A cadaveric study of ulnar nerve strain at the elbow associated with cubitus valgus/varus deformity
Abstract Background Cubital tunnel syndrome can be caused by overtraction and dynamic compression in elbow deformities. The extent to which elbow deformities contribute to ulnar nerve strain is unknown. Here, we investigated ulnar nerve strain caused by cubitus valgus/varus deformity using fresh-fro...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-09-01
|
| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-022-05786-9 |
| _version_ | 1798004318784192512 |
|---|---|
| author | Mitsuyuki Nagashima Shohei Omokawa Yasuaki Nakanishi Pasuk Mahakkanukrauh Hideo Hasegawa Takamasa Shimizu Kenji Kawamura Yasuhito Tanaka |
| author_facet | Mitsuyuki Nagashima Shohei Omokawa Yasuaki Nakanishi Pasuk Mahakkanukrauh Hideo Hasegawa Takamasa Shimizu Kenji Kawamura Yasuhito Tanaka |
| author_sort | Mitsuyuki Nagashima |
| collection | DOAJ |
| description | Abstract Background Cubital tunnel syndrome can be caused by overtraction and dynamic compression in elbow deformities. The extent to which elbow deformities contribute to ulnar nerve strain is unknown. Here, we investigated ulnar nerve strain caused by cubitus valgus/varus deformity using fresh-frozen cadavers. Methods We used six fresh-frozen cadaver upper extremities. A strain gauge was placed on the ulnar nerve 2 cm proximal to the medial epicondyle of the humerus. For the elbow deformity model, osteotomy was performed at the distal humerus, and plate fixation was performed to create cubitus valgus/varus deformities (10°, 20°, and 30°). Ulnar nerve strain caused by elbow flexion (0–125°) was measured in both the normal and deformity models. The strains at different elbow flexion angles within each model were compared, and the strains at elbow extension and at maximum elbow flexion were compared between the normal model and each elbow deformity model. However, in the cubitus varus model, the ulnar nerve deflected more than the measurable range of the strain gauge; elbow flexion of 60° or more were considered effective values. Statistical analysis of the strain values was performed with Friedman test, followed by the Williams’ test (the Shirley‒Williams’ test for non-parametric analysis). Results In all models, ulnar nerve strain increased significantly from elbow extension to maximal flexion (control: 13.2%; cubitus valgus 10°: 13.6%; cubitus valgus 20°: 13.5%; cubitus valgus 30°: 12.2%; cubitus varus 10°: 8.3%; cubitus varus 20°: 8.2%; cubitus varus 30°: 6.3%, P < 0.001). The control and cubitus valgus models had similar values, but the cubitus varus models revealed that this deformity caused ulnar nerve relaxation. Conclusions Ulnar nerve strain significantly increased during elbow flexion. No significant increase in strain 2 cm proximal to the medial epicondyle was observed in the cubitus valgus model. Major changes may have been observed in the measurement behind the medial epicondyle. In the cubitus varus model, the ulnar nerve was relaxed during elbow extension, but this effect was reduced by elbow flexion. |
| first_indexed | 2024-04-11T12:21:35Z |
| format | Article |
| id | doaj.art-87df73e85cb0471d89c0f61458bef12b |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-04-11T12:21:35Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-87df73e85cb0471d89c0f61458bef12b2022-12-22T04:24:04ZengBMCBMC Musculoskeletal Disorders1471-24742022-09-012311710.1186/s12891-022-05786-9A cadaveric study of ulnar nerve strain at the elbow associated with cubitus valgus/varus deformityMitsuyuki Nagashima0Shohei Omokawa1Yasuaki Nakanishi2Pasuk Mahakkanukrauh3Hideo Hasegawa4Takamasa Shimizu5Kenji Kawamura6Yasuhito Tanaka7Department of Orthopedic Surgery, Nara Medical UniversityDepartment of Hand Surgery, Nara Medical UniversityDepartment of Orthopedic Surgery, Nara Medical UniversityDepartment of Anatomy, Faculty of Medicine, Chiang Mai UniversityDepartment of Orthopedic Surgery, Nara Medical UniversityDepartment of Orthopedic Surgery, Nara Medical UniversityDepartment of Orthopedic Surgery, Nara Medical UniversityDepartment of Orthopedic Surgery, Nara Medical UniversityAbstract Background Cubital tunnel syndrome can be caused by overtraction and dynamic compression in elbow deformities. The extent to which elbow deformities contribute to ulnar nerve strain is unknown. Here, we investigated ulnar nerve strain caused by cubitus valgus/varus deformity using