Search Results (19)

Background/Objectives: Ulnar nerve neuropathy at the elbow (UNE) is the second most common focal neuropathy of the upper extremity and often results from entrapment of the ulnar nerve as it traverses the elbow with insidious onset and gradual progression. This study describes the clinical, electrodiagnostic (EDX), and ultrasound (US) findings in a cohort of patients presenting with acute UNE. Methods: This is a review of 103 patients with clinical features of UNE with acute onset who underwent EDX and US studies over a 25-year period (2010–2026) at our Neurodiagnostic Center. Results: Of the 103 patients with acute UNE, all experienced paresthesia in the ulnar nerve distribution. A total of 27 (26.2%) patients had elbow pain, and 99 (96.1%) had decreased pinprick sensation in the ulnar nerve distribution. Weakness of the following muscles was detected: abductor digiti minimi (ADM) (94 [91.3%]), FDI (first dorsal interosseous) (91 [88.3%]), and FDPu (flexor digitorum profundus—ulnar) (76 [73.8%]). Most patients had a clinical grade of 3 (severe: sensory and motor abnormalities as well as atrophy of the FDI and ADM muscles) (93 [90.3%]). Perioperative injuries were the most common etiology of acute UNE, consisting of 65 (63.1%) patients. The perioperative injury was noted after surgical procedures at varied locations, most frequently at the shoulder in 23 (35.4%) followed by coronary artery bypass in 9 (13.8%) and knee joint surgery in 8 (12.3%). Non-iatrogenic injuries affected 11 (10.7%) patients. The US study revealed cysts and tumors such as a Schwannoma in 14/76 (18.4%) patients. Focal demyelination was observed by EDX studies in 95 (92.2%) patients, and a conduction block was detected in 24 (23.3%). Motor and sensory axonal involvement was identified in 81 (78.6%) and 86 (83.5%) patients, respectively. Of the 76 patients who underwent an US study, 68 (90.6%) had an increase in the cross-sectional area of the ulnar nerve and 51 (68.0%) had a hypoechoic ulnar nerve at the elbow. Conclusions: In this study, the most common cause of acute UNE was periprocedural injury, most frequently following shoulder surgery. Acute UNE may also occur without a history of antecedent trauma or a surgical procedure. EDX and US studies provide complementary data to determine the severity and the etiology of acute UNE and guide further management. Full article

This case highlights the diagnostic value of high-resolution ultrasonography in identifying postoperative injury of the posterior branch of the medial antebrachial cutaneous nerve (MABCN) following cubital tunnel surgery. A 45-year-old man developed localized pain, warmth, and paresthesia extending from the medial epicondyle to the proximal anterior forearm one month after ulnar nerve decompression and anterior transposition. Physical examination revealed focal allodynia and a positive Tinel sign. Because previous surgery may substantially alter the anatomical location of the surrounding nerves, electrodiagnostic localization can be technically challenging and less reliable. Ultrasonography therefore played a key diagnostic role. The images demonstrated the normal sonoanatomy of the MABCN and its anatomical relationship with the basilic vein and ulnar nerve, followed by pathologic findings of focal enlargement of the posterior branch adjacent to postoperative scar tissue. These imaging features, together with a positive sonographic Tinel sign, supported the diagnosis of localized nerve irritation. Ultrasound-guided hydrodissection using 5% dextrose and methylcobalamin resulted in marked clinical improvement, with the Visual Analog Scale pain score decreasing from 9 to 2. This case is particularly illustrative because postoperative injury of the MABCN may mimic recurrent cubital tunnel syndrome yet typically produces purely sensory symptoms confined to the medial elbow region. Targeted ultrasonographic evaluation can reveal subtle postoperative nerve pathology and guide effective ultrasound-guided intervention. Full article

