Cubital tunnel syndrome is often accompanied by paresthesia in ulnar nerve sites and hand muscle atrophy. When muscle weakness occurs, or after failure of more conservative treatments, anterior transposition is used. ...Cubital tunnel syndrome is often accompanied by paresthesia in ulnar nerve sites and hand muscle atrophy. When muscle weakness occurs, or after failure of more conservative treatments, anterior transposition is used. In the present study, the ulnar nerve and its blood vessels were examined in the elbows of 18 adult cadavers, and the external diameter of the nutrient vessels of the ulnar nerve at the point of origin, the distances between the origin of the vessels and the medial epicondyle of the humerus, and the length of the vessels accompanying the ulnar nerve in the superior ulnar collateral artery, the inferior ulnar collateral artery, and the posterior ulnar recurrent artery were measured. Anterior transposition of the vascularized ulnar nerve was per- formed to treat cubital tunnel syndrome. The most appropriate distance that the vascularized ulnar nerve can be moved to the subcutaneous tissue under tension-free conditions was 1.8 ± 0.6 cm （1.1-2.5 cm）, which can be used as a reference value during the treatment of cubital tunnel syndrome with anterior transposition of the vascularized ulnar nerve.展开更多
For severe cubital tunnel syndrome, patients with absent sensory nerve action potential tend to have more severe nerve damage than those without. Thus, it is speculated that such patients generally have a poor prognos...For severe cubital tunnel syndrome, patients with absent sensory nerve action potential tend to have more severe nerve damage than those without. Thus, it is speculated that such patients generally have a poor prognosis. How absent sensory nerve action potential affects surgical outcomes remains uncertain owing to a scarcity of reports and conflicting results. This retrospective study recruited one hundred and fourteen cases(88 patients with absent sensory nerve action potential and 26 patients with present sensory nerve action potential) undergoing either subcutaneous transposition or in situ decompression. The minimum follow-up was set at 2 years. Primary outcome measures of overall hand function included their McGowan grade, modified Bishop score, and Disabilities of the Arm, Shoulder, and Hand Questionnaire(DASH) score. For patients with absent sensory nerve action potential, 71 cases(80.7%) achieved at least one McGowan grade improvement, 76 hands(86.4%) got good or excellent results according to the Bishop score, and the average DASH score improved 49.5 points preoperatively to 13.1 points postoperatively. When compared with the present sensory nerve action potential group, they showed higher postoperative McGowan grades and DASH scores, but there was no statistical difference between the modified Bishop scores of the two groups. Following in situ decompression or subcutaneous transposition, great improvement in hand function was achieved for severe cubital tunnel syndrome patients with absent sensory nerve action potential. The functional outcomes after surgery for severe cubital tunnel syndrome are worse in patients with absent sensory nerve action potential than those without. This study was approved by the Ethical Committee of Huashan Hospital, Fudan University, China(approval No. 2017142).展开更多
Purpose: Although carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CuTS) are the most common neuropathies in the upper extremities, there have been few studies describing the etiology and associated factors i...Purpose: Although carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CuTS) are the most common neuropathies in the upper extremities, there have been few studies describing the etiology and associated factors in the general population. The purpose of this study was to investigate and clarify the etiology and associated factors for CTS and CuTS in the Japanese general population. Methods: A total of 1875 participants, who participated in health checkups conducted in rural areas in Japan in 2010, were enrolled. The prevalence of CTS and CuTS was investigated. Logistic regression models were performed to examine the relationship between CTS and CuTS and correlated factors such as occupational status, smoking and alcohol preferences, and medical characteristics. Results: The overall prevalence of CTS and CuTS was 2.0% and 2.2%, respectively. With regards to CTS, female subjects showed 7.33-times higher risk of CTS compared with male subjects. In addition, hypertension was also at high risk of CTS (5.56-times higher in borderline and 4.55-times higher in definite hypertension compared with normal blood pressure). However, there were no significant associations between CuTS and age, gender, occupation, smoking and alcohol preferences, or metabolic factors. Conclusions: CTS was associated with female gender and hypertension, whereas there was no obvious risk factor contributing to the onset of CuTS.展开更多
