Application of ulnar nerve diameter changes examined by HRUS in patients with cubital tunnel syndrome / 中国骨伤

OBJECTIVE@#To evaluate the value of high-resolution ultrasound the diagnosis and prognosis of cubital tunnel syndrome.@*METHODS@#From January 2018 to June 2019, 47 patients with cubital tunnel syndrome were treated with ulnar nerve release and anterior subcutaneous transposition. There were 41 males and 6 females, aged from 27 to 73 years old. There were 31 cases on the right, 15 cases on the left, and 1 case on both sides. The diameter of ulnar nerve was measured by high-resolution ultrasound pre-and post-operatively, and measured directly during the operation. The recovery status of the patients was evaluated by the trial standard of ulnar nerve function assessment, and the satisfaction of the patients was assessed.@*RESULTS@#All the 47 cases were followed up for an average of 12 months and the incisions healed well. The diameter of ulnar nerve at the compression level was (0.16±0.04) cm pre-operatively, and the diameter of ulnar nerve was (0.23±0.04) cm post-operatively. The evaluation of ulnar nerve function:excellent in 16 cases, good in 18 cases and fair in 13 cases. Twelve months post-operatively, 28 patients were satisfied, 10 patients were general and 9 patients were dissatisfied.@*CONCLUSION@#The preoperative examination of ulnar nerve by high-resolution ultrasound is consistent with the intuitive measurement during operation, and the result of postoperative examination of ulnar nerve by high-resolution ultrasound is consistent with follow-up results. High-resolution ultrasound is an effective auxiliary method for the diagnosis and treatment of cubital tunnel syndrome.

Liberación endoscópica del túnel cubital. Técnica y resultados clínico-funcionales / Endoscopic release of the ulnar tunnel. Technique and clinical-functional outcomes

Resumen: Introducción: El síndrome del túnel cubital es la segunda neuropatía por compresión de la extremidad superior, seguido del síndrome del túnel del carpo, por lo que es un motivo de consulta frecuente dentro de la cirugía de mano. Existen pocos estudios publicados acerca de la técnica endoscópica. Material y métodos: Se incluyeron 26 pacientes con el diagnóstico clínico y electromiográfico de síndrome de túnel cubital, en quienes se realizó liberación endoscópica del túnel cubital. Nueve (35%) fueron mujeres y 17 (65%) hombres. Se utilizó la clasificación de McGowan modificada y la clasificación de Wilson y Krout para analizar las características de las variables en su estado prequirúrgico y postquirúrgico. Resultados: Posterior a la intervención, obtuvimos 18 pacientes (69%) con resultado excelente, seis (24%) con un buen resultado y dos (7%) con resultados regulares o aceptables, obteniendo una p significativa con un valor < 0.05. Conclusión: La liberación endoscópica del túnel cubital se considera una técnica segura, con buenos resultados.

Abstract: Introduction: The ulnar tunnel syndrome is the second compressive neuropathy, followed by the carpal tunnel, making it a frequent reference in hand surgery. There are few published studies about endoscopic technique. Material and methods: We studied 26 patients with ulnar tunnel syndrome diagnosis, were operated by endoscopic release of the ulnar tunnel. Nine women (35%) and 17 (65%) male patients. We used the modified McGowan, and the Wilson and Krout classification to analyze preoperative and postoperative variables. Results: After endoscopic decompression we obtained 18 patients (69%) with excellent evolution, 6 (24%) with good evolution, and 2 (7%) with acceptable outcome. We obtained a significant p of < 0.05. Conclusion: Endoscopic decompression of the ulnar tunnel is a safe technique, less invasive and with good outcome.

Modified simple decompression in the treatment of cubital tunnel syndrome: avoiding ulnar nerve subluxation / Descompressão simples modificada no tratamento da síndrome do túnel cubital: evitando subluxação do nervo ulnar

ABSTRACT Objective In this study, we propose a modification to the simple decompression technique that contains the ulnar nerve in the cubital fossa, thus preventing subluxation during forearm flexion movements. Methods Five consecutive patients with leprosy-associated cubital tunnel syndrome underwent surgery with the modified technique between July 2011 and October 2012. Results The most common symptoms were neuropathic pain and sensory changes (both 60%). On the McGowan scale, three patients maintained their preoperative score and two patients improved by two points, while on the Louisiana State University Health Sciences Center scale, two patients maintained the same scores, two improved by two points, and one improved by one point. Four patients were able to discontinue corticosteroid use. The mean follow-up time was 25.6 months (range 2-48 months). There were no recurrences or subluxations in the long-term. Conclusion This alternative technique resulted in excellent functional results, as well as successful withdrawal from corticosteroids. Furthermore, it resulted in no ulnar nerve subluxations.

