Anatomical Evaluation of Ulnar Nerve according to the Elbow Position

OBJECTIVE: To investigate the anatomy of the ulnar nerve according to the degree of elbow flexion and to obtain optimal elbow position for ulnar nerve conduction study. METHODS: Eleven elbows in nine cadavers were dissected. We estimated the 10 cm elbow segment to be the distance between 2 points, 4 cm distal and 6 cm proximal to the center of the cubital tunnel, which was determined to be the halfway point between the medial epicondyle and olecranon with elbow position in extension and 45o, 90o, 135o flexion. Anatomical measurements of the actual length of ulnar nerve, distance between medial epicondyle and ulnar nerve, and distance between medial epicondyle and olecranon were obtained in each position. The actual length of the ulnar nerve was measured between two points of the ulnar nerve closest to the landmarks of the estimated 10 cm with flexible ligature. RESULTS: The actual lengths of ulnar nerve were 10.23 cm, 10.00 cm, 9.44 cm, and 9.08 cm in elbow extension, and 45o, 90o, 135o flexion, respectively. The difference between actual length and estimated lengths were least in 45o elbow flexion (p=0.0001). The distance between medial epicondyle and olecranon increased with increasing elbow flexion (p=0.0001). However, there was no difference in the distance between medial epicondyle and ulnar regardless of the elbow position. As a result, the ulnar nerve seemed to have migrated anteriorly in the cubital tunnel with increasing elbow flexion. CONCLUSION: This study suggest that the optimal angle in ulnar nerve conduction study would be 45o flexion, under the condition that the distance measurement is through the halfway point between the medial epicondyle and olecranon.

New Instrument to Measure the Stiffness of the Finger Joints; StifMeter

OBJECTIVE: To examine the stiffness of finger joints with StifMeter among the patients with rheumatoid arthritis and to calculate the absolute value of the stiffness with a unit of power and to compare the values of the StifMeter with visual analog scale about stiffness (VASstiff). METHOD: Subjects were 53 rheumatoid arthritis patients (male 8, female 45) with disease duration at least 6 months. StifMeter was made up of 10 graded springs of a same spring-constant. Stiffness and pain by VAS and StifMeter, finger circumference and pinch strength were measured at outpatient clinic as well as questionaire, prospectively. Laboratory data were reviewed from medical records to verify the state of disease. We compared StifMeter with VASstiff and VASpain. RESULTS: Mean score of StifMeter was 5.59 on the right side and 5.53 on the left. The corrected values of the StifMeter with a unit of power were 0.01684 on the right side and 0.01672 on the left side. VASstiff score was positively correlated with that of StifMeter. The older the age, the higher the score of VASstiff that was positively correlated with that of StifMeter. The longer the duration of disease, the higher the score of VASstiff that was positively correlated with that of StifMeter. CONCLUSION: StifMeter is a semi-objective method which may be of value in the measurement of finger joint stiffness.

Quality of Life after Stroke

OBJECTIVE: The purposes of this study were to examine overall quality of life (QOL) in long term stroke survivals and to identify variables that predict QOL after stroke. METHOD: Subjects were 51 stroke patients (male; 28, female; 23) with stroke onset at least 6 months previously. Interview, measurement of depression and QOL were performed at outpatient clinic after discharge. Review of medical records included characteristics of stroke and communication disorders. Interview questionnare included caregiver, religion, education level, occupation and income. Depression and functional status was measured by the Beck depression inventory (BDI) and modified Barthel index (MBI), respectively. QOL was measured with the use of 5-item (activity, daily living, health, support, outlook) version of the Quality of Life Index (QLI) and its range of scores is 0~10. We compared QLI scores according to various factors obtained from medical records and questionnaire. RESULTS: Mean duration after onset of stroke was 33.6 months (range, 6~216 months). The mean score of QLI were 7.0+/-2.1. Low MBI score, communication disorder and depression had a negative effect on QOL (p0.05). CONCLUSION: Low MBI score, depression and communication disorders would be negative predictors of QOL and identification of these factor may assist stroke patients in coping their personal and social life.

Median and Ulnar Sensory Nerve Conduction Study in Five Digits

OBJECTIVE: To establish the reference values of the sensory conduction for all the digits in the hand, conduction studies were performed using the standard technique. METHOD: One hundred hands of fifty neurologically healthy adults with mean age of 45 years (range, 23~69) were tested. Depending on ages, the 50 adults were devided into three groups: group 1, 20~45 years old; group 2, 46~60 years old; group 3, 61~ years old. Antidromic sensory nerve conduction techniques using a fixed distance were performed. The onset latency and baseline to peak amplitude of the sensory nerve action potentials (SNAPs) were measured. During the test, the skin temperature of the hand was maintained at 34 degrees C or above. These variables from SNAPs were compared according to age, gender, side, and recording digits. RESULTS: Comparison of the median and ulnar SNAPs between age groups revealed longer onset latency and smaller amplitude in the elderly group. The amplitude of SNAPs was larger in females than in males and the left side than the right side. Comparison of the latencies and amplitudes between the second and third digits showed no significant difference statistically. Also, the latencies and amplitudes of the median and ulnar nerves recorded from the fourth digits showed no significant difference statistically. CONCLUSION: Based on these results, the reference values for sensory conductions from all the digits were obtained. These values would be helpful in evaluation of CTS or unspecified finger pain or upper extremity neuropathy.