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The Utility of Ultrasound in Determining the Etiology of Failure in Ulnar Nerve Transposition
Michael Vosbikian, MD; David Tarity, MD; Asif M. Ilyas, MD
Thomas Jefferson University, Philadelphia, PA

Background: Cubital tunnel syndrome is the second most common peripheral nerve entrapment in the upper extremity. Cubital tunnel syndrome is often managed with an ulnar nerve transposition. When or if a transposition fails to improve symptom, often an ultrasound is ordered to diagnose the casue of the failure. While the sonographic findings in cubital tunnel syndrome are well documented, there is very little published literature regarding findings of a postoperative symptomatic ulnar nerve. To better determine if there is a role for ultrasound in determining the cause of postoperative symptomatology, ultrasounds of the ulnar nerve in patients who have failed ulnar nerve transposition were examined in order to determine if there is a reproducible finding on these imaging studies that may lead to finding a mode of failure.
Methods: A retrospective review of 68 consecutive ulnar nerve ultrasounds from January 2007 to February 2012 was performed on patients that had a failed transposition. Failure was defined as persistence or recurrence of preoperative symptomatology. The cross sectional area (CSA) of the nerve, subjective echogenicity, and sites of nerve compression were recorded for each imaging study. These data were analyzed to determine if there was a commonality amongst this patient population.
Results: The ulnar nerves that a failed transposition had a mean CSA of 17.26 9.93-mm2, which is significantly larger than published studies regarding the CSA of the ulnar nerve in patients with cubital tunnel syndrome as well as in the normal ulnar nerve. However, the nerves that had failed transposition did not have a consistent change in echogenicity, nor did the nerves show definitive locations of postoperative residual compression.
Conclusion: Patients that have failed ulnar nerve transposition show an enlarged CSA when compared to both symptomatic nerves in situ as well as normal ulnar nerves. However, ultrasound findings did not specifically show a specific site of compression or changes with respect to echogenicity. Due to the frequency of essentially negative studies in symptomatic patients, this data suggests that the utility of ultrasound in diagnosing the etiology for failed ulnar nerve transposition may not be as high yield as is seen in diagnosing cubital tunnel syndrome.


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