RESUMO Objetivo Neste manuscrito apresentamos uma modificação da técnica de descompressão simples do nervo ulnar no túnel cubital que impede a subluxação do nervo em movimentos de flexão do antebraço. Métodos Foram incluídos cinco pacientes consecutivos acometidos por síndrome do túnel cubital (Hanseníase) submetidos à cirurgia entre 2011 e 2012. Resultados Os sintomas mais comuns foram dor neuropática e alterações sensitivas (60%). No pós-operatório, três pacientes mantiveram o mesmo escore e dois melhoraram dois pontos na escala de McGowan, enquanto na escala Louisiana State University Health Sciences Center, dois pacientes mantiveram o mesmo escore, dois melhoraram dois pontos e um melhorou um ponto. Os corticosteróides foram descontinuados em quatro pacientes. O tempo médio de seguimento foi 25,6 meses (variação 2-48 meses). Não foram observadas recorrência ou subluxação no longo prazo. Conclusões A técnica alternativa apresentou excelentes resultados funcionais e foi bem sucedida na retirada dos corticosteróides. Ademais, subluxações do nervo ulnar não foram observadas.

Compressão do nervo ulnar na região do cotovelo ­ síndrome do túnel cubital: revisão da literatura / Compression of the Ulnar Nerve in the Elbow Region - Cubital Tunnel Syndrome: Review of the Literature

A síndrome do túnel cubital é responsável pela neuropatia do nervo ulnar, sendo superada em frequência apenas pela síndrome do túnel do carpo. O nervo ulnar apresenta anatomia complexa podendo sofrer compressão em distintos pontos ao longo de seu trajeto, por isso o entendimento das nuances clínicas e da anatomia pormenorizada assim como da técnica cirúrgica meticulosa torna-se essencial no tratamento desta patologia.

The cubital tunnel syndrome is responsible for the ulnar nerve neuropathy, this condition is surpassed in frequency only by carpal tunnel syndrome. The ulnar nerve has complex anatomy andmay suffer compression at different points along its path, so understanding the clinical nuances and detailed anatomy as well asmeticulous surgical technique becomes essential in the treatment of this pathology.

Accuracy of mucocutaneous leishmaniasis diagnosis using polymerase chain reaction: systematic literature review and meta-analysis

The diagnosis of mucocutaneous leishmaniasis (MCL) is hampered by the absence of a gold standard. An accurate diagnosis is essential because of the high toxicity of the medications for the disease. This study aimed to assess the ability of polymerase chain reaction (PCR) to identify MCL and to compare these results with clinical research recently published by the authors. A systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement was performed using comprehensive search criteria and communication with the authors. A meta-analysis considering the estimates of the univariate and bivariate models was performed. Specificity near 100% was common among the papers. The primary reason for accuracy differences was sensitivity. The meta-analysis, which was only possible for PCR samples of lesion fragments, revealed a sensitivity of 71% [95% confidence interval (CI) = 0.59; 0.81] and a specificity of 93% (95% CI = 0.83; 0.98) in the bivariate model. The search for measures that could increase the sensitivity of PCR should be encouraged. The quality of the collected material and the optimisation of the amplification of genetic material should be prioritised.

Resultados da descompressão e anteriorização do nervo ulnar no cotovelo / Results of ulnar nerve descompression and anterior transposition at the elbow

INTRODUÇÃO: A compressão do nervo ulnar no cotovelo é a segunda causa mais frequente de neuropatia compressiva no membro superior. Na maioria dos casos, a compressão ocorre no canal cubital, vulnerável à compressão extrínseca, intrínseca ou idiopática. O tratamento cirúrgico é controverso. MÉTODO: Os autores descrevem os resultados da descompressão e transposição anterior do nervo ulnar realizadas em 58 pacientes. RESULTADOS: Identificou-se como causa principal a fratura de cotovelo e a hanseníase. Na Rede Sarah, entretanto, têm sido frequente (15 por cento) também as indicações por compressão causada por ossificação heterotópica em casos de lesados medulares e/ou cerebrais. Realizamos 57 por cento de procedimentos associados à retinaculotomia dos flexores, descompressão no canal de Guyon e transferência tendínea para músculos intrínsecos. Obteve-se 80 por cento de bons e excelentes resultados, 20 por cento de complicações, dor neuropática, distrofia simpática reflexa e manutenção dos sintomas, observadas em pacientes diabéticos e portadores de hanseníase.