Background: Cubital Tunnel Syndrome (CuTS) is the second-most common compressive neuropathy of the upper limb, traditionally associated with prolonged elbow flexion, trauma, or anatomical constraints. With the widespread adoption of smartphones, sustained upper-limb postures have emerged as potential novel risk factors for ulnar nerve compression. This retrospective study aimed to investigate the potential correlation between smartphone use patterns and the development of CuTS. Methods: A retrospective observational study was conducted on 100 subjects recruited between 2021 and 2024, including 50 patients with EMG-confirmed CuTS who underwent surgical decompression and 50 matched controls without clinical or electrophysiological evidence of ulnar neuropathy. Demographic variables, daily smartphone use (h/day), predominant activity type, and habitual posture during device handling were collected through clinical records and questionnaires. Group comparisons were performed using t-tests and Chi-square analyses, with significance set at p < 0.05. Results: Daily smartphone use was higher in the CuTS group compared with controls (4.94 ± 1.8 vs. 4.04 ± 1.5 h/day), although the difference did not reach statistical significance (p = 0.0716). Posture during device use showed a significant association with CuTS: 82% of affected patients reported using smartphones with the elbow flexed, compared with 56% of controls, whereas supportive postures were less frequent among CuTS patients (16% vs. 38%) (p = 0.019). No significant differences were found between groups regarding smartphone activity type (p = 0.858). Conclusions: Smartphone use may contribute to ulnar nerve compression primarily through ergonomically disadvantageous postures, particularly sustained elbow flexion, rather than total usage time. These findings highlight a modifiable behavioral risk factor relevant to the rising prevalence of CuTS in the digital era. Increased clinical attention to device-handling habits and public-health strategies promoting ergonomic posture may support CuTS prevention. Prospective and biomechanically informed studies are warranted to further elucidate causal mechanisms. Unmeasured confounders (e.g., occupational and sleep-related elbow flexion) may influence these associations. Full article

Objectives: This cross-sectional case–control study, conducted at the Department of Physiotherapy, Academy of Physical Education, in Katowice, between July 2022 and April 2023, aimed to assess the overall health status (OHS) of patients with mild-to-moderate cubital tunnel syndrome (CuTS) compared with a healthy control population. Methods: The SF-36 questionnaire was used to evaluate the following domains: physical functioning (PF), role limitations due to physical health problems (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role limitations due to emotional problems (RE), and mental health (MH). Results: A total of 152 participants were enrolled in the study. The CuTS and control groups consisted of 82 and 70 individuals, respectively. The CuTS group had significantly lower scores in most domains when compared with the control group; however, no significant difference was observed in the BP domain. Notably, the VT domain showed a statistically significant difference in favor of the CuTS group, indicating slightly higher perceived vitality despite functional limitations. Conclusions: Mild and moderate forms of CuTS are associated with significant deterioration in general health, encompassing both physical and psychological components, as assessed by the SF-36 questionnaire; however, no significant difference was observed in the BP domain, suggesting that the burden of CuTS may manifest more strongly in functional, psychosocial, and mental health aspects rather than in generalized pain perception. These findings highlight the importance of a comprehensive evaluation and management strategy that addresses both physical and psychosocial dimensions of patient care. Full article

In recent decades, information technology has grown. Computers have become a daily activity, facilitating access to information, faster communication and faster work. If used responsibly, it has many advantages. Objectives: To explore the potential link between prolonged use of computer input devices—such as keyboards and mice—and the development of compressive neuropathies, including carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CuTS), in individuals whose daily routines are heavily reliant on computer-based activities. Methods: A comprehensive review of the literature was undertaken to assess the correlation between the use of computer input devices and the incidence of compressive neuropathies in the upper limbs, with particular attention to repetitive strain, ergonomic posture deviations, and personal risk factors. Results: Current evidence indicates a potential association between prolonged computer use and the development of upper limb compressive neuropathies; however, a definitive consensus within the scientific literature remains elusive. Repetitive movements and non-neutral postures appear to be significant contributing factors, particularly among individuals with predisposing risk factors. Despite increasing awareness of this issue, standardized, evidence-based clinical guidelines for the evaluation and management of work-related nerve disorders remain lacking. Conclusions: While the relationship between computer use and compressive neuropathies remains debated, healthcare professionals should be aware of the risks, particularly in individuals exposed to repetitive strain and ergonomic stress. Further research and the development of clinical guidelines are needed to better understand and manage these work-related conditions. Full article

