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.

Abordaje medial modificado para dislocación codo crónico: un abordaje quirúrgico novedoso con buen resultado funcional / Modified medial approach for chronic elbow dislocation: a novel surgical approach with good functional outcome

Background : Chronic elbow dislocation is defined as untreated elbow dislocation for longer than 2 weeks. Goal of treatment is stable reduction of elbow joint and facilitation of early elbow motion for optimal end result. Known operative methods is the Kocher posterolateral approach.which can accumulate hematome, and longer time needed to identify Ulnar nerve. Therefore, we would like to introduce the new modified medial elbow joint incision approach. Methodology: This study utilized a cross-sectional review of patients with surgical treatment of simple chronic elbow dislocation. Questionnaires were taken using Oxford Elbow Score, Mayo Elbow Performance Index, and Disability of Arm, Shoulder, and Hand Questionnaire to assess current elbow status Result : Utilizing Oxford elbow score, the analytic group score value ranged from 21-46, while control group's score value were 37-42 (P-value <0.0001). Mayo Elbow Performance Index score, from the analytic group, scored ranges from 45 - 82. the control group, a mean value of 85 were scored (P-value <0.0001), the DASH score revealed total mean value of 8.3 in the analytic group, compared to score 6 in the control group (P-value = 0.0468 ). The range of motion is increased in total flexion and extension from both groups(P-value <0.0001) Conclusion: Modified medial elbow approach provides faster method of identifying ulnar nerve, requires less skin flap for closure and less space for blood accumulation. Modified medial elbow approach provides good functional outcome with no complications related to ulnar nerve reported in this study.

Anconeus Epitrochlearis Muscle as a Cause of Ulnar Nerve Compression at the Elbow

Ulnar nerve entrapment is the second most common compressive neuropathy in the upper limb, after carpal tunnel syndrome (Dellon, 1986). One of the causes that must be considered is the accessory anconeus epitrochlearis muscle, which is present in 4% to 34% of the general population (Husarik et al, 2010; Vanderpool et al, 1968; Nellans et al, 2014). We describe a patient with symptoms of compression of the left ulnar nerve at the elbow and the result of the surgical treatment. The patient presented with hypoesthesia in the fourth and fifth fingers of the left hand, and reduction of strength in the fifth finger abduction. No alterations were found in the thumb adduction. Initially, the treatment was conservative (splint, physiotherapy, analgesics); surgical treatment was indicated due to the continuity of the symptoms. The ulnar nerve was surgically released and transposed, with complete recovery after 6 months of follow-up. Ulnar nerve entrapment at the elbow by the anconeus epitrochlearis muscle is not common, but it must not be ignored (Chalmers, 1978). Ultrasonography (Jung et al, 2013; Bargalló et al, 2010), elbow magnetic resonance imaging (MRI) (Jeon, 2005), and electromyography (Byun, 2011) can help establish the proper diagnosis.

A compressão do nervo ulnar é a segunda causa mais frequente de neuropatia compressiva no membro superior, após a síndrome do túnel do carpo (Dellon, 1986). Uma das causas que dever ser considerada é a presença do músculo anconeu epitroclear, que está presente em cerca de 4% a 34% da população (Husarik et al, 2010; Vanderpool et al, 1968; Nellans et al, 2014). Descrevemos uma paciente com sintomas de compressão do nervo ulnar esquerdo no cotovelo, e o resultado do tratamento cirúrgico. A paciente apresentava hipoestesia no IV e V dedos da mão esquerda, e diminuição de força na abdução do V dedo; não foram encontradas alterações na adução do polegar. Inicialmente, o tratamento foi conservador (uso de splint, fisioterapia e analgésicos); a cirurgia foi indicada pela persistência dos sintomas. O nervo ulnar foi cirurgicamente liberado e transposto, com melhora total dos sintomas após 6 meses de acompanhamento. A compressão do nervo ulnar no cotovelo não é comum, mas não deve ser ignorada (Chalmers, 1978). Ultrassonografia (Jung et al, 2013; Bargalló et al, 2010), ressonância magnética do cotovelo (Jeon, 2005) e eletromiografia (Byun, 2011) auxiliam no diagnóstico.

