RESUMO
BACKGROUND: Fibrous bands (FB) are structures that cross the ulnar nerve (UN), distal to the cubital tunnel (CT). In surgical decompression of the UN in the elbow region, by endoscopy, these FB significantly impact UN visibility. The aim of the current study was to characterize the anatomical characteristics of these FB distal to the CT. METHODOLOGY: Eighteen formalinized upper limbs were dissected, nine right and nine left, within the Department of Anatomy of the Federal University of the State of Rio de Janeiro (UNIRIO). The dissections were performed with micro techniques, under a magnifying glass and a microscope. Classical UN exposure was established in the elbow region. RESULTS: Of the 18 upper limbs studied, 50% lacked any FB. When present, both the number and location of the FB varied, as near to the cubital tunnel as 3 cm past the UN's entrance into the tunnel, and as far away as almost 11 cm distal to it. Overall, there were no FB on either the left or right side in three cadavers (33.3%), FB on both the left and right side in three, and FB only on the left in three, meaning that FB were twice as common in left limbs (n = 6) as on the right (n = 3). CONCLUSIONS: Our study identified FB in 50% of the dissected limbs, all within 3-11 cm of the CT, though their number and location varied. Further studies are necessary to describe FB variations associated with compressive neuropathies of the UN distal to the CT.
Assuntos
Síndrome do Túnel Ulnar/patologia , Descompressão Cirúrgica/métodos , Nervo Ulnar/anatomia & histologia , Cadáver , Síndrome do Túnel Ulnar/cirurgia , Feminino , Humanos , Masculino , Nervo Ulnar/patologia , Nervo Ulnar/cirurgiaRESUMO
The purpose of this study was to assess the simple decompression as surgical treatment for ulnar tunnel syndrome at elbow. The review was in eight patients with a total of ten cases. The electromyography and neuroconduction study was altered in all cases. The classification according McGowan was: 40 percent of cases in grade I, 40 percent grade IIA and 20 percent grade IIB. In the 63 percent of cases a concomitant carpal tunnel syndrome was treated surgically. In all cases, a compressive Osbornes arcade was observed. The follow up are 3,8 months with an 100 percent of excellent (complete relief of symptoms) and good (minimal residual symptoms) results. This review shows that the simple decompression is a proved and reproducible surgical technique. This technique can be the first option for the surgical treatment of the ulnar tunnel syndrome.
Se presenta trabajo prospectivo sobre la descompresión simple como tratamiento quirúrgico del síndrome de compresión del nervio ulnar en el codo. Se revisa una serie de 8 pacientes y 10 codos operados. Hubo electromiografía alterada en todos los casos. Se clasificó preoperatoriamente según McGowan(40 por ciento grado I, 40 por ciento grado IIA y 20 por ciento grado IIB). En el 63 por ciento de los casos hubo un síndrome de túnel del carpo asociado que también se trató. En todos los casos se observó una fascia de Osborne tensa y compresiva sobre el nervio ulnar. El seguimiento promedio fue de 3,8 meses y se obtuvo un 100 por ciento de resultados buenos y excelentes. En este trabajo se confirma que ésta es una técnica quirúrgica reproducible y basada en la simplicidad. Se le puede considerar como primera opción para el tratamiento quirúrgico del síndrome de compresión del nervio ulnar en el codo.