Ulnar Neuropathy at the Elbow: From Ultrasound Scanning to Treatment

Kamal Mezian, Jakub Jačisko, Radek Kaiser, Stanislav Machač, Petra Steyerová, Karolína Sobotová, Yvona Angerová, Ondřej Naňka, Kamal Mezian, Jakub Jačisko, Radek Kaiser, Stanislav Machač, Petra Steyerová, Karolína Sobotová, Yvona Angerová, Ondřej Naňka

Abstract

Ulnar neuropathy at the elbow (UNE) is commonly encountered in clinical practice. It results from either static or dynamic compression of the ulnar nerve. While the retroepicondylar groove and its surrounding structures are quite superficial, the use of ultrasound (US) imaging is associated with the following advantages: (1) an excellent spatial resolution allows a detailed morphological assessment of the ulnar nerve and adjacent structures, (2) dynamic imaging represents the gold standard for assessing the ulnar nerve stability in the retroepicondylar groove during flexion/extension, and (3) US guidance bears the capability of increasing the accuracy and safety of injections. This review aims to illustrate the ulnar nerve's detailed anatomy at the elbow using cadaveric images to understand better both static and dynamic imaging of the ulnar nerve around the elbow. Pathologies covering ulnar nerve instability, idiopathic cubital tunnel syndrome, space-occupying lesions (e.g., ganglion, heterotopic ossification, aberrant veins, and anconeus epitrochlearis muscle) are presented. Additionally, the authors also exemplify the scientific evidence from the literature supporting the proposition that US guidance is beneficial in injection therapy of UNE. The non-surgical management description covers activity modifications, splinting, neuromobilization/gliding exercise, and physical agents. In the operative treatment description, an emphasis is put on two commonly used approaches-in situ decompression and anterior transpositions.

Keywords: US-guidance; cubital tunnel syndrome; elbow; entrapment neuropathy; musculoskeletal; peripheral nerve; ulnar nerve (MeSH); ultrasound.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Mezian, Jačisko, Kaiser, Machač, Steyerová, Sobotová, Angerová and Naňka.

Figures

Figure 1
Figure 1
Possible sites of compression of the ulnar nerve at and around the elbow: (1) the medial intermuscular septum of the arm, (2) arcade of Struthers, (3) cubital tunnel, and (4) connective tissue between flexor carpi ulnaris and flexor digitorum superficialis muscles. RTC, retroepicondylar groove; HUA, humeroulnar aponeurotic arcade.
Figure 2
Figure 2
Course of the ulnar nerve in the arm. (A) Relationship of the ulnar nerve (U) and the medial septum (MIS). Ulnar nerve penetrates the medial septum—the penetration is demarcated by a ligamentous thickening (Struther's arcade). (B) Penetration of the septum and further course of the ulnar nerve is covered by muscular fibers of medial head of triceps brachii muscle, which begins on the medial intermuscular septum. (C) Transverse section of midarm depicting the relationship between ulnar nerve (U) and medial intermuscular septum (white arrow). BA, brachial artery; Bi, biceps brachii muscle; Br, brachialis muscle; BV, brachial vein; Hu, humerus; M, median nerve; ME, medial epicondyle; MIS, medial intermuscular septum; U, ulnar nerve; white arrow, medial intermuscular septum.
Figure 3
Figure 3
Retroepicondylar groove and the entrance to the cubital tunnel. (A) Entrance of the ulnar nerve to the cubital tunnel. (B) Demarcation of the cubital tunnel. BA, brachial artery; Br, brachialis muscle; BT, biceps brachii muscle tendon; BV, brachial vein; CFT, common flexor tendon; FCU, flexor carpi ulnaris muscle; ME, medial epicondyle; ole, olecranon; U, ulnar nerve; black arrow, medial collateral ligament, posterior bundle; white arrow, retroepicondylar retinaculum.
Figure 4
Figure 4
Cubital tunnel. (A) View on proximal part of the cubital tunnel with humeroulnar aponeurotic arcade (HUA) and ulnar nerve (U) going between humeral (1) and ulnar (2) head of flexor carpi ulnaris muscle (FCU). The course of ulnar nerve between FCU and flexor digitorum superficialis muscle (FDS). Humeral head is moved away, and the retroepicondylar retinaculum is transsected (white arrow). (B) Ulnar nerve exiting the cubital tunnel to forearm. The nerve is in close relationship to intermuscular connective tissue between FCU and FDS (black asterisk). (C) Cross section of the forearm depicting the relationship between the ulnar nerve and surrounding muscles and connective tissues (red and blue arrows). (1) flexor carpi ulnaris muscle, humeral head; (2) flexor carpi ulnaris muscle, ulnar head; HUA, humeroulnar aponeurotic arcade; Brachiorad, brachioradialis muscle; FCU, flexor carpi ulnaris muscle; FDP, flexor digitorum profundus muscle; FDS, flexor digitorum superficialis muscle; ole, olecranon; PrT, pronator teres; U, ulnar nerve; blue arrow, intermuscular connective tissue between FCU and FDS, deep flexor pronator aponeurosis; red arrow, intermuscular connective tissue between FCU and FDP.