Luxación bilateral del vientre medial del tríceps (snapping triceps) asociada a luxación del nervio cubital. presentación de un caso / Bilateral dislocation of the medial fold of the triceps tendon (snapping triceps) with ulnar nerve dislocation. a case report

Snapping triceps es la luxación del vientre medial del tríceps por encima de la epitróclea, asociada o no a la luxación del nervio cubital. En algunos casos publicados, los pacientes eran intervenidos por luxación del nervio cubital y, durante la cirugía, se diagnosticaba la luxación del vientre medial del tríceps, incluso algunos pacientes eran operados en varias oportunidades. Presentamos un paciente de 16 años que refiere un resalto en la región medial de ambos codos. En el examen físico, es evidente un doble resalto tanto del nervio cubital, como del vientre medial del tríceps. Estos hallazgos se confirman por ecografía comparativa bilateral. El tratamiento quirúrgico consistió en la transposición cubital transmuscular y la resección del vientre medial del tríceps que se luxaba anterior a la epitróclea. Los dos codos fueron operados con diferencia de un mes. El paciente tuvo una excelente evolución sin complicaciones a los dos meses de las operaciones. Esta patología poco frecuente debe ser considerada con atención, ya que puede llevar a errores de diagnóstico y de tratamiento. Nivel de Evidencia: IV.

Snapping triceps is the dislocation of the medial triceps belly above the medial epicondyle, with or without the ulnar nerve. In some cases described in the literature, patients were operated on by ulnar nerve dislocation and dislocation of the medial triceps belly was diagnosed during surgery; some patients were even operated on several occasions. We report the case of a 16-year-old patient with a snap in the medial region of both elbows. Physical examination reveals a clear doublé click of the ulnar nerve and the medial triceps belly. These findings are confirmed by bilateral comparative ultrasound. Surgical treatment consisted of transmuscular ulnar transposition and resection of dislocated medial triceps belly. Both elbows were operated on one month apart. Two months after surgeries, the patient achieved an excellent outcome without complications. This rare condition must be carefully considered since it may lead to diagnostic and therapeutic errors. Level of Evidence: IV.

Una opción para restaurar la musculatura intrínseca cubital cuando el nervio interóseo anterior no se encuentra disponible / An option to restore ulnar intrinsic muscles when the anterior interosseus nerve is not available

Resumen: Antecedentes: Las lesiones de nervio periférico, principalmente las traumáticas, tienen efectos devastadores para la función. Tradicionalmente las opciones eran en forma temprana el injerto nervioso y en forma tardía la transferencia tendinosa. Durante los últimos años se han venido realizando transferencias nerviosas cuando la lesión es temprana y la placa motora aún es viable. Los resultados en su mayoría son superiores a los injertos nerviosos y a las transferencias tendinosas. Métodos y resultados: Se presenta el caso de una paciente que sufrió lesión de nervio mediano y cubital en el antebrazo y se utilizaron las ramas redundantes de los músculos extensor carpi ulnaris y extensor digiti quinti. Los resultados fueron buenos a los cuatro años. Conclusión: Cuando existe un déficit de la musculatura intrínseca cubital de la mano, el donador favorito es la rama terminal del nervio interóseo anterior. Cuando éste no se encuentra, debemos tener opciones para restaurar esta función.

Abstract: Background: The peripheral nerve injuries are devastating for the patient; the classic reconstructive options are the Nerve Graft and Tendon Transfers. Lately the Nerve Transfers are being used more and more broadly. They are an excellent option on early injuries and when the motor plate is still alive. The advantages are numerous, because the functional recovery is much better. Methods and results: We report the case of a patient who sustained and injury on the median and ulnar nerve, so the EDQ and ECU branches were used to restore the Ulnar Intrinsic Function. The 4-year follow-up showed good results. Conclusion: The ulnar intrinsic innervations provide dexterity; fine motor function and pinch, which is essential for a functioning hand. The most popular donor to restore the function of the motor branch of the ulnar nerve is the anterior interosseous nerve. When this is unavailable the use of the redundant branches of the EDQ and ECU must be considered.

