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1.
Rev. Bras. Ortop. (Online) ; 58(3): 449-456, May-June 2023. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1449834

RESUMEN

Abstract Objective The endoscopic release of the ulnar nerve reproduces a simple (in situ) procedure with smaller incisions, less soft tissue damage, and higher preservation of nerve vascularization. Endoscopy allows the clear visualization of the entire path of the nerve and surrounding noble structures. Moreover, it reveals any signs of compression and allows a safe release of 10cm distally or proximally to the medial epicondyle. Methods A retrospective survey revealed that 15 subjects (1 with a bilateral injury) underwent an ulnar nerve compression release at the elbow using the endoscopic technique with Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA) equipment from January 2016 to January 2020. Results Symptoms of ulnar nerve compression improved in all patients; on average, they resumed their work activities in 26.5 days. There was no recurrence or need for another procedure. In addition, there were no severe procedure-related complications, such as infection and nerve or vascular injury. One patient had transient paresthesia of the sensory branches to the forearm, with complete functional recovery in 8 weeks. Conclusion Our study shows that the endoscopic release of the ulnar nerve at the elbow with the Agee equipment is a safe, reliable technique with good outcomes.


Resumo Objetivo A liberação endoscópica do nervo ulnar permite reproduzir uma liberação simples (in situ), mas através de incisões menores e com menor lesão de partes moles e uma maior preservação da vascularização do nervo. A visualização clara através da endoscopia permite observar todo o trajeto do nervo e das estruturas nobres circundantes, mostrando os sinais de compressão, possibilitando realizar a liberação de forma segura em um trajeto de 10 cm nos sentidos distal e proximal ao epicôndilo medial. Método Foram encontrados, de forma retrospectiva, no período entre janeiro de 2016 e janeiro de 2020, 15 pacientes (sendo 1 com lesão bilateral) submetidos a liberação da compressão do nervo ulnar no cotovelo pela técnica endoscópica com equipamento de Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA). Resultados Todos os pacientes tiveram melhora dos sintomas de compressão do nervo ulnar e o período de retorno ao trabalho foi de em média 26,5 dias. Não houve recidivas e não houve a necessidade de outro procedimento. Também não houve complicações graves decorrentes do procedimento, como infecção, lesão nervosa ou vascular. Em um paciente, houve parestesia transitória dos ramos sensitivos para o antebraço, com retorno completo da função em 8 semanas. Conclusão Os resultados mostram que a liberação endoscópica do nervo ulnar no cotovelo comoequipamentodeAgeeéuma técnica segura, confiável e com bons resultados.


Asunto(s)
Humanos , Parestesia , Procedimientos Quirúrgicos Mínimamente Invasivos , Síndrome del Túnel Cubital/terapia , Codo/cirugía , Síndromes de Compresión Nerviosa
2.
Rev. Bras. Ortop. (Online) ; 58(1): 114-120, Jan.-Feb. 2023. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1441346

RESUMEN

Abstract Objectives To better characterize the role of endoscopic cubital tunnel release in leprosy neuritis and determine whether there is an improvement in pain, sensitivity, and strength with the use of this minimally invasive technique. Methods A total of 44 endoscopic procedures for ulnar nerve decompression at the elbow were performed in patients who were previously diagnosed with leprosy neuritis. The inclusion criteria were surgical indication for ulnar nerve release and clinical treatment failure for 4 weeks in patients with cubital tunnel syndrome who had their ulnar nerve function, whether motor or sensitive, deteriorated progressively despite the treatment with prednisone 1 mg/kg/day and physiotherapy. For endoscopic release, the CTS Relief Kit (Linvatec. Largo, FL, USA) and a standard 4mm 30° arthroscope were used. Results The study included 39 patients, 29 (74.4%) males and 10 (25.6%) females. The age of the patients ranged from 12 to 64 years (33 ± 14.97). Five patients underwent bilateral release. The release demonstrated a statistically significant improvement in pain (p 0.002), in sensitivity (p< 0.001), and in strength (p< 0.001). The best results were obtained when ulnar release was performed less than 6 months after surgery indication. None of the procedures were converted from endoscopic to open. No major complications (infection, vascular injury, and nervous injury) were reported. One patient had ulnar nerve subluxation. Conclusion The endoscopic release of the ulnar nerve at the elbow in leprosy neuritis entails true and safe benefits for the patient, such as improvement in pain, sensitivity and strength.