Purpose: Failure after radial head arthroplasty is uncommon, but clinically significant. Treatment for failure may involve implant removal. We describe fourteen patients who underwent implant removal after failed radi...Purpose: Failure after radial head arthroplasty is uncommon, but clinically significant. Treatment for failure may involve implant removal. We describe fourteen patients who underwent implant removal after failed radial head arthroplasty. Methods: A retrospective review was performed to determine the cause of failure and clinical data were prospectively collected. Results: At mean follow up of 38 months the mean VAS for pain score was 3.0 and the mean DASH score was 40.5. The mean MEPS was 69. All patients demonstrated improved elbow range of motion. Mean elbow flexion at final follow up was 124°to an average extension deficit of 25°. Fifty percent of patients exhibited clinical symptoms of cubital tunnel syndrome. Three patients required additional surgery after implant removal. Conclusions: Implant removal for failed radial head arthroplasty improves range of motion and demonstrates acceptable outcomes at intermediate-term follow up. However, 50% of patients developed cubital tunnel syndrome and 21% required revision surgery.展开更多
Cubital tunnel syndrome is a disease in which ulnar nerve is compressed by its surrounding tissues,and its main clinical manifestations are pain,sensory disturbance and dyskinesia.Its incidence rate is the second high...Cubital tunnel syndrome is a disease in which ulnar nerve is compressed by its surrounding tissues,and its main clinical manifestations are pain,sensory disturbance and dyskinesia.Its incidence rate is the second highest among peripheral nerve entrapment diseases,and it is one of the common clinical diseases.The theory of liver,spleen and kidney can guide the treatment of cubital tunnel syndrome with traditional Chinese medicine and acupuncture.By discussing the traditional Chinese medicine(TCM)pathogenesis and treatment principles of cubital tunnel syndrome,it provides modern medical theoretical support for TCM treatment of cubital tunnel syndrome.展开更多
OBJECTIVE:To explore the optimal surgery in treating moderate-severe cubital tunnel(CuTS) syndrome by comparing the clinical efficiency of decompression and anterior subcutaneous transposition of ulnar nerve and decom...OBJECTIVE:To explore the optimal surgery in treating moderate-severe cubital tunnel(CuTS) syndrome by comparing the clinical efficiency of decompression and anterior subcutaneous transposition of ulnar nerve and decompression and anterior submuscular transposition of ulnar nerve,and to provide a theoretical basis for the appropriate surgical programs in treating moderate-severe Cu TS.METHODS:47 consecutive cases of moderate-severe Cu TS were surgically treated in our department from January 2014 to January 2017.All patients were divided into two groups by the doctor in our department.21 Cu TS cases were treated with decompression and anterior subcutaneous transposition of ulnar nerve,and other 26 cases were treated with decompression and anterior submuscular transposition of ulnar nerve.All the patients were followed 1 month,3 months and 6 months after operation to evaluate the recovery degree of ulnar nerve function and the clinical efficiency of the two methods was compared.RESULTS:Clinical symptoms of two groups were significant alleviated.There was no significant statistical difference between two groups in the clinical efficiency.CONCLUSION:Completely releasing of nerve truck is the most important step in treating mediate-severe Cu TS.Theclinical results of the two methods are similar,but the anterior subcutaneous transposition of ulnar nerve is more easy to operate and can be widely used.展开更多
Background：To study lesions＇ location and prognosis of cubital tunnel syndrome （CubTS） by routine motor nerve conduction studies （MNCSs） and short-segment nerve conduction studies （SSNCSs,inching test）.Methods...Background：To study lesions＇ location and prognosis of cubital tunnel syndrome （CubTS） by routine motor nerve conduction studies （MNCSs） and short-segment nerve conduction studies （SSNCSs,inching test）.Methods：Thirty healthy subjects were included and 60 ulnar nerves were studied by inching studies for normal values.Sixty-six patients who diagnosed CubTS clinically were performed bilaterally by routine MNCSs and SSNCSs.Follow-up for 1-year,the information of brief complaints,clinical symptoms,and physical examination were collected.Results：Sixty-six patients were included,88 of nerves was abnormal by MNCS,while 105 was abnormal by the inching studies.Medial epicondyle to 2 cm above medial epicondyle is the most common segment to be detected abnormally （59.09％）,P ＜ 0.01.Twenty-two patients were followed-up,17 patients＇ symptoms were improved.Most of the patients were treated with drugs and modification of bad habits.Conclusions：（1） SSNCSs can detect lesions of compressive neuropathy in CubTS more precisely than the routine motor conduction studies.（2） SSNCSs can diagnose CubTS more sensitively than routine motor conduction studies.（3） In this study,we found that medial epicondyle to 2 cm above the medial epicondyle is the most vulnerable place that the ulnar nerve compressed.（4） The patients had a better prognosis who were abnormal in motor nerve conduction time only,but not amplitude in compressed lesions than those who were abnormal both in velocity and amplitude.Our study suggests that SSNCSs is a practical method in detecting ulnar nerve compressed neuropathy,and sensitive in diagnosing CubTS.The compound muscle action potentials by SSNCSs may predict prognosis of CubTS.展开更多
