Ultrasonographic measurements of the ulnar nerve at the elbow: role of confounders.
(9/23)
OBJECTIVE: The purpose of this study was to identify factors confounding high-resolution ultrasonographic measurements of the ulnar nerve to test their influence when discriminating between limbs affected and unaffected by ulnar nerve entrapment (UNE) at the elbow. METHODS: High-resolution ultrasonographic measurements of ulnar nerve dimensions at the elbow were compared between 2 groups of subjects: symptomatic and asymptomatic for UNE. Rank analysis of covariance regression tests were performed to determine whether significant differences existed between the 2 groups. The changing coefficient method (using rank analysis of covariance tests) was used to test for potential confounding effects of age, weight, height, body mass index, sex, limb sidedness, limb handedness, and nerve mobility. These tests were repeated for each measurement while controlling for the identified confounders. Exact 2-tailed Wilcoxon signed rank tests were performed to test for significant differences between measurements of the diameter of the ulnar nerve with the elbow in full extension and full flexion. RESULTS: Age, weight, body mass index, sex, and elbow position were shown to have confounding influences on high-resolution ultrasonographic measurements of the ulnar nerve. No confounding effect was apparent for limb sidedness or dominance. Cross-sectional area and long-axis diameter measurements demonstrated significant differences between nerves with and without UNE after controlling for confounders. CONCLUSIONS: Two cross-sectional measurements (area and maximum cross-sectional diameter) of the ulnar nerve, made at the level of the medial epicondyle, were found to be robust discriminators between nerves with and without UNE. In the absence of normative reference values of the ulnar nerve, the contralateral limb may be used as the comparative control. (+info)
The pathology of the ulnar nerve in acromegaly.
(10/23)
Ulnar nerve entrapment neuropathy at the elbow: decisional algorithm and surgical considerations.
(12/23)
INTRODUCTION: We propose our surgical experience and the decisional algorithm we use to select the surgical procedure for the ulnar nerve entrapment at the elbow according to defined parameters. MATERIALS AND METHODS: Between 2005 and 2007, 44 patients were operated according to our algorithm that is based both on clinical parameters, classified through the McGowan scale, and on biological ones (the nervous morphology and the amount of scar around the medial epicondyle). Patients were treated through "modified" in situ simple decompression, subcutaneous and sub muscular transpositions. RESULTS: After an average follow-up of 13.4 months, function improved by one grade in 70% of patients, two grades in 16% and there was no change in 14%. Moreover 84.8% of patients operated through the modified in situ decompression technique reported an excellent outcome. CONCLUSION: We suggest an algorithm for uniformly treat the patients with cubital tunnel syndrome through a clinical and biological point of view. The modified in situ decompression is a safe and effective treatment for the majority of these patients reducing the risk of redo surgery. (+info)
Incidence of re-operation and subjective outcome following in situ decompression of the ulnar nerve at the cubital tunnel.
(13/23)