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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A diagnosis of ulnar artery thrombosis should be considered when a patient reports symptoms of ulnar neuropathy, ischemia in the hand, or a mass in the hypothenar area. A history of repetitive blunt trauma to the hypothenar area is particularly suggestive of this. Ulnar artery thrombosis is possibly associated with an anomalous muscle in the Guyon's canal. The anomalous muscle in this case originated on the flexor carpi ulnaris muscle, was ulnarly innervated, and joined the flexor digiti minimi muscle distally. This patient had a history of blunt injury and a significant smoking history, thus, a causal relationship between the anomalous muscle and ulnar artery thrombosis cannot be stated with certainty.
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PMID:Anomalous hand muscle found in the Guyon's canal at exploration for ulnar artery thrombosis. A case report. 807 Jan 82

The complex injury is characterized by a fracture and/or dislocation of the elbow in association with a serial injury of the upper extremity, or a severe soft tissue trauma, or a prolonged ischemia caused by vascular injury or compartment syndrome. They are defined as complex injuries because their treatment differs from that of a simple fracture implying that standardized concepts usually cannot be employed. The results of primary treatment show a high rate of complications. They are accompanied by functional deficits including pseudarthrosis and ankylosis. As a consequence, ulnar neuropathy may occur. Inadequate treatment leads to delayed rehabilitation and several secondary operations. The main goal points at the reconstruction of the elbow joint to restore function. Therefore, the logistical pathway of individual therapy is the key for success. The operation has to include fracture stabilisation of all injuries of the upper extremity. Only stable osteosynthesis makes early mobilisation possible. Transfixation of the elbow joint should be reserved for exceptional cases. The principals of AO have proven to be practical both for the distal humerus and the proximal forearm. Successful reconstruction of the elbow joint often demands extended approaches. ORIF of the proximal ulna can be achieved by indirect reposition techniques. Dynamic stabilisation should be established by conservation of the radial head and coronoid process. For treatment of soft tissue injury it is necessary to undertake local reconstructive measures. Operative treatment is widely indicated for forearm compartment syndrome. Diagnosis and therapy of possible accompanying vascular injury should be made early to avoid prolonged ischemia. Operative treatment of nerve injury is only indicated in case of sharp dissection of the nerve. Otherwise the reconstruction should be performed, but not earlier than three months. Rehabilitation outcome depends on primary therapy. Sufficient functional results are only achieved after early mobilisation and intensive physiotherapy. If necessary, arthrolysis is planned early and combined with removal of implants at 6 months post injury.
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PMID:[Complex trauma of the elbow]. 949 6

We describe the clinical and neurophysiologic findings in a group of diabetic patients with a severe ulnar neuropathy. All patients attending a large inner-city diabetes center were prospectively screening for hand wasting and weakness due to ulnar nerve disease. Twenty diabetic patients fulfilling the clinical criteria underwent nerve conduction studies and electromyography. All but one patient with a motor ulnar neuropathy had systemic complications, mostly severe: ten were amputees, four had had a renal transplant, and two were blind. The onset of hand weakness was sudden in five. All patients had a classical "ulnar hand" (bilateral in five) but forearm muscles were little affected. Sensory loss was prominent in only one-half. Nerve conduction studies showed markedly reduced ulnar motor responses (mean, 1.2 mV versus 7.4 mV in controls) and ulnar/median motor ratios. Motor conduction was disproportionately slowed across the elbows, with or without conduction block, in only eight of 34 affected ulnar nerves. Five of these patients had a habit of leaning on their elbows and/or a Tinel's sign. Median sensory action potentials (SAPs) were recordable in 12 patients but ulnar SAPs were absent in 30 of 34 affected nerves. Electromyography revealed advanced denervation of ulnar supplied hand muscles. We conclude that motor ulnar neuropathy is not uncommon in patients with diabetes of long standing, especially in those with severe systemic complications. Nerve entrapment at the elbows occurs in some, but in many the lesion is axonal, and damage may occur through ischemia.
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PMID:Observations on severe ulnar neuropathy in diabetes. 961 67

Men develop perioperative ulnar neuropathies more frequently than women. To determine the role of anatomical gender differences in the development of these neuropathies, we performed several studies of the anatomy of the ulnar nerve, cubital tunnel, and elbow region. These studies included detailed dissection of male and female embalmed and unembalmed cadavers, ultrasound measurements of the tissue layers at the elbow, and measurement of various dimensions of the coronoid process of the ulna in multiple skeletal sets. No gross anatomical differences were found between genders regarding the course of the ulnar nerve through the upper limb. However, there was a strikingly larger (2-19 times greater) fat content on the medial aspect of the elbow in women compared to men, and the tubercle of the coronoid process was approximately 1.5 times larger in men (P < or = .002, rank sum test). Our finding suggest that the tubercle of the coronoid process is a likely area for external compression-induced ischemia of the ulnar nerve because the nerve and its arterial supply (the posterior ulnar recurrent artery) are covered at the tubercle only by skin, subcutaneous fat, and a very thin aponeurosis of the flexor carpi ulnaris. Importantly, this tubercle is larger and the nerve and blood vessels passing by it are less protected by subcutaneous fat in men than in women. These two anatomical differences between men and women may contribute to the increased frequency of perioperative ulnar neuropathy induced by external pressure at the medial aspect of the elbow in men.
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PMID:Anatomy of the ulnar nerve at the elbow: potential relationship of acute ulnar neuropathy to gender differences. 980 Sep 16