Background：Surgical decompression of the ulnar nerve is effective for cubital tunnel syndrome.However,deep approaches may result in iatrogenic elbow stiffness.This long-term study was to evaluate the range of motion ...Background：Surgical decompression of the ulnar nerve is effective for cubital tunnel syndrome.However,deep approaches may result in iatrogenic elbow stiffness.This long-term study was to evaluate the range of motion （ROM） of the elbow and functional outcomes after anterior subcutaneous transposition.Methods：A total of 115 patients （78 male and 37 female;mean age：46.6 years） who underwent anterior subcutaneous transposition of the ulnar nerve between 2001 and 2005 were evaluated retrospectively;mean follow-up was 13.5 years.Elbow ROM was measured as flexion arc,flexion,and extension preoperatively and at the final follow-up,and compared via a mixed analysis of variance adjusting for age.Neuropathy was assessed preoperatively using a modified McGowan neuropathy grade and postoperatively using modified Wilson-Krout criteria.An ordinal logistic regression analysis used postoperative modified Wilson-Krout criteria as the outcome and preoperative factors as predictors.Results：Preoperative McGowan grades were Grade 1 in 14 patients （12.2%）,Grade 2A in 28 （24.3%）,Grade 2B in 53 （46.1%）,and Grade 3 in 20 （17.4%） patients.Postoperatively,66 patients （57.4%） had excellent results,26 （22.6%） had good results,16 （13.9%） had fair results,and 7 （6.1%） had poor results at the final follow-up,as per the Wilson-Krout criteria.There were no complications.Pre-and postoperative elbow ROM was significantly decreased in patients with previous trauma or surgery of the elbow compared with those without （P 〈 0.05）.Anterior subcutaneous transposition of the ulnar nerve did not significantly affect elbow ROM regardless of previous trauma or surgical history nor preoperative ROM （P 〉 0.05）,after adjusting for age.Patients with prolonged symptoms prior to surgery and worse neuropathy tended to have less satisfactory functional outcomes （P 〈 0.05）,after adjusting for covariates.Conclusions：Anterior subcutaneous transposition of the ulnar nerve is an effective and reliable treatment of cubital tunnel syndrome with satisfactory outcomes and minimal effect on elbow ROM.展开更多
To study whether liver cirrhosis associated with Helicobacter pylori ( H pylori ) infection will induce increased serum ammonia and whether the peripheral serum ammonia reflects the level of portal vein serum ...To study whether liver cirrhosis associated with Helicobacter pylori ( H pylori ) infection will induce increased serum ammonia and whether the peripheral serum ammonia reflects the level of portal vein serum ammonia Methods Blood was taken from the portal vein and the cubital vein in cirrhotic patients with and without H pylori infection and non cirrhotic patients (splenic rupture) with and without H pylori infection, and the serum ammonia was measured Results The mean levels of serum ammonia in the group of cirrhotic patients with H pylori infection were 167 82±8 97?μmol/L (portal vein) and 142 2±13 35?μmol/L (cubital vein) They were increased significantly as compared with cirrhotic patients without H pylori infection (47 68±12 03?μmol/L portal vein and 37 23±7 04?μmol/L cubital vein), and also compared with the groups of splenic rupture patients with and without H pylori infection ( P <0 01) There was no significant difference between the serum ammonia level of the cubital vein and portal vein ( P >0 05) Conclusions H pylori infection can induce an increase in serum ammonia in patients with liver dysfunction, and the peripheral serum ammonia measurement may replace the portal vein serum ammonia as a monitoring method Eradication of H pylori in cirrhotic patients may prevent hepatic encephalopathy (HE)展开更多
Background Cubital tunnel syndrome is a well-recognized clinical condition and is the second most common peripheral compression neuropathy. This study was designed to investigate the causes of cubital tunnel syndrome...Background Cubital tunnel syndrome is a well-recognized clinical condition and is the second most common peripheral compression neuropathy. This study was designed to investigate the causes of cubital tunnel syndrome by surgical means and to assess the clinical value of the neurophysiological diagnosis of cubital tunnel syndrome. Methods Twenty-one patients (involving a total of 22 limbs from 16 men and 5 women, aged 22 to 63, with a mean age of 49 years) with clinical symptoms and signs indicating a problem with their ulnar nerve underwent motor conduction velocity examinations at different sites along the ulnar nerve and examinations of sensory conduction velocity in the hand, before undergoing anterior transposition of the ulnar nerve.Results Electromyographic abnormalities were seen in 21 of 22 limbs [motor nerve conduction velocity (MCV) range (15.9-47.5) m/s, mean 32.7 m/s] who underwent motor conduction velocity examinations across the elbow segment of the ulnar nerve. Reduced velocity was observed in 13 of 22 limbs [MCV (15.7-59.6) m/s, mean 40.4 m/s] undergoing MCV tests in the forearms. An absent or abnormal sensory nerve action potential following stimulation was detected in the little finger of 14 of 22 limbs. The factors responsible for ulnar compression based on observations made during surgery were as follows: 15 cases involved compression by arcuate ligaments, muscle tendons, or bone hyperplasia; 2 involved fibrous adhesion; 3 involved compression by the venous plexus or a concurrent thick vein; 2 involved compression by cysts. Conclusions Factors inducing cubital tunnel syndrome include both common factors that have been reported and rare factors, involving the venous plexus, thick veins, and cysts. Tests of motor conduction velocity at different sites along the ulnar nerve should be helpful in diagnosis cubital tunnel syndrome, especially MCV tests indicating decreased velocity across the elbow segment of the ulnar nerve.展开更多
