1
|
Kimura M, Nagata S, Suzuki M, Nashiki K, Kawata H, Abe T. The relationship between diffusion tensor imaging and the clinical classification of cubital tunnel syndrome. Radiol Phys Technol 2024; 17:645-650. [PMID: 38782839 DOI: 10.1007/s12194-024-00813-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/29/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024]
Abstract
The purpose of the study was to investigate the relationship between diffusion tensor imaging (DTI) and the clinical classification of cubital tunnel syndrome (CuTS). Ten patients with CuTS (7 men and 3 women; mean age: 52.7 years) and 5 patients without ulnar neuropathy (2 men and 3 women; mean age: 38.0 years) were enrolled in this retrospective study. Fifteen patients were clinically classified into three groups: "Normal", "1 and 2A", and "2B and 3" by an orthopedic surgeon using the modified McGowan stages. DTI was acquired using a 3.0-T MRI. Fractional anisotropy (FA) of the ulnar nerve was measured in slices covering 20 mm proximal to 20 mm distal to ulnar sulcus. Median FA values in each group were compared by Kruskal-Wallis and Steel-Dwass test (P < 0.05). Five patients with CuTS were classified as "1 and 2A" and five patients as "2B and 3". The FA values, proximal 12 mm to the ulnar sulcus were 0.486 ± 0.117, 0.425 ± 0.166 and 0.298 ± 0.0386 in the "Normal", "1 and 2A" and "2B and 3" groups, respectively. The FA values of patients classified as "Normal" were significantly higher than those classified as "2B and 3" (P = 0.0326 in Steel-Dwass test). FA proximal to the ulnar sulcus might be associated to the modified McGowan stages for the clinical classification of CuTS.
Collapse
Affiliation(s)
- Mitsuhiro Kimura
- Department of Radiology, Kurume University Hospital, Fukuoka, Japan.
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Makoto Suzuki
- Department of Radiology, Kurume University Hospital, Fukuoka, Japan
| | - Kazutaka Nashiki
- Department of Radiology, Kurume University Hospital, Fukuoka, Japan
| | - Hidemichi Kawata
- Department of Radiology, Kurume University Hospital, Fukuoka, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
| |
Collapse
|
2
|
Becciolini M, Pivec C, Raspanti A, Riegler G. Ultrasound of the Ulnar Nerve: A Pictorial Review: Part 2: Pathological Ultrasound Findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1153-1173. [PMID: 38444253 DOI: 10.1002/jum.16442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 03/07/2024]
Abstract
This is the second part of a two-part article in which we focus on the ultrasound (US) appearance of the pathological ulnar nerve (UN) and its main branches. Findings in a wide range of our pathological cases are presented with high-resolution US images obtained with the latest-generation US machines and transducers.
Collapse
Affiliation(s)
- Marco Becciolini
- Department of Ultrasound, Misericordia di Pistoia, Pistoia, Italy
- Scuola Siumb di Ecografia Muscolo-Scheletrica, Pisa, Italy
| | - Christopher Pivec
- Department of Ultrasound, PUC - Private Ultrasound Center Vienna, Vienna, Austria
| | - Andrea Raspanti
- Department of Orthopedics, SOC Ortopedia e Traumatologia, Ospedale Santa Maria Annunziata, Azienda USL Toscana Centro, Firenze, Italy
| | - Georg Riegler
- Department of Ultrasound, PUC - Private Ultrasound Center Graz, Graz, Austria
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| |
Collapse
|
3
|
Hussein M, Hanumanthu MM, Shirodkar K, Papineni VRK, Rahij H, Velicheti S, Iyengar KP, Botchu R. Cubital tunnel syndrome: anatomy, pathology, and imaging. Skeletal Radiol 2024:10.1007/s00256-024-04705-4. [PMID: 38760642 DOI: 10.1007/s00256-024-04705-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/19/2024]
Abstract
Cubital tunnel syndrome (CuTS) is the second most common peripheral neuropathy in the upper limb. It occurs due to ulnar nerve compression within the fibro-osseous cubital tunnel at the elbow joint. Although CuTS is typically diagnosed clinically and with electrodiagnostic studies, the importance of imaging in evaluating the condition is growing. Knowing the typical imaging findings of ulnar nerve entrapment is necessary for precise diagnosis and proper treatment. In this article, we focus on the clinical features, workup and complex imaging of the "anatomic" cubital tunnel and relevant pathological entities.
