Artikel
Surgical treatment of proximal nerve entrapment at the elbow by release of the lacertus fibrosus realease with ultra soundguided surgery and WALANT
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Autoren
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Gilles Candelier
- Hand and Ultrasound Surgery Center, Private Hospital St Martin, Caen Cedex, France
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Yann Erwan Favennec
- Hand and Ultrasound Surgery Center, Private Hospital St Martin, Caen Cedex, France
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Thomas Apard
- Hand and Ultrasound Surgery Center, Private Hospital St Martin, Caen Cedex, France
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Compression of the median nerve to the elbow (PMNE) is considered rare. Difficult to diagnose, simulating a carpal tunnel with which it can sometimes be associated, it is rarely detected with conduction studies. The purpose of this study was to assess the feasibility and benefits of the ultrasound-guided release of lacertus fibrosus with Walant for the treatment of PMNE.
Methods: We conducted a prospective study from April 2015 to January 2017. Only patients with an isolated PMNE were included.
All patients received a bilateral clinical examination including muscle testing, a scratch collapse test, the search for a Tinel sign (elbow and wrist) and a Phalen sign. The strength was measured with a Jamar and the function was evaluated with a Quick DASH. All the patients have had a conduction study
Diagnostic criteria were: an anomaly in the FPL, FCR and FDP II tests, a Tinel sign at the elbow below the Lacertus, a positive scratch collapse test, which disappears after cold application, an absence of clinical signs suggestive for a carpal tunnel syndrome and normal conduction study. Anesthesia was performed according to the WALANT protocol. A limited incision was made at the proximal edge of the lacertus. The section was performed with a kemis knife and an ultrasound guidance with a 6-15mHz probe. A the end of the procedure a testing of the FPL and the FDP II was performed to confirm the improvement of the immediate recovery of the motor function. All the patients have had a clinical review at D8, D45, and D90.
Results: We included 36 patients (20 women and 16 men) with an average age of 46.2 years (19-70). The dominant side injury involved 21 patients, two patients had bilateral injuries. No adverse events were noted during the procedure and no additional anesthesia was useful. Two postoperative hematoma was observed, which did not require resumption, and motor testing was normalized for all patients at the last follow up. The average preoperative Quick DASH was 38.9 (12 - 68,2). At the last follow up the average Quick Dask was 11 (0 - 38).
Conclusion: The Ultrasound-guided release of the lacertus fibrosus is effective and reliable for the treatment of the pronator median nerve entrapment. The Walant protocol allows immediate evaluation of the effectiveness of the treatment.
