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Rofo 2015; 187(11): 998-1002
DOI: 10.1055/s-0035-1553221
Musculoskeletal System
© Georg Thieme Verlag KG Stuttgart · New York

The Ulnar Nerve After Surgical Transposition: Can Sonography Define the Reason of Persisting Neuropathy?

Der Nervus ulnaris nach chirurgischer Transposition: Kann die Sonografie die Ursache einer anhaltenden Neuropathie definieren?
H. Gruber
1   Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
,
E. M. Baur
2   Department of Plastic-, Reconstructive- and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
,
M. Plaikner
1   Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
,
A. Loizides
1   Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
› Author Affiliations
Further Information

Publication History

29 March 2015

11 May 2015

Publication Date:
19 June 2015 (online)

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Abstract

Purpose: Ulnar nerve neuropathy is mainly caused by compression at the level of the cubital tunnel. Two main approaches are currently known for the surgical treatment of this condition: decompression of the nerve in its usual position or transposition to the ulnar flexor side. This study was performed to define the usefulness of ultrasound in patients with persisting symptoms after ulnar nerve transposition.

Materials and Methods: We present the data of 8 subjects with persisting symptoms after nerve transposition due to compressive neuropathy. The cross-section areas (CSA) and texture changes were recorded. Each ulnar nerve was divided into 6 segments – 3 segments at the proximal pass and 3 segments at the distal pass through the subcutaneous fascia.

Results: Texture changes were recorded in 4.6 (76.7 %) ± 1.2 and outer nerve sheath blurring in mean 4.1 (68.3 %) ± 1.1 of the segments. Caliber changes were found in the course of the nerve based on the 6 segments: A mean CSA of 7.45 mm² ± 2.24 was found proximal to the upper fascial passage (PUF), a mean CSA of 11.96 mm² ± 3.61 at the upper fascial passage (UF), a mean CSA of 11.49 mm² ± 8.16 distal to the upper fascial passage (DUF), a mean CSA of 10.84 mm² ± 4.73 proximal to the lower fascial passage (PLF), a mean CSA of 12.12 mm² ± 5 at the lower fascial passage (LF), and a mean CSA of 7.89 mm² ± 3.42 distal to the lower fascial passage (DLF). All transposed nerves presented relevant kinks at the UF, 6 nerves presented relevant kinks at the LF.

Conclusion: In cases of secondary ulnar neuropathy after nerve transposition, ultrasound can reliably assess the actual “situation” of the nerve and thus at least ease the decision for secondary surgery.

Key points

• Sonography can reliably define pathology of the ulnar nerve.

• Blood flow restriction after nerve transposition can be the cause of secondary neuropathy.

• Secondary neuropathy after ulnar nerve transposition can be assessed by sonography.

Citation Format:

• Gruber H., Baur E. M., Plaikner M. et al. The Ulnar Nerve After Surgical Transposition: Can Sonography Define the Reason of Persisting Neuropathy?. Fortschr Röntgenstr 2015; 187: 998 – 1002

Zusammenfassung

Ziel: Die Ulnarisneuropathie wird durch eine Einengung auf Höhe des Kubitaltunnels verursacht. Derzeit sind zwei chirurgische Hauptschulen für die Behandlung einer Ulnarisneuropathie bekannt: Dekompression des Nervens in seiner üblichen Lage oder Nerventransposition auf die ulnare Beugeseite. Diese Arbeit wurde durchgeführt, um den Nutzen der Sonografie bei Patienten mit persistierender Symptomatik nach Ulnaris-Transposition zu definieren.

Material und Methoden: Wir präsentieren die Daten von 8 Patienten mit persistierender Symptomatik nach Transposition der Nervi ulnares. Querschnittsflächen (CSA) sowie Texturänderungen wurden dokumentiert. Jeder Nerv wurde in 6 Segmente – 3 Segmente am proximalen Durchtritt und 3 Segmente am distalen Durchtritt durch die subkutane Faszie segmentiert.

Ergebnisse: Textur-Veränderungen konnten in 4,6 (76,7 %) ± 1,2 nachgewiesen werden, Veränderungen der äußeren Nervenscheide in 4,1 (68,3 %) ± 1,1 der Segmente. Kaliber-Veränderungen basierend auf die 6 Segmente konnten nachgewiesen werden: eine CSA von 7,45 mm² ± 2,24 wurde proximal des oberen Faszien-Durchtritts (PUF) gefunden, am oberen Faszien-Durchtritt (UF) eine mittlere CSA von 11,96 mm² ± 3,61, distal des oberen Faszien-Durchtritts (DUF) eine mittlere CSA von 11,49 mm² ± 8,16, proximal des unteren Faszien-Durchtritts (PLF) eine mittlere CSA von 10,84 mm² ± 4,73, am unteren Faszien-Durchtritt (LF) eine mittlere CSA von 12,12 mm² ± 5 und distal des unteren Faszien-Durchtritts (DLF) eine mittlere CSA von 7,89 mm² ± 3,42. Alle verlagerten Nerven zeigten relevanten Knickstellen an der UF, 6 Nerven präsentierten relevanten Knickstellen an der LF.

Schlussfolgerungen: Die Sonografie kann in Fällen von sekundärer Ulnarisneuropathie nach Transposition des Nervs zuverlässig die tatsächliche „Situation“ des Nervs beurteilen und somit die Entscheidung einer Sekundär-Operation erleichtern.

Kernaussagen

• Die Sonografie kann zuverlässig eine Pathologie des Nervus ulnaris definieren.

• Blutflussrestriktion nach Nerv-Transposition kann eine mögliche Ursache einer sekundären Neuropathie sein.

• Die Sonographie kann eine sekundäre Neuropathie nach Ulnaris-Transposition definieren.

Key words

elbow - nervous-peripheral - ultrasound
 

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