Collapse
Affiliation(s)
- Mohsin Hussein
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Manasa Mayukha Hanumanthu
- Department of Radiology, Dr.Pinnamaneni, Siddhartha Institute of Medical Sciences & Research Foundation, Vijayawada, India
| | - Kapil Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Hasan Rahij
- Imperial College School of Medicine, London, UK
| | - Sandeep Velicheti
- Department of Radiology, Dr.Pinnamaneni, Siddhartha Institute of Medical Sciences & Research Foundation, Vijayawada, India
| | - Karthikeyan P Iyengar
- Department of Radiology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
- Department of Trauma & Orthopaedics, Southport and Ormskirk Hospitals, Mersey and West Lancashire NHS Trust, Southport, PR8 6PN, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
| |
Collapse
|
4
|
Telleman JA, Sneag DB, Visser LH. The role of imaging in focal neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:19-42. [PMID: 38697740 DOI: 10.1016/b978-0-323-90108-6.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Electrodiagnostic testing (EDX) has been the diagnostic tool of choice in peripheral nerve disease for many years, but in recent years, peripheral nerve imaging has been used ever more frequently in daily clinical practice. Nerve ultrasound and magnetic resonance (MR) neurography are able to visualize nerve structures reliably. These techniques can aid in localizing nerve pathology and can reveal significant anatomical abnormalities underlying nerve pathology that may have been otherwise undetected by EDX. As such, nerve ultrasound and MR neurography can significantly improve diagnostic accuracy and can have a significant effect on treatment strategy. In this chapter, the basic principles and recent developments of these techniques will be discussed, as well as their potential application in several types of peripheral nerve disease, such as carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow (UNE), radial neuropathy, brachial and lumbosacral plexopathy, neuralgic amyotrophy (NA), fibular, tibial, sciatic, femoral neuropathy, meralgia paresthetica, peripheral nerve trauma, tumors, and inflammatory neuropathies.
Collapse
Affiliation(s)
- Johan A Telleman
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
| | - Leo H Visser
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| |
Collapse
|
5
|
Kim KH, Lee MH, Park SY, Kim HJ, Chee CG, Yoon MA, Chung HW, Lee SH. Ulnar neuropathy at the elbow: associations of pre-operative DTI parameters with clinical outcomes after cubital tunnel decompression. Eur Radiol 2023; 33:6351-6358. [PMID: 37014404 DOI: 10.1007/s00330-023-09562-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES To evaluate whether DTI parameters of the ulnar nerve at the elbow are associated with clinical outcomes in patients receiving cubital tunnel decompression (CTD) surgery for ulnar neuropathy. METHODS This retrospective study included 21 patients with cubital tunnel syndrome who received CTD surgery between January 2019 and November 2020. All patients underwent pre-operative elbow MRI, including DTI. Region-of-interest analysis was performed on the ulnar nerve at three levels around the elbow: above (level 1), cubital tunnel (level 2), and below (level 3). Fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were calculated on three sections at each level. Clinical data on symptom improvement in respect to pain and tingling sensation after CTD were recorded. Logistic regression analysis was used to compare DTI parameters of the nerve at three levels and the entire nerve course between patients with and without symptom improvement after CTD. RESULTS After CTD, 16 patients showed improvement in symptoms, but five did not. ROC analysis of DTI parameters showed that AUCs of FA, AD, and MD were higher at level 1 than at levels 2 and 3, with FA showing the highest AUC (level 1: FA, 0.7104 [95% CI, 0.5206-0.9002] vs AD, 0.6521 [95% CI, 0.4900-0.8142] vs MD, 0.6153 [95% CI, 0.4187-0.8119]). CONCLUSION In patients who underwent CTD surgery for ulnar neuropathy at the elbow, the DTI parameters of FA, AD, and MD above the cubital tunnel level were associated with clinical outcomes, with FA showing the strongest associations. KEY POINTS • After CTD surgery for ulnar neuropathy at the elbow, persistent symptoms may be observed, depending on symptom severity. • DTI parameters of the ulnar nerve at the elbow showed differences in their capacity for discriminating between patients with and without symptom improvement following CTD surgery, with this capacity depending on the nerve level at the elbow. • FA, AD, and MD measured above the cubital tunnel on pre-operative DTI may be associated with surgical outcomes, with FA showing the strongest association (AUC at level 1, 0.7104 [95% CI, 0.5206-0.9002]).