Background： The appropriate elbow position of short-segment nerve conduction study （SSNCS） to diagnose cubital tunnel syndrome （CubTS） is still controversial. The goal of this study was to determine the effect of...Background： The appropriate elbow position of short-segment nerve conduction study （SSNCS） to diagnose cubital tunnel syndrome （CubTS） is still controversial. The goal of this study was to determine the effect of different elbow positions at full extension and 70° flexion on SSNCS in CubTS. Methods： In this cross-sectional study, the clinical data of seventy elbows from 59 CubTS patients between September, 2011 and December, 2014 in the Peking University First Hospital were included as CubTS group. Moreover, thirty healthy volunteers were included as the healthy group. SSNCS were conducted in all subjects at elbow fhll extension and 70° elbow flexion. Paired nonparametric test, bivariate correlation, Bland-Altman, and Chi-squared test analysis were used to compare the effectiveness of elbow full extension and 70° flexion elbow positions on SSNCS in CubTS patients. Results： Data of upper limit was calculated from healthy group, and abnormal latency was judged accordingly. CubTS group＇s latency and compound muscle action potential （CMAP） of each segment at 70° elbow flexion by SSNCS was compared with lull extension position, no statistically significant difference were found （all P 〉 0.05）. Latency and CMAP of each segment at elbow full extension and 70° flexion were correlated （all P 〈 0 elbow （P - 0.43）, and the latency （P = 0.15） and the CMAP （P = 01）, except the latency of segment of 4 cm to 6 cm above 0.06） of segment of 2 cm to 4 cm below elbow. Bivariate correlation and Bland-Altman analysis proved the correlation between elbow full extension and 70° flexion. Especially in segments across the elbow （2 cm above the elbow and 2 cm below it）, latency at elbow full extension and 70° flexion were strong direct associated（r=0.83, P〈0.01;r=0.55, P〈0.01）,andsodidtheCMAP（r 0.49, P〈0.01;r=0.72, P〈0.01）.Therewasno statistically significant difference in abnormality of each segment at full extension as measured by SSNCS compared with that at 70° flexion （P 〉 0.05, respectively）. Conclusions： There was no statistically significant difference in the diagnosis of CubTS with the elbow at full extension compared with that at 70° flexion during SSNCS. We suggest that elbow positon at full extension can also be used during SSNCS.展开更多
Ulnar nerve neuropathy at the elbow represents the second most frequent compression neuropathy of the upper extremity.Of the five different anatomical areas responsible for ulnar nerve compression at the elbow region,...Ulnar nerve neuropathy at the elbow represents the second most frequent compression neuropathy of the upper extremity.Of the five different anatomical areas responsible for ulnar nerve compression at the elbow region,the epitrochlear-olecranon channel and Osborne’s arcade are the most common.An additional cause of nerve damage is a dynamic process in which the ulnar nerve dislocates anteriorly at the epitrochlear-olecranon level during elbow flexion,partially or completely,causing nerve friction and constriction leading to chronic neuropathic pain.Failure after primary surgery is generally secondary to procedural errors or technical omissions,frequently represented by incomplete nerve decompression,failure to recognize nerve instability after nerve decompression,loosening of the nerve anchor after superficial nerve transposition with consequent spontaneous nerve relocation in the epitrochlear-olecranon channel,perineural fibrosis and neurodesis,which creates new nerve compression.In association with the clinical evaluation,electromyography studies,magnetic resonance imaging and ultrasound are useful tools that may aid in the decision-making process when considering revision surgery.Superficial anterior transposition is the most commonly employed technique but also has a high failure rate,as opposed to anterior deep transposition that is the method of choice for many surgeons despite being more technically demanding.The results of revision surgery following recalcitrant ulnar nerve compression at the elbow are inferior to those obtained after primary surgery.Nonetheless,the clinical advantages remain relevant provided that the revision surgery is performed by an expert surgeon.To avoid misinterpretation,the patient is completely informed of the quality of results.展开更多
Cubital tunnel syndrome(CTS)is a chronic condition caused by the compression of the ulnar nerve at the elbow.The ulnar nerve is susceptible to entrapment at multiple sites along its path,with the elbow joint being the...Cubital tunnel syndrome(CTS)is a chronic condition caused by the compression of the ulnar nerve at the elbow.The ulnar nerve is susceptible to entrapment at multiple sites along its path,with the elbow joint being the most critical.Symptoms typically include numbness in the ulnar nerve distribution area,hand muscle atrophy,and weakness.Patients exhibiting mild symptoms can be treated conservatively,whereas those with moderate to severe symptoms often require surgical intervention.Extensive research has been conducted on the clinical treatment of CTS.The complex etiology of this condition,coupled with the unique anatomical structure of the ulnar nerve,has led to less-than-satisfactory clinical outcomes.Physiotherapy plays an important role in aiding