Resumo Objetivos Os objetivos deste estudo foram caracterizar melhor o papel da liberação endoscópica do túnel cubital na neurite hansênica e determinar se há melhora da dor, sensibilidade e força com esta técnica minimamente invasiva. Métodos Um total de 44 procedimentos endoscópicos para descompressão do nervo ulnar no cotovelo foram realizados em pacientes previamente diagnosticados com neurite por hanseníase. Os critérios de inclusão foram indicação cirúrgica para liberação do nervo ulnar e insucesso do tratamento clínico por 4 semanas em pacientes com síndrome do túnel cubital que sofreram deterioração progressiva da função motora ou sensitiva do nervo ulnar apesar do tratamento de 1 mg/kg/dia de prednisona e fisioterapia. A liberação endoscópica foi realizada com CTS Relief Kit (Linvatec. Largo, FL, EUA) e um artroscópio padrão de 4 mm e 30°. Resultados O estudo incluiu 39 pacientes, sendo 29 (74,4%) homens e 10 (25,6%) mulheres. A idade dos pacientes variou de 12 a 64 anos (33 ± 14,97). Cinco pacientes foram submetidos à liberação bilateral. A liberação provocou melhora estatisticamente significativa de dor (p= 0,002), sensibilidade (p <0,001) e força (p <0,001). Os melhores resultados foram obtidos quando a liberação ulnar foi realizada em menos de 6 meses após a indicação da cirurgia. Nenhum procedimento foi convertido de endoscópico para aberto. Não foram relatadas complicações maiores (infecção, lesão vascular e lesão nervosa). Um paciente apresentou subluxação do nervo ulnar. Conclusão A liberação endoscópica do nervo ulnar no cotovelo na neurite hansênica traz benefícios verdadeiros e seguros para o paciente, como melhora da dor, sensibilidade e força.


Asunto(s)
Humanos , Neuropatías Cubitales , Síndrome del Túnel Cubital/terapia , Endoscopía
3.
J Hand Surg Am ; 48(6): 622.e1-622.e7, 2023 06.
Artículo en Inglés | MEDLINE | ID: mdl-35221174

RESUMEN

PURPOSE: Cubital tunnel syndrome is the second most common upper-extremity compressive neuropathy, and persistent symptoms can necessitate operative treatment. Surgical options include simple decompression and ulnar nerve transposition. The cause of wound dehiscence after surgery is not well known, and the factors leading to the development of these complications have not been previously described. METHODS: Patients undergoing ulnar nerve surgery from January 1, 2016, to December 31, 2019, were retrospectively evaluated for the development of wound dehiscence within 3 months of surgery. There were 295 patients identified who underwent transposition and 1,106 patients who underwent simple decompression. Patient demographics and past medical history were collected to evaluate the risk factors for the development of wound dehiscence. RESULTS: The overall rate of wound dehiscence following surgery was 2.5%. In the simple decompression group, the rate of wound dehiscence was 2.7% (30/1,106), which occurred a mean of 21 days (range, 2-57 days) following surgery. In the transposition group, the rate of wound dehiscence was 1.7% (5/295), which occurred a mean of 20 days (range, 12-32 days) following surgery. The difference in rates of dehiscence between the decompression and transposition groups was not significant. Five patients in the simple decompression group and 1 patient in the transposition group required a secondary surgery for closure of the wound. Age, body mass index, smoking status, and medical comorbidities were not found to contribute to the development of wound dehiscence. CONCLUSIONS: Wound dehiscence can occur following both simple decompression and transposition, even after postoperative evaluation demonstrates a healed wound. Surgeons should be aware of this possibility and specifically counsel patients about remaining cautious with, and protective of, their wound for several weeks after surgery. Dehiscence may be related to suboptimal vascularity in the soft tissue envelope in the posteromedial elbow. When it occurs, dehiscence can generally be treated by allowing healing by secondary intention. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Asunto(s)
Síndrome del Túnel Cubital , Codo , Humanos , Estudios Retrospectivos , Codo/cirugía , Descompresión Quirúrgica/efectos adversos , Nervio Cubital/cirugía , Nervio Cubital/fisiología , Síndrome del Túnel Cubital/cirugía , Síndrome del Túnel Cubital/diagnóstico , Complicaciones Posoperatorias/cirugía , Resultado del Tratamiento
4.
Surg Radiol Anat ; 43(5): 713-720, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33420865