Collapse
Affiliation(s)
- Kyung Ho Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
- Department of Radiology, BNS Neurosurgery, 68, Yangpyeong-ro, Yeongdeungpo-gu, Seoul, South Korea
| | - Min Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Sun-Young Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Choong Guen Chee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Min A Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Sang Hoon Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| |
Collapse
|
6
|
Hasegawa H, Omokawa S, Nakanishi Y, Nakano K, Nagashima M, Sananpanich K, Kawamura K, Mahakkanukrauh P, Tanaka Y. Dynamic analysis of the ulnar nerve and cubital tunnel morphology using ultrasonography: a cadaveric study. J Shoulder Elbow Surg 2022; 31:2322-2327. [PMID: 35817372 DOI: 10.1016/j.jse.2022.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The causes of ulnar neuropathy at the elbow are unclear. The authors hypothesized that the humeral trochlea protrudes into the cubital tunnel during elbow flexion and causes a dynamic morphologic change of the ulnar nerve in the cubital tunnel. METHODS An ultrasonic probe was fixed to the ulnar shafts of 10 fresh cadavers with an external fixator, and dynamic morphology of the cubital tunnel and ulnar nerve was observed. The distance from the Osborne band to the trochlea (OTD), distance from ulnar nerve center to the trochlea (UTD), and the short- and long-axis diameters of the nerve at 30°, 60°, 90°, and 120° of elbow flexion were recorded. We compared the OTD, UTD, and the flattening of the ulnar nerve at the different angles of flexion using single-factor analysis of variance. Correlation between the ulnar nerve flattering, OTD, and UTD was examined using Spearman correlation coefficient. A P value less than .05 was used to denote statistical significance. RESULTS Flattening of the ulnar nerve progressed with increasing elbow flexion and was significantly different between 0° and 60°, 90°, and 120° (P = .03 at 60°, P < .01 at 90° and 120°). OTD decreased with elbow flexion, and there was a significant difference at all elbow flexion angles (all P < .01). UTD decreased significantly from 0° flexion to 90° flexion (P = .03). Flattening of the nerve was significantly correlated with the OTD (r = 0.66, P < .01). CONCLUSIONS A positive correlation was found between the protrusion of the humeral trochlea into the cubital tunnel during elbow flexion and ulnar nerve flattening using cadaveric elbow and ultrasonography.
Collapse
Affiliation(s)
- Hideo Hasegawa
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Shohei Omokawa
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan.
| | - Yasuaki Nakanishi
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Kenichi Nakano
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | | | - Kanit Sananpanich
- Department of Orthopedic Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kenji Kawamura
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| |
Collapse
|
7
|
Postoperative MR Imaging of the Elbow. Magn Reson Imaging Clin N Am 2022; 30:629-643. [DOI: 10.1016/j.mric.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
8
|
Griffith JF. How to Report: Elbow MRI. Semin Musculoskelet Radiol 2021; 25:661-669. [PMID: 34861711 DOI: 10.1055/s-0041-1736190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The elbow is the least common of the main joints examined with magnetic resonance imaging (MRI), thus radiologists may be less familiar with writing these reports. This article addresses the main pathologies encountered in and around the elbow, emphasizing the specific features that need reporting and providing examples of terminology to use when describing these abnormalities.