nerve recovery and reducing disability rates.Initiating physiotherapy early can address the cause of the disease,mitigate nerve damage,improve functional impairment due to nerve injury,and enhance the quality of patients’daily activities.However,definitive guidelines for the treatment and evaluation of cubital tunnel syndrome are lacking.This review compiles the various modalities and advancements in the diagnosis and rehabilitation of CTS,drawing from recent domestic and international literature.It summarizes and compares the diagnostic tools currently employed in clinical practice and offers suggestions for physicians and therapists in selecting personalized diagnostic tools for patient assessment.Additionally,the review describes various rehabilitation methods,providing fresh insights for patients with cubital tunnel syndrome who have received conservative or surgical treatment.展开更多
基金supported by the Hunan Provincial Science and Technology Research Project Foundation for Colleges and Universities in China,No.12A119Construct Program of the Key Discipline in Hunan Province,China
文摘Cubital tunnel syndrome is often accompanied by paresthesia in ulnar nerve sites and hand muscle atrophy. When muscle weakness occurs, or after failure of more conservative treatments, anterior transposition is used. In the present study, the ulnar nerve and its blood vessels were examined in the elbows of 18 adult cadavers, and the external diameter of the nutrient vessels of the ulnar nerve at the point of origin, the distances between the origin of the vessels and the medial epicondyle of the humerus, and the length of the vessels accompanying the ulnar nerve in the superior ulnar collateral artery, the inferior ulnar collateral artery, and the posterior ulnar recurrent artery were measured. Anterior transposition of the vascularized ulnar nerve was per- formed to treat cubital tunnel syndrome. The most appropriate distance that the vascularized ulnar nerve can be moved to the subcutaneous tissue under tension-free conditions was 1.8 ± 0.6 cm （1.1-2.5 cm）, which can be used as a reference value during the treatment of cubital tunnel syndrome with anterior transposition of the vascularized ulnar nerve.
基金supported by the National Natural Science Foundation of China,No.81371374(to ZD)
文摘For severe cubital tunnel syndrome, patients with absent sensory nerve action potential tend to have more severe nerve damage than those without. Thus, it is speculated that such patients generally have a poor prognosis. How absent sensory nerve action potential affects surgical outcomes remains uncertain owing to a scarcity of reports and conflicting results. This retrospective study recruited one hundred and fourteen cases(88 patients with absent sensory nerve action potential and 26 patients with present sensory nerve action potential) undergoing either subcutaneous transposition or in situ decompression. The minimum follow-up was set at 2 years. Primary outcome measures of overall hand function included their McGowan grade, modified Bishop score, and Disabilities of the Arm, Shoulder, and Hand Questionnaire(DASH) score. For patients with absent sensory nerve action potential, 71 cases(80.7%) achieved at least one McGowan grade improvement, 76 hands(86.4%) got good or excellent results according to the Bishop score, and the average DASH score improved 49.5 points preoperatively to 13.1 points postoperatively. When compared with the present sensory nerve action potential group, they showed higher postoperative McGowan grades and DASH scores, but there was no statistical difference between the modified Bishop scores of the two groups. Following in situ decompression or subcutaneous transposition, great improvement in hand function was achieved for severe cubital tunnel syndrome patients with absent sensory nerve action potential. The functional outcomes after surgery for severe cubital tunnel syndrome are worse in patients with absent sensory nerve action potential than those without. This study was approved by the Ethical Committee of Huashan Hospital, Fudan University, China(approval No. 2017142).
文摘Purpose: Although carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CuTS) are the most common neuropathies in the upper extremities, there have been few studies describing the etiology and associated factors in the general population. The purpose of this study was to investigate and clarify the etiology and associated factors for CTS and CuTS in the Japanese general population. Methods: A total of 1875 participants, who participated in health checkups conducted in rural areas in Japan in 2010, were enrolled. The prevalence of CTS and CuTS was investigated. Logistic regression models were performed to examine the relationship between CTS and CuTS and correlated factors such as occupational status, smoking and alcohol preferences, and medical characteristics. Results: The overall prevalence of CTS and CuTS was 2.0% and 2.2%, respectively. With regards to CTS, female subjects showed 7.33-times higher risk of CTS compared with male subjects. In addition, hypertension was also at high risk of CTS (5.56-times higher in borderline and 4.55-times higher in definite hypertension compared with normal blood pressure). However, there were no significant associations between CuTS and age, gender, occupation, smoking and alcohol preferences, or metabolic factors. Conclusions: CTS was associated with female gender and hypertension, whereas there was no obvious risk factor contributing to the onset of CuTS.