Resultado da neurotização do nervo ulnar para o músculo bíceps braquial na lesão do plexo braquial / Results of ulnar nerve neurotization to brachial biceps muscle in brachial plexus injury

OBJETIVO: Avaliar de forma crítica os fatores que influenciam os resultados da neurotização do nervo ulnar no ramo motor do músculo bíceps braquial, visando a restauração da flexão do cotovelo em pacientes com lesão do plexo braquial. MÉTODOS: 19 pacientes, 18 homens e uma mulher, com idade média de 28,7 anos foram avaliados entre fevereiro de 2003 e maio de 2007. Oito pacientes apresentavam lesão das raízes C5-C6 e 11, das raízes C5-C6-C7. O intervalo de tempo médio entre a injúria e o tratamento cirúrgico foi 7,5 meses. Quatro pacientes apresentavam fraturas cervicais associadas à lesão do plexo braquial. O seguimento pós-operatório foi de 15,7 meses. RESULTADO: Oito pacientes recuperaram força de flexão do cotovelo MRC grau 4; dois, MRC grau 3 e nove, MRC < 3. Não houve prejuízo da função prévia do nervo ulnar. CONCLUSÃO: Os resultados da cirurgia de neurotização do nervo ulnar no ramo motor no músculo bíceps braquial são dependentes: do intervalo decorrido entre a lesão do plexo e o tratamento cirúrgico, da presença de fraturas associadas da coluna cervical e côndilo occipital, da função residual das raízes de C8-T1 após o trauma e do acometimento da raiz de C7. Sinais de reinervação manifestados até 3 meses no pós cirúrgico mostram melhores resultados ao longo prazo. Nível de Evidência: IV, Série de Casos.

OBJECTIVE: To evaluate the factors influencing the results of ulnar nerve neurotization at the motor branch of the brachial biceps muscle, aiming at the restoration of elbow flexion in patients with brachial plexus injury. METHODS: 19 patients, with 18 men and 1 woman, mean age 28.7 years. Eight patients had injury to roots C5-C6 and 11, to roots C5-C6-C7. The average time interval between injury and surgery was 7.5 months. Four patients had cervical fractures associated with brachial plexus injury. The postoperative follow-up was 15.7 months. RESULTS: Eight patients recovered elbow flexion strength MRC grade 4; two, MRC grade 3 and nine, MRC <3. There was no impairment of the previous ulnar nerve function. CONCLUSION: The surgical results of ulnar nerve neurotization at the motor branch of brachial biceps muscle are dependent on the interval between brachial plexus injury and surgical treatment, the presence of associated fractures of the cervical spine and occipital condyle, residual function of the C8-T1 roots after the injury and the involvement of the C7 root. Signs of reinnervation manifested up to 3 months after surgery showed better results in the long term. Level of Evidence: IV, Case Series.

Distal anterior interosseous nerve transfer to the deep ulnar nerve and end-to-side suture of the superficial ulnar nerve to the third common palmar digital nerve for treatment of high ulnar nerve injuries: experience in five cases / Transferência do nervo interósseo anterior distal para o ramo profundo do nervo ulnar e sutura término-lateral do nervo ulnar superficial ao terceiro nervo digital comum para tratamento de lesões altas do nervo ulnar: experiência em cinco casos

OBJECTIVE: To demonstrate the results of a double nerve transfer at the level of the hand for recovery of the motor and sensory function of the hand in cases of high ulnar nerve injuries. METHOD: Five patients underwent a transfer of the distal branch of the anterior interosseous nerve to the deep ulnar nerve, and an end-to-side suture of the superficial ulnar nerve to the third common palmar digital nerve. RESULTS: Two patients recovered strength M3 and three cases were graded as M4; recovery of protective sensation (S3+ in three patients and S4 in two) was observed in the fourth and fifth fingers, and at the hypothenar region. The monofilament test showed values of 3.61 or less in all cases and the two-point discrimination test demonstrated values of 7 mm in three cases and 5 mm in two. CONCLUSION: This technique of double nerve transfer is effective for motor and sensory recovery of the distal ulnar-innervated side of the hand.

