• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.99-105
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• 2007

Purpose: The morphological study and dynamic stability of the ulnar nerve around the elbow joint was investigated in asymptomatic normal population using ultrasonography. The purpose of this study is to provide fundamental data for ultrasonographic diagnosis of ulnar neuropathy in cubital tunnel syndrome. Materials and Methods: Fifty cases of 25 healthy male volunteers, aged between 20 to 30 years, included in this study. High resolution 7.5 MHz linear probe was used to examine the ulnar nerve in axial and longitudinal views. In a longitudinal view, the course, position and the thickness of nerve were monitored, the diameter of ulnar nerve and dynamic stability at elbow flexion and extension were measured in an axial view at four different points; 1cm proximal to medial epicondyle, behind the medial epicondyle, entrance to Osborne ligament, and 1cm distal to Osborne ligament. Results: The short diameters of ulnar nerve at elbow extension at four anatomic points were 2.66 mm, 2.97 mm, 2.64 mm, and 2.69 mm and the long diameters were 4.61 mm, 4.56 mm, 4.36 mm, and 4.37 mm, which showed no significant change at each point. However, at elbow flexion, the short diameters were changed to 2.72 mm, 2.34 mm, 2.65 mm, and 2.41 mm and the long diameters into 4.49 mm, 5.40 mm, 4.16 mm, and 4.66 mm. At elbow flexion, significant morphologic change was observed in the medial epicondyle area, and the diameter of the ulnar nerve was shortest at the entrance of Osborne ligament both at flexion and extension. In terms of dynamic stability, nine subluxations and seven dislocations were observed. Conclusion: This study shows dynamic instability and a morphological change of long and short diameters of ulnar nerve at flexion and extension in a normal person, which should be considered in the ultrasonographic diagnosis of ulnar neuropathy.

• Clinics in Shoulder and Elbow
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• v.15 no.2
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• pp.109-116
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• 2012

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.

• Clinics in Shoulder and Elbow
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• v.13 no.2
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• pp.270-274
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• 2010

Purpose: Here we present tardy ulnar nerve palsy cases that were caused by the anconeus epitroch-learis muscle. Materials and Methods: A 37 year old female patient presented with tardy ulnar nerve palsy findings for the elbow. During surgery, an atypical anconeus epitrochlearis muscle was observed, which originated from the triceps aponeurosis and inserted into the medial intermuscular septum. Muscle resection, nerve decompression and ulnar nerve anterior transposition were done. A 35 year old male patient presented with tardy ulnar nerve palsy findings for the elbow. During surgery, a typical anconeus epitrochlearis muscle was found. Muscle resection, nerve decompression and ulnar nerve anterior transposition were done. Results and Conclusion: Tardy ulnar nerve palsy can be associated with and caused by either an atypical or a typical anconeus epitrochlearis muscle.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.1 no.2
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• pp.128-133
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• 2008

Nerve compression is caused by external force or internal pathology, which symptom develops along nerve distribution. There are median, ulnar and radial nerve compression neuropathies below elbow. Carpal tunnel syndrome at the flexor retinaculum is most common among all the entrapment neuropathies. Other causes of median nerve neuropathy include Struther's ligament, biceps aponeurosis, pronator teres, FDS aponeurosis and aberrant muscles, which induce pronator syndrome or anterior interosseous nerve syndrome. Ulnar nerve can be compressed at the elbow by arcade of Struther, medial epicondylar groove, FCU two heads, which develops cubital tunnel syndrome, at the wrist by ganglion, fracture of hamate hook and vascular problem, which develops Guyon's canal syndrome. Radial tunnel syndrome is caused by supinator muscle, which compresses its deep branch. Treatment is conservative at initial stage like NSAID, night splint or steroid injection. If symptom persists, operative treatment should be considered after electrodiagnostic or imaging studies.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2008.03a
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• pp.171-171
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• 2008

발음성 삼두근 증후군은 주관절을 굴곡하거나 신전할 때 삼두근 말단부 일부와 척골 신경이 내상과 전방으로 탈구되는 드문 질환이다. 이학적 검사 만으로는 다른 질환으로 오진되는 경우가 많아 정확한 진단이 필수적이며 확진을 위하여는 척골 신경 및 삼두근의 비정상적인 움직임을 관찰할 수 있는 영상 검사가 필요하다. 초음파 검사는 자기 공명 영상 촬영 등 다른 검사에 비해 간편하고 효과적으로 연부 조직의 동적 검사를 시행할 수 있는 장점이 있다. 저자들은 발음성 삼두근 증후군 환자를 동적 초음파 검사를 사용하여 진단하고 척골 신경 전방 전위술 및 삼두근 내두의 이전술을 시행하여 치유하였기에 문헌 고찰과 함께 초음파 검사의 유용성을 보고하고자 한다.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.4 no.1
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• pp.28-32
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• 2011

