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SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
Since the carpal tunnel exists as a confined space, entrapment of the median nerve may occur within it. This is commonly due to a build-up of fluid within the carpal tunnel, or because of hypertrophy of the bones/ligaments/tendons that surround, or are contained within, the carpal tunnel. Compression of the median nerve within the carpal tunnel is known as carpal tunnel syndrome. Note this is different from cubital tunnel syndrome, which refers to compression of the ulnar nerve behind the medial epicondyle at the elbow. The ulnar artery and nerve do not pass through the carpal tunnel, but instead pass superficial to the carpal tunnel in their own fibro-osseous tunnel commonly given the name Guyon’s canal. The ulnar nerve and artery are therefore unaffected in carpal tunnel syndrome.
Test Paper 1
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
Cubital tunnel syndrome is the most common entrapment neuropathy of the elbow. It is seen in throwing sports, tennis and volleyball. Traction injuries to the ulnar nerve can occur secondary to the dynamic valgus forces. Compression of the ulnar nerve within the cubital tunnel occur secondary to direct trauma, repetitive stresses, or replacement of the overlying retinaculum with an anomalous anconeus epitrochlearis muscle. Recurrent subluxation of the nerve due to acquired laxity from repetitive stress or trauma can lead to friction neuritis. Finally, osseous spurring within the ulnar groove caused by overuse and posteromedial impingement in throwers can cause nerve irritation. Ulnar nerve thickening and increased T2-weighted signal are typical MRI features. Oedema-like signal changes or atrophy of the flexor carpi ulnaris and flexor digitorum profundus muscles may also be secondary to ulnar neuropathy.
Electrodiagnosis
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Ross E. Lipton, David M. Glick
Radial nerve compression at the humerus (Saturday night palsy) is the usual cause of wrist drop, which is mostly a motor phenomenon, although it may cause pain. The ulnar nerve is classically compressed at the elbow (cubital tunnel syndrome). This is diagnosed when ulnar motor nerve slowing is found with stimulation above the elbow. Ulnar nerve lesions at the wrist are usually noted at Guyon’s canal in the wrist or at the pisohamate hiatus in the hand. SEPs can be helpful in confirming an ulnar neuropathy, as well as in ruling out a more proximal medial cord plexopathy or preganglionic C8/T1 radiculopathy.
Effect of dry needling on cubital tunnel syndrome: Three case reports
Published in Physiotherapy Theory and Practice, 2019
Sudarshan Anandkumar, Murugavel Manivasagam
Peripheral nerve entrapments typically occur at mechanical interfaces in the upper extremity. The most common entrapment is of the median nerve at the carpal tunnel (Ibrahim, Khan, Goddard, and Smitham, 2012). Ulnar nerve entrapment is the second most common entrapment neuropathy and may occur at the wrist, thoracic outlet, or elbow (Elhassan and Steinmann, 2007). In the elbow, ulnar nerve entrapment occurs at the cubital tunnel and was described as “cubital tunnel syndrome” cubital tunnel syndrome by Feindel and Stratford in 1958 (Wojewnik and Bindra, 2009). Other nomenclatures that have previously been used to describe this entrapment are “ulnar nerve entrapment syndrome,” “sulcus ulnaris syndrome,” and “tardive ulnar neuritis” (Assmus, Antoniadis, and Bischoff, 2015; Qing et al., 2014).
Superior sulcus tumor disguised as cervical radiculopathy with metastasis to brachial plexus
Published in Baylor University Medical Center Proceedings, 2019
James Rizkalla, Seagal Dauglas, Scott Nimmons, Waleed El-Feky, Ishaq Syed
A 74-year-old man, a former smoker, was referred to a spinal orthopedic surgeon for evaluation of his neck pain that frequently radiated down into his left arm, with maximal pain in the axilla, arm, and forearm. The pain was chronic, had progressively worsened, and was described as intermittent, moderate, stabbing, throbbing, and aching. Resting the limb, acetaminophen, and topical anti-inflammatory gel provided minimal relief. The patient was known to have arthritis, atrial fibrillation, previous hernia surgeries, and left rotator cuff injury. Other orthopedic surgeons told him that he had cubital tunnel syndrome, and he underwent an ulnar release on the left side in an attempt to alleviate his symptoms, without success.
‘Bony’ cubital tunnel syndrome caused by heterotopic ossification
Published in British Journal of Neurosurgery, 2019
Cubital tunnel syndrome (CuTS) is an injury of the elbow ulnar nerve mainly caused by ischaemia or compression. Compression may be direct, or involve repeated flexion and extension of the elbow, traumatic scars, or ectopic muscle.1 Patients with severe burns, traumas, traumatic brain injuries, or other disorders causing heterotopic ossification should undergo an early auxiliary examination to observe bony hyperplasia development in the elbow joint, and nerve decompression surgery if required.