Collapse
Affiliation(s)
- James Francis Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
9
|
Deely DM, Morrison WB. Imaging the Postoperative Elbow. Semin Musculoskelet Radiol 2021; 25:628-636. [PMID: 34706392 DOI: 10.1055/s-0041-1731333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Evaluation of postoperative images of any joint can be a daunting task, and the elbow is no exception. Patients may be imaged with a complication of the repair, or the postoperative changes may be incidentally observed as the patient is imaged for other reasons. We divide the postoperative elbow into soft tissue procedures (covering ligament and tendon repairs, as well as compartmental release and nerve transposition), joint-related procedures (osteochondral lesion treatment, ostectomy, and joint replacement), and bone procedures (fracture fixation). We summarize the procedures and their indications, show normal imaging appearances, and finally cover common complications.
Collapse
Affiliation(s)
- Diane M Deely
- Division of General and Musculoskeletal Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - William B Morrison
- Division of General and Musculoskeletal Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
10
|
Węgiel A, Zielinska N, Tubbs RS, Olewnik Ł. Possible points of compression of the ulnar nerve: Tricks and traps that await clinicians from an anatomical point of view. Clin Anat 2021; 35:155-173. [PMID: 34610170 DOI: 10.1002/ca.23798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022]
Abstract
The ulnar nerve can be subject to numerous types of compression. The most common are cubital tunnel and ulnar tunnel syndromes, but there are many others with more uncommon etiologies. The existence of additional communicating branches, median nerve involvement, various types of injuries, and unusual anatomical variations can be a challenge for both diagnosis and treatment. This review presents a comprehensive depiction of ulnar nerve entrapment syndromes with particular reference to their anatomical background, risk factors, and clinical evaluation. Even common disorders can result from atypical morphological changes. It is important to be familiar with them as it is a key ability in daily medical practice.
Collapse
Affiliation(s)
- Andrzej Węgiel
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Łódź, Poland
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Łódź, Poland
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Anatomical Sciences, St. George's University, True Blue, Grenada
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Łódź, Poland
| |
Collapse
|
11
|
Davis GA, Lal T, Hearps SJC. Risk factors and outcomes in 385 cases of ulnar nerve submuscular transposition. J Clin Neurosci 2021; 87:8-16. [PMID: 33863539 DOI: 10.1016/j.jocn.2021.01.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/23/2020] [Accepted: 01/26/2021] [Indexed: 11/16/2022]
Abstract
Submuscular transposition (SMT) for treatment of ulnar nerve entrapment is commonly performed, however published comparisons of surgical techniques exclude a high proportion of the at-risk population encountered in real world practice. To examine the influence of risk factors on the clinical outcome following SMT we performed a retrospective review of all patients who underwent SMT, including patient self-reported outcome and Louisiana State University Medical Centre ulnar nerve grading scale. A total of 403 ulnar nerves were operated, with follow-up data available for 385 cases (359 patients). Risk factors (including smoking, diabetes, previous elbow trauma/pathology, subluxation, workers' compensation) were reported in 266 of 385 surgeries (69.09%). SMT was the primary procedure in 339 nerves (88.05%), revision procedure in 46 nerves (11.95%). At last follow up 91.05% reported symptomatic improvement. Nerve grade improvement in 71.09% of primary and 67.39% revision surgery (p = 0.605). No significant difference in improvement was identified between demographic and risk categories, except for patient reported improvement in those without peripheral neuropathy (90.59% vs 73.33%, p = 0.027), and those not improved were on average older than those improved (62.94 vs. 55.68 years, p = 0.012). Superficial infection occurred in 2.6% and there were no deep infections. Application of published exclusion criteria would have resulted in exclusion of ½-⅔ of our cohort. SMT in patients with a history of elbow trauma, diabetes, workers compensation, smoking history, nerve subluxation or revision surgery have similar outcomes compared to those without these factors, whilst improved results were observed in younger patients and those without peripheral neuropathy.