Figure 5
Figure 5
Ultrasound (US) imaging of the ulnar nerve (U) at the level of the medial epicondyle (ME) in a patient with symptomatic ulnar nerve dislocation. Both longitudinal (A) and short-axis (B) views clearly demonstrate a close contact between the ulnar nerve and common flexor tendon origin. U, ulnar nerve; CFT, common flexor tendon; ME, medial epicondyle.
Figure 6
Figure 6
Normal ultrasound images of the ulnar nerve. (A) Short axis. (B) Long axis. U, ulnar nerve; ME, medial epicondyle; arrowheads, retroepicondylar retinaculum.
Figure 7
Figure 7
Proximal and distal tracking of the ulnar nerve starting from the retroepicondylar groove. (A) Midarm, arrowhead: medial intermuscular septum. (B) Proximal midarm. (C) Flexor carpi ulnaris muscle (FCU) level. (D) Proximal forearm. (E) Proximal mid-forearm, the ulnar nerve accompanied by the ulnar artery. (F) Ulnar nerve in Guyon canal (arrowheads). FDP, flexor digitorum profundus muscle; FDS, flexor digitorum superficialis muscle; U, ulnar nerve; BA, brachial artery; BV, brachial vein.
Figure 8
Figure 8
Comparative ultrasound (US) imaging of the ulnar nerve (U) at the level of the medial epicondyle (ME) in a patient with cubital tunnel syndrome. When compared with the normal side. (A) The asymptomatic side in a long axis of the ulnar nerve. (B) The symptomatic side ulnar nerve shows swelling (“bottle neck appearance”) proximal to the cubital tunnel inlet in long-axis. (D,E) In short axis, compared with the normal side (C), the ulnar nerve on the symptomatic side shows enlargement in its cross-sectional area of 18 mm2 outlined using the direct US tracing method (green dotted line). Hum, humerus; FCU, flexor carpi ulnaris muscle.
Figure 9
Figure 9
Ultrasound images of the ulnar nerve exemplary pathologies. (A) Short-axis image at the level of the humeral medial epicondyle (ME) shows the ulnar nerve (U) in an intimate contact with a ganglion (white arrowhead), likely derived from the triceps tendon. (B) A short-axis US image of the ulnar nerve situated just next to the heterotopic ossification (HO). (C) The ulnar nerve short-axis image shows an accessory anconeus epitrochlearis muscle (asterisk). (D) A longitudinal US image of the post-traumatic degenerative joint disease with effusion compressing the ulnar nerve. (E) A longitudinal image of the ulnar nerve depicts the nerve compression from scar tissue after olecranon surgery. (F) A short-axis view at the ulnar nerve (U) shows an aberrant vein (white arrow) next to it. ME, medial epicondyle of humerus; U, ulnar nerve.
Figure 10
Figure 10
(A) Prone position for the ultrasound-guided ulnar nerve in-plane injection with the elbow flexed and hanging over the examination bed. (B) The same procedure as described before in detail. (C) Supine position for the ultrasound-guided ulnar nerve in-plane injection; the patient is positioned on the examination bed with the elbow flexed and hand over the head. (D) The same procedure as described before in details.
Figure 11
Figure 11
(A)In situ decompression of the ulnar nerve in the cubital tunnel. (B) Anterior subcutaneous transposition—after wide decompression, the ulnar nerve is transposed anteriorly under the cutaneous flap.