RESUMEN

PURPOSE: The cubital tunnel is limited anteriorly by the medial epicondyle (ME), laterally by the medial collateral ligament, and superiorly by Osborne's fascia and the cubital tunnel retinaculum. Previous studies were mostly dedicated to the roof of the cubital tunnel, in the way that the study of the groove for ulnar nerve and ME anatomy is relatively scarce in the literature. We sought to describe the radiological anatomy of the groove for ulnar nerve and ME in healthy volunteers with multiplanar computed tomography (CT). METHODS: We analyzed 3D CT images of 30 healthy volunteers (mean age 39 years, range 18-66 years). Nine variables were measured from the right elbow, including sizes, areas and angles in two different planes (coronal and axial). RESULTS: Mean ME width and length were 17.3 ± 3.5 mm and 31.7 ± 4.5 mm, respectively. According to categorical correlation studies, ME width (X) was deemed the most representative morphological characteristic because of the positive correlation to five other different anatomical measurements. A three-tiered anatomical classification was proposed based on data distribution. CONCLUSION: Large individual variation is found in the shape of ME, both in coronal and axial planes. The knowledge of individual osseous morphology is of great value potentially contributing to the surgical decision-making in patients affected by cubital tunnel syndrome.


Asunto(s)
Variación Anatómica , Codo/inervación , Húmero/inervación , Nervio Cubital/anatomía & histología , Adolescente , Adulto , Anciano , Estudios Transversales , Síndrome del Túnel Cubital/etiología , Síndrome del Túnel Cubital/cirugía , Codo/diagnóstico por imagen , Femenino , Voluntarios Sanos , Humanos , Húmero/diagnóstico por imagen , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Adulto Joven
6.
J Hand Surg Am ; 45(3): 252.e1-252.e6, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31420244

RESUMEN

PURPOSE: To determine whether the triceps sling reconstruction technique is a safe and effective treatment of intraoperative ulnar nerve subluxation after in situ decompression. METHODS: Twelve patients who underwent a triceps sling reconstruction for intraoperative ulnar nerve subluxation after in situ release were retrospectively reviewed. The triceps sling technique consists of harvesting a small, distally based strip of triceps tendon and suturing the proximal end of the strip to the posterior aspect of the released Osborne ligament. Thus, a sling is created between the medial epicondyle and the olecranon, preventing the nerve from subluxating. Patients were clinically evaluated before and after surgery. Visual analog scale pain scores, static 2-point discrimination, strength, and Disabilities of the Arm, Shoulder, and Hand score were assessed. RESULTS: At a mean follow-up of 31 months (range, 24-38 months), there was a significant improvement in mean visual analog pain scores from 8.6 to 0.2. Static 2-point discrimination was improved from a mean of 9.1 mm before surgery to 5.7 mm afterward. Strength improved by a mean of 33% and 30% with grip and pinch, respectively. Mean Disabilities of the Arm, Shoulder, and Hand score improved from 45.9 to 3.7. No subluxation of the ulnar nerve was noted after surgery. No other complications were noted. No reoperations were required during the follow-up period. CONCLUSIONS: Triceps sling reconstruction is a safe treatment in patients with intraoperative ulnar nerve subluxation after in situ decompression. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Asunto(s)
Síndrome del Túnel Cubital , Nervio Cubital , Brazo , Síndrome del Túnel Cubital/cirugía , Descompresión Quirúrgica , Humanos , Estudios Retrospectivos , Nervio Cubital/cirugía
7.
Acta ortop. mex ; 33(5): 303-307, sep.-oct. 2019. tab, graf
Artículo en Español | LILACS | ID: biblio-1284961

RESUMEN

Resumen: Introducción: El síndrome del túnel cubital es la segunda neuropatía por compresión de la extremidad superior, seguido del síndrome del túnel del carpo, por lo que es un motivo de consulta frecuente dentro de la cirugía de mano. Existen pocos estudios publicados acerca de la técnica endoscópica. Material y métodos: Se incluyeron 26 pacientes con el diagnóstico clínico y electromiográfico de síndrome de túnel cubital, en quienes se realizó liberación endoscópica del túnel cubital. Nueve (35%) fueron mujeres y 17 (65%) hombres. Se utilizó la clasificación de McGowan modificada y la clasificación de Wilson y Krout para analizar las características de las variables en su estado prequirúrgico y postquirúrgico. Resultados: Posterior a la intervención, obtuvimos 18 pacientes (69%) con resultado excelente, seis (24%) con un buen resultado y dos (7%) con resultados regulares o aceptables, obteniendo una p significativa con un valor < 0.05. Conclusión: La liberación endoscópica del túnel cubital se considera una técnica segura, con buenos resultados.


