• Archives of Reconstructive Microsurgery
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• v.23 no.2
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• pp.86-88
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• 2014

A schwannoma is a benign soft tissue tumor arising from the nerve sheath of a Schwann cell. Clinically, a schwannoma is an asymptomatic mass rarely causing neurologic deficits. However, it can cause discomfort as well as motor and sensory disturbances by compressing the nerve of its origin. The authors encountered a huge schwannoma arising from the median nerve at the proximal forearm, which caused symptoms mainly in the ulnar nerve. The tingling sensation along the ulnar nerve disappeared completely after enucleation of the schwannoma originating from the median nerve.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.11 no.2
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• pp.62-70
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• 2005

The determination of peripheral nerve conduction velocity is an important part to electrodiagnosis. Its value as neurophysiologic investigative procedure has been known for many years but normal value of median and ulnar motor nerve was poorly reported in Korea. To evaluate of median and ulnar motor nerve terminal latency, amplitude of CMAP(compound muscle action potential), conduction velocity and F-wave latency for obtain clinically useful reference value. 71 normal volunteers(age, 19-65 years; 142 hands) examined who has no history of peripheral neuropathy, diabetic mellitus, chronic renal failure, endocrine disorders, anti-cancer medicine, anti-tubercle medicine, alcoholism, trauma, radiculopathy. Nicolet Viking II was use for detected terminal latency, amplitude of CMAP, conduction velocity and F-wave latency of median and ulnar motor nerve. Data analysis was performed using SPSS. Descriptive analysis was used for obtain mean and standard deviation, independent t-test was used to compare between Rt and Lt side also compare between different in genders. The results are summarized as follows: 1. Median motor nerve terminal latency was right 3.00ms, left 2.99ms and there was no significantly differences between right and left side and genders. 2. Median motor nerve amplitude of CMAP was right 17.26mV, left 1750mV and there was no significantly differences between right and left side and genders. 3. Median motor nerve conduction velocity was right 57.89m/sec, left 58.03m/sec and there was no significantly differences between right and left side and genders. 4. Median motor nerve F-wave latency was right 25.74ms, left 25.59ms and there was significantly differences between genders. 5. Ulnar motor nerve terminal latency was right 2.38ms, left 2.45ms and there was significantly differences between right and left side. 6. Ulnar motor nerve amplitude of CMAP was right 15.99mV, left 16.02mV and there was no significantly differences between right and left side and genders. 7. Ulnar motor nerve conduction velocity was right 60.35m/sec, left 59.73m/sec and there was no significantly differences between right and left side and genders. 8. Ulnar motor nerve F-wave latency was right 25.53ms, left 25.57ms and there was significantly differences between genders.

• Clinics in Shoulder and Elbow
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• v.3 no.1
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• pp.54-60
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• 2000

As a surgical treatment of ulnar nerve entrapment syndrome includes simple decompression, medial epicondylectomy, and anterior transposition of the ulnar nerve into a subcutaneous or submuscular bed have been widely used. Despite many reports of these surgical procedure, there is little to guide the choice of one surgical technique. The purpose of our study is to analyse clinical and electrodiagnostic result after minimal invasive decompression by decompression and medial epicondyloplasty(deepening of ulnar groove). We have experienced 9 cases of ulnar nerve entrapment syndrome who were treated with decompression and medial epicondyloplasty. Male were five and female were four. The mean age at operation was 36 years ranging from 23 to 47 years. Operative procedure was to incise the medial intermuscular septum and aponeurotic arch of flexor carpiulnaris and to deepen the ulnar groove. Patients are allowed to do range of motion(ROM) exercise on the average 5days. All patient were relieved pain and improved motor and sensory function, and this procedure allows early ROM exercise after operation because the muscle have not been detached.

• Archives of Plastic Surgery
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• v.37 no.6
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• pp.783-787
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• 2010

Purpose: There are many articles describing about Guyon canal compression syndrome. Until recently, most of these articles have been presented about the symptoms of ulnar nerve compression, but there have been no reports about ulnar artery compression. In this article, besides the nerve compression symptoms in the Guyon's canal, we represented the symptoms and treatments based on the ulnar artery obstruction. Methods: Guyon canal is composed of the hamate and pisiform, and the ligaments which connect them. The course of the ulnar nerve and artery, which passes through this narrow canal, is affected by the anatomical structure of the base of the canal. Out of 14 patients (21 cases) were retrospectively reviewed in this study from 2006 to 2009. Of 14 patients, there were 5 men and 9 women with ages between 21 to 61 years old. The symptoms had volar sensory loss of ulnar sided digits, with muscular atrophy of hypothenar muscles. Prior to surgery, most of these patients had vascular disorders which was diagnosed definitively by angiography and electromyogram. Results: The release of Guyon canal and interposition graft of the obstructed arteries was carried out to 11 patients (15 cases) who had artery (vascular) occlusive disorder, and. 12 cases had sympathectomy and interposition graft after resection of obstructed ulnar artery. Six cases had release of carpal tunnel performed simultaneously. There were no major complications after surgery. The circulation of the ulnar artery was improved along with the patients' symptoms. Conclusion: The pre-existing articles about Guyon canal compression syndrome were mainly focused on ulnar nerve compression. This study, which was carried out by our department, showed that most of these patients had ulnar artery obstruction or stenosis simultaneously with ulnar nerve compression. The vascular disorder was corrected by interposition graft after the resection of the site of ulnar artery occlusion. And to conclude, When we resolve the ulnar nerve compression, the proper diagnosis & treatment of impaired ulnar artery circulation should be carried out concomitantly.

