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Sci Rep 2022 Jun 2;12(1):9217. Epub 2022 Jun 2.

Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, 308232, Singapore, Singapore.

Median nerve cross-sectional area (CSA) was used for screening and diagnosis of neuropathy, but few studies have suggested reference range. Hence, this systematic review was performed to evaluate a normative values of median nerve CSA at various landmarks of upper limb based on ultrasonography. PubMed and Web of science were used to search relevant articles from 2000 to 2020. Read More

J Shoulder Elbow Surg 2022 May 27;31(5):1035-1041. Epub 2021 Dec 27.

Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan.

Background: The baseball pitching motion creates valgus stress to the medial elbow, which contributes to increased medial elbow joint space gapping. The musculoskeletal systems of preadolescent baseball players are immature compared with those of adults, but it is unclear whether the repetitive pitching action causes an increase in medial elbow joint space gapping. This study aimed to examine differences in medial elbow joint space gapping based on the pitch count of preadolescent baseball players compared with those of adult players. Read More

J Hand Surg Eur Vol 2021 11;46(9):1014-1015

Department of Orthopedics and Traumatology, Medical University of Sofia, Sofia, Bulgaria.

Orthop J Sports Med 2021 Aug 27;9(8):23259671211022681. Epub 2021 Aug 27.

Sportsclinic Cologne, University of Witten/Herdecke, Cologne, Germany.

Background: Stand-up paddleboarding (SUP) is a water sport that has gained in popularity. Still, very little is known about its injury profile.

Purpose: To analyze the incidence, mechanisms, and risk factors for SUP-related injuries in mainly calm waters and the use of safety equipment. Read More

J Hand Surg Eur Vol 2021 12 9;46(10):1114-1115. Epub 2021 Jun 9.

Department of Plastic Surgery, Leeds General Infirmary, Leeds, UK.

Semin Musculoskelet Radiol 2021 Feb 21;25(1):105-122. Epub 2021 May 21.

Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.

Pediatric upper extremity injuries, acute and chronic due to overuse, are commonly encountered in the clinical setting. However, interpretation of imaging studies is often challenging in pediatric patients because of changing postnatal skeletal development and the broad spectrum of pathology that can potentially occur. This article discusses normal skeletal development and the pathomechanics of skeletal injuries in pediatric patients. Read More

Orthop J Sports Med 2021 Jan 20;9(1):2325967120977090. Epub 2021 Jan 20.

Department of Physical Therapy, University of Florida, Gainesville, Florida, USA.

Background: Gymnastics is a demanding sport that places unique forces on the upper extremity. The repetitive nature of the sport and the high-impact forces involved may predispose the gymnast to overuse injuries. Risk factors for injuries in gymnastics are not well understood. Read More

J Occup Health 2021 Jan;63(1):e12186

Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.

Objectives: To evaluate the evidence of an association between occupational and non-occupational exposure to biomechanical risk factors and lateral elbow tendinopathy, medial elbow tendinopathy, and olecranon bursitis.

Methods: We carried out a systematic review of the literature. We searched MEDLINE (up to November 2019) and checked the reference lists of relevant articles/reviews. Read More

Orthop Traumatol Surg Res 2021 02 13;107(1S):102754. Epub 2020 Dec 13.

Sorbonne Université, Service de chirurgie orthopédique et traumatologique-SOS mains, Hôpital Saint-Antoine, Centre de Recherche Saint-Antoine UMR_S938 INSERM, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France. Electronic address:

At the elbow, the ulnar nerve (UN) may be the site of a static compression (by the cubital tunnel retinaculum and Osborne's ligament between the two heads of the flexor carpi ulnaris), or a dynamic compression, especially when the nerve is unstable (subluxation/dislocation outside the ulnar groove). The clinical basis for the diagnosis of ulnar neuropathy involves looking for subjective and objective signs of sensory and/or motor deficit in the ulnar nerve's territory in the hand, a pseudo-Tinel's sign, and doing manipulations to provoke UN irritation. The diagnosis is confirmed by electromyography and ultrasonography. Read More

J Hand Surg Asian Pac Vol 2020 Dec;25(4):393-401

Department of Orthopaedic Surgery, Royal Wolverhampton NHS Trust, Wolverhampton, UK.

Cubital tunnel syndrome is the second most common nerve compression syndrome seen in the upper limb. Paresthesia and weakness are the two most common presentations in the hand. If left untreated, compression can lead to irreversible nerve damage, resulting in a loss of function of the forearm and hand. Read More

J Hand Surg Am 2020 Dec 22;45(12):1141-1147. Epub 2020 Jul 22.

Department of Orthopedy and Traumatology, Selcuk University, Akademi Mahallesi, Selçuklu/Konya, Turkey.

Purpose: This is a retrospective observational study that assessed the prevalence of positive diagnostic imaging and electrodiagnostic (EDX) findings in patients diagnosed with pronator syndrome (PS), who previously had a carpal tunnel syndrome (CTS) surgery. The other purpose of our study was to determine how often PS occurred and was missed in patients treated surgically for CTS.