The aim of this study was to evaluate the efficacy of manual therapy based on neurodynamic techniques and electrophysical modalities in the conservative treatment of cubital tunnel syndrome (CuTS). A total of 128 upper limbs affected by CuTS were initially enrolled in this study, with 82 completing the full treatment protocol. The participants were divided into the following two intervention arms: the first arm (MT) (42 arms) received therapy based on sliding and tensioning neurodynamic techniques, while the second arm (EM) (40 arms) underwent physiotherapy based on electrophysical modalities, specifically low-level laser therapy (LLLT) and ultrasound therapy (US). Chi² and Student’s t-test were used to compare the intervention arms, and no statistically significant differences were found. The evaluated outcomes included nerve conduction testing, ultrasound assessments (measuring cross-sectional area and shear modulus), pain levels, two-point discrimination, thresholds for cutaneous sensory perception, symptom severity, functional ability in specific tasks, and overall post-treatment improvement. Baseline comparisons indicated no statistically significant differences in any measured variables between the intervention groups (p > 0.05). Following treatment, each group exhibited significant improvements in their respective parameters (p < 0.01). Comparisons between groups post-intervention revealed statistically significant differences in nerve conduction results, ultrasound measurements (cross-sectional area and shear modulus), two-point discrimination, and sensory perception thresholds. These parameters improved more in the MT intervention arm. The use of neurodynamic techniques, ultrasound, and low-level laser therapy in the conservative treatment of mild to moderate forms of CuTS has a beneficial therapeutic effect. Full article

Background: Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb, and it is characterized by ulnar nerve compression at the elbow. Traditional surgical options, including simple decompression and anterior transposition, have limitations in addressing ulnar nerve instability. This study introduces and evaluates the short-term outcomes of a novel surgical technique, the fascio-aponeurotic epicondylar flap (FAEF), for stabilizing the ulnar nerve and managing its instability. Materials and methods: A retrospective study was conducted on ten patients with longstanding cubital tunnel syndrome and confirmed ulnar nerve dislocation or instability. All patients underwent surgical intervention using the FAEF technique, which involves creating a quadrangular fascial flap from the epicondylar fascia to stabilize the ulnar nerve within the retrocondylar groove. Outcomes were assessed using clinical follow-ups, the Michigan Hand Outcomes Questionnaire (MHQ), VAS, and qDASH scores over a 90-day postoperative period. Results: All ten patients experienced complete resolution of neurological symptoms, including paresthesia, pain, and nerve clicking, by the final follow-up. Postoperative recovery was uneventful, with no complications such as infections or hematomas. Grip strength and hand functionality were fully restored, with significant improvements in MHQ scores (mean: 94). Dynamic elbow mobilization initiated on the first postoperative day resulted in full recovery of elbow range of motion. No recurrence of ulnar nerve dislocation was observed. Discussion: The FAEF technique effectively stabilizes the ulnar nerve, alleviates symptoms, and restores function while minimizing risks associated with traditional procedures, such as nerve trauma and elbow instability. By preserving the anatomical integrity of the medial epicondyle and enhancing nerve mobility, this approach represents a less invasive alternative to anterior transposition and medial epicondylectomy. Conclusions: The FAEF technique is a viable and effective surgical option for managing ulnar nerve instability in cubital tunnel syndrome. It offers a less invasive solution with excellent short-term outcomes, making it a promising addition to the surgical armamentarium for this condition. Further studies are warranted to evaluate long-term efficacy and broader applicability. Full article

Background/Objective: To assess the effectiveness of therapy based on sliding and tensioning neurodynamic techniques in the conservative treatment of mild and moderate forms of cubital tunnel syndrome (CuTS) compared to sham therapy. Methods: A single-blinded, randomized placebo-controlled trial. The study was conducted at several medical clinics. Individuals diagnosed with CuTS (initially 136 subjects, of whom 91 completed the full protocol) participated in the experiment. In the experimental group (MT), sliding and tensioning neurodynamic techniques were applied, whereas in the control group (ST), a sham therapy was used, involving the performance of neurodynamic techniques in an intermediate position without following the specific neurodynamic sequence for the ulnar nerve. The therapy was administered five times per week over the course of 10 sessions. All participants underwent assessments, including nerve conduction studies, ultrasound imaging (cross-sectional area and shear modulus), pain levels, two-point discrimination sensation, cutaneous sensory perception threshold, symptoms, ability to perform certain activities, and changes in improvement following treatment. Results: A baseline assessment revealed no significant inter-group differences in all examined parameters (p > 0.05). After therapy, there was a statistically significant intra-group improvement in all parameters tested (p < 0.01). In the MT group, the intra-group differences were significant across all parameters tested (p < 0.01). However, in the ST group (sham therapy), only the shear modulus showed statistically significant changes, while the other tested parameters remained unchanged. Conclusions: Neurodynamic techniques demonstrate superior therapeutic effects compared to sham therapy in the treatment of mild to moderate forms of CuTS. Full article