• Clinics in Shoulder and Elbow
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• v.19 no.4
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• pp.256-263
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• 2016

Although arthroscopic surgery has been used conventionally, it has not been widely adopted yet due to the risks of complications, including nerve damage, technical difficulties, and limited indications. As shown in other joints, however, the use of an arthroscope will gradually increased in the elbow joint ('Arthroscopy always wins'). Herein, arthroscopic treatments and arthroscopic ulnar nerve decompression will be discussed in cases of elbow osteoarthritis.

• Archives of Plastic Surgery
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• v.37 no.1
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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.

• Archives of Plastic Surgery
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• v.37 no.6
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• pp.815-818
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• 2010

Purpose: Soft tissue chondroma is a rare benign tumor, found mainly on the palm and sole and grows slowly. Typically, mature hyaline cartilage is the dominant pathological feature. There are reports that assert soft tissue chondromas to be a cause of median nerve entrapment syndrome. However, this is the first case report showing soft tissue chondroma to be a cause of simultaneous median and ulnar neuropathy. Methods: A 62 year-old woman presented with chief complaints of numbness and hypoesthesia of her right palm for 4 to 5 years, and a palpable mass on her right palm that had been increasing in size slowly for 3 years. Physical examination revealed a firm, mobile, non-tender and about $3{\times}3\;cm^2$ sized mass in the center of the right palm. Electromyography showed entrapment neuropathy of the median and ulnar nerve. Ultrasonography showed an approximately $5.7\;cm^2$ mass below the flexor tendon of ring finger. Upon surgical excision, a $3{\times}3\;cm^2$ mass attached to the flexor digitorum profundus of ring finger and redness and hypertrophy of both the median and ulnar nerve were discovered. Mass excision was performed gently and the specimen was referred for histopathologic study. Mass excision resulted in median and ulnar nerve release. Results: The pathology report confirmed the mass to be a soft tissue chondroma with mature hyaline cartilage. The patient exhibited post-operative improvement of her symptoms and did not show any complications. Conclusion: This is the first case report showing soft tissue chondroma to be a cause of simultaneous median and 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.

• Journal of Korean Neurosurgical Society
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• v.50 no.4
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• pp.377-380
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• 2011

Objective : The purpose of this study was to determine the anatomic relationships between neurovascular structures and the transverse carpal ligament so as to avoid complications during endoscopic carpal tunnel surgery. Methods : Twenty-eight patients (age range, 35-69 years) with carpal tunnel syndrome were entered into the study. We examined through wrist magnetic resonance imaging in three different positions (neutral, radial flexion, and ulnar flexion) and determined several anatomic landmark (distance from the hamate hook to the median nerve, ulnar nerve, and ulnar vessel) based on the lateral margin of the hook of the hamate. The median nerve and ulnar neurovascular structure were studied with the wrist in the neutral, ulnar, and radial flexion positions. Results : The ulnar neurovascular structures usually passed just over or ulnar to the hook of the hamate. However, in 12 hands, a looped ulnar artery coursed 0.6-3.3 mm radial to the hook of the hamate and continued to the superficial palmar arch. The looped ulnar artery migrates on the ulnar side of Guyon's canal (-5.2-1.8 mm radial to the hook of the hamate) with the wrist in radial flexion. During ulnar flexion of the wrist, the ulnar artery shifts more radially beyond the hook of the hamate (-2.5-5.7 mm). Conclusion : It is appropriate to transect the ligament greater than 4 mm apart from the lateral margin of the hook of the hamate without placing the edge of the scalpel toward the ulnar side. We would also recommend not transecting the transverse carpal ligament in the ulnar flexed wrist position to protect the ulnar neurovascular structure.

• Biomedical Science Letters
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• v.11 no.2
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• pp.193-199
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• 2005

The present study was performed to assess peripheral neural involvement by exposure to hand-arm vibration. Segmental sensory nerve conduction in the median and ulnar nerves were measured in shipyard workers exposed to vibration. The subjects were 47 male adults exposed to hand-arm vibration and 7 healthy male controls. The subjects underwent an extensive bilateral neurophysiological examination. Sensory compound nerve action potential (SNAP) of the median and ulnar nerves in palm-finger and wrist-palm segments were measured by antidromic method. And SNAP of the median and ulnar nerves in wrist-proximal finger and wrist-distal finger segments were measured by orthodromic method. Result of sensory nerve conduction study was abnormal in 31 patients $(66\%)$ and normal in 16 patients $(34\%)$ of subjects. The pathological pattern in the hand-arm vibration exposed group was 13 patients $(28\%)$ of carpal tunnel syndrome, 18 patients $(38\%)$ of distal sensory neuropathy, 7 patients $(15\%)$ of multifocal and 1 patient $(2\%)$ of Guyon syndrome. The present study indicates that vibration-induced nerve impairments exist both in the finger-palm and palm-wrist segment of median and ulnar sensory nerves. The results suggest that segmental sensory nerve conduction study would be useful as objective indication of peripheral nerve impairment induced by the hand-arm vibration.