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.

Subclinical Ulnar Neuropathy at the Elbow in Diabetic Patients

Ji Eun Jang,Yun Tae Kim,Byung Kyu Park,In Yae Cheong,김동휘 대한재활의학회 2014 Annals of Rehabilitation Medicine Vol.38 No.1

Objective To demonstrate the prevalence and characteristics of subclinical ulnar neuropathy at the elbow in diabetic patients.Methods One hundred and five patients with diabetes mellitus were recruited for the study of ulnar nerve conduction analysis. Clinical and demographic characteristics were assessed. Electrodiagnosis of ulnar neuropathy at the elbow was based on the criteria of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM1 and AANEM2). The inching test of the ulnar motor nerve was additionally performed to localize the lesion.Results The duration of diabetes, the existence of diabetic polyneuropathy (DPN) symptoms, the duration of symptoms, and HbA1C showed significantly larger values in the DPN group (p<0.05). Ulnar neuropathy at the elbow was more common in the DPN group. There was a statistically significant difference in the number of cases that met the three diagnostic criteria between the no DPN group and the DPN group. The most common location for ulnar mononeuropathy at the elbow was the retrocondylar groove.Conclusion Ulnar neuropathy at the elbow is more common in patients with DPN. If the conduction velocities of both the elbow and forearm segments are decreased to less than 50 m/s, it may be useful to apply the AANEM2 criteria and inching test to diagnose ulnar neuropathy.

척골 신경 병증을 동반한 주관절 퇴행성 관절염에서 최소 절개 척골 신경 감압술과 동시에 시행한 관절경적 변연 절제술의 효과

제갈믿음(Midum Jegal),유건웅(Kun-Woong Yu),박성배(Sung-Bae Park),김종필(Jong-Pil Kim) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.1

목적: 척골 신경병이 동반된 주관절의 퇴행성 관절염에서 최소 절개 척골 신경 감압술과 동시 시행한 관절경적 변연 절제술의 효과를 알아보았다. 대상 및 방법: 2006년 5월부터 2014년 7월까지 43명을 대상으로 최소 절개 신경 감압술만 시행받은 18예를 1군, 관절경적 변연 절제술과 신경 감압술을 동시 시행받은 25예를 2군으로 나누어 분석하였다. 술 전과 술 후 6개월의 통증 점수, 관절 운동 범위, Mayo elbow performance score (MEPS), disabilities of the arm, shoulder and hand (DASH), McGowan grade, Bishop rating score를 분석하였다. 결과: 두 군 간의 통증 점수, 관절 운동 범위, MEPS, DASH 호전 정도는 차이가 없었다. McGowan grade는 각각 1예를 제외하고 모두 1등급 이상의 호전을 보였으나 2군이 유의하게 더 우수하였고(p=0.001), Bishop rating score도 2군이 유의하게 더 우수하였다(p=0.036). 결론: 척골 신경병이 동반된 주관절 퇴행성 관절염에 대하여 최소 절개 척골 신경 감압술과 동시에 시행한 관절경적 변연 절제술은 관절 기능 향상과 척골 신경 회복에 유용한 술식이다. Purpose: The aim of this study was to determine the effectiveness of arthroscopic debridement with mini-open ulnar nerve decompression in primary osteoarthritis of the elbow with ulnar neuropathy. Materials and Methods: Between May of 2006 and July of 2014, a total of 43 patients who had undergone surgery for primary osteoarthritis of the elbow with ulnar neuropathy were included in this study. We divided the subjects into two groups according to the method of surgery: group 1 (n=18) received mini-open ulnar nerve decompression only, and group 2 (n=25) received arthroscopic debridement with mini-open ulnar nerve decompression. Patients were assessed for the following clinical outcomes: visual analogue scales (VAS) score, range of motion of the elbow joint, Mayo elbow performance score (MEPS), and disabilities of the arm, shoulder and hand (DASH) at the time before surgery and 6 months after surgery. We analyzed the recovery of the ulnar nerve by the McGowan grade and Bishop rating score preoperatively and at 6 months after the surgery. Results: The VAS score, range of motion of the elbow joint, MEPS, and DASH showed significant statistical difference after the surgery (p<0.05). However, between the 2 groups, there was no significant difference. For the McGowan grade, all cases of both groups–except one case each group–showed at least one grade improvement. Moreover, group 2 showed a greater significant difference than group 1 (p=0.001). At the final follow-up, according to the Bishop rating score, group 2 had a greater significant difference than group 1 (p=0.036). Conclusion: Arthroscopic debridement with mini-open ulnar nerve decompression in primary osteoarthritis of the elbow with ulnar neuropathy is a useful technique, which has several advantages, including the benefits associated with a minimally invasive surgery and also the improvement of elbow joint function and excellent recovery of the ulnar nerve.