Snapping triceps syndrome is a rare disease in which medial head of triceps dislocates over the medial epicondyle during elbow flexion. It is difficult to diagnose the snapping triceps syndrome, because that this syndrome is frequently misdiagnosed as other elbow disease such as ulnarnerve dislocation. The dynamic ultrasonographic imaging allows continual visualization of the ulnar nerve and triceps muscle throughout active elbow flexion and extension. We report two patients of snapping triceps syndrome who were diagnosed with the use of dynamic ultrasonography and treated with ulnar nerve anterior transposition and repositioning or resectioning of medial head of triceps.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2004.03a
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• pp.53-53
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• 2004

후내측 접근법을 이용한 척골신경 감압술, OK 술식, 그리고 관절막 절제술은 주관절 퇴행성 관절염으로 인한 척골 신경증에 임상증상을 호전시킬 수 있는 용이한 술식으로 사료되었다.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.3 no.2
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• pp.79-83
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• 2010

Musculoskeletal ultrasonography has been used as a convenient and simple tool for diagnosis of various conditions of orthopaedic diseases for many years. Generally magnetic resonance imaging (MRI) is thought to be the best method to search for anatomical structures or variations. However, for dynamic conditions such as dislocation or subluxation of tendons and nerves, MRI is not superior to ultrasonography, especially dynamic ultrasonography. So we present such a patient with an ulnar nerve subluxation at the elbow who has symtoms mimicking cubital tunnel syndrome diagnosed by dynamic ultrasonography and treated successfully by ulnar nerve anterior transposition and think that dynamic ultrasonography is a useful method for diagnosing dynamic condition such as ulnar nerve subluxation mimicking cubital tunnel syndrome.

• Journal of the Korean Orthopaedic Association
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• v.52 no.1
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• pp.15-24
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• 2017

Purpose: The aim of this study was to determine the effectiveness of arthroscopic debridement with mini-open ulnar nerve decompression in primary osteoarthritis of the elbow with ulnar neuropathy. Materials and Methods: Between May of 2006 and July of 2014, a total of 43 patients who had undergone surgery for primary osteoarthritis of the elbow with ulnar neuropathy were included in this study. We divided the subjects into two groups according to the method of surgery: group 1 (n=18) received mini-open ulnar nerve decompression only, and group 2 (n=25) received arthroscopic debridement with mini-open ulnar nerve decompression. Patients were assessed for the following clinical outcomes: visual analogue scales (VAS) score, range of motion of the elbow joint, Mayo elbow performance score (MEPS), and disabilities of the arm, shoulder and hand (DASH) at the time before surgery and 6 months after surgery. We analyzed the recovery of the ulnar nerve by the McGowan grade and Bishop rating score preoperatively and at 6 months after the surgery. Results: The VAS score, range of motion of the elbow joint, MEPS, and DASH showed significant statistical difference after the surgery (p<0.05). However, between the 2 groups, there was no significant difference. For the McGowan grade, all cases of both groups-except one case each group-showed at least one grade improvement. Moreover, group 2 showed a greater significant difference than group 1 (p=0.001). At the final follow-up, according to the Bishop rating score, group 2 had a greater significant difference than group 1 (p=0.036). Conclusion: Arthroscopic debridement with mini-open ulnar nerve decompression in primary osteoarthritis of the elbow with ulnar neuropathy is a useful technique, which has several advantages, including the benefits associated with a minimally invasive surgery and also the improvement of elbow joint function and excellent recovery of the ulnar nerve.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.1 no.1
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• pp.27-30
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• 2008

Snapping triceps syndrome is a rare condition in which a distal portion of triceps and ulnar nerve dislocate over the medial epicondyle as the elbow is flexed or extended from flexed position. Because it is frequently misdiagnosed as other elbow pathologies, accurate diagnosis is essential and imaging study is often needed to confirm the abnormal movement of ulnar nerve and triceps. Ultraonography is a convenient and effective method which is able to allow continual visualization of soft tissue movement compared to the other imaging modality including MRI. We reported one patient of snapping triceps syndrome who was diagnosed with the use of dynamic ultrasonography and treated with ulna nerve anterior transposition and repositioning of medial head of triceps. And we also provide the usefulness of musculoskeletal ultrasonography for the diagnosis of snapping triceps syndrome.