fresh-frozen cadavers. Methods We used six fresh-frozen cadaver upper extremities. A strain gauge was placed on the ulnar nerve 2 cm proximal to the medial epicondyle of the humerus. For the elbow deformity model, osteotomy was performed at the distal humerus, and plate fixation was performed to create cubitus valgus/varus deformities (10°, 20°, and 30°). Ulnar nerve strain caused by elbow flexion (0–125°) was measured in both the normal and deformity models. The strains at different elbow flexion angles within each model were compared, and the strains at elbow extension and at maximum elbow flexion were compared between the normal model and each elbow deformity model. However, in the cubitus varus model, the ulnar nerve deflected more than the measurable range of the strain gauge; elbow flexion of 60° or more were considered effective values. Statistical analysis of the strain values was performed with Friedman test, followed by the Williams’ test (the Shirley‒Williams’ test for non-parametric analysis). Results In all models, ulnar nerve strain increased significantly from elbow extension to maximal flexion (control: 13.2%; cubitus valgus 10°: 13.6%; cubitus valgus 20°: 13.5%; cubitus valgus 30°: 12.2%; cubitus varus 10°: 8.3%; cubitus varus 20°: 8.2%; cubitus varus 30°: 6.3%, P < 0.001). The control and cubitus valgus models had similar values, but the cubitus varus models revealed that this deformity caused ulnar nerve relaxation. Conclusions Ulnar nerve strain significantly increased during elbow flexion. No significant increase in strain 2 cm proximal to the medial epicondyle was observed in the cubitus valgus model. Major changes may have been observed in the measurement behind the medial epicondyle. In the cubitus varus model, the ulnar nerve was relaxed during elbow extension, but this effect was reduced by elbow flexion.https://doi.org/10.1186/s12891-022-05786-9Ulnar nerve strainCubitus valgus/varus deformityElbow flexion |
| spellingShingle | Mitsuyuki Nagashima Shohei Omokawa Yasuaki Nakanishi Pasuk Mahakkanukrauh Hideo Hasegawa Takamasa Shimizu Kenji Kawamura Yasuhito Tanaka A cadaveric study of ulnar nerve strain at the elbow associated with cubitus valgus/varus deformity BMC Musculoskeletal Disorders Ulnar nerve strain Cubitus valgus/varus deformity Elbow flexion |
| title | A cadaveric study of ulnar nerve strain at the elbow associated with cubitus valgus/varus deformity |
| title_full | A cadaveric study of ulnar nerve strain at the elbow associated with cubitus valgus/varus deformity |
| title_fullStr | A cadaveric study of ulnar nerve strain at the elbow associated with cubitus valgus/varus deformity |
| title_full_unstemmed | A cadaveric study of ulnar nerve strain at the elbow associated with cubitus valgus/varus deformity |
| title_short | A cadaveric study of ulnar nerve strain at the elbow associated with cubitus valgus/varus deformity |
| title_sort | cadaveric study of ulnar nerve strain at the elbow associated with cubitus valgus varus deformity |
| topic | Ulnar nerve strain Cubitus valgus/varus deformity Elbow flexion |
| url | https://doi.org/10.1186/s12891-022-05786-9 |
| work_keys_str_mv | AT mitsuyukinagashima acadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity AT shoheiomokawa acadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity AT yasuakinakanishi acadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity AT pasukmahakkanukrauh acadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity AT hideohasegawa acadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity AT takamasashimizu acadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity AT kenjikawamura acadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity AT yasuhitotanaka acadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity AT mitsuyukinagashima cadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity AT shoheiomokawa cadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity AT yasuakinakanishi cadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity AT pasukmahakkanukrauh cadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity AT hideohasegawa cadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity AT takamasashimizu cadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity AT kenjikawamura cadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity AT yasuhitotanaka cadavericstudyofulnarnervestrainattheelbowassociatedwithcubitusvalgusvarusdeformity |