References

    1. Staples JR, Calfee R. Cubital tunnel syndrome: current concepts. J Am Acad Orthop Surg. (2017) 25:e215–e24. 10.5435/JAAOS-D-15-00261
    1. Wu C-H, Chang K-V, Özçakar L, Hsiao M-Y, Hung C-Y, Shyu S-G, Wang T-G, et al. . Sonographic tracking of the upper limb peripheral nerves: a pictorial essay and video demonstration. Am J Phys Med Rehabil. (2015) 94:740–7. 10.1097/PHM.0000000000000344
    1. Kara M, Gürçay E, Ekiz T, Sekizkardeş M, Yorulmaz E, Ata AM, et al. . EURO-MUSCULUS/USPRM global report on musculoskeletal ultrasound publications. Am J Phys Med Rehabil. (2020) 99:847–52. 10.1097/PHM.0000000000001390
    1. Ricci V, Özçakar L. Ultrasonographic examination: the “X-Factor” in physiatry. Am J Phys Med Rehabil. (2020) 99:e131–e2. 10.1097/PHM.0000000000001372
    1. Mezian K, Steyeorova P, Vacek J, Navratil L. Introduction to neuromuscular ultrasound. Cesk Slov Neurol N. (2016) 79:656–61. 10.14735/amcsnn2016656
    1. Contreras MG, Warner MA, Charboneau WJ, Cahill DR. Anatomy of the ulnar nerve at the elbow: potential relationship of acute ulnar neuropathy to gender differences. Clin Anat. (1998) 11:372–8. 10.1002/(SICI)1098-2353(1998)11:6<372::AID-CA2>;2-R
    1. Standring S. Gray's Anatomy. The Anatomical Basis of Clinical Practice. 41st ed. Edinburgh: Churchill Livingstone/Elsevier; (2015).
    1. Mizia E, Zarzecki MP, Pekala JR, Baginski A, Kaythampillai LN, Golebiowska M, et al. . An anatomical investigation of rare upper limb neuropathies due to the Struthers' ligament or arcade: a meta-analysis. Folia Morphol. (2020). 10.5603/FM.a2020.0050. [Epub ahead of print].
    1. Tubbs RS, Deep A, Shoja MM, Mortazavi MM, Loukas M, Cohen-Gadol AA. The arcade of struthers: an anatomical study with potential neurosurgical significance. Surg Neurol Int. (2011) 2:184. 10.4103/2152-7806.91139
    1. Spinner M, Kaplan EB. The relationship of the ulnar nerve to the medial intermuscular septum in the arm and its clinical significance. Hand. (1976) 8:239–42. 10.1016/0072-968X(76)90008-5
    1. Michelin P, Leleup G, Ould-Slimane M, Merlet MC, Dubourg B, Duparc F. Ultrasound biomechanical anatomy of the soft structures in relation to the ulnar nerve in the cubital tunnel of the elbow. Surg Radiol Anat. (2017) 39:1215–21. 10.1007/s00276-017-1879-y
    1. O'Driscoll SW, Horii E, Carmichael SW, Morrey BF. The cubital tunnel and ulnar neuropathy. J Bone Joint Surg Br. (1991) 73:613–7. 10.1302/0301-620X.73B4.2071645
    1. Jacobson JA, Fessell DP, Lobo LDG, Yang LJ-S. Entrapment neuropathies I: upper limb (carpal tunnel excluded). Semin Musculoskelet Radiol. (2010) 14:473–86. 10.1055/s-0030-1268068
    1. Mahan MA, Gasco J, Mokhtee DB, Brown JM. Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited. J Neurosurg. (2015) 123:1216–22. 10.3171/2014.10.JNS141379
    1. Won H-S, Liu H-F, Kim J-H, Kwak D-S, Chung I-H, Kim I-B. Intermuscular aponeuroses between the flexor muscles of the forearm and their relationships with the ulnar nerve. Surg Radiol Anat. (2016) 38:1183–9. 10.1007/s00276-016-1695-9
    1. An TW, Evanoff BA, Boyer MI, Osei DA. The prevalence of cubital tunnel syndrome: a cross-sectional study in a U.S. Metropolitan Cohort. J Bone Joint Surg Am. (2017) 99:408–16. 10.2106/JBJS.15.01162
    1. Frost P, Johnsen B, Fuglsang-Frederiksen A, Svendsen SW. Lifestyle risk factors for ulnar neuropathy and ulnar neuropathy-like symptoms. Muscle Nerve. (2013) 48:507–15. 10.1002/mus.23820
    1. Uzunkulaoglu A, Ikbali Afsar S, Karataş M. Association between gender, body mass index, and ulnar nerve entrapment at the elbow: a retrospective study. J Clin Neurophysiol. (2016) 33:545–8. 10.1097/WNP.0000000000000288
