• Journal of Korean Neurosurgical Society
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• v.66 no.1
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• pp.90-94
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• 2023

Objective : Cubital tunnel syndrome, the most common ulnar nerve entrapment neuropathy, is usually managed by simple decompression or anterior transposition. One of the concerns in transposition is damage to the nerve branches around the elbow. In this study, the location of ulnar nerve branches to the flexor carpi ulnaris (FCU) was assessed during operations for cubital tunnel syndrome to provide information to reduce operation-related complications. Methods : A personal series (HJY) of cases operated for cubital tunnel syndrome was reviewed. Cases managed by transposition and location of branches to the FCU were selected for analysis. The function of the branches was confirmed by intraoperative nerve stimulation and the location of the branches was assessed by the distance from the center of medial epicondyle. Results : There was a total of 61 cases of cubital tunnel syndrome, among which 31 were treated by transposition. Twenty-one cases with information on the location of branches were analyzed. The average number of ulnar nerve branches around the elbow was 1.8 (0 to 3), only one case showed no branches. Most of the cases had one branch to the medial head, and one other to the lateral head of the FCU. There were two cases having branches without FCU responses (one branch in one case, three branches in another). The location of the branches to the medial head was 16.3±8.6 mm distal to the medial epicondyle (16 branches; range, 0 to 35 mm), to the lateral head was 19.5±9.5 mm distal to the medial epicondyle (19 branches; range, -5 to 30 mm). Branches without FCU responses were found from 20 mm proximal to the medial condyle to 15 mm distal to the medial epicondyle (five branches). Most of the branches to the medial head were 15 to 20 mm (50% of cases), and most to the lateral head were 15 to 25 mm (58% of cases). There were no cases of discernable weakness of the FCU after operation. Conclusion : In most cases of cubital tunnel syndrome, there are ulnar nerve branches around the elbow. Although there might be some cases with branches without FCU responses, most branches are to the FCU, and are to be saved. The operator should be watchful for branches about 15 to 25 mm distal to the medial epicondyle, where most branches come out.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.1 no.2
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• pp.73-77
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• 2008

Purpose: The purpose of this study was to describe the method of dynamic sonographic measurements in the evaluation of the MCL injury of the knee joint while applying valgus and varus stress. Materials and Methods: Seven cases of MCL injury from January to April of 2008 was used for the study. For the evaluation of the medial instability, sonography was used immediately after injury, 6 weeks and 12 weeks after conservative treatment with limited motion brace. The length between the foot of the medial femoral epicondyle and the most proximal point of the tibial cortex was measured in 30 degrees flexion with valgus and varus stress of the knee joint. Results: The foot of the medial epicondyle and the starting point of the proximal tibial cortex underneath the round portion of the articular cartilage were always able to be seen on ultrasonography, even in varus and valgus stress with gravity in 30 degrees flexion of the knee joint. The results of measurements were always constant. Conclusion: Sonography can be used in evaluation of medial instability under the dynamic valgus and varus stress of the knee joint without further injury.

• 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.19 no.4
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• pp.249-251
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• 2016

iepicondylar fracture of the humerus is very rare in adults. To date, there have been limited evidence of this injury in the English literature. We report a case of a 65-year-old female with a biepicondylar fracture of the left distal humerus without dislocation. Open reduction and internal fixation with K-wires, cannulated screw, and suture anchor were performed. We obtained stability of the elbow and a satisfactory functional outcome. Because this type of injury is associated with varus and valgus instability, operative reduction and fixation are essential in order to gain stability and early recovery of normal function.

• Journal of Korean Orthopaedic Sports Medicine
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• v.1 no.1
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• pp.43-48
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• 2002

Purpose : We evaluated radiographic changes and clinical manifestations of the elbow joint to identify the effects of the throwing between dominant and non-dominant arms. Materials and Methods : A hundred and five little leaguer’s baseball player in 5 elementary school and 2 middle school were evaluated for clinical symptoms and radiographic changes about elbow joint. Mean age was 12 years old and average periods of exercise were 32 months. Elbow functions were evaluated using ASES standardized assessment form and radiographic changes of medial epicondyle were examinated for enlargement, separation of the apophyses, fragmentation and irregularity. Results : Thirty seven players (35$\%$) were complained pain with throwing and the average score was 4.8 using visual analog scale. There were no significant differences in range of motion except flexion angle, valgus angle, and strength between dominant arm and non-dominant arm. Valgus laxity was more prominent in dominant arm. Ulnohumeral tenderness, radiocapitellar tenderness and medial flexor origin tenderness were in 18, 6, and 17 cases respectively in dominant arm. Medial epicondyle was enlarged in dominant arm with 13.0 by 6.3 mm compared to non-dominant arm with 11.7 by 6.1 mm. Apophyseal separation was 0.8 mm in dominant arm and 0.5 mm in non-dominant arm. Fragmentation and irregularity were 14 (13$\%$) and 25 (24$\%$) cases respectively in dominant arm. Conclusion : In little league baseball player, it needs usage of ball and bat with appropriate weight, and careful conditioning programs through throwing exercise in order to avoid elbow injuries.

• Journal of Veterinary Clinics
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• v.37 no.1
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• pp.46-49
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• 2020

Flexor enthesopathy is an important cause of elbow lameness in dogs. Flexor enthesopathy is divided into primary and concomitant forms deciding the treatment. The imaging characteristics in affected dogs are irregular medial humeral epicondyles, spur, calcified bodies adjacent to medial humeral epicondyle, thickened and contrast enhancement of the affected muscles. In this report, the radiography, computed tomography (CT), and magnetic resonance imaging (MRI) were performed for right forelimb lameness of a 3-year-old dog. The irregular sclerotic changes and spur of the medial humeral epicondyles were shown with calcified bodies on radiography. Thickened flexor muscles in right forelimb and fragmented coronoid processes of both elbows were observed on CT. On MRI, high signal intensity of the bilaterally thickened flexor muscles with contrast enhancement was detected. Based on these results, concomitant flexor enthesopathy with fragmented medial coronoid process of bilateral elbows was diagnosed in this dog.