Methods: The files of 180 patients who underwent CTS surgery were reviewed retrospectively. Read More

J Hand Surg Eur Vol 2021 Feb 22;46(2):197-199. Epub 2020 Jul 22.

Upper Limb Unit, Wrightington Hospital, Wigan, UK.

Cureus 2020 May 15;12(5):e8139. Epub 2020 May 15.

Orthopaedic Surgery, University of Tennessee, Memphis, USA.

Introduction Walk-in and after-hours clinics are being increasingly utilized in orthopedics and are especially beneficial for patients with simple sprains, fractures, or overuse injuries that might otherwise require an emergency room visit. To meet the increased patient load, additional staffing often is required, which might include a family medicine physician, nurse practitioner, or physician assistant. Few studies have evaluated the performance of these non-surgeon providers in an orthopedic clinical setting. Read More

J Biomech 2020 06 8;107:109835. Epub 2020 May 8.

Ottawa Hospital Research Institute, 505 Smyth Road, Ottawa, ON K1H8M2 Canada; University of Ottawa, Faculty of Medicine, 451 Smyth Rd, Ottawa, ON K1H8M5, Canada.

Lower extremity powered exoskeletons with crutch support can provide upright mobility to persons with complete spinal cord injury (SCI); however, crutch use for balance and weight transfer may increase upper extremity (UE) joint loads and injury risk. This research presented the first exoskeleton-human musculoskeletal model to estimate upper extremity biomechanics, driven by 3D motion data of persons with complete SCI walking with an exoskeleton and crutch assistance. Forearm crutches instrumented with strain gauges, force plates, and a 3D motion capture system were used to collect kinematic and kinetic data from five persons with complete SCI while walking with the ARKE exoskeleton. Read More

Orthop Traumatol Surg Res 2020 06 2;106(4):757-763. Epub 2020 Apr 2.

Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea. Electronic address:

Introduction: Medial skin incision is obligatory for ulnar nerve transposition in cubital tunnel syndrome. However, inadvertent surgical damage to the terminal branches of both the medial antebrachial cutaneous nerve (MACN) and the medial brachial cutaneous nerve (MBCN) has been a concern in the current surgical approach.

Hypothesis: We hypothesized a modified curved skin incision to avoid the damage to the medial cutaneous nerve. Read More

Eur J Orthop Surg Traumatol 2019 Oct 21;29(7):1559-1563. Epub 2019 Jun 21.

Department of Οrthopedics, University Hospital of Ioannina, Stavros Niarchos Avenue, 45500, Ioannina, Greece.

Introduction: Intraneural cysts usually involve the common peroneal nerve, and in many cases, they are causing symptoms due to neural compression. It is hypothesized that these cysts originate from the adjacent joints while articular pathology is a major contributing factor for the formation of these lesions. Although ulnar nerve is the second most commonly affected nerve, these lesions usually develop distally at the Guyon tunnel, so cubital tunnel syndrome due to epineural cysts is very rare. Read More

Phys Sportsmed 2019 09 11;47(3):242-246. Epub 2019 Mar 11.

The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University , Baltimore , MD , USA.

Ulnar collateral ligament (UCL) tears can occur from trauma or chronic overuse, and the treatment depends on the type of sport the patient plays and the severity of symptoms. Overuse UCL injuries are most commonly due to micro-trauma in overhead athletes such as baseball players, softball players, and tennis players. Acute complete UCL tears in athletes due to trauma are less common but generally operative treatment is recommended. Read More

J Vis Exp 2019 01 11(143). Epub 2019 Jan 11.

Department of Orthopedics & Traumatology, The University of Hong Kong;

Axonal degeneration, indicative of surgical decompression, may coexist in carpal tunnel syndrome (CTS) as the disease progresses. However, the current diagnostic and severity gradation system cannot clearly indicate its coexistence, resulting in confusion of appropriate treatment prescription. There are also constraints in conventional methods for differentiation as well. Read More

J Hand Surg Asian Pac Vol 2018 Jun;23(2):198-204

* 5th Orthopaedic Department, Hand and Upper Extremity Service, Asklepieion Voulas General Hospital, Athens, Greece.

Background: Simultaneous compression of the median and ulnar nerve at the elbow region has not been sufficiently highlighted in the literature. The purposes of the present study are to report our experience regarding this entity, to elucidate the clinical features, and to describe the operative technique and findings as well as the results of simultaneous decompression performed through the same medial incision.

Methods: We performed a retrospective study of thirteen elbows in thirteen patients -nine men and four women- with simultaneous compression of the median and ulnar nerve at the elbow region between 2000 and 2011. Read More

Hand (N Y) 2019 11 22;14(6):776-781. Epub 2018 Apr 22.

Washington University in St. Louis, MO, USA.