    1. Jačisko J, Sobotová K, Mezian K. The utility of ultrasound examination in cubital tunnel syndrome caused by heterotopic ossification. Med Ultrason. (2020) 22:117–8. 10.11152/mu-2419
    1. Ashworth NL, Huang C, Chan KM. Laterality and risk factors for ulnar neuropathy at the elbow. Muscle Nerve. (2020) 61:101–4. 10.1002/mus.26737
    1. Dawson DM. Entrapment neuropathies of the upper extremities. N Engl J Med. (1993) 329:2013–8. 10.1056/NEJM199312303292707
    1. Van Den Berg PJ, Pompe SM, Beekman R, Visser LH. Sonographic incidence of ulnar nerve (sub)luxation and its associated clinical and electrodiagnostic characteristics. Muscle Nerve. (2013) 47:849–55. 10.1002/mus.23715
    1. Omejec G, Podnar S. Does ulnar nerve dislocation at the elbow cause neuropathy? Muscle Nerve. (2016) 53:255–9. 10.1002/mus.24786
    1. Ochi K, Horiuchi Y, Tanabe A, Waseda M, Kaneko Y, Koyanagi T. Shoulder internal rotation elbow flexion test for diagnosing cubital tunnel syndrome. J Shoulder Elbow Surg. (2012) 21:777–81. 10.1016/j.jse.2011.10.015
    1. Patel P, Norbury JW, Fang X. Sonographic measurements of the ulnar nerve at the elbow with different degrees of elbow flexion. PM R. (2014) 6:395–9. 10.1016/j.pmrj.2013.12.011
    1. Rosenberg ZS, Beltran J, Cheung Y, Broker M. MR imaging of the elbow: normal variant and potential diagnostic pitfalls of the trochlear groove and cubital tunnel. AJR Am J Roentgenol. (1995) 164:415–8. 10.2214/ajr.164.2.7839980
    1. Cornelson SM, Sclocco R, Kettner NW. Ulnar nerve instability in the cubital tunnel of asymptomatic volunteers. J Ultrasound. (2019) 22:337–44. 10.1007/s40477-019-00370-9
    1. Bordes SJ, Jenkins S, Bang K, Turgut M, Iwanaga J, Loukas M, et al. . Ulnar nerve subluxation and dislocation: a review of the literature. Neurosurg Rev. (2020) 44:793–8. 10.1007/s10143-020-01286-3
    1. Leis AA, Smith BE, Kosiorek HE, Omejec G, Podnar S. Complete dislocation of the ulnar nerve at the elbow: a protective effect against neuropathy? Muscle Nerve. (2017) 56:242–6. 10.1002/mus.25483
    1. Mackinnon SE. Pathophysiology of nerve compression. Hand Clin. (2002) 18:231–41. 10.1016/S0749-0712(01)00012-9
    1. Omejec G, Podnar S. Precise localization of ulnar neuropathy at the elbow. Clin Neurophysiol. (2015) 126:2390–6. 10.1016/j.clinph.2015.01.023
    1. Bäumer T, Grimm A, Schelle T. [Diagnostic nerve ultrasonography]. Radiologe. (2017) 57:157–65. 10.1007/s00117-017-0218-y
    1. Wilson TJ, Tubbs RS, Yang LJS. The anconeus epitrochlearis muscle may protect against the development of cubital tunnel syndrome: a preliminary study. J Neurosurg. (2016) 125:1533–8. 10.3171/2015.10.JNS151668
    1. Said J, Abboudi J, Gallant G, Jones C, Kirkpatrick W, Liss F, et al. . Prospective evaluation of sleep improvement after cubital tunnel decompression surgery. J Shoulder Elbow Surg. (2019) 28:e144–e9. 10.1016/j.jse.2018.11.046
    1. Hrehová L, Mezian K. Non-pharmacologic treatment of insomnia in primary care settings. Int J Clin Pract. (2021). 10.1111/ijcp.14084. [Epub ahead of print].
    1. Hsu P-C, Chang K-V, Mezian K, Nanka O, Wu W-T, Yang Y-C, et al. . Sonographic pearls for imaging the brachial plexus and its pathologies. Diagnostics. (2020) 10:324. 10.3390/diagnostics10050324
    1. McGOWAN AJ. The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg Br. (1950) 32-B:293–301. 10.1302/0301-620X.32B3.293
    1. Ehler E, Nakladalova M, Urban P, Mazanec R, Fenclova Z, Matulova H, et al. . Neurophysiological diagnosis of the ulnar nerve damage at the elbow. Cesk Slov Neurol N. (2012) 75:320–5.
