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October 12, 1979, Vol 242, No. 15 >
ARTICLE | October 12, 1979

Postoperative Ulnar Neuropathy FREE

Robert G. Miller, MD; Perry E. Camp, MD
[+] Author Affiliations

Reprint requests to Neuromuscular Research, Children's Hospital of San Francisco, 3700 California St, San Francisco, CA 94119 (Dr Miller).


JAMA. 1979;242(15):1636-1639. doi:10.1001/jama.1979.03300150034023
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References

Although compressive ulnar neuropathy developing during surgical procedures under general anesthesia has been recognized, clinical and electrophysiological features of this neuropathy have been incompletely described. During the past two years, we have seen eight patients with this complication, mainly following intra-abdominal or intrathoracic operations. Neuropathy was associated with a persistent severe deficit during a mean follow-up of 23.5 months (range, six to 96 months) after operation. Electrophysiological studies verified substantial Wallerian degeneration in the majority of patients. Clinical and electrophysiological data, as well as intraoperative findings in some patients, suggest that compression occurred at the cubital tunnel. These patients with ulnar neuropathy had a particularly poor prognosis, whether treated surgically (decompression or transposition) or medically. Prevention of ulnar nerve compression during major operations therefore assumes paramount importance.

(JAMA 242:1636-1639, 1979)

REFERENCES

1 +
Miller RG:  The cubital tunnel syndrome: Diagnosis and precise localization . Ann Neurol 6:56-59, 1979;.
2 +
Panas P:  Sur une cause peu connue de paralysie du nerf cubital . Arch Gen Med 2:5, 1878;.
3 +
Feindel W, Stratford J:  Cubital tunnel compression in tardy ulnar palsy . Can Med Assoc J 78:351-353, 1958;.
4 +
Feindel W, Stratford J:  The role of the cubital tunnel in tardy ulnar palsy . Can J Surg 1:287-300, 1958;.
5 +
Payan J:  Electrophysiological localization of ulnar nerve lesions . J Neurol Neurosurg Psychiatry 32:208-220, 1969;.
6 +
Eisen A:  Early diagnosis of ulnar nerve palsy . Neurology 24:256-262, 1974;.
7 +
Dhuner KG:  Nerve injuries following operations: A survey of cases occurring during a six-year period . Anesthesiology 11:289-293, 1950;.
8 +
Jones HD:  Ulnar nerve damage following general anesthesia . Anesthesia 22:471-475, 1967;.
9 +
Wadsworth TG, Williams JR:  Cubital tunnel external compression syndrome . Br Med J 1:662-666, 1973;.
10 +
Murphy JP, Devers JC:  Prevention of postsurgical ulnar neuropathy . JAMA 227:1123-1124, 1974;.
11 +
Ochoa J, Fowler TJ, Gilliatt RW:  Anatomical changes in peripheral nerves compressed by a pneumatic tourniquet . J Anat 113:433-455, 1972;.
12 +
Gilliatt RW:  Conduction block in acute compression , in Canal N, Pozza G (eds): Peripheral Neuropathies . New York, Elsevier-North Holland Biomedical Press, 1978;, pp 305-311.
13 +
Bruner JM:  Safety factors in the use of pneumatic tourniquet for hemostasis in surgery of the hand . J Bone Joint Surg Am 33:221-224, 1951;.
14 +
Rudge P:  Tourniquet paralysis with prolonged conduction block . J Bone Joint Surg Br 56:716-720, 1974;.
15 +
Bolton CF, McFarlane RM:  Human pneumatic tourniquet paralysis . Neurology 28:787-793, 1978;.
16 +
Neary D, Ochoa J, Gilliatt RW:  Sub-clinical entrapment neuropathy in man . J Neurol Sci 24:283-298, 1975;.
17 +
Denny-Brown D, Brenner C:  Paralysis of nerve induced by direct pressure and by tourniquet . Arch Neurol Psych 51:1-26, 1944;.
18 +
Rudge P, Ochoa J, Gilliatt RW:  Acute peripheral nerve compression in the baboon . J Neurol Sci 23:403-420, 1974;.

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1 +
Miller RG:  The cubital tunnel syndrome: Diagnosis and precise localization . Ann Neurol 6:56-59, 1979;.
2 +
Panas P:  Sur une cause peu connue de paralysie du nerf cubital . Arch Gen Med 2:5, 1878;.
3 +
Feindel W, Stratford J:  Cubital tunnel compression in tardy ulnar palsy . Can Med Assoc J 78:351-353, 1958;.
4 +
Feindel W, Stratford J:  The role of the cubital tunnel in tardy ulnar palsy . Can J Surg 1:287-300, 1958;.
5 +
Payan J:  Electrophysiological localization of ulnar nerve lesions . J Neurol Neurosurg Psychiatry 32:208-220, 1969;.
6 +
Eisen A:  Early diagnosis of ulnar nerve palsy . Neurology 24:256-262, 1974;.
7 +
Dhuner KG:  Nerve injuries following operations: A survey of cases occurring during a six-year period . Anesthesiology 11:289-293, 1950;.
8 +
Jones HD:  Ulnar nerve damage following general anesthesia . Anesthesia 22:471-475, 1967;.
9 +
Wadsworth TG, Williams JR:  Cubital tunnel external compression syndrome . Br Med J 1:662-666, 1973;.
10 +
Murphy JP, Devers JC:  Prevention of postsurgical ulnar neuropathy . JAMA 227:1123-1124, 1974;.
11 +
Ochoa J, Fowler TJ, Gilliatt RW:  Anatomical changes in peripheral nerves compressed by a pneumatic tourniquet . J Anat 113:433-455, 1972;.
12 +
Gilliatt RW:  Conduction block in acute compression , in Canal N, Pozza G (eds): Peripheral Neuropathies . New York, Elsevier-North Holland Biomedical Press, 1978;, pp 305-311.
13 +
Bruner JM:  Safety factors in the use of pneumatic tourniquet for hemostasis in surgery of the hand . J Bone Joint Surg Am 33:221-224, 1951;.
14 +
Rudge P:  Tourniquet paralysis with prolonged conduction block . J Bone Joint Surg Br 56:716-720, 1974;.
15 +
Bolton CF, McFarlane RM:  Human pneumatic tourniquet paralysis . Neurology 28:787-793, 1978;.
16 +
Neary D, Ochoa J, Gilliatt RW:  Sub-clinical entrapment neuropathy in man . J Neurol Sci 24:283-298, 1975;.
17 +
Denny-Brown D, Brenner C:  Paralysis of nerve induced by direct pressure and by tourniquet . Arch Neurol Psych 51:1-26, 1944;.
18 +
Rudge P, Ochoa J, Gilliatt RW:  Acute peripheral nerve compression in the baboon . J Neurol Sci 23:403-420, 1974;.

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