• Journal of Korean Neurosurgical Society
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• 제65권2호
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• pp.307-314
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• 2022

Objective : The percutaneous thread transection technique is a surgical dissecting method using a dissecting thread inserted through a needle under ultrasound guidance without skin incision. As the new dissecting threads were developed domestically, this cadaver study was conducted to compare the effectiveness and safety between the new threads (ultra V sswire and smartwire-01) and a pre-existing commercial dissecting thread (loop & shear) by demonstrating a modified looped thread cubital tunnel release. Methods : The percutaneous cubital tunnel release procedure was performed on 29 fresh cadaveric upper extremities. The pre-existing commercial thread was used in 5 upper extremities. The two newly developed threads were used in 24 upper extremities. Two practitioners performed the procedures separately. After the modified looped thread cubital release, anatomical and histological analyses were performed by a blinded anatomist. The presence of the dissected cubital tunnel and damaged adjacent soft tissue was assessed. Results : Out of the 29 cadaveric upper extremities, 27 specimens showed complete dissection of the Osborne ligament and the proximal fascia of the flexor carpi ulnaris muscle. One specimen was incompletely dissected in each of the ultra V sswire and smartwire-01 groups. There were no injuries of adjacent structures including the ulnar nerve, ulnar artery, medial antebrachial cutaneous nerve, or flexor tendon with either the commercial thread or the newly developed threads. The anatomical analysis revealed clear and sharp incisional margins of the cubital tunnel in the Smartwire-01 and loop & shear groups. All three kinds of threads maintained proper linear elasticity for easy handling during the procedure. The smartwire-01 provided higher visibility in ultrasound than the other threads. Conclusion : The newly developed threads were effective and safe for use in the thread cubital tunnel release procedure.

• The Korean Journal of Pain
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• 제21권3호
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• pp.224-228
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• 2008

Ulnar nerve compression in the cubital tunnel is a common entrapment syndrome of the upper limb. Pulsed radiofrequency lesioning (PRFL) has been reported as a treatment method for relieving neuropathic pain. Since the placement of the electrode in close proximity to a targeted nerve is very important for the success of PRFL, ultrasound seems to be well suited for this technique. A 36-year-old woman presented with complaints of numbness and pain on the medial aspect of the elbow and the pain radiated down to the $4^{th}$ and $5^{th}$ fingers for 10 years after she suffered an elbow contusion, we then scheduled this woman for the ultrasound guided PRFL of the ulanr nerve. The initial ultrasound examination demonstrated a swollen nerve, loss of the fascicular pattern and an increased cross sectional area of the ulnar nerve. After confirmation of the most swollen site of the nerve via ultrasound, two sessions of PRFL were performed. The postprocedural 10 cm visual analog scale score decreased from 8 to 1 after the two sessions of PRFL.

• Journal of Korean Neurosurgical Society
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• 제59권1호
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• pp.75-77
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• 2016

Double compression of the ulnar nerve, including Guyon's canal syndrome associated with cubital tunnel syndrome caused by the anconeus epitrochlearis muscle, is a very rare condition. We present a case of double crush syndrome of the ulnar nerve at the wrist and elbow in a 55-year-old man, as well as a brief review of the literature. Although electrodiagnostic findings were consistent with an ulnar nerve lesion only at the elbow, ultrasonography revealed a ganglion compressing the ulnar nerve at the hypothenar area and the anconeus epitrochlearis muscle lying in the cubital tunnel. Careful physical examination and ultrasound assessment of the elbow and wrist confirmed the clinical diagnosis prior to surgery.