文摘Purpose: Failure after radial head arthroplasty is uncommon, but clinically significant. Treatment for failure may involve implant removal. We describe fourteen patients who underwent implant removal after failed radial head arthroplasty. Methods: A retrospective review was performed to determine the cause of failure and clinical data were prospectively collected. Results: At mean follow up of 38 months the mean VAS for pain score was 3.0 and the mean DASH score was 40.5. The mean MEPS was 69. All patients demonstrated improved elbow range of motion. Mean elbow flexion at final follow up was 124°to an average extension deficit of 25°. Fifty percent of patients exhibited clinical symptoms of cubital tunnel syndrome. Three patients required additional surgery after implant removal. Conclusions: Implant removal for failed radial head arthroplasty improves range of motion and demonstrates acceptable outcomes at intermediate-term follow up. However, 50% of patients developed cubital tunnel syndrome and 21% required revision surgery.
基金TCM science and Technology project of Hebei Provincial Administration of Traditional Chinese Medicine in 2021(No.2021352):The therapeutic effect of cubital tunnel expansion plasty combined with Huangqi Guizhi Wuwu Decoction on cubital tunnel syndrome。
文摘Cubital tunnel syndrome is a disease in which ulnar nerve is compressed by its surrounding tissues,and its main clinical manifestations are pain,sensory disturbance and dyskinesia.Its incidence rate is the second highest among peripheral nerve entrapment diseases,and it is one of the common clinical diseases.The theory of liver,spleen and kidney can guide the treatment of cubital tunnel syndrome with traditional Chinese medicine and acupuncture.By discussing the traditional Chinese medicine(TCM)pathogenesis and treatment principles of cubital tunnel syndrome,it provides modern medical theoretical support for TCM treatment of cubital tunnel syndrome.
文摘OBJECTIVE:To explore the optimal surgery in treating moderate-severe cubital tunnel(CuTS) syndrome by comparing the clinical efficiency of decompression and anterior subcutaneous transposition of ulnar nerve and decompression and anterior submuscular transposition of ulnar nerve,and to provide a theoretical basis for the appropriate surgical programs in treating moderate-severe Cu TS.METHODS:47 consecutive cases of moderate-severe Cu TS were surgically treated in our department from January 2014 to January 2017.All patients were divided into two groups by the doctor in our department.21 Cu TS cases were treated with decompression and anterior subcutaneous transposition of ulnar nerve,and other 26 cases were treated with decompression and anterior submuscular transposition of ulnar nerve.All the patients were followed 1 month,3 months and 6 months after operation to evaluate the recovery degree of ulnar nerve function and the clinical efficiency of the two methods was compared.RESULTS:Clinical symptoms of two groups were significant alleviated.There was no significant statistical difference between two groups in the clinical efficiency.CONCLUSION:Completely releasing of nerve truck is the most important step in treating mediate-severe Cu TS.Theclinical results of the two methods are similar,but the anterior subcutaneous transposition of ulnar nerve is more easy to operate and can be widely used.
文摘Background：To study lesions＇ location and prognosis of cubital tunnel syndrome （CubTS） by routine motor nerve conduction studies （MNCSs） and short-segment nerve conduction studies （SSNCSs,inching test）.Methods：Thirty healthy subjects were included and 60 ulnar nerves were studied by inching studies for normal values.Sixty-six patients who diagnosed CubTS clinically were performed bilaterally by routine MNCSs and SSNCSs.Follow-up for 1-year,the information of brief complaints,clinical symptoms,and physical examination were collected.Results：Sixty-six patients were included,88 of nerves was abnormal by MNCS,while 105 was abnormal by the inching studies.Medial epicondyle to 2 cm above medial epicondyle is the most common segment to be detected abnormally （59.09％）,P ＜ 0.01.Twenty-two patients were followed-up,17 patients＇ symptoms were improved.Most of the patients were treated with drugs and modification of bad habits.Conclusions：（1） SSNCSs can detect lesions of compressive neuropathy in CubTS more precisely than the routine motor conduction studies.（2） SSNCSs can diagnose CubTS more sensitively than routine motor conduction studies.（3） In this study,we found that medial epicondyle to 2 cm above the medial epicondyle is the most vulnerable place that the ulnar nerve compressed.（4） The patients had a better prognosis who were abnormal in motor nerve conduction time only,but not amplitude in compressed lesions than those who were abnormal both in velocity and amplitude.Our study suggests that SSNCSs is a practical method in detecting ulnar nerve compressed neuropathy,and sensitive in diagnosing CubTS.The compound muscle action potentials by SSNCSs may predict prognosis of CubTS.