INTRODUCTION: Ulnar nerve compression is the second most frequent entrapment neuropathy of the upper extremity. The most cases to occur at the elbow, with an extrinsic, intrinsic or idiopathic compression. The surgical technique varies. METHODS: This study assesses the results of a series of subcutaneous transpositions of the ulnar nerve. RESULTS: The most frequent cause is elbow fracture, and Hansen disease. In the Sarah Network is frequent heterotopic ossification entrapment because spinal cord injury and stroke. We performed 57 percent associated surgical procedures for Guyon, carpal decompression and tendinous transference. This study shows 80 percent cases were good and excellent results and 20 percent of complications, neuropathy pain, complex regional pain and persistent symptoms in diabetes and Hansen disease.

Descompresión simple de nervio ulnaren el codo: informe preliminar / Simple decompression of the ulnar nerve at elbow: preliminary report

The purpose of this study was to assess the simple decompression as surgical treatment for ulnar tunnel syndrome at elbow. The review was in eight patients with a total of ten cases. The electromyography and neuroconduction study was altered in all cases. The classification according McGowan was: 40 percent of cases in grade I, 40 percent grade IIA and 20 percent grade IIB. In the 63 percent of cases a concomitant carpal tunnel syndrome was treated surgically. In all cases, a compressive Osborne’s arcade was observed. The follow up are 3,8 months with an 100 percent of excellent (complete relief of symptoms) and good (minimal residual symptoms) results. This review shows that the simple decompression is a proved and reproducible surgical technique. This technique can be the first option for the surgical treatment of the ulnar tunnel syndrome.

Se presenta trabajo prospectivo sobre la descompresión simple como tratamiento quirúrgico del síndrome de compresión del nervio ulnar en el codo. Se revisa una serie de 8 pacientes y 10 codos operados. Hubo electromiografía alterada en todos los casos. Se clasificó preoperatoriamente según McGowan(40 por ciento grado I, 40 por ciento grado IIA y 20 por ciento grado IIB). En el 63 por ciento de los casos hubo un síndrome de túnel del carpo asociado que también se trató. En todos los casos se observó una fascia de Osborne tensa y compresiva sobre el nervio ulnar. El seguimiento promedio fue de 3,8 meses y se obtuvo un 100 por ciento de resultados buenos y excelentes. En este trabajo se confirma que ésta es una técnica quirúrgica reproducible y basada en la simplicidad. Se le puede considerar como primera opción para el tratamiento quirúrgico del síndrome de compresión del nervio ulnar en el codo.

Sindrome del tunel cubital: descompresion in situ y cierre del canal epitrocleo-olecraniano / Cubital tunnel syndrome: in situ decompression and epithroclear-olecranon groove closure

Introduccion: El síndrome del túnel cubital responde, en la gran mayoría de los casos, a un tratamiento conservador. Cuando debe recurrirse al tratamiento quirúrgico existen dos categorías de procedimientos: la descompresión (in situ y la epitroclectomía) y la transposición (subcutánea, submuscular o intramuscular). En este trabajo se propone la descompresión in situ y el cierre del canal epitrócleo-olecraniano que modifica los dos mecanismos de producción en forma conjunta: compresión y tracción. Materiales y metodos: Entre 1996 y 2004 fueron operados 64 pacientes con síndrome del túnel cubital primario de ambos sexos, cuya una edad promedio era de 42 años (10-75). Se incluyeron 15 pacientes de tipo I, 33 de tipo II y 16 de tipo III de la clasificación de McGowan. La tecnica consistio en: apertura del ligamento de Osborne y de la fascia del flexor carpi ulnaris; liberación amplia del nervio cubital con preservación de su irrigación extrínseca y las ramas motoras del flexor carpi ulnaris y cierre del canal epitrócleo-olecraniano. Todos los pacientes fueron operados con la tecnica propuesta comenzando en el posoperatorio inmediato con movimientos de pronosupinación completa, asociados con flexion-extension limitada durante tres semanas. En todos los casos el seguimiento fue de al menos 6 meses. Resultados: Fueron satisfactorios en 62 pacientes (97 por ciento). Dos pacientes (tipo III) no mostraron ninguna mejoría. Aunque algunos presentaron hiperestesia en la cicatriz, todos retomaron sus actividades habituales. Ninguno debio ser reoperado. Conclusiones: El procedimiento propuesto actua por undoble mecanismo. La descompresión in situ corrige la compresion y el cierre del canal epitrocleo-olecranianoevita el mecanismo de tracción. Es un procedimiento simple y seguro que permite una amplia movilidad del nervio, aunque manteniendo íntegra su vascularización y sin riesgos para las ramas motoras proximales. Evita la subluxacion recidivante del nervio cubital, por...