FESSH prep Compressive neuropathies Cubital tunnel syndrome — concomitant proximal lesions and electrodiagnostic localisation
The double-crush hypothesis and ulnar neuropathy at the elbow
The double-crush hypothesis (Upton and McComas, 1973) and ulnar neuropathy at the elbow
1.Wilbourn and Gilliatt's critical reanalysis concluded that the original double-crush dataset did not establish a causal interaction between proximal and distal nerve lesions.
2.Cervical radiculopathy and cubital tunnel syndrome can coexist, and concomitant proximal and distal lesions of the ulnar fibres should be sought when symptoms exceed those expected from either lesion alone.
3.Decompression of the ulnar nerve alone is sufficient to relieve symptoms in all patients with concurrent cervical and cubital ulnar-nerve compression.
4.Needle electromyography of the cervical paraspinal and non-ulnar C8/T1-innervated muscles, combined with focal motor conduction across the elbow, helps distinguish C8 radiculopathy from ulnar neuropathy at the elbow.
5.When patients have symptomatic compression at two anatomical sites along the ulnar nerve's course, addressing both lesions is likely to produce better functional outcomes than treating one site in isolation.
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