文摘Background：Surgical decompression of the ulnar nerve is effective for cubital tunnel syndrome.However,deep approaches may result in iatrogenic elbow stiffness.This long-term study was to evaluate the range of motion （ROM） of the elbow and functional outcomes after anterior subcutaneous transposition.Methods：A total of 115 patients （78 male and 37 female;mean age：46.6 years） who underwent anterior subcutaneous transposition of the ulnar nerve between 2001 and 2005 were evaluated retrospectively;mean follow-up was 13.5 years.Elbow ROM was measured as flexion arc,flexion,and extension preoperatively and at the final follow-up,and compared via a mixed analysis of variance adjusting for age.Neuropathy was assessed preoperatively using a modified McGowan neuropathy grade and postoperatively using modified Wilson-Krout criteria.An ordinal logistic regression analysis used postoperative modified Wilson-Krout criteria as the outcome and preoperative factors as predictors.Results：Preoperative McGowan grades were Grade 1 in 14 patients （12.2%）,Grade 2A in 28 （24.3%）,Grade 2B in 53 （46.1%）,and Grade 3 in 20 （17.4%） patients.Postoperatively,66 patients （57.4%） had excellent results,26 （22.6%） had good results,16 （13.9%） had fair results,and 7 （6.1%） had poor results at the final follow-up,as per the Wilson-Krout criteria.There were no complications.Pre-and postoperative elbow ROM was significantly decreased in patients with previous trauma or surgery of the elbow compared with those without （P 〈 0.05）.Anterior subcutaneous transposition of the ulnar nerve did not significantly affect elbow ROM regardless of previous trauma or surgical history nor preoperative ROM （P 〉 0.05）,after adjusting for age.Patients with prolonged symptoms prior to surgery and worse neuropathy tended to have less satisfactory functional outcomes （P 〈 0.05）,after adjusting for covariates.Conclusions：Anterior subcutaneous transposition of the ulnar nerve is an effective and reliable treatment of cubital tunnel syndrome with satisfactory outcomes and minimal effect on elbow ROM.
文摘To study whether liver cirrhosis associated with Helicobacter pylori ( H pylori ) infection will induce increased serum ammonia and whether the peripheral serum ammonia reflects the level of portal vein serum ammonia Methods Blood was taken from the portal vein and the cubital vein in cirrhotic patients with and without H pylori infection and non cirrhotic patients (splenic rupture) with and without H pylori infection, and the serum ammonia was measured Results The mean levels of serum ammonia in the group of cirrhotic patients with H pylori infection were 167 82±8 97?μmol/L (portal vein) and 142 2±13 35?μmol/L (cubital vein) They were increased significantly as compared with cirrhotic patients without H pylori infection (47 68±12 03?μmol/L portal vein and 37 23±7 04?μmol/L cubital vein), and also compared with the groups of splenic rupture patients with and without H pylori infection ( P <0 01) There was no significant difference between the serum ammonia level of the cubital vein and portal vein ( P >0 05) Conclusions H pylori infection can induce an increase in serum ammonia in patients with liver dysfunction, and the peripheral serum ammonia measurement may replace the portal vein serum ammonia as a monitoring method Eradication of H pylori in cirrhotic patients may prevent hepatic encephalopathy (HE)
文摘Background Cubital tunnel syndrome is a well-recognized clinical condition and is the second most common peripheral compression neuropathy. This study was designed to investigate the causes of cubital tunnel syndrome by surgical means and to assess the clinical value of the neurophysiological diagnosis of cubital tunnel syndrome. Methods Twenty-one patients (involving a total of 22 limbs from 16 men and 5 women, aged 22 to 63, with a mean age of 49 years) with clinical symptoms and signs indicating a problem with their ulnar nerve underwent motor conduction velocity examinations at different sites along the ulnar nerve and examinations of sensory conduction velocity in the hand, before undergoing anterior transposition of the ulnar nerve.Results Electromyographic abnormalities were seen in 21 of 22 limbs [motor nerve conduction velocity (MCV) range (15.9-47.5) m/s, mean 32.7 m/s] who underwent motor conduction velocity examinations across the elbow segment of the ulnar nerve. Reduced velocity was observed in 13 of 22 limbs [MCV (15.7-59.6) m/s, mean 40.4 m/s] undergoing MCV tests in the forearms. An absent or abnormal sensory nerve action potential following stimulation was detected in the little finger of 14 of 22 limbs. The factors responsible for ulnar compression based on observations made during surgery were as follows: 15 cases involved compression by arcuate ligaments, muscle tendons, or bone hyperplasia; 2 involved fibrous adhesion; 3 involved compression by the venous plexus or a concurrent thick vein; 2 involved compression by cysts. Conclusions Factors inducing cubital tunnel syndrome include both common factors that have been reported and rare factors, involving the venous plexus, thick veins, and cysts. Tests of motor conduction velocity at different sites along the ulnar nerve should be helpful in diagnosis cubital tunnel syndrome, especially MCV tests indicating decreased velocity across the elbow segment of the ulnar nerve.
