2012, Number 6
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Acta Ortop Mex 2012; 26 (6)
Cubital tunnel syndrome and the scratch test to determine the surgical procedure
González G, Mackinnon SE, Espinosa A, Barbour J
Language: Spanish
References: 19
Page: 375-378
PDF size: 80.24 Kb.
ABSTRACT
Background: Neuropathy due to ulnar nerve compression at the elbow level is the second most frequent neuropathy. The scratch collapse test is useful to diagnose compression neuropathies. This test helps us rank compression sites and decide the type of treatment to use.
Methods: From May to July 2011, 34 patients, mostly females, were preoperatively analyzed with this test. Ethyl chloride was also used to show other compression sites.
Results: The main compression site was found to be at the level of Osborne’s ligament, contrary to the idea that it was located at the medial epicondyle. Another finding was that at the hand and wrist level it is more common to find compression in the proximal fascia of the forearm than in Guyon’s canal. After surgery, CRP became negative in all patients.
Discussion and conclusions: When the primary collapse point is Osborne’s ligament, the patient will require ulnar nerve transposition. When the primary collapse point is located at the level of the medial epicondyle, decompression is enough. In case of several simultaneous collapse points before applying ethyl chloride, a surgical procedure will not necessarily be required for each one of them.
REFERENCES
Mackinnon SE: Pathophysiology of nerve compression. Hand Clin 2002; 18; 231-41.
Maggi SP, Lowe JB III, Mackinnon SE: Pathophysiology of nerve injury. Clin Plast Surg 2003; 30: 109-26.
Dawson DH, Hallett M, Wilborn AJ: Entrapment Neuropathies. 3rd ed. Philadelphia: Lippincott-Raven; 1999.
Mackinnon SE, Dellon AL: Surgery of the Peripheral Nerve. New York: Thieme Medical Publishers; 1988: 65-85.
Stewart JD: Focal Peripheral Neuropathies. 2nd ed. New York: Thieme Medical Publishers; 1991.
Cheng CJ, Mackinnon-Patterson B, Beck JL, Mackinnon SE: Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. J Hand Surg 2008; 33A: 1518-24.
Chung KC: Treatment of ulnar nerve compression at the elbow. J Hand Surg 2008; 33A: 1625–7.
Osborne G: Compression neuritis of the ulnar nerve at the elbow. Hand 1970; 2: 10-3.
Greenwald D, Blum LC, Adams D, Mercantonio C, Moffit M, Cooper B: Effective surgical treatment of cubital tunnel syndrome based on provocative clinical testing without electrodiagnostics. Plast Reconstr Surg 2006; 117: 87-91.
Dellon AL: Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg 1989; 14A: 688-700.
Novak C, Mackinnon SE: Selection of operative procedures for cubital tunnel syndrome. Hand 2009; 4: 50-4.
Mackinnon, SE: Comparative clinical outcomes of submuscular and subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. JHS 2009; 3: 3A.
Charles YP, Coulet B, Rouzard JC, Daures JP, Chammas M: Comparative clinical outcomes of submuscular and subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg 2009; 34A: 866-74.
Goldfarb CA, Sutter MM, Martins EJ, Manse PR: Incidence of reoperation and subjective outcome following in situ decompression of the ulnar nerve at the cubital tunnel. J Hand Surg 2009; 34B: 379-83.
McAdam SA, Gandhi R, Bezuhly M, Lefaivre KA: Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve, a meta-analysis. J Hand Surg 2008; 33A: 1314-21.
Karatsa A, Apaydin N, Uz A, Tubbs SR, Loukas M, Gezen F: Regional anatomic structures of the elbow that may potentially compress the ulnar nerve. J Shoulder Elbow Surg 2009; 18: 627-31.
Mackinnon SE, Novak C: Operative findings in reoperation of patients with cubital tunnel syndrome. Hand 2007; 2: 137-43.
Brown JM, Mohktee D, Evangelista MS, Mackinnon SE: Scratch collapse test localizes Osborne’s band as the point of maximal nerve compression in cubital tunnel syndrome. Hand 2010; 5 (2): 141-7.
Siquera MG, Martins RS: The controversial arcade of Struthers. Surg Neurol 2005; 64: 17-20.