Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Ultrasonographic Findings and Usefulness in Ulnar Neuropathy at the Elbow

주관절부 척골 신경병증에서의 초음파 소견 및 유용성

  • Kim, Dong-Hu (Department of Orthopedic Surgery, School of Medicine, Dongsan Medical Center, Keimyung University) ;
  • Cho, Chul-Hyun (Department of Orthopedic Surgery, School of Medicine, Dongsan Medical Center, Keimyung University) ;
  • Lee, Kyung-Rak (Department of Orthopedic Surgery, School of Medicine, Dongsan Medical Center, Keimyung University)
  • 김동후 (계명대학교 의과대학 동산의료원 정형외과학교실) ;
  • 조철현 (계명대학교 의과대학 동산의료원 정형외과학교실) ;
  • 이경락 (계명대학교 의과대학 동산의료원 정형외과학교실)
  • Received : 2012.03.07
  • Accepted : 2012.09.15
  • Published : 2012.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The aim of this study was to evaluate preoperative ultrasonographic findings and usefulness in ulnar neuropathy around elbow. Materials and Methods: Twenty-two patients with ulnar neuropathy were performed preoperative ultrasonogram. The route, location, thickness of the ulnar nerve and space occupying lesion through longitudinal scan were evaluated. Cross-sectional areas of the ulnar nerve were measured at the level of medial epicondyle and 3 cm proximal and distal to the medial epicondyle through axial scan. Correlations between swelling ratio of ulnar nerve and eletrophysiologic study and preoperative Dellon's assessment were checked. Results: In 21 cases (95.6%) of total 22 cases, diffuse swelling of the ulnar nerve around elbow were identified. 4 cases had space occupying lesions including 3 ganglionic cysts and 1 heterotopic ossification. Cross sectional areas at the level of medial epicondyle were significantly larger than at the level of 3 cm proximal and distal to the medial epicondyle (p<0.05). There were no statistically significant correlations between swelling ratio of ulnar nerve and eletrophysiologic study and preoperative clinical assessment (p>0.05). Conclusion: This study showed that ultrasonography was helpful to detect etiology of ulnar neuropathy around elbow such as space occupying lesion, morphological change or dislocation of ulnar nerve. It could be useful tool for diagnosis and treatment in patients with ulnar neuropathy at elbow.

목적: 주관절부 척골 신경병증에서 술 전에 시행한 초음파 소견과 그 유용성에 대하여 알아보고자 하였다. 대상 및 방법: 척골 신경병증을 진단 받고 술 전 초음파 검사를 시행한 22예를 대상으로 하였다. 장축 영상을 통해 척골 신경의 주행 경로, 위치, 굵기와 신경 주위 공간 점유 병소 등을 확인하였고, 단축 영상을 통해 내상과 근위부 3 cm, 후방, 원위부 3 cm에서의 단면적 및 척골 신경 부종비를 측정하여 전기 생리학적 검사 및 술 전 임상적 평가와의 연관성을 파악하였다. 결과: 초음파 검사상 총 22예 중 21예 (95.5%)에서 주관절 내상과 후방부에 척골 신경의 미만성 부종 소견이 관찰되었다. 이 중 공간 점유 병소는 4예로, 결절성 낭종이 3예, 이소성 골화가 1예 있었다. 내상과 부위 척골 신경의 평균 단면적이 근위부 및 원위부의 평균 단면적보다 통계학적으로 유의하게 컸다 (p<0.05). 척골 신경 부종 비는 전기 생리학적 검사 및 술 전 임상적 평가와 통계학적 유의성을 가지지 않았다 (p>0.05). 결론: 주관절부 척골 신경병증에서의 초음파 검사로 신경의 형태학적 변화를 알 수 있을 뿐만 아니라 공간 점유 병소 또는 신경 탈구 등의 원인을 파악하는데 도움이 되었다. 초음파 검사는 전기 생리학적 검사와 더불어 척골 신경병증의 정확한 진단 및 치료 방법의 선택에 유용한 방법으로 판단된다.

