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Use of ultrasonography in ulnar nerve entrapment surgery—a prospective study

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Abstract

The purpose of our study is to assess the usefulness of high-resolution ultrasonography in observing the morphology and dynamics of the ulnar nerve in the cubital tunnel and also the efficacy of ultrasonography in a more accurate diagnosis and appropriate surgical treatment decision. Cross-sectional area of the ulnar nerves of 40 healthy volunteers in the control group were measured bilaterally at the level of the epicondyle, 2 cm proximal to and 2 cm distal to the epicondyle. Measurements were obtained for elbows both in extension and flexion. Then, we prospectively obtained the cross-sectional area values of 18 patients at the same levels, elbows in extension and flexion position, and compared the data obtained from the patient group and the control group. The differences between the cross-sectional areas of the ulnar nerves in extension and flexion were statistically significant in the patient population (p < 0.001). Mean cross-sectional area of the ulnar nerve in the patient population was calculated as 0.16 cm2, and we accepted the cut-off point as 0.1 cm2. This value for cross-sectional area yielded a sensitivity of 90% and a specificity of 100% in diagnosis of ulnar nerve entrapment. Results substantiated conspicuous morphological changes in ulnar nerve during flexion and extension of the elbow. We also observed that as the degree of the nerve displacement by virtue of elbow flexion that is discerned by ultrasonography increased, a more aggressive decompressive surgery was needed for an appropriate treatment.

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Authors and Affiliations

  1. Department of Neurosurgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey

    Murat Kutlay, Ahmet Çolak, Hakan Şimşek, Kıvanç Topuz & Mehmet Nusret Demircan

  2. Department of Radiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey

    Ersin Öztürk

  3. Department of Neurology, GATA Haydarpasa Training Hospital, Istanbul, Turkey

    Mehmet Güney Şenol

  4. GATA Haydarpaşa Eğitim Hastanesi, Nöroşirürji Servisi, Üsküdar, 34668, İstanbul, Turkey

    Hakan Şimşek

Authors
  1. Murat Kutlay
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  2. Ahmet Çolak
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  3. Hakan Şimşek
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  4. Ersin Öztürk
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  5. Mehmet Güney Şenol
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  6. Kıvanç Topuz
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  7. Mehmet Nusret Demircan
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Correspondence to Hakan Şimşek.

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Comments

Damianos Sakas, Athens, Greece

The paper highlights the value of good sonographic imaging in making the correct diagnosis and well-justified preoperative surgical decisions with respect to the management of ulnar nerve entrapment. Ultrasonography may prove a valuable adjunct to careful clinical examination, history taking, and electromyographic studies. It can lead us to more secure decisions on the necessity of performing carpal tunnel decompression procedures. In future studies, it would be interesting to examine whether ultrasonography can help us to determine the potential causes of poor postoperative results after a presumed satisfactory carpal tunnel decompression and to plan further surgical treatment in such patients.

I. Erol Sandalcioglu, Essen, Germany

The use of ultrasound for ulnar nerve entrapment surgery has been the subject of several previous studies. However, this is a well-written article emphasizing the diagnostic value of high-resolution ultrasound in patients who underwent decompression of the ulnar nerve in and around the cubital tunnel. Mostly, diagnosis can be confirmed by clinical signs, although electrophysiological examinations remain without pathological findings. In their study, the authors pointed out the correlation between the degree of clinical signs and the changes of ultrasound findings during elbow flexion and extension. They indicate the necessity of a more aggressive approach depending on the severity of ulnar nerve displacement as detected by the use of high resolution ultrasound, particularly in patients with dislocation of the nerve. Undoubtedly, MRI as a diagnostic tool proved to have a higher resolution. Nevertheless, the advantages of ultrasound are obviously representing a dynamic, time sparing imaging technique with lower costs but depend closely on the investigators’ experience. With this report, the authors called to our attention the importance of ultrasound in the subject of peripheral nerve surgery.

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Kutlay, M., Çolak, A., Şimşek, H. et al. Use of ultrasonography in ulnar nerve entrapment surgery—a prospective study. Neurosurg Rev 32, 225–232 (2009). https://doi.org/10.1007/s10143-008-0162-4

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  • DOI: https://doi.org/10.1007/s10143-008-0162-4

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