• Journal of Korean Neurosurgical Society
• /
• v.65 no.2
• /
• pp.307-314
• /
• 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
• /
• v.21 no.3
• /
• pp.224-228
• /
• 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
• /
• v.59 no.1
• /
• pp.75-77
• /
• 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.

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

• Archives of Reconstructive Microsurgery
• /
• v.17 no.1
• /
• pp.36-41
• /
• 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.

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

• Clinical Pain
• /
• v.20 no.2
• /
• pp.70-73
• /
• 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.

• The Journal of Korean Orthopaedic Ultrasound Society
• /
• v.1 no.1
• /
• pp.64-72
• /
• 2008

Compression neuropathy around elbow and wrist are one of the common disturbing problems in the upper extremity. The understanding of normal nerve architectures and pathophysiologic changes in compression neuropathy is important to interpret the ultrasonographic images correctly. Compression neuropathies have characteristic ultrasonographic imaging features of flattened nerve at compression and hypoechoic swollen nerve with loss of fascicular patterns at proximal segments. Dynamic ultrasonographic imagings on motion can show dymanic subluxation of ulnar nerve and medial head of triceps muscle over the medial epicondyle in snapping triceps syndrome. Dynamic compression of median nerve also can be visualized in pronator teres syndrome by dynamic imaging studies. A quantitative measures of cross sectional area or compression ratio can be helpful to diagnose compression neuropathies, such as carpal tunnel syndrome or cubital tunnel syndrome. With the clinical features and electeophysiologic studies, the untrasonographic imagings are useful tool for evaluation of the compression neuropathies in the upper extremities.

• Archives of Plastic Surgery
• /
• v.37 no.1
• /
• pp.95-98
• /
• 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
• /
• v.18 no.2
• /
• pp.102-104
• /
• 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.