In baseball pitchers, injuries to the throwing arm are common due to the extreme stresses placed on the elbow and shoulder joints. These result in peripheral nerve syndromes including ulnar neuropathy at the elbow and suprascapular neuropathy at the shoulder. Recurrent trauma to the axillary artery causing aneurysm and thrombus formation may lead to distal ischemia and stroke. Careful evaluation is required to identify musculoskeletal, neurologic, and vascular causes of upper extremity symptoms in the throwing athlete.
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PMID:Neurologic injuries in baseball players. 1094 38

Perioperative nerve injuries can be a complication of surgical procedures and account for a significant number of anesthesia-related claims in the United States. Whereas ulnar neuropathy at the elbow is the most common, other nerve injuries of the upper extremity and injuries to the lower extremities are not rare occurrences. A number of possible etiologies have been proposed to explain perioperative nerve injury to include stretch, compression, ischemia, and direct trauma from agents such as suture and cement material. An important aspect of perioperative nerve injury is the underrecognition (or underreporting) that can occur for a multitude of reasons. Good collaboration between surgeons and neurologists can lead to more detailed neurologic assessments and well-timed electrodiagnostic studies, ultimately improving our understanding of such unfortunate incidents.
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PMID:A review of perioperative nerve injury to the lower extremities: part I. 1907 97

Perioperative nerve injuries can be a complication of surgical procedures and accounts for approximately 16% of all anesthesia-related claims in the United States. Whereas ulnar neuropathy at the elbow is the most common, other nerve injuries of the upper extremity and the phrenic nerve are not rare occurrences. A number of possible etiologies have been proposed to explain perioperative nerve injury to include stretch, compression, ischemia, and metabolic derangement. There appears to be additional factors making some patients more prone to nerve injury than others, for example, the sex of the patient and pre-existing disease. Also, in some cases there is a discrepancy between the timing of the surgery and the injury manifestations that can be the result of delayed recognition or an insult in the postoperative setting.
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PMID:A review of perioperative nerve injury to the upper extremities. 1907 2

Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy after carpal tunnel syndrome and occurs most commonly at the elbow due to mechanical forces that produce traction or ischemia to the nerve. The primary symptom associated with UNE is diminished sensation or dysesthesias in the fourth or fifth digits, often coupled with pain in the proximal medial aspect of the elbow. Treatment may be conservative or surgical, but optimal management remains controversial. Surgery should include exploration of the ulnar nerve throughout its course around the elbow and release of all compressive structures.
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PMID:Diagnosis and Treatment of Work-Related Ulnar Neuropathy at the Elbow. 2623 62

The complex injury is characterized by a fracture and/or dislocation of the elbow in association with a serial injury of the upper extremity, or a severe soft tissue trauma , or a prolonged ischemia caused by vascular injury or compartment syndrom. They are defined as complex injuries because their treatment differs from that of a simple fracture implying that standardized concepts usually cannot be employed. The results of primary treatement show a high rate of complications. They are accompanied by functional deficits including pseudarthrosis and ankylosis. As a consequence, ulnar neuropathy may occur. Inadequate treatment leads to delayed rehabilitation and several secondary operations. The main goal points at the reconstruction of the elbow joint to restore function. Therefore, the logistical pathway of individual therapy is the key for success. The operation has to include fracture stabilisation of all injuries of the upper extremity. Only stable osteosynthesis makes early mobilisation possible. Transfixation of the elbow joint should be reserved for exceptional cases. The principals of AO have proven to be practical both for the distal humerus and the proximal forearm. Successful reconstruction of the elbow joint often demands extended approaches. ORIF of the proximal ulna can be achieved by indirect reposition techniques. Dynamic stabilisation should be established by conservation of the radial head and coronoid process. For treatment of soft tissue injury it is necessary to undertake local reconstructive measures. Operative treatment is widely indicated for forearm compartment syndrom. Diagnosis and therapy of possible accompanying vascular injury should be made early to avoid prolonged ischemia. Operative treatement of nerve injury is only indicated in case of sharp dissection of the nerve. Otherwise the reconstruction should be performed, but not earlier than three months. Rehabilitation outcome depends on primary therapy. Sufficient functional results are only achieved after early mobilisation and intensive physiotherapy. If necessary, arthrolysis is planned early and combined with removal of implants at 6 months post injury.
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PMID:The complex injury of the elbow. 2824 68