    1. AAEM . Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement. Muscle Nerve. (1999) 22:408–11. 10.1002/(SICI)1097-4598(199903)22:3<408::AID-MUS16>;2-7
    1. Dimberg EL. Electrodiagnostic evaluation of ulnar neuropathy and other upper extremity mononeuropathies. Neurol Clin. (2012) 30:479–503. 10.1016/j.ncl.2011.12.003
    1. Omejec G, Podnar S. Normative values for short-segment nerve conduction studies and ultrasonography of the ulnar nerve at the elbow. Muscle Nerve. (2015) 51:370–7. 10.1002/mus.24328
    1. Martin SP, Schauer KT, Czyrny JJ, Ablove RH. Electrophysiological findings in common median-ulnar nerve interconnections and their clinical implications. J Hand Surg Am. (2019) 44:884–94. 10.1016/j.jhsa.2019.04.010
    1. Ehler E, Ridzon P. Ulnar nerve. Cesk Slov Neurol N. (2017) 80:130–40. 10.14735/amcsnn2017130
    1. Lee K-S, Oh C-S, Chung I-H, Sunwoo I-N. An anatomic study of the Martin-Gruber anastomosis: electrodiagnostic implications. Muscle Nerve. (2005) 31:95–7. 10.1002/mus.20141
    1. Gans P, Van Alfen N. Nerve ultrasound showing Martin-Gruber anastomosis. Muscle Nerve. (2017) 56:E46–E7. 10.1002/mus.25746
    1. Mezian K, Machač S, Zavareh A, Majerníková L, Vacek J, Navrátil L, et al. . Positioning techniques to improve the ultrasound evaluation of the elbow. Ultrasound Q. (2019) 35:136–41. 10.1097/RUQ.0000000000000377
    1. Özçakar L, Muynck MD. Musculoskeletal Ultrasound in Physical Rehabilitation Medicine. Italy: Edi Ermes; (2014).
    1. Martinoli C, Bianchi S, Zamorani MP, Zunzunegui JL, Derchi LE. Ultrasound of the elbow. Eur J Ultrasound. (2001) 14:21–7. 10.1016/S0929-8266(01)00142-2
    1. Cheng Y, Xu X, Chen W, Wang Y. Doppler sonography for ulnar neuropathy at the elbow. Muscle Nerve. (2016) 54:258–63. 10.1002/mus.25022
    1. Chang K-V, Wu W-T, Han D-S, Özçakar L. Ulnar nerve cross-sectional area for the diagnosis of cubital tunnel syndrome: a meta-analysis of ultrasonographic measurements. Arch Phys Med Rehabil. (2018) 99:743–57. 10.1016/j.apmr.2017.08.467
    1. Volpe A, Rossato G, Bottanelli M, Marchetta A, Caramaschi P, Bambara LM, et al. . Ultrasound evaluation of ulnar neuropathy at the elbow: correlation with electrophysiological studies. Rheumatology. (2009) 48:1098–101. 10.1093/rheumatology/kep167
    1. Chen I-J, Chang K-V, Wu W-T, Özçakar L. Ultrasound parameters other than the direct measurement of ulnar nerve size for diagnosing cubital tunnel syndrome: a systemic review and meta-analysis. Arch Phys Med Rehabil. (2019) 100:1114–30. 10.1016/j.apmr.2018.06.021
    1. Grimm A, Rattay TW, Winter N, Axer H. Peripheral nerve ultrasound scoring systems: benchmarking and comparative analysis. J Neurol. (2017) 264:243–53. 10.1007/s00415-016-8305-y
    1. Qi HT, Wang XM, Li SY, Wang GB, Wang DH, Wang ZT, et al. . The role of ultrasonography and MRI in patients with non-traumatic nerve fascicle torsion of the upper extremity. Clin Radiol. (2013) 68:e479–83. 10.1016/j.crad.2013.03.021
    1. Childress HM. Recurrent ulnar-nerve dislocation at the elbow. Clin Orthop Relat Res. (1975) 108:168–73. 10.1097/00003086-197505000-00027
    1. Calfee RP, Manske PR, Gelberman RH, Van Steyn MO, Steffen J, Goldfarb CA. Clinical assessment of the ulnar nerve at the elbow: reliability of instability testing and the association of hypermobility with clinical symptoms. J Bone Joint Surg Am. (2010) 92:2801–8. 10.2106/JBJS.J.00097
    1. Kiliç E, Ozçakar L. Ulnar nerve compression possibly due to aberrant veins: sonography is elucidatory for idiopathic cubital tunnel syndrome. Rheumatol Int. (2011) 31:139–40. 10.1007/s00296-009-1352-2
    1. Chuang H-J, Hsiao M-Y, Wu C-H, Özçakar L. Dynamic ultrasound imaging for ulnar nerve subluxation and snapping triceps syndrome. Am J Phys Med Rehabil. (2016) 95:e113–4. 10.1097/PHM.0000000000000466