• 대한정형외과 초음파학회지
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• 제1권2호
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• pp.128-133
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• 2008

신경 압박의 원인은 외부로부터 가해지는 것도 있고, 신체 내부 병리가 발생하여 신경 주행에 따라 발생할 수 있다. 주관절 이하부에서 압박성 신경병증으로 정중 신경, 척골 신경, 요골신경병증이 있다. 정중 신경은 굴곡 지대부위에서 수근관 증후군이 대표적이며, 모든 신경 포착 증후군 가운데 가장 흔하다. 그 외 주관절 부위에서 스트러더스 인대, 상완 이두근 건막, 회내근, 천수지 굴근 기시부 그리고 비정상 근육들에 의한 회내근 증후군과 전 골간 신경 증후군이 있다. 척골 신경은 스트러더스 궁, 내측 상과 후방의 주관, 척수근 굴근 두 기시부 사이의 건막 등에서 눌리는 주관 증후군과, 수근부에서 결절종, 유구골 갈고리 골절 그리고 혈관성으로 오는 척골 관 증후군이 있다. 요골 신경의 심부 분지가 회외근속을 지나면서 만들어지는 부위에서 눌리는 경우 요골 관 증후군이라고 한다. 치료는 초기에는 소염제나 야간부목, 스테로이드 주사와 같은 보존적 치료를 시행할 수 있으며, 이에 호전되지 않을 경우 전기적 검사나 영상 검사에서 이상이 나타나면 수술적 감압술을 시행하여야 한다.

• Archives of Reconstructive Microsurgery
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• 제17권1호
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• pp.36-41
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• 2008

Surgical treatment of compressive ulnar neuropathy at the elbow has been performed with a wide variety of techniques. Among these techniques, anterior submuscular transposition of the ulnar nerve has been regarded as the method of choice by many authors. It has many advantages including a low recurrence rate, scar-free vascular bed, and protection from repeated trauma to the nerve. However, anterior submuscular transposition is technically demanding and requires more extensive soft tissue dissection. On the other hand, anterior subfascial transposition is less invasive, requires a relatively shorter operation time than the submuscular technique, and also can be done safely even in patiensts with elbow arthritis. We evaluated the clinical results of anterior submuscular transposition compared with anterior subfascial transposition. Fifteen patients underwent anterior submuscular transposition and ten patients underwent anterior subfascial transposition of the ulnar nerve. The mean follow-up time was 15 months (range 10 to 38 months) in the anterior submuscular transposition group and 7 months (range 6 to 15 months) in the anterior subfascial transposition group. According to the outcome status determination algorithm devised by Mowlavi, 3 patients (20%) showed total relief, 10 patiensts (66.7%) improvement and 2 patients (13.3%) no changes in the anterior submuscular transposition group. In the anterior subfascial transposition group, 2 patients (20%) showed total relief, 7 patients (70%) improvement and 1 patient (10%) displayed no changes. Statistically there was no significant difference of the clinical results between the two surgical techniques. Therefore we would suggest anterior subfascial transposition of the ulnar nerve as a preferred method for treatment of cubital tunnel syndrome.

• 대한정형외과 초음파학회지
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• 제3권2호
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• pp.79-83
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• 2010

근골격계 초음파는 오랜 기간 동안 다양한 정형외과적 질환의 진단을 위해 유용하고 간단한 방법으로 사용되어 왔다. 일반적으로 MRI가 해부학적 구조나 변이를 발견하기 위한 가장 좋은 방법으로 알려져 있으나 건이나 신경의 탈구 또는 아탈구 등과 같은 동적인 조건의 경우에는 초음파, 특히 동적 초음파의 유용성에는 미치지 못하는 것으로 알려져 있다. 본원에서는 주관 증후군 유사 증상을 보인 환자에서 동적 초음파 검사를 이용하여 척골 신경 아탈구를 확인한 후, 척골 신경 이전술을 시행하여 만족스러운 결과를 보여, 주관 증후군과 유사한 증상을 유발하는 척골 신경 아탈구 환자에게 동적 초음파의 이용은 매우 유용한 방법으로 생각하여 그 증례를 보고하고자 한다.

• Clinical Pain
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• 제20권2호
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• pp.70-73
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• 2021

A minimally invasive procedure refers to a procedure that minimizes tissue damage due to incision. By limiting the size of the incision, it can be expected to reduce the time taken for wound healing, reduce pain, and reduce the risk of infection. Recently, studies have been attempted to dissect the structures of the neuromusculoskeletal system using ultrasound-guided minimally invasive technique. Among those, dissecting thread may be utilized in several musculoskeletal diseases, including carpal tunnel syndrome, cubital tunnel syndrome, trigger finger, and selective crural fasciectomy. In this brief review, the use of dissecting thread in treating neuromusculoskeletal diseases are described.

