The purview of multifascicle ulnar nerves in cubital tunnel syndrome: Single-case sonographic observation

Ultrasound Measurements and Assessments of the Ulnar Nerve at the Elbow and Cubital Tunnel: A Scoping Review

Ulnar neuropathy at the elbow (UNE) is the second most frequent peripheral nerve entrapment neuropathy in the upper extremity. The diagnosis is determined through a combination of history, physical examination, and electrodiagnostic testing. However, the use of high-resolution sonography is increasing, with sonographic measurements of ulnar nerve dimension established as a reliable diagnostic criterion for UNE. Sonographic imaging can describe anatomical features beyond ulnar nerve size, and therefore additional observations could potentially be used in UNE diagnosis and treatment follow-up. This review was a scoping of the literature on different sonographic measurements and assessments that have been reported to evaluate the ulnar nerve and cubital tunnel. This should provide a guide to scanning protocols for sonographers.

Double Crush Syndrome

Double crush syndrome is a distinct compression at two or more locations along the course of a peripheral nerve that can coexist and synergistically increase symptom intensity. In addition, dissatisfaction after treatment at one site may be the result of persistent pathology at another site along a peripheral nerve. Double crush syndrome is a controversial diagnosis; some scientists and surgeons believe it is an illness construction that may do more harm than good because it emphasizes an objective pathophysiologic explanation for unexplained symptoms, disability, and dissatisfaction that may be more psychosocially mediated. However, peripheral neuropathy may coexist with compressive neuropathy and contribute to suboptimal outcomes following nerve decompression. To better manage patients' expectations, treating practitioners should be aware of the possibility of concomitant cervical radiculopathy and carpal tunnel syndrome, as well as the presence of underlying systemic neuropathy.

Ultrasonographic evaluation of sciatic nerves in patients with spinal cord injury

STUDY DESIGN

Cross-sectional, controlled study.

OBJECTIVE

To evaluate the sciatic nerves of subjects with spinal cord injury (SCI) by using ultrasound (US) imaging and to explore whether US measurements are associated with clinical and electrophysiological findings.

SETTING

National Rehabilitation Center in Ankara, Turkey.

METHODS

Fifteen SCI subjects (12 male (M), 3 female (F)) and 23 (16 M, 7 F) healthy controls were included in the study. After clinical assessment of the subjects, lower limb nerve conduction studies and US imaging of the sciatic nerves were performed. Cross-sectional area (CSA) values of the sciatic nerves were correlated with the clinical and electrophysiologic data.

RESULTS

Mean CSA values were lower in the patient group when compared with the control group (P=0.042). Reduced compound motor action potentials regarding tibial and peroneal nerves were observed in the patient group (P=0.003 and P=0.005, respectively). US measurements did not correlate with the electrophysiological findings. However, sciatic nerve CSA values were positively correlated with body mass index in the control (r=0.534, P<0.05) and patient (r=0.482, P<0.05) groups.

CONCLUSION

Sciatic nerves seem to be smaller in subjects with SCI. Together with our electrophysiological data, this preliminary finding could possibly be attributed to primary axonal loss.

Electromyography and ultrasonography in the diagnosis of a rare double-crush ulnar nerve injury

Reported here is a 46-year-old man who was seen for pain, numbness, and weakness in his left upper limb and hand. Electromyographic studies demonstrated denervation of ulnar-innervated muscle groups except for the flexor carpi ulnaris. A localized nerve conduction block could not be depicted because of severe axonal loss. Ultrasonographic evaluation showed enlargement of the ulnar nerve at 2 sites: at the level of the epicondylar groove and the inside of the flexor carpi ulnaris muscle. Herein, we would like to emphasize the complementary role of an ultrasound in peripheral nerve pathologies, not only does it confirm the entrapment but it also displays the underlying cause(s).