Abstract: Introduction: The ulnar tunnel syndrome is the second compressive neuropathy, followed by the carpal tunnel, making it a frequent reference in hand surgery. There are few published studies about endoscopic technique. Material and methods: We studied 26 patients with ulnar tunnel syndrome diagnosis, were operated by endoscopic release of the ulnar tunnel. Nine women (35%) and 17 (65%) male patients. We used the modified McGowan, and the Wilson and Krout classification to analyze preoperative and postoperative variables. Results: After endoscopic decompression we obtained 18 patients (69%) with excellent evolution, 6 (24%) with good evolution, and 2 (7%) with acceptable outcome. We obtained a significant p of < 0.05. Conclusion: Endoscopic decompression of the ulnar tunnel is a safe technique, less invasive and with good outcome.


Asunto(s)
Humanos , Masculino , Femenino , Descompresión Quirúrgica , Síndrome del Túnel Cubital/cirugía , Nervio Cubital , Resultado del Tratamiento , Vértebras Lumbares
8.
Arq. bras. neurocir ; 38(1): 1-6, 15/03/2019.
Artículo en Inglés | LILACS | ID: biblio-1362608

RESUMEN

Introduction Cubital tunnel syndrome (CTS) is responsible for one of the types of ulnar nerve neuropathy and is the second cause of compressive neuropathy of the upper limb, only surpassed by carpal tunnel syndrome. Objective To describe the epidemiological data of the ulnar nerve transposition surgical code in the treatment of CTS by the United Health System (SUS) from 2005 to 2015. Methodology This is a descriptive epidemiological study, in which data were obtained through consultation of the DATASUS database. Results/Discussion During this period, 774 procedures were performed and, despite the addition of 20.3 million people to the Brazilian population, the incidence was 0.33/ 1,000,000. National and international epidemiology point to a slightly higher prevalence of the procedure between men, in the fourth and fifth decades of life. Low permanence rate, as well as the absence of hospital deaths related to the procedure, infer that the procedure is safe, with low morbidity and mortality rates. Conclusion The annual incidence of the cubital syndrome submitted to surgical treatment at SUS in the Brazilian population was 1/7,670,833 in 2005 and½,174,468 in 2015. The cost of each surgical procedure during the same period ranged from R$ 318.88 to R$ 539.74. The mean hospitalization time for CTS surgery was 1.85 days.


Asunto(s)
Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Sistema Único de Salud , Costos de Hospital/estadística & datos numéricos , Síndrome del Túnel Cubital/mortalidad , Síndrome del Túnel Cubital/epidemiología , Brasil/epidemiología , Epidemiología Descriptiva , Tiempo de Internación/estadística & datos numéricos
9.
J Hand Surg Am ; 44(8): 697.e1-697.e6, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30420193

RESUMEN

PURPOSE: To determine the minimum incision size needed using an open cubital tunnel technique to obtain equivalent visualization comparable with an endoscopic technique. METHODS: Visualization was assessed in 10 fresh-frozen cadavers with a 2-cm incision, using percutaneous needle localization with the endoscopic system. The most proximal and distal extent of the field of view was marked. Next, an open cubital tunnel release was performed on each cadaver specimen. The incision size was increased incrementally, and the most proximal and distal extents of visualization were recorded for each incision size. The mean visualization distance and standard deviation for each incisional length were calculated. RESULTS: The mean proximal field of view with the endoscopic technique was 8.1 cm. The mean distal field of view was 8.3 cm. Using the open technique, a 2-cm incision allowed 5.9 cm visualization proximally and 5.2 cm distally, which was significantly less than the endoscopic view. A 4-cm open incision provided similar visualization as the endoscopic technique. A 6-cm open incision was required to obtain statistically significant improvements in visualization compared with an endoscopic technique. CONCLUSIONS: A 4-cm open incision allowed visualization of approximately 9 cm proximal and 9 cm distal to the medial epicondyle, which was equivalent to the 2-cm endoscopic technique for cubital tunnel release. CLINICAL RELEVANCE: Although the endoscopic release allows greater visualization of the ulnar nerve with a smaller incision, it is unclear whether this improvement in visualization improves the surgeon's ability to decompress the ulnar nerve.