• Journal of Korean Neurosurgical Society
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• v.58 no.6
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• pp.499-503
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• 2015

Objective : The transradial catheterization (TRC) is becoming widespread, primarily for neurointerventions. Therefore, the evaluation of radial artery puncture in clinical practice and a better understanding of the anatomy are important to improve the safety of neuroendovascular surgery. Methods : Ten formalin-fixed adult Korean cadavers were dissected to expose radial artery (RA), brachial artery (BrA) and subclvian artery (ScA), bilaterally. Vessel lengths and diameters were meaured using a caliper and distance between the specific point of vessels and the anatomical landmarks including the radial styloid process, the medial epicondyle of the humerus, the sternoclavicular joint, and the vertebral artery orifice were also measured. Results : The average length between the radial (RAPS) and the BrA puncture sites (BrAPS) and between the vertebral artery orifice (VAO) and the BrA bifurcation (BrAB) did not differ between sides (p>0.05). The average length between the radial styloid process (RSP) and the RAPS was $13.41{\pm}2.19mm$, and the RSP was $26.85{\pm}2.47mm$ from the median nerve (MN). The mean length between the medial epicondyle (ME) and the BrAPS as $44.23{\pm}5.47mm$, whereas the distance between the ME and the MN was $42.23{\pm}4.77mm$. The average VAO-ScA angle was $70.94{\pm}6.12^{\circ}$, and the length between the ScA junction (SCJ) and the VAO was $60.30{\pm}8.48mm$. Conclusion : This study provides basic anatomical information about the radial artery and the brachial route and can help improving new techniques, selection of size and shape of catheters for TRC. This can help neurointerventionists who adopt a transradial neuroendovascular approach and offers comprehensive and safe care to their patients.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.250-254
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• 2009

Purpose: Snapping triceps syndrome is dynamic condition in which medial head of triceps snaps (dislocates) over the medial epicondyle as the elbow is flexed. Materials and Methods: The symptoms are pain or snapping at the medial aspect of the elbow and/or symptoms from coexisting ulnar nerve irritation. The diagnosis can be made by dynamic ultrasonography. Results and Conclusion: And successful outcome can be archived by operative treatment, which are ulnar nerve anterior transposition and tenotomy of medial head of triceps.

• Journal of Korean Orthopaedic Sports Medicine
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• v.6 no.1
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• pp.50-56
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• 2007

Purpose: To evaluate the aspect of occurrence and transition of the elbow injuries in baseball players from childhood to adult. Materials and Methods: We had a survey and took the simple X-ray from the anteroposterior view and the lateral view of both elbows for subjects of total 320 baseball players. - each of 80 players in elementary school, middle school, high school, and professional baseball players between January and December in 2004. Results: The region of pain and the bony changes in elbow were the most frequent in medial side from all the groups of players. Especially, hypertrophy of medial epicondyle were the most numerous. As baseball players got older, the radiological changes of elbow were increased. The bony changes were found out 52 cases (65%) of the elementary school players, 66 cases (82%) of the middle school players, 68 cases (85%) of the high school players and 70 cases (88%) of the professional players out of the total 320 baseball players. Conclusion: The bony changes of the elbow in baseball players got frequent as they were getting older and increased in comparison with past.

• Journal of Biomedical Engineering Research
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• v.19 no.4
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• pp.393-401
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• 1998

Based on clinical observations, it is suspected that the bone-tendon origin is the site where piratical failure, leading to pathophysiological changes in the humeral epicondyle after repetitive loading, is initiated Mechanical properties and failure patterns of the common extensor and flexor tendons of the humeral epicondyle under static and repetitive loading have not been well documented. Our goal was to determine mechanical properties of failure strength and strain changes, to correlate strain changes and the number of cyclic repetitions, and to identify the failure pattern of bone-tendon specimens of common extensor and flexor tendons of the humeral epicondyle. Mechnaical properties of human cadaver bone-tendon specimens of the common extensor and flexor tendons of the humeral epicondyle were tested under two different loading rates. No statistically significant difference in ultimate tensile strength was found between male and female specimens or between slow (10 mm/sec) and fast elongation (100 mm/sec) rates. However, a statistically significant difference in ultimate tensile strength between the common extensor (1190.0 N/$cm^2{\pm}$388.8) and flexor 1922.0 N/$cm^2{\pm}$764.4)tendons was found (p<0.05). When loads of 25%, 33%, and 41% of the ultimate tensile strength of their contralateral sides were applied, the number of cycles required to reach 24% strain change for the common extersor and flexor tendons were approximately 8,893, 1,907, and 410, respectively. The relationship between cycles and loads was correlated ($R^2$=0.46) Histological observation showed that complete or partial failure after tensile or cyclic loadings occurred at the transitional zone, which is the uncalcified fibrocartilage zone between tendon and bone of the humeral epicondyle. Sequential histological sections revealed that failure initiated at the upper, medial aspect of the extensor carpi radialis brevis tendon origin. Biomechanical and hstological data obtained in this study indicated that the uncalcified fibrocartilage zone at the bone-tendon origin of the common extensor and flexor tendons is the weak anatomical structure of the humeral epicondyle.