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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 10 cm 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.

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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.

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ABSTRACT Background: Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy. There is little information about the application of F-wave studies for evaluation of UNE. Objective: The aim of this study was to evaluate the diagnostic value of minimum F-wave (F-min) latency alterations by comparing this with nerve conduction analyses in UNE-suspected patients. Methods: Ninety-four UNE-suspected patients were admitted to this study. Sensory and motor nerve conduction and F-wave analyses on the median and ulnar nerves were performed on both upper extremities. Results: A total of 188 upper extremities of 94 patients were examined. Their mean age was 41.4±12.9 years, and 69 patients were female (73.4%). The mean ulnar-nerve across-elbow motor conduction velocity (MCV) in the affected arms was significantly slower than the velocity in healthy arms. The mean ulnar-nerve F-min latencies were significantly longer in the affected arms. Fifty-one patients were electrophysiologically diagnosed as presenting UNE (54.2%). Significantly slower mean ulnar-nerve across-elbow MCV, longer mean ulnar-nerve F-min latency and longer distal onset latency were detected in UNE-positive arms. Lastly, patients who were symptomatic but had normal nerve conduction were evaluated separately. Only the mean ulnar F-min latency was significantly longer in this group, compared with the healthy arms. Conclusion: Our study confirmed the utility of F-min latency measurements in the electrodiagnosis of UNE. F-wave latency differences can help in making an early diagnosis to provide better treatment options.

RESUMO Introdução: A neuropatia ulnar do cotovelo (NUC) é a segunda neuropatia por encarceramento mais comum. Existem poucas informações sobre a aplicação dos estudos da onda F para avaliação da NUC. Objetivo: O objetivo deste estudo foi avaliar o valor diagnóstico das alterações mínimas de latência da onda F (F-min), comparando-as com análises de condução nervosa em pacientes com suspeita de NUC. Métodos: Noventa e quatro pacientes com suspeita de NUC foram admitidos neste estudo. A condução nervosa sensitiva e motora e as análises da onda F nos nervos mediano e ulnar foram realizadas em ambas as extremidades superiores. Resultados: Um total de 188 membros superiores de 94 pacientes foi examinado. A média de idade foi 41,4±12,9 anos e 69 pacientes eram do sexo feminino (73,4%). A velocidade de condução motora média do nervo ulnar através do cotovelo (VCM) nos braços afetados foi significativamente mais lenta do que a velocidade em braços saudáveis. As latências médias F-min do nervo ulnar foram significativamente mais longas nos braços afetados. Cinquenta e um pacientes foram diagnosticados eletrofisiologicamente como apresentando NUC (54,2%). Pacientes com presença de NUC tiveram, de forma significativa, detecção de VCM mais lenta no nervo ulnar ao nível do cotovelo, presença de latência mais longa da onda F-mínima no nervo ulnar, bem como latência de início distal mais longa. Por fim, os pacientes sintomáticos, e com condução nervosa normal, foram avaliados separadamente. Apenas a latência da onda F mínima média do nervo ulnar foi significativamente maior neste grupo, em comparação com os braços saudáveis. Conclusão: Nosso estudo confirmou a utilidade das medidas de latência da onda F-mínima no eletrodiagnóstico da NUC. As diferenças de latência da onda F podem ajudar a fazer um diagnóstico precoce para fornecer melhores opções de tratamento.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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)

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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.

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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).

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).

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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.

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ABSTRACT Objectives: Retrospective clinical evaluation of 31 patients who underwent ulnar nerve decompression at the elbow and subcutaneous anterior transposition. Methods: From January 2000 to December 2013, 71 patients underwent subcutaneous anterior transposition of the ulnar nerve. Thirty-one patients returned for evaluation. The mean follow-up period was 60 months. Patients were evaluated for the degree of satisfaction after surgery, paresthesia, pain, Tinel sign, Froment test and sensitivity test by esthesiometer, muscle strength of the intrinsic muscles and deep flexor of the fifth digit, visual analogic pain scale (VAS) and were subjected to the QuickDash questionnaire. Results: Thirty-nine per cent of patients had compression on the right side and 61% on the left side. Sixty-one percent were idiopathic, 35% post traumatic and 3% had Poems syndrome. Forty-eight per cent of patients were very much satisfied after surgery and 52% were satisfied. Forty-eight per cent had paresthesia after surgery and 52% did not. Conclusion: The ulnar neurolysis of the cubital tunnel with anterior subcutaneous transposition is a safe and effective technique for treating idiopathic or post-traumatic compressive neuropathy, with high success rate and excellent function for activities of daily living. Level of Evidence IV, Case Series.