Ulnar nerve transposition (UNT) surgery is performed for the treatment of cubital tunnel syndrome. Improperly performed UNT can create iatrogenic pain and neuropathy. The aim of this study is to identify anatomical structures distal to the medial epicondyle that should be recognized by all surgeons performing UNT to prevent postoperative neuropathy. Read More

J Hand Surg Am 2017 Nov;42(11):917-923

Tufts University School of Medicine, Tufts Medical Center, Boston, MA; Department of Hand and Upper Extremity Surgery, Newton-Wellesley Hospital, Newton, MA; Hand Surgery Research and Education Foundation, Newton, MA. Electronic address:

Chronic exertional compartment syndrome (CECS) refers to exercise-induced, reversible increases in pressure within well-defined inelastic fascial compartments leading to compromised tissue perfusion followed by functional loss, ischemic pain, and neurologic symptoms. Symptoms typically resolve when the activity ceases and there are usually no permanent sequelae. In the upper extremity, this condition most commonly affects athletes during sports requiring repetitive and vigorous gripping, such as rowers. Read More

J Shoulder Elbow Surg 2017 Dec 28;26(12):2220-2225. Epub 2017 Sep 28.

West Tennessee Bone and Joint Clinic, Jackson, TN, USA.

Background: Elite-level women's fastpitch softball players place substantial biomechanical strains on the elbow that can result in medial elbow pain and ulnar neuropathic symptoms. There is scant literature reporting the expected outcomes of the treatment of these injuries. This study examined the results of treatment in a series of these patients. Read More

Arch Phys Med Rehabil 2018 04 6;99(4):743-757. Epub 2017 Sep 6.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

Objective: To examine the performance of sonographic cross-sectional area (CSA) measurements in the diagnosis of cubital tunnel syndrome (CuTS).

Data Sources: Electronic databases, comprising PubMed and EMBASE, were searched for the pertinent literature before July 1, 2017.

Study Selection: Fourteen trials comparing the ulnar nerve CSA measurements between participants with and without CuTS were included. Read More

J Plast Reconstr Aesthet Surg 2017 Nov 28;70(11):1582-1588. Epub 2017 Jun 28.

Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria.

Background: During cubital tunnel surgery, the medial antebrachial cutaneous nerve (MACN) may be injured, causing painful scars, neuromas, hypaesthesia or hyperalgesia. As the literature on the anatomy of crossing branches in this area is contradictory, this study aimed to re-examine the anatomy of the MACN in this region.

Methods: Forty upper limbs were dissected. Read More

Surg Radiol Anat 2016 Dec 12;38(10):1183-1189. Epub 2016 May 12.

Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.

Introduction: The aim of this study was to clarify the morphological characteristics of the intermuscular aponeurosis between the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS; IMAS), and that between the FCU and flexor digitorum profundus (FDP; IMAP), and their topographic relationships with the ulnar nerve.

Materials And Methods: Fifty limbs of 38 adult cadavers were studied.

Results: The IMAS extended along the deep surface of the FCU adjoining the FDS, having the appearance of a ladder, giving off "steps" that decreased in width from superficial to deep around the middle of the forearm. Read More

Acta Reumatol Port 2016 Jan-Mar;41(1):40-4

Objectives: To compare the nerve cross sectional areas (CSA) of patients with RA without any sign of peripheral neuropathy to healthy controls.

Methods: Clinical, electrophysiological and sonographic assessments were done by three blinded researchers. The patients who had an electrodiagnostic or clinical of peripheral neuropathy were excluded from the study. Read More

Orthop J Sports Med 2015 Jan 22;3(1):2325967114566796. Epub 2015 Jan 22.

Mercy St Vincent Medical Center, Toledo, Ohio, USA.

Background: Previous studies investigating the windmill softball pitch have focused primarily on shoulder musculature and function, collecting limited data on elbow and forearm musculature. Little information is available in the literature regarding the forearm. This study documents forearm muscle electromyographic (EMG) activity that has not been previously published. Read More

J Hand Surg Am 2015 May 24;40(5):984-6. Epub 2015 Mar 24.

Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC. Electronic address:

Two patients with an anteriorly positioned ulnar nerve at the elbow, identified during cubital tunnel release, are presented. Upon encountering an empty cubital tunnel, additional dissection found the ulnar nerve to course posterior to and to penetrate through the intermuscular septum 3 to 5 cm proximal to the medial epicondyle. It then ran anterior to the pronator-flexor mass before entering the forearm between the ulnar and the humeral heads of the flexor carpi ulnaris. Read More

BMC Musculoskelet Disord 2014 Dec 6;15:412. Epub 2014 Dec 6.

Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D, 9220 Aalborg, Denmark.

Background: Musculoskeletal pain from the upper extremity and shoulder region is commonly reported by computer users. However, the functional status of central pain mechanisms, i.e. Read More

Sports Med Arthrosc Rev 2014 Sep;22(3):164-8

*Menlo Medical Clinic, Menlo Park, CA †Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA ‡Department of Orthopaedics and Traumatology, St Elisabeth Hospital Tilburg, Tilburg, The Netherlands.

Medial epicondylar tendinopathy, also known as golfer's elbow, is less common than lateral elbow tendinopathy. Overhead throwing athletes and those participating in sports that require repeated forearm pronation and wrist flexion are most commonly affected by this disorder. This problem predominates in amateur as opposed to professional athletes and is also seen more commonly in patients over 40 years of age. Read More