OBJETIVO: Demonstrar os resultados obtidos com uma dupla transferência nervosa ao nível da mão para tratamento de lesões do nervo ulnar localizadas acima do cotovelo. MÉTODO: Cinco pacientes foram submetidos à transferência do nervo interósseo anterior para o ramo profundo do nervo ulnar, associado à sutura término-lateral do nervo ulnar superficial ao terceiro nervo digital comum. RESULTADOS: Dois pacientes recuperaram força M3 e os outros três casos foram graduados como M4. Recuperação de sensibilidade protetora (S3+ em três pacientes e S4 em dois) foi observada nos quarto e quinto dedos, além da região hipotenar. O teste de monofilamentos demonstrou valores iguais ou menores do que 3,61 em todos os casos e o teste de discriminação de dois pontos apresentou valores de 7 mm em três casos e 5 mm em dois. CONCLUSÃO: A técnica de dupla transferência nervosa é eficaz como modalidade de tratamento para lesões altas do nervo ulnar.

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.

Evaluation of anterior subcutaneous transposition of ulnar nerve in cubital tunnel syndrome

Regarding the frequency of Cubital Tunnel Syndrome, varieties of treatment modalities, and ambiguity of anterior subcutaneous transposition of ulnar nerve method, we aimed to evaluate the efficacy of this procedure in patients with Cubital Tunnel Syndrome referred to Taleghani hospital in 2004-2007. This study was a case series including all referred patients with definite diagnosis of Cubital Tunnel Syndrome, treated by anterior subcutaneous transposition. Treatment results were measured according to modified Bishop rating system, and were ranked into excellent, good, fair, and poor. Variables such as gender, age < 45 years>, causation, and initial severity, determined by Dellon criteria preoperatively, were analyzed by Fisher's exact test. This study was performed on 26 eligible patients including 29 elbows [38% males and 62% females, with mean age of 44.5 years], with an age range of 23-72 years. In a 12 months follow-up post-operatively, 62% showed excellent, 20.7%good, and 17.3% were reported fair with no poor result. In a 1-12 months follow-up post-operatively, results showed improvement, and initial severity and old age were demonstrated to significantly affect treatment results [p < 0.07]. Our study findings strongly support the concept that anterior subcutaneous transposition of ulnar nerve is successful in patients with Cubital Tunnel Syndrome; however, further experimental studies are suggested

Repaired ulnar nerve and effect on its innervating muscles in rat / 法医学杂志

OBJECTIVE@#To study the morphological changes of the rat claw inner skeletal muscle after ulnar nerve injury at different sections and different recovery times.@*METHODS@#Forty-two adult male Sprague-Dawley rats were selected and placed randomly in seven groups. After establishing model of injury and repair of claw inner skeletal muscle by cutting off the ulnar nerve, the muscle wet weight, cross section area of myocytes, and collagen fibers were measured.@*RESULTS@#Claw inner skeletal muscle atrophy was significantly less in experiment groups compared with the control groups after ulnar nerve injuries. The functional recovery was better in the early repair groups than the late repair group. Collagen fibers increased slowly in earlier stage, but more significantly in late stage. The muscle atrophy was similar in wrist and elbow after ulnar nerve injury during the same recovery period.@*CONCLUSION@#The function can recover completely or partly in early repair groups, but not quite effective in late stage. The increase of collagen fiber is one of the reasons to undermine the recovery effect of damaged ulnar nerve. There is no obvious difference of effect on the morphological changes of the rat claw inner skeletal muscle no matter the ulnar nerve is injured at wrist or elbow.

