Objective To investigate the blood supply of the ulnar nerve in the elbow region and to design the procedure of anterior transposition of ulnar nerve accompanied with arteries for cubital tunnel syndrome.Methods The vascularity of the ulnar nerve was observed and measured in20adult cadaver upper limb specimens. And the clinical surgical procedure was imitated in 3 adult cadaver upper limb specimens. Results There were three major arteries to supply the ulnar nerve at the elbow region: the superior ulnar collateral artery, the inferior ulnar collateral artery and the posterior ulnar recurrent artery. The distances from arterial origin to the medial epicondyle were 14.2±0.9, 4.2±0.6 and 4.8±1.1 cm respectively. And the total length of the vessels travelling alone with the ulnar nerve were 15.0±1.3,5.1±0.3 and 5.6±0.9 cm. The external diameter of the arteries at the beginning spot were 1.5±0.5, 1.2±0.3 and 1.4±0.5 mm respectively. The perpendicular distance of the three arteries were 1.2±0.5,2.7±0.9 and 1.3±0.5 cm respectively.Conclusion It is feasible to perform anterior transposition of the ulnar nerve accompanied with arteries for cubital tunnel syndrome. And the procedure preserves the blood supply of the ulnar nerve following transposition.
Objective To investigate the methods and outcome of endoscopic ulnar neurolysis and minimal medial epicondylectomy in treatment of cubital tunnel syndrome with ulnar nerve subluxation. Methods Between June 2004 and June 2009, 11 cases of cubital tunnel syndrome with ulnar nerve subluxation were treated with endoscopic ulnar neurolysis andminimal medial epicondylectomy. There were 7 males and 4 females with an average age of 36 years (range, 18-47 years). All cases had numbness in l ittle finger and ring finger. The disease duration varied from 3 to 18 months (7 months on average). Nine cases had atrophy in the first dorsal interosseous muscle and hypothenar muscles. The preoperative electromyography showed that the ulnar nerve conduction velocity (NCV) were slowed down at elbow, which was (27.0 ± 1.5) m/s. Results All incisions healed by first intention, and no compl ication occurred. Eleven cases were followed up 6-37 months (19 months on average). All cases had normal sensation after 1 month of operation. The muscle strength was obviously improved in 11 cases after 3 months postoperatively (grade 4 in 7 cases and grade 3-4 in 4 cases). The postoperative electromyography showed that the NCV was obviously improved, which was (43.5 ± 9.5) m/s, showing significant difference when compared with preoperative one (P lt; 0.05). According to Amadio’ efficacy appraisal standard, the results were excellent in 7 cases and good in 4 cases. Conclusion The method of endoscopic ulnar neurolysis and minimal medial epicondylectomy has the advantages of safety, convenient manipulation, small incision, and early recovery for cubital tunnel syndrome with ulnar nerve subluxation.
lectrophysiological examination was used in 15 cases of cubital tunnel syndrome before andduring opcration. The velocity, latency and amplitude of the conduction of the ulnar nerve 5cm aboveand below the elbew joint were measured by surface electrodes and direct stimulation. There is nosignificant difference(Pgt; 0.5 )between the results from the two kinds of testing. After the ulnarnerve was decompressed from the cubital tunnel, the conduction velocity increased by 50%, latency shortenee by 40%, the improvement in conduciton velocity being particularly significant(P lt; 0.02). which show that conduction velocity is a relatively sensitive testing parameter. Electrophysiological examination plays a monitoring role during cubital tunnel syndrome decompression.
Objective To investigate the relationship between the elbow flexion angle and the cubital tunnel pressure in patients with cubital tunnel syndrome. Methods Between June 2010 and June 2011, 63 patients with cubital tunnel syndrome were treated. There were 47 males and 16 females with an average age of 59 years (range, 31-80 years). The lesion was at left side in 18 cases and at right side in 45 cases. During anterior transposition of ulnar nerve, the cubital tunnel pressure values were measured at full elbow extension, elbow flexion of 30, 60, and 90°, and full elbow flexion with microsensor. The elbow flexion angle-cubital tunnel pressure curve was drawn. Results The cubital tunnel pressure increased smoothly with increased elbow flexion angle when the elbow flexed less than 60°, and the pressure increased sharply when the elbow flexed more than 90°. The cubital tunnel pressure values were (0.13 ± 0.15), (1.75 ± 0.30), (2.62 ± 0.34), (5.78 ± 0.47), and (11.40 ± 0.62) kPa, respectively at full elbow extension, elbow flexion of 30, 60, and 90°, and full elbow flexion, showing significant differences among different angles (P lt; 0.05). Conclusion The cubital tunnel pressure will increase sharply when the elbow flexes more than 90°, which leads to the chronic ischemic damage to ulnar nerve. Long-term ischemic damage will induce cubital tunnel syndrome.