    1. Shin R, Ring D. The ulnar nerve in elbow trauma. J Bone Joint Surg Am. (2007) 89:1108–16. 10.2106/JBJS.F.00594
    1. Omejec G, Podnar S. Long-term outcomes in patients with ulnar neuropathy at the elbow treated according to the presumed aetiology. Clin Neurophysiol. (2018) 129:1763–9. 10.1016/j.clinph.2018.04.753
    1. Kooner S, Cinats D, Kwong C, Matthewson G, Dhaliwal G. Conservative treatment of cubital tunnel syndrome: a systematic review. Orthop Rev. (2019) 11:7955. 10.4081/or.2019.7955
    1. Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. (2016) 11:CD006839. 10.1002/14651858.CD006839.pub4
    1. Svernlöv B, Larsson M, Rehn K, Adolfsson L. Conservative treatment of the cubital tunnel syndrome. J Hand Surg. (2009) 34:201–7. 10.1177/1753193408098480
    1. Vinitpairot C, Jianmongkol S, Thammaroj T, Wattanakamolchai S. Ulnar nerve strain in functional elbow and shoulder motions. J Hand Surg. (2019) 24:323–8. 10.1142/S2424835519500413
    1. Gelberman RH, Yamaguchi K, Hollstien SB, Winn SS, Heidenreich FP, Bindra RR, et al. . Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow. An experimental study in human cadavera. J Bone Joint Surg Am. (1998) 80:492–501. 10.2106/00004623-199804000-00005
    1. Hong CZ, Long HA, Kanakamedala RV, Chang YM, Yates L. Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation. Arch Phys Med Rehabil. (1996) 77:573–7. 10.1016/S0003-9993(96)90297-X
    1. Assmus H, Antoniadis G, Bischoff C, Hoffmann R, Martini A-K, Preissler P, et al. . Cubital tunnel syndrome - a review and management guidelines. Cent Eur Neurosurg. (2011) 72:90–8. 10.1055/s-0031-1271800
    1. Butler D. The Sensitive Nervous System. Adelaide, SA: Noigroup Publications; (2000). 10.1016/B978-012529650-2/50026-3
    1. Myers RR, Murakami H, Powell HC. Reduced nerve blood flow in edematous neuropathies: a biomechanical mechanism. Microvasc Res. (1986) 32:145–51. 10.1016/0026-2862(86)90050-6
    1. Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM, Bartko JJ. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther. (1998) 11:171–9. 10.1016/S0894-1130(98)80035-5
    1. Burke FD, Ellis J, McKenna H, Bradley MJ. Primary care management of carpal tunnel syndrome. Postgrad Med J. (2003) 79:433–7. 10.1136/pmj.79.934.433
    1. Millesi H, Zöch G, Reihsner R. Mechanical properties of peripheral nerves. Clin Orthop Relat Res. (1995) 314:76–83. 10.1097/00003086-199505000-00011
    1. Coppieters MW, Butler DS. Do “sliders” slide and “tensioners” tension? An analysis of neurodynamic techniques and considerations regarding their application. Man Ther. (2008) 13:213–21. 10.1016/j.math.2006.12.008
    1. Basso JC, Suzuki WA. The effects of acute exercise on mood, cognition, neurophysiology, and neurochemical pathways: a review. Brain Plast. (2017) 2:127–52. 10.3233/BPL-160040
    1. Bilgin Badur N, Unlu Ozkan F, Aktas I. Efficacy of shortwave diathermy in ulnar nerve entrapment at the elbow: a double-blind randomized controlled clinical trial. Clin Rehabil. (2020) 34:1048–55. 10.1177/0269215520930062
    1. Mense S, Hoheisel U. Shock wave treatment improves nerve regeneration in the rat. Muscle Nerve. (2013) 47:702–10. 10.1002/mus.23631
    1. Hausner T, Pajer K, Halat G, Hopf R, Schmidhammer R, Redl H, et al. . Improved rate of peripheral nerve regeneration induced by extracorporeal shock wave treatment in the rat. Exp Neurol. (2012) 236:363–70. 10.1016/j.expneurol.2012.04.019
    1. Paoloni M, Tavernese E, Cacchio A, D'orazi V, Ioppolo F, Fini M, et al. . Extracorporeal shock wave therapy and ultrasound therapy improve pain and function in patients with carpal tunnel syndrome. A randomized controlled trial. Eur J Phys Rehabil Med. (2015) 51:521–8.
