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• Ulnar neuropathy
  A J Larner
  Published on: 14 April 2016
• Nerve ultrasonography in practical work
  Mahamoud M Gabal
  Published on: 14 April 2016

• Published on: 14 April 2016

  Ulnar neuropathy

  • A J Larner, Consultant Neurologist

  Dear Editor

  I very much enjoyed Dr Stewart’s informative article on ulnar neuropathies in the August issue of the journal,1 which included images of Rodin’s The Thinker to demonstrate that elbow flexion may increase the likelihood of nerve damage.

  May I suggest the painting of Saint Bartholomew of 1661 (see fig) by Rembrandt van Rijn (1606–69) in the J Paul Getty Museum, Los Angeles, as a possible exam...

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  Dear Editor

  I very much enjoyed Dr Stewart’s informative article on ulnar neuropathies in the August issue of the journal,1 which included images of Rodin’s The Thinker to demonstrate that elbow flexion may increase the likelihood of nerve damage.

  May I suggest the painting of Saint Bartholomew of 1661 (see fig) by Rembrandt van Rijn (1606–69) in the J Paul Getty Museum, Los Angeles, as a possible example of ulnar neuropathy? Wasting of the first dorsal interosseous muscle seems evident in the apostle’s left hand. In the differential diagnosis of ulnar neuropathy, camptodactyly (bent little finger) might also be included. Although there are no motor or sensory signs, patients may sometimes be referred for neurophysiological studies to exclude ulnar neuropathy because of the clawed hand posture.2

  

  REFERENCES
  1. Stewart J. Ulnar neuropathies: where, why, and what to do? Practical Neurology 2006;6:218–29.

  2. Larner AJ. Camptodactyly in a neurology outpatient clinic. Int J Clin Pract 2001;55:592–5.

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  Conflict of Interest:
  None declared.

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• Published on: 14 April 2016

  Nerve ultrasonography in practical work

  • Mahamoud M Gabal, radiologist

  Dear Editor,

  I read with interest this work ..indeed nerve ultrasonography has other parameters more than cross section area measurements in detection of the pathological changes and prediction of outcome of the treatment (medical or surgical}...the normal nerve as seen by high resolution ultrasonography is:

  1- oval shaped or round with high ability to change its shape in response to applied pressure easi...

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  Dear Editor,

  I read with interest this work ..indeed nerve ultrasonography has other parameters more than cross section area measurements in detection of the pathological changes and prediction of outcome of the treatment (medical or surgical}...the normal nerve as seen by high resolution ultrasonography is:

  1- oval shaped or round with high ability to change its shape in response to applied pressure easily seen by dynamic study during flexion and extension of the limbs

  2- the nerve according to the number of fascicles has a normal fascicular pattern

  3- it has the ability to change its position according to the force applied on it during limb movement this excursion can be calculated by the dynamic study

  4- in response to exercise it reacts in the form of increase its cross section area and increase signals from its blood vessels

  5- in response to the applied pressure the cross section area is reduced by 20-30% with flattening of the contour so by applying all these parameters the subtle changes can be detected first = the loss of fascicular pattern which seen with long standing pathology can be detected and its length can be measured = second the loss of compressibility by applied pressure [most probably due to fibrosis and new short nerve fiber growth] can be easily measured and the less the compressibility the poorer the outcome of treatment third = loss of normal nerve excursion during limb movement on the dynamic study due either intrinsic changes or surrounding fibrosis fourth the focal nerve changes can be estimated and the change in the volume by measuring the affected segment length and the cross section area can calculated and used for follow up ....so the cross section area as single criterion do not explain the recurrent cases of the operated cubital tunnel syndrome or the poor response to the operation in conservative cases finally to use the gray ultrasound alone the echotexture of the nerve with applied stress compressibility test together with the cross sectional area in rest and on dynamic stress condition should be used in all examined cases thanks

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  Conflict of Interest:
  None declared.

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