Objective To report the operation method and the cl inical effect of decompression and anterior transposition of the ulnar nerve with inferior ulnar collateral artery for cubital tunnel syndrome. Methods From September 2005 to May 2006, 25 cases of cubital tunnel syndrome were treated by the method of decompression and anterior transposition of the ulnar nerve with inferior ulnar collateral artery. There were 19 males and 6 females with an average of 60 years (20-72 years). The disease course was 2 months to 3 years (mean 6.7 months). The causes were ostesarthritis in 23 cases, cubital tunnel cyst in 1 case and ulnar nerve ol isthy in 1 case. According to Pasque grading system for cubital tunnel syndrome, 19 cases were graded as good and 6 cases were graded as poor. Electrophysiological examination showed the motor nerve conduction velocity of the ulnar nerve around the elbow joint was less than 42 m/s. Results All wounds healed by first intention and no operative compl ications and recurrences occurred. All patients were followed up for one year to two and half years (13.9 months on average). According to Pasque grading system for cubital tunnel syndrome, 15 cases were graded as excellent, 9 cases as good and 1 case as fair. The excellent and good rate was 96%, indicating a significant difference compared with the results before operation (P lt; 0.05). Electrophysiological examination showed the motor nerve conduction velocity of the ulnar nerve around the elbow joint was more than 42 m/s. Conclusion The method of decompression and anterior transposition of the ulnar nerve with inferior ulnar collateral artery is safe and effective for the treatment of cubital tunnel syndrome.
Objective To discuss the optimal approach to treat suprascapular nerve compression syndrome. Methods From January 2000 to June 2003, 8 cases of suprascapular nerve compression syndrome were treated by surgical intervention to cut the transverse scapular ligament through posterior approach. Of the 8 patients, there were 2 males and 6 females (age ranged from 21 to 53) with duration of 6 months to 3 years. The change of symptom, muscle power, and muscle atrophy after operation were observed. Results One week after operation, pain around the scapular disappeared, muscle power of supraspinatus and infraspinatus muscles recovered to normal. One, 6, 12 and 16 months after the operation, the patients were followed up. No recurrence was observed. Muscle atrophy didn’t recover.Conclusion To treat suprascapular nerve compression syndrome with operation through posterior approach is easy to operate. When the suprascapular nerve is entrapped in scapular notch, this approach is a good choice.
Objective To discuss the concept of ulnar tunnel at thewrist, the types, causes, traits of compression, diagnosis, and clinical significance of ulnar tunnel syndrome(UTS). Methods Thirty-nine cases diagnosed as having UTS from 1986 were retrospectively reviewed combined with previous relevant literature. Results Ulnar tunnel included Guyon’s canal, pisohamate tunnel and hypothenar segment. There were 8 types andmany causes of UTS. Some patients had compression in more than one zones and might be associated with carpal tunnel syndrome or cubital tunnel syndrome. UTS could be diagnosed through clinical manifestations and electrophysiological examination. Conclusion Defining the concept of ulnar tunnel and the knowledge of the complexity and rarity of UTS can effectively guide diagnosis and treatment.
Objective To produce anatomical theory evidence for treatment of cubital tunnel syndrome with anterior submuscular transposition.Methods Of 32 patients with cubital tunnel syndrome, there were 22 males and 10 females, aged 17-73 years. The distribution of the branches of superior ulnar collateral arteryand the relationship between superior ulnar collateral artery and ulnar nerve were observed; the position, scope and diameter of ulnar nerve lesion were also observed; the volume of new cubit tunnel was measured with dilator. Twenty cubituses of adult cadavers were made the models of anterior subcutaneous transposition and anterior submuscular transposition of ulnar nerve. Length changes of ulnar nerve in different situations were observed.Results Superior ulnar collateral artery could be transposed with ulnar nerve, and new cubit tunnel was wide enough to contain ulnar nerve. In the context of anterior subcutaneous transposition, the ulnar nerve was lengthened by 7.55%±0.52% when compared with that of preoperation in the case of elbow extension, there was significant difference (P＜0.05). In the context of anterior submuscular transposition, there was nosignificant difference in length of the ulnar nerves between preoperation and postoperation(P＞0.05).Conclusion Anterior submuscular transposition can overcome compression and pull of elbow on the ulnar nerve and has sufficient blood supply. New cubital tunnel is wide enough to contain ulnar nerve. Ulnar nerve anterior submuscular transposition is a useful method in treating cubital tunnel syndrome.