文摘Background： The appropriate elbow position of short-segment nerve conduction study （SSNCS） to diagnose cubital tunnel syndrome （CubTS） is still controversial. The goal of this study was to determine the effect of different elbow positions at full extension and 70° flexion on SSNCS in CubTS. Methods： In this cross-sectional study, the clinical data of seventy elbows from 59 CubTS patients between September, 2011 and December, 2014 in the Peking University First Hospital were included as CubTS group. Moreover, thirty healthy volunteers were included as the healthy group. SSNCS were conducted in all subjects at elbow fhll extension and 70° elbow flexion. Paired nonparametric test, bivariate correlation, Bland-Altman, and Chi-squared test analysis were used to compare the effectiveness of elbow full extension and 70° flexion elbow positions on SSNCS in CubTS patients. Results： Data of upper limit was calculated from healthy group, and abnormal latency was judged accordingly. CubTS group＇s latency and compound muscle action potential （CMAP） of each segment at 70° elbow flexion by SSNCS was compared with lull extension position, no statistically significant difference were found （all P 〉 0.05）. Latency and CMAP of each segment at elbow full extension and 70° flexion were correlated （all P 〈 0 elbow （P - 0.43）, and the latency （P = 0.15） and the CMAP （P = 01）, except the latency of segment of 4 cm to 6 cm above 0.06） of segment of 2 cm to 4 cm below elbow. Bivariate correlation and Bland-Altman analysis proved the correlation between elbow full extension and 70° flexion. Especially in segments across the elbow （2 cm above the elbow and 2 cm below it）, latency at elbow full extension and 70° flexion were strong direct associated（r=0.83, P〈0.01;r=0.55, P〈0.01）,andsodidtheCMAP（r 0.49, P〈0.01;r=0.72, P〈0.01）.Therewasno statistically significant difference in abnormality of each segment at full extension as measured by SSNCS compared with that at 70° flexion （P 〉 0.05, respectively）. Conclusions： There was no statistically significant difference in the diagnosis of CubTS with the elbow at full extension compared with that at 70° flexion during SSNCS. We suggest that elbow positon at full extension can also be used during SSNCS.
文摘Ulnar nerve neuropathy at the elbow represents the second most frequent compression neuropathy of the upper extremity.Of the five different anatomical areas responsible for ulnar nerve compression at the elbow region,the epitrochlear-olecranon channel and Osborne’s arcade are the most common.An additional cause of nerve damage is a dynamic process in which the ulnar nerve dislocates anteriorly at the epitrochlear-olecranon level during elbow flexion,partially or completely,causing nerve friction and constriction leading to chronic neuropathic pain.Failure after primary surgery is generally secondary to procedural errors or technical omissions,frequently represented by incomplete nerve decompression,failure to recognize nerve instability after nerve decompression,loosening of the nerve anchor after superficial nerve transposition with consequent spontaneous nerve relocation in the epitrochlear-olecranon channel,perineural fibrosis and neurodesis,which creates new nerve compression.In association with the clinical evaluation,electromyography studies,magnetic resonance imaging and ultrasound are useful tools that may aid in the decision-making process when considering revision surgery.Superficial anterior transposition is the most commonly employed technique but also has a high failure rate,as opposed to anterior deep transposition that is the method of choice for many surgeons despite being more technically demanding.The results of revision surgery following recalcitrant ulnar nerve compression at the elbow are inferior to those obtained after primary surgery.Nonetheless,the clinical advantages remain relevant provided that the revision surgery is performed by an expert surgeon.To avoid misinterpretation,the patient is completely informed of the quality of results.
基金This research was funded by the Zhejiang Key Research and Development Programof China(No.2021C03050)the Zhejiang Key Research and Development Program of China(No.2022C03038).
文摘Cubital tunnel syndrome(CTS)is a chronic condition caused by the compression of the ulnar nerve at the elbow.The ulnar nerve is susceptible to entrapment at multiple sites along its path,with the elbow joint being the most critical.Symptoms typically include numbness in the ulnar nerve distribution area,hand muscle atrophy,and weakness.Patients exhibiting mild symptoms can be treated conservatively,whereas those with moderate to severe symptoms often require surgical intervention.Extensive research has been conducted on the clinical treatment of CTS.The complex etiology of this condition,coupled with the unique anatomical structure of the ulnar nerve,has led to less-than-satisfactory clinical outcomes.Physiotherapy plays an important role in aiding nerve recovery and reducing disability rates.Initiating physiotherapy early can address the cause of the disease,mitigate nerve damage,improve functional impairment due to nerve injury,and enhance the quality of patients’daily activities.However,definitive guidelines for the treatment and evaluation of cubital tunnel syndrome are lacking.This review compiles the various modalities and advancements in the diagnosis and rehabilitation of CTS,drawing from recent domestic and international literature.It summarizes and compares the diagnostic tools currently employed in clinical practice and offers suggestions for physicians and therapists in selecting personalized diagnostic tools for patient assessment.Additionally,the review describes various rehabilitation methods,providing fresh insights for patients with cubital tunnel syndrome who have received conservative or surgical treatment.
