Levaro PF

Language: Spanish
References: 18
Page: 17-25
PDF size: 54.16 Kb.

ABSTRACT

In the pathophysiology of ulnar nerve compression, although there may be several causes, ischemic component is the critical means by which nerve function is affected and symptoms occur. The most common site of compression ulnar nerve is at the elbow, and represents the second most common neuropathy after carpal tunnel. The diagnosis is mainly clinical, by paresthesias and cramps, and paresis at the elbow, that extends down to the hand, Tinel sign (+), and in advanced cases, we can see changes in the hand and fingers appearance. The EMG in the ulnar neuropathy is useless.
Should always start nonsurgical treatment, including measures of physical therapy, splints and non-steroid medications. If that does not improve in 2-3 months, surgery should be assessed, which includes techniques of decompression in situ, medial epicondylectomy, anterior subcutaneous transposition, intramuscular transposition, submuscular transposition, and endoscopic ulnar tunnel release. Each of these techniques has its indications and potential risks, where decompression in situ seems to offer the best results, according to the medical literature reviewed.

REFERENCES

1. Apfelberg DB, Larson SJ. Dynamic anatomy of the ulnar nerve at the elbow. Plast Reconstr Surg 1973; 51: 79-81.

2. Peechan J, Julius I. The pressure measurement in the ulnar nerve. A contribution to the pathophysiology of the cubital tunnel syndrome. J Biomech 1975; 8: 75-79.

3. Gelberman RH, Yamaguchi K, Hollstien SB, et al. Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow. J Bone Joint Surg Am 1998; 80: 492-501.

4. Novak CB, Lee GW, Mackinnon SE, et al. Provocative testing for cubital tunnel syndrome. J Hand Surg Am 1994; 19: 817-820.

5. McGowan AJ. The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg Br 1994; 32: 293-301.

6. Lowe JB, Novak CB, Mackinnon SE. Current approach to cubital tunnel syndrome. Neurosurg Clin N Am 2001; 12: 267-284.

7. Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet 1973; 18; 2(7825): 359-362.

8. Lister G. The hand, diagnosis and indications. 3rd ed. New York: Churchill Livingstone; 1993.

9. King T, Morgan FP. Late results of removing the medial humeral epicondyle for traumatic ulnar neuritis. J Bone Joint Surg Br 1959; 41: 51-55.

10. O’Driscoll SW, Jaloszynski R, Morrey BF, et al. Origin of the medial ulnar collateral ligament. J Hand Surg Am 1992; 17: 164-168.

11. Black BT, Barron OA, Townsend PF, Glickel SZ, Eaton RG. Stabilized subcutaneous ulnar nerve transposition with immediate range of motion. Long-term follow-up. J Bone Joint Surg Am 2000; 82-A(11): 1544-1151.

12. Kleinman WB, Bishop AT. Anterior intramuscular transposition of the ulnar nerve. J Hand Surg Am 1989; 14: 972-979.

13. Learmonth JR. A technique for transplanting the ulnar nerve. Surg Gynecol Obstet 1942; 75: 792-793.

14. Posner MA. Submuscular transposition for the ulnar nerve at the elbow. Bull Hosp Jt Dis Orthop Inst 1984; 44(2): 406-423.

15. Tsai TM, Bonczar M, Tusuruta T, Syed SA. A new operative technique: cubital tunnel decompression with endoscopic assistance. Hand Clin 1995; 11(1): 71-80.

16. Jiang S, Xu W, Shen Y, Xu JG, Gu YD. Endoscopy-assisted cubital tunnel release under carbon dioxide insufflation and anterior transposition. Ann Plast Surg 2012; 68(1): 62-66. (Epub ahead of print).

17. Mowlavi A, Andrews K, Lille S, et al. The management of cubital tunnel syndrome: a meta-analysis of clinical studies. Plast Reconstr Surg 2000; 106: 327-334.

18. Bartels RHMA, Menovsky T, Van Overbeeke JJ, et al. Surgical management of ulnar nerve compression at the elbow: an analysis of the literature. J Neurosurg 1998; 89: 722-727.