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ABSTRACT Objective: The aim of this study was to investigate whether haemogram parameters are predictive factors for both the severity of the disease and a decision in favor of surgical treatment in patients with an established diagnosis of cubital tunnel syndrome (CuTS) . Methods: The medical files of patients with a diagnosis of CuTS who were followed-up conservatively (n=92) or surgically treated (n=92) were retrospectively screened and the haemogram parameters were recorded . Results: The receiver operating characteristic (ROC) curve analysis revealed an area of 0.665 under the curve, with 76.3% sensitivity and 84.8% specificity at the cut-off of a red cell distribution width (RDW) level grater than 15.45%. RDW levels higher than 15.5%, electromyography (EMG) severity, and a clinical score higher than three were found to be independently associated with surgery . Conclusion: An elevated RDW value was related to the severity of the electromyogram. RDW may, therefore, be a useful independent predictor for the decision to surgical treatment of CuTS. Level of Evidence III, Retrospective Study.

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A dermatopolimiosite émiopatia inflamatória de etiologia provavelmente autoimune e comportamento heterogêneo, afetando principalmente pele e músculos e ocasionando manifestações exantemáticas características, como o eritema heliótropo e a pápula de Gottron, e fraqueza muscular proximal simétrica. A associação dessa patologia a neuropatias periféricas é pouco conhecida, podendo raramente ocorrer neuropatia múltipla. O objetivo deste artigo é relatar um caso de síndrome compressiva de múltiplos nervos em portador de dermatopolimiosite. O paciente apresentava fraqueza muscular proximal e exantema característico e foi submetido à revisão laboratorial, ressonância magnética de abdome e eletroneuromiografia, que mostraram alterações. Foi então tratado através da neurólise do nervo mediano ao nível do túnel do carpo e do nervo ulnar ao nível do túnel cubital. Trata-se de importante possibilidade terapêutica em casos como o descrito,mas estudos de maior porte sobre a descompressão simultânea dos túneis carpal e ulnar são necessários.

Dermatopolymyositis is an inflammatory myopathy ­ whose etiology is probably autoimmune ­ that has heterogeneous manifestations that occur mainly in skin and muscles and cause characteristic rash, such as heliotrope rash, Gottron's sign and symmetric proximal weakness. The association between this pathology and peripheral neuropathies is little known and multiple neuropathies rarely occur. The purpose of this article is to report a case of multiple nerve compression syndrome in a patient with dermatopolymyositis. The patient had proximal weakness and characteristic rash and underwent a laboratorial review, abdominal MRI and electromyography, which showed changes. So he was treated by neurolysis of median and ulnar nerves at carpal and cubital tunnels levels, respectively. It is an important therapeutic possibility in cases like this, but larger studies on simultaneous decompression of carpal and cubital tunnels are necessary.

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OBJECTIVE: The aim of this study was to investigate whether haemogram parameters are predictive factors for both the severity of the disease and a decision in favor of surgical treatment in patients with an established diagnosis of cubital tunnel syndrome (CuTS) . METHODS: The medical files of patients with a diagnosis of CuTS who were followed-up conservatively (n=92) or surgically treated (n=92) were retrospectively screened and the haemogram parameters were recorded . RESULTS: The receiver operating characteristic (ROC) curve analysis revealed an area of 0.665 under the curve, with 76.3% sensitivity and 84.8% specificity at the cut-off of a red cell distribution width (RDW) level grater than 15.45%. RDW levels higher than 15.5%, electromyography (EMG) severity, and a clinical score higher than three were found to be independently associated with surgery . CONCLUSION: An elevated RDW value was related to the severity of the electromyogram. RDW may, therefore, be a useful independent predictor for the decision to surgical treatment of CuTS. Level of Evidence III, Retrospective Study.

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OBJECTIVES: Retrospective clinical evaluation of 31 patients who underwent ulnar nerve decompression at the elbow and subcutaneous anterior transposition. METHODS: From January 2000 to December 2013, 71 patients underwent subcutaneous anterior transposition of the ulnar nerve. Thirty-one patients returned for evaluation. The mean follow-up period was 60 months. Patients were evaluated for the degree of satisfaction after surgery, paresthesia, pain, Tinel sign, Froment test and sensitivity test by esthesiometer, muscle strength of the intrinsic muscles and deep flexor of the fifth digit, visual analogic pain scale (VAS) and were subjected to the QuickDash questionnaire. RESULTS: Thirty-nine per cent of patients had compression on the right side and 61% on the left side. Sixty-one percent were idiopathic, 35% post traumatic and 3% had Poems syndrome. Forty-eight per cent of patients were very much satisfied after surgery and 52% were satisfied. Forty-eight per cent had paresthesia after surgery and 52% did not. CONCLUSION: The ulnar neurolysis of the cubital tunnel with anterior subcutaneous transposition is a safe and effective technique for treating idiopathic or post-traumatic compressive neuropathy, with high success rate and excellent function for activities of daily living. Level of Evidence IV, Case Series.