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Related Experiment Videos

Ulnar neuropathy after median sternotomy

C D Casscells1, R W Lindsey, J Ebersole

  • 1Department of Orthopaedic Surgery, Yale University School of Medicine, New Haven, Connecticut.

Clinical Orthopaedics and Related Research
|June 1, 1993
PubMed
Summary

Post-sternotomy neuropathy may be linked to pre-existing ulnar nerve conduction slowing. Preoperative nerve conduction studies can identify patients at risk for this complication.

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Area of Science:

  • Neurology
  • Neurosurgery
  • Cardiac Surgery

Background:

  • Ulnar neuropathy is a recognized complication following median sternotomy.
  • The exact etiology of this neuropathy remains unclear.
  • A "double-crush" phenomenon is hypothesized, involving intraoperative brachial plexus compression in susceptible individuals.

Purpose of the Study:

  • To investigate the correlation between preoperative ulnar nerve conduction velocity and the incidence of post-median sternotomy neuropathy.
  • To identify patients predisposed to developing ulnar neuropathy after cardiac surgery.

Main Methods:

  • Eighty-four arms from 42 patients undergoing cardiac surgery were assessed.
  • Pre- and postoperative clinical examinations were conducted by blinded evaluators.

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  • Nerve conduction studies (NCS) were performed preoperatively and postoperatively by a single examiner.

    • Main Results:

    • Postoperative neuropathy was observed in 18% of arms (26% of patients).
    • All symptomatic patients exhibited significant slowing in their preoperative nerve conduction studies.
    • A direct correlation was found between preoperative ulnar nerve conduction slowing and the development of post-median sternotomy neuropathy.

    Conclusions:

    • Preoperative slowing of ulnar nerve conduction is a significant risk factor for developing neuropathy after median sternotomy.
    • Preoperative NCS can help identify at-risk patients.
    • Surgeons should consider the possibility of a "double-crush" injury, not an isolated cubital tunnel lesion, in postoperative neuropathy cases.