ABSTRACT
INTRODUCTION: The best treatment strategy for mild ulnar neuropathy at the elbow (UNE) is not known, due to lack of trials comparing surgery vs conservative treatment. METHODS: We recruited patients with clinical symptoms and signs of mild UNE and an electrophysiologically or sonographically confirmed diagnosis. Patients were randomly allocated to either in situ decompression or conservative treatment. The primary outcome was the proportion of patients with subjective symptom improvement at short-term (3 months) and long-term (6-12 months) follow-up. RESULTS: One hundred seventeen patients were included: 56 and 61 patients were allocated to surgery and conservative treatment, respectively. A larger proportion of surgically treated patients showed improvement at short-term follow-up (85% vs 50%; odds ratio, 5.6; P < .001), but no differences were observed at long-term follow-up. DISCUSSION: In situ decompression for mild UNE may result in faster relief of symptoms when compared with conservative treatment, but at long-term follow-up no differences were observed.
Subject(s)
Conservative Treatment/methods , Decompression, Surgical/methods , Elbow , Ulnar Neuropathies/therapy , Action Potentials , Adult , Aged , Aged, 80 and over , Electrodiagnosis , Female , Humans , Hypesthesia/physiopathology , Male , Middle Aged , Muscle Weakness/physiopathology , Neural Conduction , Paresthesia/physiopathology , Severity of Illness Index , Time Factors , Treatment Outcome , Ulnar Neuropathies/diagnostic imaging , Ulnar Neuropathies/physiopathology , UltrasonographySubject(s)
Cubital Tunnel Syndrome/diagnosis , Electrodiagnosis , Ulnar Nerve/diagnostic imaging , Female , Humans , Male , UltrasonographyABSTRACT
INTRODUCTION: The aim of this study was to assess the presence of (sub)luxation of the ulnar nerve in patients with ulnar neuropathy at the elbow (UNE) compared with healthy controls (HC). We assessed its clinical patterns, electrodiagnostic, and sonographic characteristics. METHODS: Using high-resolution sonography, we studied the incidence of (sub)luxation in a cohort of 342 patients and 70 HC. RESULTS: Subluxation occurred in 14% and luxation in 6.7% of the UNE patients versus 5.7% and 5.7%, respectively, in HC (no significant differences). Pain at the elbow occurred more often in patients with (sub)luxation (P = 0.007). Electrodiagnostic and sonographic findings did not differ between patients with or without (sub)luxation. CONCLUSIONS: The incidence of ulnar nerve (sub)luxation between patients with UNE and HC does not differ. UNE patients with (sub)luxation do not have specific clinical or electrodiagnostic findings, apart from experiencing pain at the elbow more often.
Subject(s)
Cubital Tunnel Syndrome/diagnosis , Electrodiagnosis , Ulnar Nerve/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Female , Humans , Male , Middle Aged , Neural Conduction , Prospective Studies , Ulnar Nerve/physiopathology , Ultrasonography , Young AdultABSTRACT
OBJECTIVE: To compare the diagnostic accuracy of ultrasonographic ulnar nerve diameter, cross-sectional area (CSA) and swelling ratio measurement in ulnar neuropathy at the elbow (UNE). METHODS: Ultrasonographic diameter, CSA, and swelling ratio measurements were compared with a reference standard including clinical examination, electrophysiological studies, and follow-up in a prospective cohort of patients. All patients in whom a diagnosis of UNE was considered were eligible for the study. Reference values for ultrasonography were obtained in 73 healthy volunteers. RESULTS: Of 191 patients, 137 had UNE or probable UNE, while 54 had another condition and these were analysed as patient controls. Patients with UNE had a larger ulnar nerve diameter, CSA and swelling ratio than healthy controls and patient controls (p < 0.01). The diagnostic accuracies of these different measurements were comparable with a specificity of 78-87%, a positive predictive value of 87-90%, a sensitivity of 42-61% and negative predictive value of 37-44%. ROC-analysis for these measurements showed an area under the curve of 0.75-0.77. CONCLUSION: Ultrasonographic measurements of ulnar nerve diameter, CSA and swelling ratio have comparable diagnostic value, which was lower than reported previously. SIGNIFICANCE: Ultrasonographic ulnar nerve diameter, CSA and swelling ratio measurements are equally useful in diagnosing UNE.
Subject(s)
Elbow/diagnostic imaging , Ulnar Neuropathies/diagnostic imaging , Adult , Aged , Aged, 80 and over , Elbow/innervation , Electrodiagnosis , Female , Humans , Male , Middle Aged , Motor Neurons , Neural Conduction , Neurologic Examination , Polyneuropathies/diagnostic imaging , Prospective Studies , ROC Curve , Reference Values , Ulnar Nerve/diagnostic imaging , Ulnar Neuropathies/diagnosis , Ultrasonography , Young AdultABSTRACT
BACKGROUND: Avellis' syndrome (lateral medulla oblongata ischaemia) is a rare neurological disorder. Early recognition of brain stem infarction may prevent referral to specialists other than a neurologist. CASE DESCRIPTION: A 53-year-old woman was initially presented to an internist with acute onset of headache, dysphagia, nausea and vomiting. She was also hoarse and had a tingling feeling on the left side of her face, and in her left arm and leg. A neurologist was consulted and diagnosed Avellis' syndrome. MRI of the brain revealed ischaemia in the lateral medulla oblongata on the right side. CONCLUSION: Brain stem infarction may be hard to recognize as lateralization is often less predominant than in hemispheric syndromes. In acute onset of dysphagia, the differential diagnosis should always include brain stem infarction.
