubital tunnel syndrome with simple decompression in 15 patients. Methods : According to Dellon's criteria, one patient was classified as grade 1, eight as grade 2, and six as grade 3. Preoperative electrodiagnostic studies were performed in all patients and 7 of them were rechecked postoperatively. Five patients of 15 underwent simple decompression using a small skin incision (2 cm or less). Results : Preoperative mean value of motor conduction velocity (MCV) within the segment (above the elbow-below the elbow) was $41.8{\pm}15.2\;m/s$ and this result showed a decrease compared to the result of MCV in the below the elbow-wrist segment ($57.8{\pm}6.9\;m/s$) with statistical significance (p<0.05). Postoperative mean values of MCV were improved in 6 of 7 patients from $39.8{\pm}12.1\;m/s$ to $47.8{\pm}12.1\;m/s$ (p<0.05). After an average follow-up of $4.8{\pm}5.3$ months, 14 patients of 15 (93%) reported good or excellent clinical outcomes according to a modified Bishop scoring system. Five patients who had been treated using a small skin incision achieved good or excellent outcomes. There were no complications, recurrences, or subluxation of the ulnar nerve. Conclusion : Simple decompression of the ulnar nerve is an effective and successful minimally invasive technique for patients with cubital tunnel syndrome.