Asunto(s)
Síndrome del Túnel Cubital/cirugía , Descompresión Quirúrgica/métodos , Endoscopía/métodos , Procedimientos Neuroquirúrgicos/métodos , Cadáver , Humanos
10.
J Hand Surg Am ; 44(1): 35-38, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30502014

RESUMEN

PURPOSE: To assess the use of preoperative, dynamic ultrasound to predict ulnar nerve instability following in situ decompression for cubital tunnel syndrome. METHODS: Prior to undergoing in situ decompression, 43 consecutive patients underwent dynamic ultrasound to assess the stability of the ulnar nerve during elbow flexion. The dynamic ultrasound findings were compared with the intraoperative assessment of nerve stability following in situ decompression. RESULTS: The preoperative dynamic ultrasound agreed with intraoperative findings in 38 of 43 patients (88%). Physical examination of ulnar nerve stability agreed with the intraoperative findings in 5 of 43 patients (12%). For the 5 of 43 cases in which the dynamic ultrasound did not correlate with the degree of ulnar nerve stability after in situ decompression, dynamic ultrasound overestimated the degree of ulnar nerve stability in 4 cases. CONCLUSIONS: Preoperative dynamic ultrasound can be used to accurately predict the degree of ulnar nerve instability following in situ decompression. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.


Asunto(s)
Síndrome del Túnel Cubital/cirugía , Descompresión Quirúrgica , Nervio Cubital/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Ultrasonografía
11.
Acta Ortop Mex ; 33(5): 303-307, 2019.
Artículo en Español | MEDLINE | ID: mdl-32253852

RESUMEN

INTRODUCTION: The ulnar tunnel syndrome is the second compressive neuropathy, followed by the carpal tunnel, making it a frequent reference in hand surgery. There are few published studies about endoscopic technique. MATERIAL AND METHODS: We studied 26 patients with ulnar tunnel syndrome diagnosis, were operated by endoscopic release of the ulnar tunnel. Nine women (35%) and 17 (65%) male patients. We used the modified McGowan, and the Wilson and Krout classification to analyze preoperative and postoperative variables. RESULTS: After endoscopic decompression we obtained 18 patients (69%) with excellent evolution, 6 (24%) with good evolution, and 2 (7%) with acceptable outcome. We obtained a significant p of 0.05. CONCLUSION: Endoscopic decompression of the ulnar tunnel is a safe technique, less invasive and with good outcome.


INTRODUCCIÓN: El síndrome del túnel cubital es la segunda neuropatía por compresión de la extremidad superior, seguido del síndrome del túnel del carpo, por lo que es un motivo de consulta frecuente dentro de la cirugía de mano. Existen pocos estudios publicados acerca de la técnica endoscópica. MATERIAL Y MÉTODOS: Se incluyeron 26 pacientes con el diagnóstico clínico y electromiográfico de síndrome de túnel cubital, en quienes se realizó liberación endoscópica del túnel cubital. Nueve (35%) fueron mujeres y 17 (65%) hombres. Se utilizó la clasificación de McGowan modificada y la clasificación de Wilson y Krout para analizar las características de las variables en su estado prequirúrgico y postquirúrgico. RESULTADOS: Posterior a la intervención, obtuvimos 18 pacientes (69%) con resultado excelente, seis (24%) con un buen resultado y dos (7%) con resultados regulares o aceptables, obteniendo una p significativa con un valor 0.05. CONCLUSIÓN: La liberación endoscópica del túnel cubital se considera una técnica segura, con buenos resultados.


Asunto(s)
Síndrome del Túnel Cubital , Descompresión Quirúrgica , Síndrome del Túnel Cubital/cirugía , Femenino , Humanos , Vértebras Lumbares , Masculino , Resultado del Tratamiento , Nervio Cubital
13.
Rev. bras. med. trab ; 16(3): 270-276, out.2018.
Artículo en Inglés, Portugués | LILACS | ID: biblio-966061