    1. Raissi GR, Ghazaei F, Forogh B, Madani SP, Daghaghzadeh A, Ahadi T. The effectiveness of radial extracorporeal shock waves for treatment of carpal tunnel syndrome: a randomized clinical trial. Ultrasound Med Biol. (2017) 43:453–60. 10.1016/j.ultrasmedbio.2016.08.022
    1. Gesslbauer C, Mickel M, Schuhfried O, Huber D, Keilani M, Crevenna R. Effectiveness of focused extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome : a randomized, placebo-controlled pilot study. Wien Klin Wochenschr. (2020). 10.1007/s00508-020-01785-9. [Epub ahead of print].
    1. Shen Y-P, Wu Y-Y, Chu H-Y, Li T-Y, Chen L-C, Yung-Tsan W. Extracorporeal shock wave therapy in cubital tunnel syndrome: a pilot study. Neurol Asia. (2018) 23:233–8.
    1. Ozkan FU, Saygi EK, Senol S, Kapci S, Aydeniz B, Aktaş I, et al. . New treatment alternatives in the ulnar neuropathy at the elbow: ultrasound and low-level laser therapy. Acta Neurol Belg. (2015) 115:355–60. 10.1007/s13760-014-0377-9
    1. Anandkumar S, Manivasagam M. Effect of dry needling on cubital tunnel syndrome: three case reports. Physiother Theory Pract. (2019) 35:363–72. 10.1080/09593985.2018.1449275
    1. Özçakar L, Kara M, Onat SS, Gürçay E. Don't touch my bone and don't run into my nerve. Am J Phys Med Rehabil. (2016) 95:e125–6. 10.1097/PHM.0000000000000493
    1. Nwawka OK, Miller TT. Ultrasound-guided peripheral nerve injection techniques. AJR Am J Roentgenol. (2016) 207:507–16. 10.2214/AJR.16.16378
    1. Ruiz A, Sala-Blanch X, Martinez-Ocón J, Carretero MJ, Sánchez-Etayo G, Hadzic A. Incidence of intraneural needle insertion in ultrasound-guided femoral nerve block: a comparison between the out-of-plane versus the in-plane approaches. Rev Esp Anestesiol Reanim. (2014) 61:73–7. 10.1016/j.redar.2013.09.023
    1. Kim JM, Oh H-M, Kim M-W. Real-time visualization of ultrasonography guided cubital tunnel injection: a cadaveric study. Ann Rehabil Med. (2012) 36:496–500. 10.5535/arm.2012.36.4.496
    1. Choi CK, Lee HS, Kwon JY, Lee W-J. Clinical implications of real-time visualized ultrasound-guided injection for the treatment of ulnar neuropathy at the elbow: a pilot study. Ann Rehabil Med. (2015) 39:176–82. 10.5535/arm.2015.39.2.176
    1. Chen L-C, Ho T-Y, Shen Y-P, Su Y-C, Li T-Y, Tsai C-K, et al. . Perineural dextrose and corticosteroid injections for ulnar neuropathy at the elbow: a randomized double-blind trial. Arch Phys Med Rehabil. (2020) 101:1296–303. 10.1016/j.apmr.2020.03.016
    1. vanVeen KEB, Alblas KCL, Alons IME, Kerklaan JP, Siegersma MC, Wesstein M, et al. . Corticosteroid injection in patients with ulnar neuropathy at the elbow: a randomized, double-blind, placebo-controlled trial. Muscle Nerve. (2015) 52:380–5. 10.1002/mus.24551
    1. Kim JM. Comment on corticosteroid injection in patients with ulnar neuropathy at the elbow: a randomized, double-blind, placebo-controlled trial. Muscle Nerve. (2016) 53:494–5. 10.1002/mus.24938
    1. Stoddard JM, Taylor CR, O'Connor FG. Ulnar nerve entrapment at the cubital tunnel successfully treated with ultrasound-guided peripheral nerve hydrodissection: a case report and further evidence for a developing treatment option. Curr Sports Med Rep. (2019) 18:382–6. 10.1249/JSR.0000000000000649
    1. Rampen AJJ, Wirtz PW, Tavy DLJ. Ultrasound-guided steroid injection to treat mild ulnar neuropathy at the elbow. Muscle Nerve. (2011) 44:128–30. 10.1002/mus.22091
    1. Alblas CL, van Kasteel V, Jellema K. Injection with corticosteroids (ultrasound guided) in patients with an ulnar neuropathy at the elbow, feasibility study. Eur J Neurol. (2012) 19:1582–4. 10.1111/j.1468-1331.2012.03676.x