• 대한정형외과 초음파학회지
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• 제1권1호
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• pp.64-72
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• 2008

주관절, 완관절 주변의 압박성 신경병증은 일상생활의 불편을 초래하는 상지에서의 흔한 신경병증의 하나로 이에 대한 초음파 검사 소견을 바르게 해석하는 데는 정상적인 신경의 구조와 압박성 신경병증의 병리적 변화를 이해하는 것이 중요하다. 압박성 신경병증에서는 특징적인 초음파 소견을 보이는데 압박부위의 신경은 눌려서 편평한 모양으로 나타나고 근위부에서는 고신호강도의 부종성 변화와 신경속 양상의 소실을 보인다. 기본적인 횡주사 및 종주사 영상 외에 관절이나 근육을 동적으로 움직이면서 시행한 초음파 검사는 척골신경이 주관절 굴곡시 삼두박건 내측두와 함께 내상과위로 아탈구 되는 탄발성 삼두박근 증후군이나 능동적 회내근의 수축시 신경압박이 일어나는 원형 회내근 증후군 등에서 신경의 아탈구나 압박소견을 보여준다. 수근관 증후군이나 주관 증후군 등에서는 신경 단면적의 정량적인 계측이나 압박비의 평가가 진단에 도움이 된다. 임상적 검사 및 전기생리적 검사와 병행하여 사용할 경우 초음파 영상은 상지에서의 압박성 신경병증을 진단하는데 있어 매우 유용한 검사방법의 하나이다.

• Archives of Plastic Surgery
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• 제37권1호
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• pp.95-98
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• 2010

Purpose: One of the most common cause of upper extremity lymphedema is breast cancer surgery. We experienced the nerve entrapment syndrome which was associated with postmastectomy lymphedema. To the best of our knowledge, this is the first case report of lymphedema induced nerve entrapment syndrome on upper extremity in Korea. Methods: A 54-year-old woman presented with a tingling sensation on her right hand, which had been present for 1 year. On her history, she had a postmastectomy lymphedema on her right upper extremity for 20 years. Initial electromyography (EMG) showed that the ampulitude of the median, ulnar, and dorsal ulnar cutaneous nerve were decreased, and conduction block was also seen in median nerve across the wrist. In needle EMG, incomplete interference patterns were observed in the muscles innervated by median and ulnar nerves. In conclusion, electrophysiologic study and clinical findings suggested right median and ulnar neuropathy below the elbow. Therefore, we performed surgical procedures, which were release of carpal tunnel, Guyon's canal, and cubital tunnel. Results: The postoperative course was uneventful until the first two years. The tingling sensation and claw hand deformity were improved, however, the motor function decreased progressively. In 7 years after the operation, patient could not flex her wrist and thumb sufficiently. EMG which was performed recently showed that ulnar motor response was of low ampulitude. Moreover, median, ulnar, dorsal ulnar cutaneous, lateral antecubital cutaneous and median antebrachial cutaneous sensory response were unobtainable. Abnormal spontaneous activities were observed in upper arm muscles. In conclusion, multiple neuropathies were eventually developed at above elbow level. Conclusion: On treating nerve entrapments associated with lymphedema, medical professionals should be fully aware of the possibility of unpredictable results after the surgery, because of the pathophysiologic traits of chronic lymphedema.

• Clinics in Shoulder and Elbow
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• 제18권2호
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• pp.102-104
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• 2015

In this report, a case of a 70-year-old man with a large ganglion cyst formed after anterior transposition of the left ulnar nerve is presented. Three months after the index surgery, the patient presented with a painless superficial ovoid, soft mass measuring $5{\times}4{\times}2cm$ in size located at the posteromedial aspect of the left elbow, the previously operated site. Magnetic resonance imaging showed a well demarcated cystic mass with a stalk connecting to the elbow joint. Excisional biopsy was performed and pathologic findings showed that the cystic wall had no definite lining cells with myxoid degeneration compatible with findings of ganglion cyst.