RESUMEN

Introdução: Os portos brasileiros têm um papel importante na economia do país. Apesar de haver um número expressivo de trabalhadores, existem poucas pesquisas disponíveis envolvendo o ambiente portuário que relatem que as doenças musculoesqueléticas mais recorrentes correspondem as dos membros superiores, como síndrome do túnel do carpo, síndrome do manguito rotador, cervicalgia e síndrome do túnel cubital, esta definida como uma neurite causada por uma compressão do nervo ulnar no túnel cubital na região do cotovelo. Objetivo: Estimar a prevalência sugestiva da síndrome do túnel cubital no ambiente portuário. Método: Foram avaliados 72 trabalhadores portuários avulsos do OGMO do Porto de São Sebastião, São Paulo, por meio de um questionário semiestruturado, o exame clínico que incluiu a pesquisa de dor à palpação na região medial do cotovelo e a realização de duas manobras específicas para síndrome do túnel cubital, o teste provocativo de pressão e o teste de flexão máxima. Resultados: A idade média foi de 48,49 anos e um tempo médio de 23,13 anos de trabalho no porto; a síndrome do túnel cubital teve diagnóstico sugestivo em cinco dos avaliados, e apenas dois trabalhadores referiam dor no cotovelo antes e três depois do início do trabalho no porto. Conclusão: A prevalência do diagnóstico sugestivo da síndrome do túnel cubital foi de 6,9%, sendo maior entre os trabalhadores com maior tempo de trabalho (acima de um ano)


Background: Ports play a substantial role in the Brazilian economy. Despite the large number of port workers, few studies report that the most common musculoskeletal disorders among them involve the upper limbs, including carpal tunnel syndrome, rotator cuff syndrome, cervicalgia and cubital tunnel syndrome. The latter is a neuritis caused by compression of the ulnar nerve at the cubital tunnel (CuTS) on the elbow. Objective: To estimate the prevalence of a suggestive diagnosis of CuTS among port workers. Method: Seventy-two independent port workers registered with the Labor Management Organ (Órgão Gestor de Mão de Obra ­ OGMO), Port of Saint Sebastian, were evaluated based on a semi-structured questionnaire and clinical examination, including investigation of pain on palpation of the middle area of the elbow and two maneuvers specific for CuTS, namely, the pressure provocation and maximal flexion tests. Results: The average age of the participants was 48.49 years old, and their average length in the job 23.13 years. Suggestive diagnosis of CuTS was established for five participants. In only two cases elbow pain had begun before, and in three after starting work at the port. Conclusion: The prevalence of a suggestive diagnosis of CuTS was 6.9%, and was higher among the participants with longer length in the job (over one year)


Asunto(s)
Humanos , Saneamiento de Puertos , Síndrome del Túnel Cubital/epidemiología , Prevención de Enfermedades , Enfermedades Profesionales , Brasil/epidemiología , Prevalencia , Encuestas y Cuestionarios
14.
Acta Neurochir (Wien) ; 160(8): 1591-1596, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29869109

RESUMEN

BACKGROUND: Fibrous bands (FB) are structures that cross the ulnar nerve (UN), distal to the cubital tunnel (CT). In surgical decompression of the UN in the elbow region, by endoscopy, these FB significantly impact UN visibility. The aim of the current study was to characterize the anatomical characteristics of these FB distal to the CT. METHODOLOGY: Eighteen formalinized upper limbs were dissected, nine right and nine left, within the Department of Anatomy of the Federal University of the State of Rio de Janeiro (UNIRIO). The dissections were performed with micro techniques, under a magnifying glass and a microscope. Classical UN exposure was established in the elbow region. RESULTS: Of the 18 upper limbs studied, 50% lacked any FB. When present, both the number and location of the FB varied, as near to the cubital tunnel as 3 cm past the UN's entrance into the tunnel, and as far away as almost 11 cm distal to it. Overall, there were no FB on either the left or right side in three cadavers (33.3%), FB on both the left and right side in three, and FB only on the left in three, meaning that FB were twice as common in left limbs (n = 6) as on the right (n = 3). CONCLUSIONS: Our study identified FB in 50% of the dissected limbs, all within 3-11 cm of the CT, though their number and location varied. Further studies are necessary to describe FB variations associated with compressive neuropathies of the UN distal to the CT.