Background and Clinical Significance: Guyon’s canal syndrome is a pathological condition caused by compression of the ulnar nerve at the level of the wrist. It is less frequent than other compression syndromes of the upper limb (cubital and carpal tunnel), and different causative agents, including vascular lesions, are described. Among these, aneurysm of the ulnar artery is described in the literature as an infrequent aetiology. Case Presentation: We report the case of a 25-year-old young man with Guyon’s canal syndrome caused by an aneurysm of the ulnar artery, who underwent surgical decompression of the Guyon’s canal without intervening on the aneurysm. The postoperative course was free of complications, and the patient reported satisfaction, with reduced symptoms. Clinical examination and ultrasound imaging showed mass reduction of the aneurysm in the postoperative period, which appears to be an evolution hitherto undocumented in the literature. Conclusions: Many treatments are available for Guyon’s canal syndrome. Past medical and surgical treatments, duration and severity of symptoms, causes, and pathogenesis are important for therapeutic choice. Surgical treatment based on ligament section and lysis of the Guyon’s canal downstream, without any action on the aneurysm and with ulnar artery preservation, determined a reduction in terms of volume, relief of the symptoms, and patient satisfaction. With this case we describe a surgical therapeutic option for the treatment of Guyon’s canal syndrome caused by an aneurysm of the ulnar artery, in which surgery is limited to canal decompression and consequential aneurysm mass reduction with concomitant relief of symptoms. Full article

Background: The lack of a clear answer regarding the efficacy of physiotherapy in the treatment of cubital tunnel syndrome (CuTS) has led to attempts to critically assess the scientific studies conducted to date. Materials and Methods: Two databases (MEDLINE via PubMed and PEDro) and Google Scholar were used to search for papers. The inclusion criteria were randomized controlled trials, case series, and case reports that evaluate the effects of physiotherapy in the treatment of patients with CuTS. Results: A total of 18 studies met the eligibility criteria, capturing a total of 425 participants. Seven papers were randomized controlled trials, three more described prospective studies without a control group, and eight papers contained case reports. An analysis of the literature evaluating the effectiveness of various forms of broadly defined physiotherapy indicates that their use can have a beneficial effect in reducing many subjective and objective symptoms and improving function. In the majority of papers included in this review, their authors indicated positive therapeutic effects. Only one randomized controlled trial reported no change following therapy. It can therefore be stated that the results of the research conducted so far are optimistic. However, only 7 of the 18 papers were randomized controlled trials, while 3 were prospective studies, and 8 papers were case studies, in which 23 people with CuTS were studied. Conclusions: The small number of randomized clinical trials and their considerable heterogeneity do not allow firm conclusions to be drawn about the effectiveness of physiotherapy in the conservative treatment of CuTS. Full article

Peripheral nerves consist of delicate structures, including a rich microvascular system, that protect and nourish axons and associated Schwann cells. Nerves are sensitive to internal and external trauma, such as compression and stretching. Ulnar nerve entrapment, the second most prevalent nerve entrapment disorder after carpal tunnel syndrome, appears frequently at the elbow. Although often idiopathic, known risk factors, including obesity, smoking, diabetes, and vibration exposure, occur. It exists in all adult ages (mean age 40–50 years), but seldom affects individuals in their adolescence or younger. The patient population is heterogeneous with great co-morbidity, including other nerve entrapment disorders. Typical early symptoms are paresthesia and numbness in the ulnar fingers, followed by decreased sensory function and muscle weakness. Pre- and postoperative neuropathic pain is relatively common, independent of other symptom severity, with a risk for serious consequences. A multimodal treatment strategy is necessary. Mild to moderate symptoms are usually treated conservatively, while surgery is an option when conservative treatment fails or in severe cases. The decision to perform surgery might be difficult, and the outcome is unpredictable with the risk of complications. There is no consensus on the choice of surgical method, but simple decompression is relatively effective with a lower complication rate than transposition. Full article

Purpose: The failure rate for operative decompression in neurogenic thoracic outlet syndrome (NTOS) is high compared to more distal nerve compression syndromes, such as cubital or carpal tunnel syndrome. Herein, we aimed to determine if a more radical approach, namely costovertebral exarticulation of the first rib, may improve the postoperative results in patients with NTOS. Methods: From October 2002 to December 2020, 105 operative decompressions in 95 patients were evaluated; in 10 cases, decompressions were performed bilaterally. We presented the clinical outcomes of 59 exarticulations compared to those of 46 conventional resections. Evaluation was performed at a minimum of one year post-operation using the DASH questionnaire. Results: The exarticulation group presented with significantly better clinical outcomes (two-sample t-test assuming unequal variances, p < 0.001). Conclusions: This study showed that significantly better results were obtained when exarticulation of the first rib was performed in patients with NTOS. This finding supports the hypothesis that, in certain cases, the proximal portion of the first rib plays a pivotal role in the pathogenesis of NTOS. Full article