Keywords

References

  1. Macadam SA, Bezuhly M, Lefaivre KA. Outcomes measures used to assess results after surgery for cubital tunnel syndrome: a systematic review of the literature. J Hand Surg Am. 2009;34:1482-91. https://doi.org/10.1016/j.jhsa.2009.05.010
  2. Jeon IH, Lee SM, Choi JW, Kim PT. Dynamic morphologic study of the ulnar nerve around the elbow using ultrasonography. J Korean Shoulder Elbow Soc. 2007;10:99-105. https://doi.org/10.5397/CiSE.2007.10.1.099
  3. Park GY, Kim JM, Lee SM. The ultrasonographic and electrodiagnostic findings of ulnar neuropathy at the elbow. Arch Phys Med Rehabil. 2004;85:1000-5. https://doi.org/10.1016/j.apmr.2003.09.016
  4. Volpe A, Rossato G, Bottanelli M, et al. Ultrasound evaluation of ulnar neuropathy at the elbow: correlation with electrophysiological studies. Rheumatology. 2009;48:1098-101. https://doi.org/10.1093/rheumatology/kep167
  5. Wiesler ER, Chloros GD, Cartwright MS, Shin HW, Walker FO. Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel. J Hand Surg Am. 2006;31:1088-93. https://doi.org/10.1016/j.jhsa.2006.06.007
  6. Yoon JS, Kim BJ, Kim Sj, et al. Ultrasonographic measurements in cubital tunnel syndrome. Muscle Nerve. 2007;36:853-5. https://doi.org/10.1002/mus.20864
  7. Okamoto M, Abe M, Shirai H, Ueda N. Diagnostic ultrasonography of the ulnar nerve in cubital tunnel syndrome. J Hand Surg Br. 2000;25:499-502. https://doi.org/10.1054/jhsb.1999.0350
  8. Thoirs K, Williams MA, Phillips M. Ultrasonographic measurements of the ulnar nerve at the elbow: role of confounders. J Ultrasound Med. 2008;27:737-43. https://doi.org/10.7863/jum.2008.27.5.737
  9. Chiou HJ, Chou YH, Cheng SP, et al. Cubital tunnel syndrome: diagnosis by high-resolution ultrasonography. J Ultrasound Med. 1998;17:643-8. https://doi.org/10.7863/jum.1998.17.10.643
  10. Koenig RW, Pedro MT, Heinen CP, et al. High-resolution ultrasonography in evaluating peripheral nerve entrapment and trauma. Neurosurg Focus. 2009;26:E13.
  11. Baryrak AO, Bayrak IK, Turker H, Elmali M, Nural MS. Ultrasonography in patients with ulnar neuropathy at the elbow: comparison of sectional area and swelling ratio with electro physiological severity. Muscle Nerve. 2010;41:661-6.
  12. American Association of Electrodiagnostic Medicine, American Academy of neurology, American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement. Muscle Nerve. 1999;22:408-11. https://doi.org/10.1002/(SICI)1097-4598(199903)22:3<408::AID-MUS16>3.0.CO;2-7
  13. Dellon AL. Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg Am. 1989;14:688-700. https://doi.org/10.1016/0363-5023(89)90192-5
  14. Akahori O. Cunital tunnel syndrome: grade of palsy and prognosis and selection of operation. Orthop Surg Traumatol. 1986;29:1745-51.
  15. Caputo AE, Watson HK. Subcutaneous anterior transposition of the ulnar nerve for failed decompression of cubital tunnel syndrome. J Hand Surg Am. 2000;25:544-51. https://doi.org/10.1053/jhsu.2000.6005
  16. Kim YJ, Lee SH, Kong BS. A retrospective review of 37 anterior subcutaneous transpositions in cubital tunnel syndrome. J Korean Soc Surg Hand. 2005;10:181-6.
  17. Park MJ, Sun JI. Clinical outcomes of McGowan grade III severe cubital tunnel syndrome following anterior submuscular transposition of the ulnar nerve. J Korean Soc Surg Hand. 2005;10:66-70.
  18. Pyun YS, Jeon SH, Bae KC, Yeo KK. Anterior subcutaneous ulnar nerve transposition for cubital tunnel syndrome. J Korean Shoulder Elbow Soc. 2005;8:36-42. https://doi.org/10.5397/CiSE.2005.8.1.036
  19. Kato H, Hirayama T, Minami A, Iwasaki N, Hirachi K. Cubital tunnel syndrome associated with medial elbow Ganglia and osteoarthritis of the elbow. J Bone Joint Surg Am. 2002;84:1413-9. https://doi.org/10.2106/00004623-200208000-00017