Asunto(s)
Síndrome del Túnel Cubital/patología , Descompresión Quirúrgica/métodos , Nervio Cubital/anatomía & histología , Cadáver , Síndrome del Túnel Cubital/cirugía , Femenino , Humanos , Masculino , Nervio Cubital/patología , Nervio Cubital/cirugía
16.
Tech Hand Up Extrem Surg ; 21(4): 137-142, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28930949

RESUMEN

In situ ulnar nerve release has been gaining popularity as a simple, effective, and low-morbidity procedure for the treatment of cubital tunnel syndrome. One concern with the technique is how to manage the unstable ulnar nerve after release. It is unclear how much nerve subluxation will lead to problems and surprisingly there is no grading system to assess ulnar nerve instability. I propose such a grading system, as well as a new technique to stabilize the unstable ulnar nerve. The blocking flap technique consists of raising a rectangular flap off the flexor/pronator fascia and attaching it to the posterior subcutaneous flap so that it blocks the nerve from subluxation/dislocation.


Asunto(s)
Síndrome del Túnel Cubital/cirugía , Descompresión Quirúrgica , Fasciotomía , Colgajos Quirúrgicos , Nervio Cubital/cirugía , Humanos
17.
Arq Neuropsiquiatr ; 75(4): 238-243, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28489144

RESUMEN

OBJECTIVE: In this study, we propose a modification to the simple decompression technique that contains the ulnar nerve in the cubital fossa, thus preventing subluxation during forearm flexion movements. METHODS: Five consecutive patients with leprosy-associated cubital tunnel syndrome underwent surgery with the modified technique between July 2011 and October 2012. RESULTS: The most common symptoms were neuropathic pain and sensory changes (both 60%). On the McGowan scale, three patients maintained their preoperative score and two patients improved by two points, while on the Louisiana State University Health Sciences Center scale, two patients maintained the same scores, two improved by two points, and one improved by one point. Four patients were able to discontinue corticosteroid use. The mean follow-up time was 25.6 months (range 2-48 months). There were no recurrences or subluxations in the long-term. CONCLUSION: This alternative technique resulted in excellent functional results, as well as successful withdrawal from corticosteroids. Furthermore, it resulted in no ulnar nerve subluxations.


Asunto(s)
Síndrome del Túnel Cubital/cirugía , Descompresión Quirúrgica/métodos , Nervio Cubital , Adulto , Síndrome del Túnel Cubital/etiología , Descompresión Quirúrgica/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Lepra Tuberculoide/complicaciones , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Nervio Cubital/lesiones
18.
Arq. neuropsiquiatr ; Arq. neuropsiquiatr;75(4): 238-243, Apr. 2017. tab, graf
Artículo en Inglés | LILACS | ID: biblio-838891

RESUMEN

ABSTRACT Objective In this study, we propose a modification to the simple decompression technique that contains the ulnar nerve in the cubital fossa, thus preventing subluxation during forearm flexion movements. Methods Five consecutive patients with leprosy-associated cubital tunnel syndrome underwent surgery with the modified technique between July 2011 and October 2012. Results The most common symptoms were neuropathic pain and sensory changes (both 60%). On the McGowan scale, three patients maintained their preoperative score and two patients improved by two points, while on the Louisiana State University Health Sciences Center scale, two patients maintained the same scores, two improved by two points, and one improved by one point. Four patients were able to discontinue corticosteroid use. The mean follow-up time was 25.6 months (range 2-48 months). There were no recurrences or subluxations in the long-term. Conclusion This alternative technique resulted in excellent functional results, as well as successful withdrawal from corticosteroids. Furthermore, it resulted in no ulnar nerve subluxations.


RESUMO Objetivo Neste manuscrito apresentamos uma modificação da técnica de descompressão simples do nervo ulnar no túnel cubital que impede a subluxação do nervo em movimentos de flexão do antebraço. Métodos Foram incluídos cinco pacientes consecutivos acometidos por síndrome do túnel cubital (Hanseníase) submetidos à cirurgia entre 2011 e 2012. Resultados Os sintomas mais comuns foram dor neuropática e alterações sensitivas (60%). No pós-operatório, três pacientes mantiveram o mesmo escore e dois melhoraram dois pontos na escala de McGowan, enquanto na escala Louisiana State University Health Sciences Center, dois pacientes mantiveram o mesmo escore, dois melhoraram dois pontos e um melhorou um ponto. Os corticosteróides foram descontinuados em quatro pacientes. O tempo médio de seguimento foi 25,6 meses (variação 2-48 meses). Não foram observadas recorrência ou subluxação no longo prazo. Conclusões A técnica alternativa apresentou excelentes resultados funcionais e foi bem sucedida na retirada dos corticosteróides. Ademais, subluxações do nervo ulnar não foram observadas.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Nervio Cubital/lesiones , Descompresión Quirúrgica/métodos , Síndrome del Túnel Cubital/cirugía , Lepra Tuberculoide/complicaciones , Estudios de Seguimiento , Resultado del Tratamiento , Descompresión Quirúrgica/efectos adversos , Síndrome del Túnel Cubital/etiología
19.
São Paulo; HSPM; 2017.
No convencional en Portugués | Coleciona SUS, Sec. Munic. Saúde SP, HSPM-Producao, Sec. Munic. Saúde SP | ID: biblio-1283241