Uso da técnica ulnar-bíceps (oberlin) em paralisias altas do plexo braquial: estudo funcional de 20 casos / The use of ulnar-biceps technique's in high paralyses of plexo brachialfunctional study of 20 cases

O autor apresenta 20 casos de paralisia alta do plexo braquial, acometendo as raízes C5, C6 ± C7, tratadas pela neurotização dos fascículos do nervo musculocutâneo que inervam o músculo bíceps braquial por fascículos do nervo ulnar para recuperação da flexão do cotovelo (Técnica de Oberlin).A neurorrafia pode ser executada sem enxertos nervosos de interposição. Em todos os paciente aferiu-se resultado positivo, com início da recuperação funcional aos 5,5 ± 1,7 meses pós- operatórios e flexão do cotovelo contra resistência aos 14,7 ± 5,5 meses depois da cirurgia.A seqüela provocada pela secção dos fascículos doadores do nervo ulnar foram clinicamente desprezíveis quando comparadas ao beneficio proporcionado. O sucesso alcançado pelo procedimento cirúrgico se deu, principalmente, pelo curto espaço de tempo entre o acidente e a cirurgia. Os resultados descritos estão de acordo com os da literatura e reafirmam que a neurotização "Ulnar-Biceps" e o procedimento de escolha para o tratamento cirúrgico das paralisias altas do plexo braquial.

The author presents 20 cases of upper brachial plexus palsies, concerning C5, C6 ± C7 roots, treated by neurotization of the musculocutaneus nerve fascicles innervating the biceps brachial muscle with ulnar nerve fascicles to recover elbow flexion (Oberlin's Technique). The neurorraphy could be executed without interposition of nerve grafts. All the patients had positive result, with beginning of the functional recovery at 5.5 ± 1.7 of postoperative month sandel bow flexi on again stresistance at 14.7 ± 5.5 months after the surgery. The sequel provoked by the sectioned donor fascicles of the ulnar nerve is clinically worthless when compared with the benefit produced. The success reached by the surgical procedure can be mainly given by short gap of time between accident and surgery. The described results are in accordance with the literature and reaffirm that the Ulnar-Biceps neurotization is the first choice procedure for the surgical treatment of the upper brachial plexus palsies.

Tecnica de Tsai modificada para la descompresion endoscopica del nervio cubital: estudio cadaverico / Modified Tsai technique for endoscopic release of the ulnar tunnel

Proposito: Evaluar y cuantificar la liberacion endoscopica del nervio cubital en cadáveres, utilizando una modificacion de la tecnica original de Tsai y analizar las complicaciones del procedimiento. Material y metodo: se realizo un estudio ciego sobre la apertura endoscopica de 12 tuneles cubitales, correspondientes a 10 cadaveres frescos. Todos los procedimientos fueron realizados por el autor utilizando la tecnica modificada de Tsai. Se estudio y midio la longitud de apertura del tunel cubital. La liberación se considero completa cuando todas las estructuras capaces de comprimir el nervio en su trayecto a traves del codo fueron seccionadas. Se evaluaron las complicaciones del procedimiento. Resultados: La longitud de descompresion promedio fue de 5,45 cm (rango 4-8 cm) a proximal y 5,06 cm a distal (rango 3,5-9 cm). La longitud de liberación total promedio fue de 10,64 cm (rango 7,5-15 cm). Ocho de las descompresiones fueron consideradas completas, mientras que las 4 restantes fueron consideradas incompletas. En ningun caso se observo compresion del nervio luego de su liberación. No se observaron lesiones neurologicas, vasculares o de tipo capsulo-ligamentario relacionadas con el procedimiento ni casos de subluxacion del nervio cubital luego de su descompresion. Conclusiones: La presente tecnica de apertura endoscopica del tunel cubital permitiria una adecuada liberación del nervio, preservando su vascularizacion y evitando disecciones extensas y posibles lesiones de ramos nerviosos. La tecnica pareciera ser simple, segura y sin mayores complicaciones.