    1. Osborne G. The surgical treatment of tardy ulnar neuritis. J Bone Joint Surg. (1957) 39B:782.
    1. Adkinson JM, Zhong L, Aliu O, Chung KC. Surgical treatment of cubital tunnel syndrome: trends and the influence of patient and surgeon characteristics. J Hand Surg Am. (2015) 40:1824–31. 10.1016/j.jhsa.2015.05.009
    1. Kholinne E, Alsharidah MM, Almutair O, Aljasser S, Alhothali W, Kwak J-M, et al. . Revision surgery for refractory cubital tunnel syndrome: a systematic review. Orthop Traumatol Surg Res. (2019) 105:867–76. 10.1016/j.otsr.2019.03.020
    1. Wade RG, Griffiths TT, Flather R, Burr NE, Teo M, Bourke G. Safety and outcomes of different surgical techniques for cubital tunnel decompression: a systematic review and network meta-analysis. JAMA Netw Open. (2020) 3:e2024352. 10.1001/jamanetworkopen.2020.24352
    1. Krejčí T, Večera Z, Krejčí O, Šalounová D, Houdek M, Lipina R. Comparing endoscopic and open decompression of the ulnar nerve in cubital tunnel syndrome: a prospective randomized study. Acta Neurochir. (2018) 160:2011–17. 10.1007/s00701-018-3647-0
    1. Kim KW, Lee HJ, Rhee SH, Baek GH. Minimal epicondylectomy improves neurologic deficits in moderate to severe cubital tunnel syndrome. Clin Orthop Relat Res. (2012) 470:1405–13. 10.1007/s11999-012-2263-1
    1. Liu C-H, Chen C-X, Xu J, Wang H-L, Ke X-B, Zhuang Z-Y, et al. . Anterior subcutaneous versus submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a systematic review and meta-analysis. PLoS ONE. (2015) 10:e0130843. 10.1371/journal.pone.0130843
    1. Chen H, Ou S, Liu G, Fei J, Zhao G, Wu L, et al. . Clinical efficacy of simple decompression versus anterior transposition of the ulnar nerve for the treatment of cubital tunnel syndrome: a meta-analysis. Clin Neurol Neurosurg. (2014) 126:150–5. 10.1016/j.clineuro.2014.08.005
    1. Said J, Van Nest D, Foltz C, Ilyas AM. Ulnar nerve in situ decompression versus transposition for idiopathic cubital tunnel syndrome: an updated meta-analysis. J Hand Microsurg. (2019) 11:18–27. 10.1055/s-0038-1670928
    1. Vogel RB, Nossaman BC, Rayan GM. Revision anterior submuscular transposition of the ulnar nerve for failed subcutaneous transposition. Br J Plast Surg. (2004) 57:311–6. 10.1016/j.bjps.2004.02.027
    1. Ruettermann M. Challenging the dogma: anterior transposition of the ulnar nerve is indicated in recurrent cubital tunnel syndrome. J Hand Surg. (2021) 46:45–9. 10.1177/1753193420970022
    1. Byvaltsev VA, Stepanov IA, Kerimbayev TT. A systematic review and meta-analysis comparing open versus endoscopic in situ decompression for the treatment of cubital tunnel syndrome. Acta Neurol Belg. (2020) 120:1–8. 10.1007/s13760-019-01149-9
    1. Schmidt S, Kleist Welch-Guerra W, Matthes M, Baldauf J, Schminke U, Schroeder HWS. Endoscopic vs open decompression of the ulnar nerve in cubital tunnel syndrome: a prospective randomized double-blind study. Neurosurgery. (2015) 77:960–70; discussion 970–1. 10.1227/NEU.0000000000000981
    1. Aldekhayel S, Govshievich A, Lee J, Tahiri Y, Luc M. Endoscopic versus open cubital tunnel release: a systematic review and meta-analysis. Hand. (2016) 11:36–44. 10.1177/1558944715616097
    1. Buchanan PJ, Chieng LO, Hubbard ZS, Law TY, Chim H. Endoscopic versus open in situ cubital tunnel release: a systematic review of the literature and meta-analysis of 655 patients. Plast Reconstr Surg. (2018) 141:679–84. 10.1097/PRS.0000000000004112

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren