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Does the ulnar nerve enlarge after surgical transposition?

Michael M Vosbikian1, T David Tarity2, Levon N Nazarian2

  • 1Departments of Orthopedic Surgery (M.M.V., T.D.T., A.M.I.) and Diagnostic Radiology (L.N.N.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania USA. michael.vosbikian@gmail.com.

Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine
|August 27, 2014
PubMed
Summary

Symptomatic transposed ulnar nerves that failed surgery had a significantly larger cross-sectional area (CSA) than those in situ. These findings suggest current reference ranges for ulnar nerve CSA may need revision after transposition surgery.

Keywords:
cross-sectional areacubital tunnel syndromefailed ulnar nerve transpositionmusculoskeletal ultrasoundsonographyulnar neuropathy

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Area of Science:

  • Neurology
  • Orthopedic Surgery
  • Medical Imaging

Background:

  • Cubital tunnel syndrome is a common entrapment neuropathy.
  • Ulnar nerve transposition is a surgical treatment for cubital tunnel syndrome.
  • Nerve cross-sectional area (CSA) measured by ultrasound can indicate neuropathy.

Purpose of the Study:

  • To test if symptomatic transposed ulnar nerves have a larger CSA than symptomatic in situ ulnar nerves.
  • To investigate potential differences in nerve CSA after failed ulnar nerve transposition.

Main Methods:

  • Retrospective review of 68 patients with failed ulnar nerve transposition and 48 controls with cubital tunnel syndrome.
  • Sonographic measurement of ulnar nerve CSA and assessment of echogenicity.
  • Comparison of preoperative and postoperative sonograms when available.

Main Results:

  • Failed transposition group: mean CSA 17.26 mm² vs. control group: mean CSA 13.45 mm² (P = .018).
  • Nontransposed nerves showed more identifiable compression sites.
  • Trend towards postoperative nerve enlargement observed.

Conclusions:

  • Patients with failed ulnar nerve transposition exhibit significantly enlarged ulnar nerve CSA.
  • The findings suggest a need to revise reference ranges for ulnar nerve CSA in postsurgical patients.
  • Etiology for CSA enlargement remains undetermined.