Significado anátomo-funcional e importância cirúrgica da anastomose mediano-ulnar de Martin-Gruber / Martin-Gruber mediano-ulnar anastomosis: anatomic/functional meaning and surgical importance

Os objetivos foram: verificar a freqüência da anastomose de Martin-Gruber, topografar e classificar as mesmas e comparar a freqüência encontrada anatomicamente e a encontrada nos exames eletroneuromiográficos de rotina. Foram dissecados 50 antebraços de cadáveres, e foram estudados 75 antebraços por eletroneuromiografia. Foram encontradas 5 anastomoses entre o nervo mediano e o nervo ulnar e nenhuma nas eletroneuromiografias.A freqüência da anastomose de Martin-Gruber no nosso meio foi de 10 por cento / The objectives were: to verify the frequency of the anastomosis of Martin-Gruber, to topography and to classify the same ones and to compare the frequency found anatomicallyand found her/it in the exams routine electroneuromiographies.50 forearms of corpses were dissected, and they were studied 75 forearms by electroneuromiographies. They were found 5 anastomosis between the median nerve and the ulnar nerve and none in the electroneuromiographies.The frequency of the anastomosis of Martin-Gruber found was 10 per cent...

The Martin-Gruber anastomosis in brazilians: an anatomical study

Communications between nerves are relatively common, and individual variations in their anatomical organization have been described. Knowledge of the prevalence of such variations is necessary when estabilishing the diagnosis of neuropathies and surgical landmarks. In this study, 64 anterior forearm regions of cadavers of blacks and whites of both sexes, were dissected to examine the communications between the median and ulnar nerves (Martin-Gruber anastomosis). This anastomosis was found in five cases (7,8%), one of which was bilateral. There were no significant gender or racial differences in the incidence of this connection. The anastomosis in Brazilians observed here, the impoprtance of an adequate investigation of these connections needs to be underscored. Understanding the existence of this variations, its location and its possible presentation is important for correct patient assistance.

Surgical management of Guyon's canal syndrome, an ulnar nerve entrapment at the wrist: report of two cases

Guyon's canal syndrome, an ulnar nerve entrapment at the wrist, is a well-recognized entity. The most common causes that involve the ulnar nerve at the wrist are compression from a ganglion, occupational traumatic neuritis, a musculotendinous arch and disease of the ulnar artery. We describe two cases of Guyon's canal syndrome and discuss the anatomy, aetiology, clinical features, anatomical classification, diagnostic criteria and treatment. It is emphasized that the knowledge of both the surgical technique and anatomy is very important for a satisfactory surgical result

Ramo cutaneo dorsal do nervo ulnar (RCDU): alternativa para biopsia diagnostica em neuropatias perifericas / ?

Co o objetivo de avaliar a importancia e viabilidade da biopsia do ramo cutaneo dorsal do nervo ulnar (RCDU), foram estudadas 14 amostras de nervo retiradas de doadores com morte encefalica e 17 biopsiadas, atraves de incisao transversal, em pacientes com idades de 5 a 73 anos, em investigacao por neuropatia periferica. Em dez pacientes foi verificada a area de hipo/anestesia resultante da biopsia. Os nervos foram fixados em glutaraldeido a 2,5 por cento em tampao cacodilato de sodio, pos-fixados em OsO4, desitratados em etanol e incluidos em resina Epon. Amostras de cada nervo tambem foram incluidas em parafina e coradas pelos metodos de Faraco, tricromico de Gomori, vermelho congo e hematoxilina-eosina. As secoes transversais semifinas foram coradas com azul de toluidina.

Lipofibroma (harmatoma lipofibromatoso) dos nervos mediano e ulnal / Lipofibroma (lipofibromatous hamartoma) of median and ulnar nerves

Lipofibroma ou hamartoma lipofibromatoso dos nervos é uma tumoraçäo rara, benigna, que afeta principalmente o nervo mediano e mais raramente o nervo ulnal. Raramente é observado no nervo radial ou nos membros inferiores. Observa-se infiltraçäo fibroadiposa difusa no interstício do nervo, dissociando os fascículos, sem invadir o tecido nervoso. O quadro clínico é de síndrome compressiva (síndrome do túnel do carpo ou do canal de Guyon). O tratamento é sintomático, isto é, descompressäo do nervo nos túneis osteofibrosos. Säo apresentados dois casos: um de lipofibroma do nervo mediano com seis meses de evoluçäo pós-operatória e outro do nervo ulnar operado há 17 anos, estando ambos assintomáticos e sem sinais de progressäo da tumoraçäo