Variations of the ulnar nerve. A surgical perspective.

A systematic review of ulnar nerve variations is presented. Many of these anomalous neural structures account for the atypical clinical or electromyographic findings that are often a source of diagnostic confusion. Knowledge of these variations will hopefully lessen the likelihood of inadvertent injury and consequent motor and/or sensory loss.

Sensory neural loop of the median nerve at the carpal tunnel.

This article discusses a sensory neural loop on the radial aspect of the median nerve in the palm. The surgeon should be aware of this anomaly when the transverse carpal ligament is divided to approach the structures contained in the carpal canal.

The failed ulnar nerve transposition. Etiology and treatment.

Various procedures have been recommended for the treatment of cubital tunnel syndrome. Simple decompression in situ, medial epicondylectomy, subcutaneous transposition, intramuscular transposition, and submuscular transposition all have their advocates. The results of the surgical treatment for cubital tunnel syndrome are related to the severity of the compressive neuropathy at the time of diagnosis and to the adequate decompression of the nerve at all sites of potential compression at the time of surgical treatment. Fourteen patients who had previously undergone surgical treatment for cubital tunnel syndrome were evaluated because of persistent pain, paresthesia, numbness, and motor weakness. All patients had documented persistent compression of the ulnar nerve on clinical and electromyographic evaluation. The indication for repeat surgical exploration in all patients was unremitting pain despite nonoperative treatment. All patients had been treated by neurolysis and submuscular transposition of the ulnar nerve as described by Learmonth. The causes of continued pain after initial surgery included retention of the medial intermuscular septum, dense perineural fibrosis of the nerve after intramuscular and subcutaneous transposition, adhesions of the nerve to the medial epicondylectomy site, and recurrent subluxation of the nerve over the medial epicondyle after subcutaneous transposition. Revision surgery was found to be highly successful for relief of pain and paresthesias; however, the recovery of motor function and return of sensibility were variable and unpredictable.

A neural loop of the deep motor branch of the ulnar nerve: an anatomic study.

A motor neural loop of the deep branch of the ulnar nerve was encountered on three occasions during neurolysis of the ulnar nerve through Guyon's canal. An anatomic study of the course of the deep motor branch of the ulnar nerve at the wrist was done to define the incidence of this neural loop. Seventy-seven cadaveric upper extremities were examined and seven (9%) cases of a neural loop were encountered. One of these cases was bilateral. This variation should be considered when there is an atypical clinical presentation after penetrating injuries or compression neuropathy of the ulnar nerve at the wrist. In addition, care must be taken not to injure this branch during decompression of Guyon's canal or excision of an ununited of the hook of the hamate.

Pyoderma gangrenosum complicating infection of the hand. A case report and review of the literature.

Pyoderma gangrenosum is infrequently encountered by the orthopedic surgeon. The appearance of progressive, painful bullae followed injury and infection in a 56-year-old man. The treatment consisted of a search for an associated underlying systemic disease in concert with high-dose steroids. The etiology is not known.

Variation of the deep motor branch of the ulnar nerve at the wrist.

An unusual variation in the course of the deep motor branch of the ulnar nerve is described. This anomaly should be kept in mind during operations for fractures of the hook of the hamate and also in atypical clinical patterns of denervation caused by trauma or compressive neuropathies.

Radiographic evaluation of the hook of the hamate: a new technique.

Radiographic confirmation in cases of suspected hook of hamate fractures can be very difficult. Films, including the carpal tunnel view, may be difficult to interpret. We describe a new semisupine oblique radiographic view of the carpus that permits excellent visualization of the hamate hook, is cost efficient, and allows for patient comfort during the study.

Fracture-dislocations of all five carpometacarpal joints: a case report.

Injuries to all five carpometacarpal joints are rare. Only four cases have been reported in the English literature. A case of fracture-dislocations of all five carpometacarpal joints is presented. An excellent result has been obtained 2 years after open reduction and internal fixation. This case is the only one in the English literature so treated and with prolonged follow-up.