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Attrition rupture of ulnar nerve in a patient with rheumatoid elbow arthritis: A case report.

Abstract Cubital tunnel syndrome has been recognized as a common pathology in rheumatoid arthritis (RA) of the elbow. We encountered a patient with RA of the elbow showing attrition rupture of the ulnar nerve. This pathology is extremely rare, and we discussed preventive measures for similar cases in the future based on our case.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29703029
OWN - NLM
STAT- MEDLINE
DCOM- 20180507
LR  - 20180507
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 17
DP  - 2018 Apr
TI  - Attrition rupture of ulnar nerve in a patient with rheumatoid elbow arthritis: A 
      case report.
PG  - e0535
LID - 10.1097/MD.0000000000010535 [doi]
AB  - RATIONALE: Cubital tunnel syndrome has been recognized as a common pathology in
      rheumatoid arthritis (RA) of the elbow. We encountered a patient with RA of the
      elbow showing attrition rupture of the ulnar nerve. This pathology is extremely
      rare, and we discussed preventive measures for similar cases in the future based 
      on our case. PATIENT CONCERNS: A 53-year-old woman, received drug treatment for
      RA since 30 years earlier, had numbness in the left ulnar nerve territory, dorsal
      interossei muscle atrophy, and resulting claw hand. DIAGNOSES: Plain x-ray
      examination showed bone destruction of the left elbow joint and marked osteophyte
      formation in the medial joint space. In nerve conduction velocity (NCV) tests,
      the Motor NCV was immeasurable in the ulnar nerve territory. Based on these
      findings, a diagnosis of left cubital tunnel syndrome was made, and anterior
      transposition of the ulnar nerve was planned. INTERVENTIONS: When the ulnar nerve
      dissection was advanced, about 80% portion of the ulnar nerve was ruptured. After
      the ends of the divided nerve were freshened, end-to-end anastomosis was possible
      by anterior transposition of the ulnar nerve. OUTCOMES: Two years after the
      operation, numbness and muscle atrophy also remained. There were no changes in
      the level of daily activities after the operation. However, motor NCV, showed
      improvement (22.8 m/s) after the operation. LESSONS: In patients with RA showing 
      ulnar neuropathy symptoms, marked osteophyte formation in the medial joint space 
      or valgus deformity may indicate attrition nerve rupture. In the future, when
      such patients with RA are examined, active nerve exposure and dissection should
      be considered in terms of ulnar nerve protection.
FAU - Kaneko, Ayaka
AU  - Kaneko A
AD  - Department of Orthopaedics, Juntendo University School of Medicine.
FAU - Sugiyama, Yoichi
AU  - Sugiyama Y
AD  - Department of Orthopaedics, Juntendo University School of Medicine.
FAU - Nagura, Nana
AU  - Nagura N
AD  - Department of Orthopaedics, Juntendo University School of Medicine.
AD  - Department of Orthopaedic surgery, Juntendo Tokyo Koto Geriatric Medical Center.
FAU - Goto, Kenji
AU  - Goto K
AD  - Department of Orthopaedics, Juntendo University School of Medicine.
FAU - Iwase, Yoshiyuki
AU  - Iwase Y
AD  - Department of Orthopaedic surgery, Juntendo Tokyo Koto Geriatric Medical Center.
FAU - Obayashi, Osamu
AU  - Obayashi O
AD  - Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, Japan.
FAU - Naito, Kiyohito
AU  - Naito K
AD  - Department of Orthopaedics, Juntendo University School of Medicine.
FAU - Kaneko, Kazuo
AU  - Kaneko K
AD  - Department of Orthopaedics, Juntendo University School of Medicine.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Antirheumatic Agents)
SB  - AIM
SB  - IM
MH  - Antirheumatic Agents/therapeutic use
MH  - Arthritis, Rheumatoid/*complications/drug therapy
MH  - Cubital Tunnel Syndrome/diagnosis/*etiology/pathology/surgery
MH  - Elbow Joint/innervation/*pathology/surgery
MH  - Female
MH  - Humans
MH  - Middle Aged
MH  - Muscular Atrophy/diagnosis/etiology
MH  - Neural Conduction
MH  - Rupture, Spontaneous
MH  - Ulnar Nerve/injuries
MH  - Ulnar Neuropathies/diagnosis/*etiology/surgery
EDAT- 2018/04/29 06:00
MHDA- 2018/05/08 06:00
CRDT- 2018/04/29 06:00
PHST- 2018/04/29 06:00 [entrez]
PHST- 2018/04/29 06:00 [pubmed]
PHST- 2018/05/08 06:00 [medline]
AID - 10.1097/MD.0000000000010535 [doi]
AID - 00005792-201804270-00061 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Apr;97(17):e0535. doi: 10.1097/MD.0000000000010535.