Ultrasound imaging (US) is increasingly being used in the diagnosis of entrapment neuropathies. The aim of the current study was to evaluate changes in stiffness (shear modulus), cross-sectional area (CSA), and trace length (TRACE) of the ulnar nerve in patients with cubital tunnel syndrome (CuTS), with shear wave elastography (SWE). A total of 31 patients with CuTS were included. CSA, shear modulus, and TRACE examinations were performed in the SWE mode in four positions of the elbow: full extension, 45° flexion, 90° flexion, and maximum flexion. There were significant side-to-side differences in the ulnar nerve elasticity value at 45°, 90°, and maximal elbow flexion (all, p < 0.001) but not at elbow extension (p = 0.36). There were significant side-to-side differences in the ulnar nerve CSA value at each elbow position (all, p < 0.001). There were significant side-to-side differences in the ulnar nerve trace value at each elbow position (all, p < 0.001). The symptomatic ulnar nerve in patients with CuTS exhibited greater stiffness (shear modulus), CSA, and TRACE values, compared with the asymptomatic side. US examinations (shear modulus, CSA, and TRACE evaluation) of the ulnar nerve can be helpful in supporting and supplementing the diagnosis in patients with CuTS. Full article

Static two-point discrimination (2PD) and Semmes–Weinstein monofilament (SWM) tests are commonly used to evaluate sensory disorders in the hand. The aim of this study was to evaluate the reliability of 2PD and SWM tests in the ulnar nerve innervation area in patients with cubital tunnel syndrome (CuTS) and healthy individuals. This was a two-group repeated-measures inter-rater and intra-rater reliability study. Twenty-one patients with CuTS and 30 healthy adults participated. The static 2PD test was performed using a standardized Dellon discriminator, whereas the SWM test was conducted using TOUCH TEST monofilaments. Two examiners performed both tests at the hypothenar eminence and the fourth and fifth digits (ulnar nerve innervation hand territory). First, examiner A conducted three series of 2PD and SWM tests twice with a 15-min rest period (within-day intra-rater reliability). Next, examiner B repeated the same examination 5 min after (inter-rater reliability). Examiner A conducted the same examination 7 days after (between-day intra-rater reliability). For single measurements, the inter-rater reliability and within-day intra-rater reliability in the 2PD was at least 0.81 in patients with CuTS or healthy subjects. The between-days intra-rater reliability for a single measurement varied from 0.56 to 0.95 in CuTS patients and healthy subjects. The between-days intra-rater reliability for mean value from three measurements was above 0.80. The kappa for SWM was above 0.8 and the percentage of agreement was at least 90% for all sessions and trials. In conclusion, the 2PD and SWM tests are reliable for assessing sensation in the ulnar nerve innervation area of the hand in patients with CuTS and healthy subjects. Full article

Background: To date, various forms of physiotherapy are used in the treatment of cubital tunnel syndrome (CuTS). The effectiveness of physiotherapy for CuTS is inconclusive. The aim of this systematic review was to evaluate the effects of physiotherapy in the conservative treatment of CuTS. Methods: The six databases were searched from December 2020 to March 2022. The inclusion criteria were randomised controlled trials, case series, and case reports that evaluate the effects of physiotherapy in the treatment of adult participants with diagnosis CuTS. A total of 11 studies met the eligibility criteria, capturing a total of 187 participants. Results: In three types of papers, pain, muscle strength, and limitation of upper limb function were the most frequently assessed characteristics. Physiotherapy was most often based on manual therapy, neurodynamic techniques, and electrical modalities. One clinical trial rated the risk of bias “high” and the other two “some concerns”. In case-series designs, five studies rated the risk of bias as “serious” and three as “moderate”. Most of the studies showed a significant improvement in the clinical condition, also in the follow-up study. Only one clinical trial showed no therapeutic effect. Conclusion: There is no possibility of recommending the best method of physiotherapy in clinical practice for people with CuTS based on the results of this systematic review. More high-quality studies are required. Full article