Delayed recovery of ulnar neuropathy due to elbow warming
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《神经病学神经外科学杂志》
Correspondence to:
Martin R Turner
Department of Neurology, The Radcliffe Infirmary, Woodstock Road, Oxford, OX2 6HE, UK; turnermr@doctors.org.uk
Keywords: Ulnar neuropathy; elbow warmer; nerve conduction
A 26 year old student presented clinically with a right ulnar sensory neuropathy, thought to have resulted from compression at the elbow during late night studying. There was no previous history, nor family history, of compression neuropathy; serum glucose and inflammatory markers were not elevated. Nerve conduction studies confirmed marked slowing across the elbow on the right, compared with the left side. Plain x ray of the right elbow revealed no bony abnormality.
Despite resting the arm, hand weakness progressed over the next 6 weeks, with evidence of hand clawing. At this time the student confessed that, in an attempt to stimulate recovery himself, he had fashioned an "elbow warmer" from an electric blanket (fig), which had been worn continuously over the previous weeks. He was instructed not to use it any more, and referred immediately for surgical intervention following which his weakness resolved.
Ulnar neuropathy at the elbow (UNE) remains a controversial entity, both in terms of neurophysiological diagnosis and subsequent management.1 UNE often improves with conservative management and simple elbow rest, but surgical referral is advised where there is progression of motor symptoms. Although it is not possible to be certain that the use of the "elbow warmer" worsened this patient’s neuropathy, neurophysiology is influenced by temperature.2 Heat induced conduction block has been described in the setting of carpal tunnel syndrome,3 and cooling has been successfully used to aid recovery in common peroneal nerve compressive neuropathy.4 It is therefore conceivable that this home-made device prevented spontaneous recovery in this patient, necessitating surgical referral.
References
Campbell WW. Ulnar neuropathy at the elbow. Muscle Nerve 2000;23:450–2.
Denys EH. AAEM minimonograph #14: The influence of temperature in clinical neurophysiology. Muscle Nerve 1991;14:795–811.
Wang AK, Raynor EM, Blum AS, et al. Heat sensitivity of sensory fibers in carpal tunnel syndrome. Muscle Nerve 1999;22:37–42.
Rutkove SB. Focal cooling improves neuronal conduction in peroneal neuropathy at the fibular neck. Muscle Nerve 2001;24:1622–6.(Martin R Turner)
Martin R Turner
Department of Neurology, The Radcliffe Infirmary, Woodstock Road, Oxford, OX2 6HE, UK; turnermr@doctors.org.uk
Keywords: Ulnar neuropathy; elbow warmer; nerve conduction
A 26 year old student presented clinically with a right ulnar sensory neuropathy, thought to have resulted from compression at the elbow during late night studying. There was no previous history, nor family history, of compression neuropathy; serum glucose and inflammatory markers were not elevated. Nerve conduction studies confirmed marked slowing across the elbow on the right, compared with the left side. Plain x ray of the right elbow revealed no bony abnormality.
Despite resting the arm, hand weakness progressed over the next 6 weeks, with evidence of hand clawing. At this time the student confessed that, in an attempt to stimulate recovery himself, he had fashioned an "elbow warmer" from an electric blanket (fig), which had been worn continuously over the previous weeks. He was instructed not to use it any more, and referred immediately for surgical intervention following which his weakness resolved.
Ulnar neuropathy at the elbow (UNE) remains a controversial entity, both in terms of neurophysiological diagnosis and subsequent management.1 UNE often improves with conservative management and simple elbow rest, but surgical referral is advised where there is progression of motor symptoms. Although it is not possible to be certain that the use of the "elbow warmer" worsened this patient’s neuropathy, neurophysiology is influenced by temperature.2 Heat induced conduction block has been described in the setting of carpal tunnel syndrome,3 and cooling has been successfully used to aid recovery in common peroneal nerve compressive neuropathy.4 It is therefore conceivable that this home-made device prevented spontaneous recovery in this patient, necessitating surgical referral.
References
Campbell WW. Ulnar neuropathy at the elbow. Muscle Nerve 2000;23:450–2.
Denys EH. AAEM minimonograph #14: The influence of temperature in clinical neurophysiology. Muscle Nerve 1991;14:795–811.
Wang AK, Raynor EM, Blum AS, et al. Heat sensitivity of sensory fibers in carpal tunnel syndrome. Muscle Nerve 1999;22:37–42.
Rutkove SB. Focal cooling improves neuronal conduction in peroneal neuropathy at the fibular neck. Muscle Nerve 2001;24:1622–6.(Martin R Turner)