Objective To provide anatomy evidence of the simple injury of the deep branch of the unlar nerve for cl inical diagnosis and treatments. Methods Fifteen fresh samples of voluntary intact amputated forearms with no deformity were observed anatomically, which were mutilated from the distal end of forearm. The midpoint of the forth palm fingerweb wasdefined as dot A , the midpoint of the hook of the hamate bone as dot B, the ulnar margin of the flexor digitorum superficial is of the l ittle finger as OD, and the superficial branch of the unlar nerve and the forth common finger digital nerve as OE, dot O was the vertex of the triangle, dot C was intersection point of a vertical l ine passing dot B toward OE; dot F was the intersection point of CB’s extension l ine and OD. OCF formed a triangle. OCF and the deep branch of the unlar nerve were observed. From May 2000 to June 2007, 3 cases were treated which were all simple injury of the deep branch of the unlar nerve by glass, diagnosed through anatomical observations. The wounds were all located in the hypothenar muscles, and passed through the distal end of the hamate bone. Muscle power controlled by the unlar nerve got lower. The double ends was sewed up in 2 cases directly intra operation, and the superficial branch of radial nerve grafted freely in the other 1 case. Results The distance between dot B and dot O was (19.20 ± 1.30) mm. The length of BC was (7.80 ± 1.35) mm. The morpha of OCF was various, and the route of profundus nervi ulnaris was various in OCF. OCF contains opponens canales mainly. The muscle branch of the hypothenar muscles all send out in front of the opponens canales. The wounds of these 3 cases were all located at the distal end of the hook of the hamate bone, intrinsic muscles controlled by the unlar nerve except hypothenar muscles were restricted without sensory disorder or any other injuries. Three cases were followed up for 2 months to 4 years. Postoperation, the symptoms disappeared, holding power got well, patients’ fingers were nimble. According to the trial standard of the function of the upper l imb peripheral nerve establ ished by Chinese Medieal Surgery of the Hand Association, the synthetical evaluations were excellent.Conclusion Simple injuries of the deep branch of the unlar nerve are all located in OCF; it is not easy to be diagnosed at the early time because of the l ittle wounds, the function of the hypothenar muscles in existence and the normal sense .
ObjectiveTo investigate the effectiveness of a modified anteromedial approach in the treatment of ulnar coronoid process fracture.MethodsBetween February 2017 and July 2018, 15 patients with ulna coronoid process fracture were reviewed. There were 9 males and 6 females, with an average age of 42.3 years (range, 24-60 years). The causes of injury included falling in 10 cases and traffic accidents in 5 cases, all cases were closed injury. According to the O’Driscoll classification, there were 4 cases of type Ⅰ, 6 cases of type Ⅱ, and 5 cases of type Ⅲ. The time from injury to operation was 2-8 days (mean, 3.7 days). All fractures were treated via a modified anteromedial approach between the pronator teres and the flexor carpi radialis plus with partial incision of flexor tendon aponeurosis. The fracture healing, muscle strength of forearm, postoperative complications were observed. At last follow-up, the elbow mobility were measured, the function of elbow was evaluated by Mayo elbow performance score (MEPS).ResultsAll cases were followed up 10-18 months (mean, 13.3 months). Fracture union was achieved in all patients with a mean time of 10 weeks (range, 8-14 weeks). No obvious decrease of hand grip strength, nerve injury, and infection occurred. One patient had slight heterotopic ossification without special treatment. At last follow-up, all patients had stable elbows with good flexion-extension and varus-valgus stability, the mean flexion was 123.3° (range, 100°-140°), mean extension loss compared with that before operation was 6.7° (range, 0°-20°), mean pronation was 76.0° (range, 60°-85°), and mean supination was 75.8° (range, 55°-90°). The MEPS score was 65-100 (mean, 90.3) with the result of excellent in 10 cases, good in 4 cases, and fair in 1 case.ConclusionThe treatment of ulnar coronoid process fracture via the modified anteromedial approach provides excellent exposure, minimal invasion, fewer complications, and satisfactory prognosis, which is conducive to elbow joint function recovery.
OBJECTIVE To investigate the compression factor and clinical manifestation of the compression of deep branch of the ulnar nerve at the wrist. METHODS Anatomic study was done on both sides of 10 cadavers, the deep branch of ulnar nerve, the Guyon’s canal and the flexor digiti minimi brevis pedis were observed. Then from Jan. 1990 to Jan. 1997, 5 patients with compression of the deep branch of ulnar nerve at the wrist were treated clinically. Among them, there were 4 males and 1 female, aged from 37 to 48 years and the course of disease ranged from 1 to 5 months. RESULTS The motor branch of the ulnar nerve passed under the tendinous arcade of flexor digiti minimi brevis pedis. Occasionally, the branch of ulnar artery overpassed the motor branch. Clinically, the tendinous arcade compressed the motor branch was released, and after 2 to 4 years follow-up, the clinical results were satisfactory. CONCLUSION The main compression factor of the ulnar nerve at the wrist is the tendinous arcade of the flexor digiti minimi brevis pedis, the tendinous arcade should be released sufficiently during the operation.