Neurorrhaphy of Ulnar Nerve with Silicon Wrapping in Guyon’s Canal to Prevent Neuropathy: A Case Report

박범,김석원,김지예 대한수부외과학회 2017 대한수부외과학회지 Vol.22 No.4

An 18-year-old female patient presented with complaints of motor function and sensory impairment of the ulnar nerve on the 9th day after primary repair with a laceration of the right palm. We performed nerve wrapping with silicone tube after primary nerve repair to prevent neuropathy due to scar formation. As a result of surgical treatment, motor function and sensory impairment of ulnar nerve were improved significantly without complication until 2 years postoperatively. Nerve wrapping with silicone tube can be widely used in patients who underwent primary repair of ulnar nerve and patients who have undergone surgical decompression due to other causes of Guyon’s canal syndrome. This surgical technique is ex-pected to prevent neuropathy caused by scar formation.

Symptomatic Neural Loop of the Distal Ulnar Nerve

Hyun Il Lee(이현일),Min Jong Park(박민종),Gi Jun Lee(이기준),Sung Han Ha(하성한) 대한정형외과학회 2014 대한정형외과학회지 Vol.49 No.3

척골관 증후군의 감압 수술 중 발견된 원위 척골 신경의 해부학적 변이를 보고하고자 한다. 척골 신경은 신경 고리 형태의 해부학적 변이를 보이고 있었으며 이 고리의 중앙으로 척측 수근 굴곡근이 통과하는 양상이었다. 능동적 손목 움직임 시 척측 수근 굴곡근에 의한 동적인 압박이 환자의 척골 신경 증상을 유발한 것으로 판단되었으며 신경박리술과 주위 조직의 이완술 후 증상의 회복을 관찰하였다. 척골 신경의 압박성 신경병증이 의심되는 완관절 척측 통증 환자의 경우 이와 같은 해부학적 변이가 압박성 신경병증의 원인이 될 수 있음을 주지하여야 할 것이다. We found a unique anatomical variant of the distal ulnar nerve, a neural loop encompassing the flexor carpi ulnaris during Guyon’s canal exploration. Compression by the flexor carpi ulnaris during active wrist movement was suspected as the cause of ulnar neuropathy. The symptom was relieved after neurolysis and release of surrounding tissue. With regard to the ulnar side wrist pain, which is suspicious for ulnar compression syndrome at the wrist level, the surgeon should always suspect anomalous nerve branch as source of compressive neuropathic pain.

Symptomatic Neural Loop of the Distal Ulnar Nerve

이현일,박민종,이기준,하성한 대한정형외과학회 2014 대한정형외과학회지 Vol.49 No.3

We found a unique anatomical variant of the distal ulnar nerve, a neural loop encompassing the flexor carpi ulnaris during Guyon’s canal exploration. Compression by the flexor carpi ulnaris during active wrist movement was suspected as the cause of ulnar neuropathy. The symptom was relieved after neurolysis and release of surrounding tissue. With regard to the ulnar side wrist pain, which is suspicious for ulnar compression syndrome at the wrist level, the surgeon should always suspect anomalous nerve branch as source of compressive neuropathic pain.

연부조직 연골종에 의한 정중, 척골포착신경병증: 증례보고

홍성택,안덕선,Hong, Sung-Taek,Ahn, Duck-Sun 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.6

Purpose: Soft tissue chondroma is a rare benign tumor, found mainly on the palm and sole and grows slowly. Typically, mature hyaline cartilage is the dominant pathological feature. There are reports that assert soft tissue chondromas to be a cause of median nerve entrapment syndrome. However, this is the first case report showing soft tissue chondroma to be a cause of simultaneous median and ulnar neuropathy. Methods: A 62 year-old woman presented with chief complaints of numbness and hypoesthesia of her right palm for 4 to 5 years, and a palpable mass on her right palm that had been increasing in size slowly for 3 years. Physical examination revealed a firm, mobile, non-tender and about $3{\times}3\;cm^2$ sized mass in the center of the right palm. Electromyography showed entrapment neuropathy of the median and ulnar nerve. Ultrasonography showed an approximately $5.7\;cm^2$ mass below the flexor tendon of ring finger. Upon surgical excision, a $3{\times}3\;cm^2$ mass attached to the flexor digitorum profundus of ring finger and redness and hypertrophy of both the median and ulnar nerve were discovered. Mass excision was performed gently and the specimen was referred for histopathologic study. Mass excision resulted in median and ulnar nerve release. Results: The pathology report confirmed the mass to be a soft tissue chondroma with mature hyaline cartilage. The patient exhibited post-operative improvement of her symptoms and did not show any complications. Conclusion: This is the first case report showing soft tissue chondroma to be a cause of simultaneous median and ulnar neuropathy.