OBJECTIVE: To investigate the mechanism, diagnosis, and treatment of common fibular nerve compression syndrome secondary to sciatic nerve injury. METHODS: Based on the clinical manifestation and Tinel’s sign at fibular tunnel, 5 cases of common fibular nerve secondary compression following sciatic nerve injury were identified and treated by decompression and release of fibular tunnel. All 5 cases were followed up for 13-37 months, 25 months in average, and were evaluated in dorsal flexion strength of ankle. RESULTS: The dorsal flexion strength of ankle in 4 cases increased from 0-I degrees to III-V degrees, and did not recover in 1 case. CONCLUSION: Fibular tunnel is commonly liable to fibular nerve compression after sciatic nerve injury. Once the diagnosis is established, either immediate decompression and release of the entrapped nerve should be done or simultaneous release of fibular tunnel is recommended when the sciatic nerve is repaired.
OBJECTIVE: To investigate the compression feature, clinical manifestation and the results of treatment of quadrilateral space syndrome. METHODS: Four patients with axillary nerve entrapment at quadrilateral space had been treated and followed up for 5 to 12 months from May 1999 to June 2000. The causes, symptoms, signs and the treatment management of those cases were analyzed. RESULTS: Among the 3 cases which received operation, sensation and motor function completely recovered in 2 cases and partially recovered in 1 case. No obvious recovery of sensation and motor function in the case which received local nerve blocking treatment. CONCLUSION: The main diagnostic evidence for axillary nerve entrapment is the deltoid muscle paralysis and paresthesia in the lateral side of shoulder, and early neurolysis is recommended as soon as the diagnosis is clarified.
OBJECTIVE To investigate the compression factor and clinical manifestation of the compression of deep branch of the ulnar nerve at the wrist. METHODS Anatomic study was done on both sides of 10 cadavers, the deep branch of ulnar nerve, the Guyon’s canal and the flexor digiti minimi brevis pedis were observed. Then from Jan. 1990 to Jan. 1997, 5 patients with compression of the deep branch of ulnar nerve at the wrist were treated clinically. Among them, there were 4 males and 1 female, aged from 37 to 48 years and the course of disease ranged from 1 to 5 months. RESULTS The motor branch of the ulnar nerve passed under the tendinous arcade of flexor digiti minimi brevis pedis. Occasionally, the branch of ulnar artery overpassed the motor branch. Clinically, the tendinous arcade compressed the motor branch was released, and after 2 to 4 years follow-up, the clinical results were satisfactory. CONCLUSION The main compression factor of the ulnar nerve at the wrist is the tendinous arcade of the flexor digiti minimi brevis pedis, the tendinous arcade should be released sufficiently during the operation.
OBJECTIVE To study the compression factor and clinical manifestation of the compression of the palmar cutaneous branch of the median nerve. METHODS Anatomic study was done on both sides of 2 cadavers and 6 cases of hand injury in the debridement, the origin, course, branch of the palmar cutaneous branch of the median nerve were observed. From 1995 to 1998, 12 patients of compression of the palmar cutaneous branch were treated by local blockade injection. Among them, there were 8 males and 4 females, aged from 23 to 65 years and the course of disease ranged 3 to 12 months. RESULTS The palmar cutaneous branch of the median nerve was (1.3 +/- 0.1) mm in diameter, it could be pulled when the wrist dorsi-extension. All cases showed good recovery of hand function and no recurrence after 4 to 12 months follow-up. CONCLUSION The palmar cutaneous branch compression syndrome is closely related to the local anatomy. The diagnosis is definite according to the clinical symptoms and signs, and local blocking is effective on the most patients.
In order to investigate the effect of nerve compression on neurons, the commonly used model of chronic nerve compression was produced in 48 SD rats. The rats were sacrificed in 1, 2, 3, 4, 5 and 6 months after compression, respectively. The number of neuron and ultrashruchure of alpha-motor neurons and ganglion cells of the corresponding spinal segment were examined. The results showed as following: After the sciatic nerve were crushed, the number of neuron and ultrastructure of alpha-motor neurons and ganglion cells might undergo ultrastructural changes, and even the death might occur. These changes might be aggravated as the time of crushing was prolonged and the compression force was increased. It was concluded that for nerve compression, decompression should be done as early as possible in order to avoid or minimize the ultructural changes of the neuron.