Collapse
Affiliation(s)
- Gavin A Davis
- Department of Neurosurgery, Austin Health, Melbourne, Victoria, Australia; Neurosurgery Department, Cabrini Health, Melbourne, Victoria, Australia.
| | - Trisha Lal
- Department of Neurosurgery, Austin Health, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Australia
| | | |
Collapse
|
12
|
MRI of the ulnar nerve pre- and post-transposition: imaging features and rater agreement. Skeletal Radiol 2021; 50:559-570. [PMID: 32909158 DOI: 10.1007/s00256-020-03598-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/31/2020] [Accepted: 09/02/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Determine the rater agreement of MRI features of the ulnar nerve pre- and post-transposition and association with recurrent symptoms. MATERIALS AND METHODS This IRB-approved retrospective cohort analysis examined 23 subjects who underwent elbow MRI pre- and post-ulnar nerve transposition from 1999 to 2018, 10 of whom developed recurrent symptoms. Pre- and post-transposition MRIs were evaluated by two blinded radiologists for ulnar nerve cross-sectional area, signal intensity, fascicular architecture, caliber change, and perineural scar. Inter-rater agreement was estimated using intraclass correlation coefficients (ICCs) for continuous variables and Gwet's agreement coefficient (AC) for categorical variables. Binary logistic regression modeling probed associations between imaging markers and symptom recurrence. RESULTS The ulnar nerve, post-operatively, demonstrated statistically significant increases in size (p < 0.001), signal intensity (p = 0.021), and abrupt caliber change (p = 0.024). None of the imaging features, except for higher signal intensity of the nerve pre-transposition as demonstrated by one rater, were predictive of symptom recurrence. Inter-rater agreement for cross-sectional area measurements of the ulnar nerve at the cubital tunnel was excellent (ICCs of 0.91 and 0.83). Substantial-to-excellent inter-rater agreement was observed pre-operatively for nerve signal intensity, caliber change, and fascicular architecture. Post-operatively, agreement on nerve signal intensity and perineural scar was excellent (ACs of 0.90 and 0.88), but only slight for caliber change (0.15). CONCLUSION Inter-rater agreement for qualitative and quantitative assessment of the ulnar nerve was generally robust. Post-transposition, the ulnar nerve was generally larger and more T2-hyperintense, but MRI features were not predictive of recurrent ulnar neuropathy, except for perhaps the signal intensity of the nerve pre-transposition.
Collapse
|
13
|
Vascular compromise in a torsed transposed ulnar nerve case in support of intravenous contrast administration. Clin Imaging 2020; 70:118-123. [PMID: 33157368 DOI: 10.1016/j.clinimag.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/08/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022]
Abstract
Nerve torsion is a recognized etiology in brachial and peripheral neuropathy. Vascular compromise of peripheral nerves is uncommon given their unique vascular supply. Preoperative imaging diagnosis of nerve torsion and vascular compromise can be made in some cases, which impacts treatment. We present a previously unreported case of long segment torsion and vascular compromise of the ulnar nerve following anterior subcutaneous transposition with a description of the imaging findings based on the unique structure of the nerve and the presence of a blood nerve barrier (BNB) and a discussion of the potential vulnerability of a transposed and torsed nerve.
Collapse
|
14
|
Abstract
Elbow pain can cause disability, especially in athletes, and is a common clinical complaint for both the general practitioner and the orthopaedic surgeon. Magnetic resonance imaging (MRI) is an excellent tool for the evaluation of joint pathology due to its high sensitivity as a result of high contrast resolution for soft tissues. This article aims to describe the normal imaging anatomy and biomechanics of the elbow, the most commonly used MRI protocols and techniques, and common MRI findings related to tendinopathy, ligamentous and osteochondral injuries, and instability of the elbow.
Collapse
|