활차상 주근에 의한 척골신경병증의 새로운 치료: 증례 보고

김영석,박윤길,박진영,김선웅,이예원,김명상 대한근전도전기진단의학회 2019 대한근전도 전기진단의학회지 Vol.21 No.2

Anconeus epitrochlearis muscle covering ulnar nerve has potential to compress it at the elbow. There has been no report that compromised nerve conduction velocity (NCV) recovered immediately after muscle releasing by electrical twitch obtaining intramuscular stimulation (ETOIMS). A 26-year-old male complaining of tingling pain on ulnar side of right hand visited our clinic. Electrodiagnostic study revealed decreased motor NCV of the ulnar nerve in the medial epicondyle of the humerus and 2 cm distal to it, suggesting cubital tunnel syndrome. Physical examination revealed tenderness in the anconeus epitrochlearis muscle, and Tinel’s sign was confirmed at the elbow. Assuming that the ulnar neuropathy had occurred by the anconeus epitrochlearis muscle, ETOIMS was performed to release it. Immediately after ETOIMS, motor NCV returned to normal and the tingling pain disappeared. This is the first case report, which electrophysiologically revealed the effect of ETOIMS on compressive neuropathy results from the muscle hypercontraction.

척골신경병증의 전기진단의학적 접근

김동휘 대한근전도전기진단의학회 2016 대한근전도 전기진단의학회지 Vol.18 No.1

Ulnar nerve can be compressed at any level along its course, from the axillae to wrist. Careful electrophysiologic studies provide an accurate diagnosis, help localize the lesion site, define the severity and pathophysiological process, identify unrecognizing or subclinical disease, and exclude other potential mimicking diseases. This article discusses the electrodiagnostic approach to ulnar neuropathy. Pertinent aspects of the history and physical examination, anatomical consideration, electrodiagnostic tests for ulnar neuropathy at the wrist and elbow are presented

망막박리 수술 후 발생한 척골신경병증 1예

선해정,백순철,최경식,이성진 대한안과학회 2009 대한안과학회지 Vol.50 No.6

Purpose: To report a case of ulnar neuropathy as an extraocular complication following retinal detachment surgery and facedown positioning. Case summary: A 65-year-old woman was referred to our hospital with decreased visual acuity in the left eye. Fundus examination revealed a rhegmatogenous retinal detachment not involving the macula in the left eye. A vitrectomy with scleral encircling and 18% SF6 gas tamponade was performed. The patient was instructed to assume a face-down position. After 5 days, the patient reported having paresthesia and numbness of the left 4th and 5th fingers. Neurologic exams were performed and the results indicated ulnar neuropathy. There was no improvement in the neurologic symptoms during the 6-month follow-up. Conclusions: Surgeons performing retinal surgery should caution their patients of ulnar neuropathy when face-down positioning is required. The patients should be instructed to minimize the time spent with their elbows flexed in a stationary position. Additionally, the pressure loaded on the bent elbow should be minimized. 목적: 망막박리 수술 후 엎드린 자세를 취한 환자에서 척골신경병증 1예를 경험하였기에 보고하고자 한다. 증례요약: 65세 여자환자가 좌안의 시력이상으로 내원하였다. 안저검사상 좌안의 황반부를 침범하지 않은 비측의 열공성 망막박리가 있었다. 유리체절제술, 공막두르기 및 가스주입술을 시행하고 수술 후 엎드린 자세를 취하였다. 술 후 5일 째 환자는 좌측 4, 5번째 손가락의 감각이상과 저림을 호소하였다. 근전도검사에서 좌측 척골신경병증에 해당하는 이상소견이 있었다. 6개월 관찰하는 동안 호전되지 않았다. 결론: 망막 수술 후 엎드린 자세를 취하는 경우 5일만에도 척골신경병증이 발생할 수 있으므로 팔꿈치를 구부리는 시간을 줄이고, 팔꿈치에 압력이 덜 가해지도록 교육이 필요하다.