RESUMEN

RESUMO Introdução: A síndrome do túnel cubital (STCU) é uma neuropatia de compressão do nervo ulnar no cotovelo. Ela é a segunda neuropatia compressiva mais comum do membro superior. O nervo ulnar é formado por fibras da oitava raiz cervical (C8) e da primeira torácica (T1). Diversos fatores podem ocasionar a neuropatia ulnar no cotovelo. Em 10% a 30% dos casos, a causa primária da compressão é indeterminada. Clinicamente pode ser notado como sintomas iniciais: parestesias intermitentes, dormência e formigamento no quinto e na borda ulnar do quarto dedo da mão. Diversas opções terapêuticas são indicadas no tratamento da síndrome do túnel cubital. Objetivo: Avaliar a prevalência da STCU nos funcionários do Hospital do Servidor Público Municipal de São Paulo (HSPM). Metodologia: Trata-se de um estudo transversal onde foi avaliada a prevalência da síndrome do túnel cubital nos funcionários do HSPM. Resultados: Foram entrevistados 75 funcionários, 57 (76%) do gênero feminino e 18 (24%) masculino, com idades que variaram de 22 anos a 69 anos, com uma média de 47,9 anos. A STCU foi diagnosticada em 38,7% dos casos. 29 trabalhadores apresentaram manobras diagnósticas positivas para STCU após trabalhar no HSPM. Conclusões: A faixa etária identificada como portadores de STCU neste estudo, foi compatível com a encontrada na literatura pesquisada, assim como a predominância no sexo feminino. A prevalência da STCU foi de 38,7% na população avaliada neste projeto. Palavras-chave: Síndrome Túnel Cubital; prevalência; trabalhadores


Asunto(s)
Humanos , Masculino , Femenino , Prevalencia , Síndrome del Túnel Cubital
20.
São Paulo; HSPM; 2017.
No convencional en Portugués | Coleciona SUS, Sec. Munic. Saúde SP, HSPM-Producao, Sec. Munic. Saúde SP | ID: biblio-1283483

RESUMEN

RESUMO Introdução: A síndrome do túnel cubital (STCU) é uma neuropatia de compressão do nervo ulnar no cotovelo. Ela é a segunda neuropatia compressiva mais comum do membro superior. O nervo ulnar é formado por fibras da oitava raiz cervical (C8) e da primeira torácica (T1). Diversos fatores podem ocasionar a neuropatia ulnar no cotovelo. Em 10% a 30% dos casos, a causa primária da compressão é indeterminada. Clinicamente pode ser notado como sintomas iniciais: parestesias intermitentes, dormência e formigamento no quinto e na borda ulnar do quarto dedo da mão. Diversas opções terapêuticas são indicadas no tratamento da síndrome do túnel cubital. Objetivo: Avaliar a prevalência da STCU nos funcionários do Hospital do Servidor Público Municipal de São Paulo (HSPM). Metodologia: Trata-se de um estudo transversal onde foi avaliada a prevalência da síndrome do túnel cubital nos funcionários do HSPM. Resultados: Foram entrevistados 75 funcionários, 57 (76%) do gênero feminino e 18 (24%) masculino, com idades que variaram de 22 anos a 69 anos, com uma média de 47,9 anos. A STCU foi diagnosticada em 38,7% dos casos. 29 trabalhadores apresentaram manobras diagnósticas positivas para STCU após trabalhar no HSPM. Conclusões: A faixa etária identificada como portadores de STCU neste estudo, foi compatível com a encontrada na literatura pesquisada, assim como a predominância no sexo feminino. A prevalência da STCU foi de 38,7% na população avaliada neste projeto. Palavras-chave: Síndrome Túnel Cubital; prevalência; trabalhadores


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Prevalencia , Síndrome del Túnel Cubital , Grupos Profesionales
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