Objective To investigate the anatomical evidence of low end-to-side anastomosis of median nerve and ulnar nerve in repair of Dejerine Klumpke type paralysis or high ulnar nerve injury. Methods Twelve formaldehyde anticorrosion specimens (24 sides) and 3 fresh specimens (6 sides) were observed. There were 9 males (18 sides) and 6 females(12 sides). The specimen dissected under the microscope. S-shape incision was made at palmar thenar approaching ulnar side, the profundus nervi ulnaris and superficial branch of ulnar nerve were separated through near end of incision, and the recurrent branch of median nerve and comman digital nerve of the ring finger were separated through far end of incision. The distances from pisiform bone to the start point of the recurrent branch of median nerve, and to the start point of comman digital nerve of the ring finger were measured. The width and thickness of the profundus nervi ulnaris and superficial branch of ulnar nerve, and the recurrent branch of median nerve and comman digital nerve of the ring finger were measured, and the cross-sectional area was calculated. The number of nerve fiber was determined with HE staining and argentaffin staining. Results The crosssectional area and the number of nerve fiber were (2.46 ± 1.03) mm2 and 1 305 ± 239 for the profundus nervi ulnaris, (2.62 ± 1.75) mm2 and 1 634 ± 343 for the recurrent branch of median nerve, (1.60 ± 1.39) mm2 and 1 201 ± 235 for the superficial branch of ulnar nerve, and (2.19 ± 0.89) mm2 and 1 362 ± 162 for the comman digital nerve of the ring finger. There were no significant differences (P gt; 0.05) in the cross-sectional area and the number of nerve fiber between the profundus nervi ulnaris and the recurrent branch of median nerve, between the superficial branch of ulnar nerve and the comman digital nerve of the ring finger; and two factors had a l inear correlation (P lt; 0.05) with correlation coefficients of 0.68, 0.66 and 0.56, 0.36. The distances were (36.98 ± 4.93) mm from pisiform bone to the start point of the recurrent branch of median nerve, and (28.35 ± 6.63) mm to the start point of comman digital nerve of the ring finger. Conclusion Low end-to-side anastomosis of median nerve and ulnar nerve has perfect match in the cross-sectional area and the number of nerve fiber.
Objective To discuss the concept of ulnar tunnel at thewrist, the types, causes, traits of compression, diagnosis, and clinical significance of ulnar tunnel syndrome(UTS). Methods Thirty-nine cases diagnosed as having UTS from 1986 were retrospectively reviewed combined with previous relevant literature. Results Ulnar tunnel included Guyon’s canal, pisohamate tunnel and hypothenar segment. There were 8 types andmany causes of UTS. Some patients had compression in more than one zones and might be associated with carpal tunnel syndrome or cubital tunnel syndrome. UTS could be diagnosed through clinical manifestations and electrophysiological examination. Conclusion Defining the concept of ulnar tunnel and the knowledge of the complexity and rarity of UTS can effectively guide diagnosis and treatment.
ObjectiveTo explore the effectiveness of modified Ilizarov semi-ring external fixator combined with an ulnar osteotomy lengthening in the treatment of old dislocation of the radial head in children. MethodsA retrospective analysis was made on the data of 14 patients with old dislocation of the radial head treated by the modified Ilizarov semi-ring external fixator combined with ulnar osteotomy lengthening between March 2012 and January 2015. The age ranged from 2 to 13 years (mean, 7.2 years), including 12 boys and 2 girls. There was 1 case of congential dislocation of the radial head and 13 cases of old Monteggia fracture. According to the Bado's classification, dislocation was rated as grade Ⅰ in 12 cases and grade Ⅲ in 2 cases. The elbow flexion-extension and forearm pronation and supination were compared between at pre- and post-operation; Mackay evaluation standard of elbow joint function was used to evaluate the effectiveness. ResultsThe operation time ranged from 50 to 65 minutes (mean, 58 minutes). All patients were followed up 6-33 months (mean, 21 months). No complication of infection, myositis ossificans, or redislocation occurred. X-ray film showed bony healing at ulnar osteotomy site within 82-114 days (mean, 90 days). The elbow flexion-extension and forearm pronation and supination were significantly improved at postoperation when compared with preoperation (P<0.05). The results of Mackay function assessment were excellent in 12 cases and good in 2 cases. ConclusionThe modified Ilizarov semi-ring external fixator combined with an ulnar osteotomy lengthening has the advantages of small incision, easy removal of fixator, satisfactory reduction, and no nonunion at ulnar osteotomy site in the treatment of old dislocation of the radial head, but the long-term effectiveness still needs to be followed up.