Abstract

Introduction: Nerve conduction study (NCS) examination of the ulnar nerve is a diagnostic tool when investigating patients presenting with cubital tunnel syndomre (CTS). However, NCS are associated with a false negative rate. Decompressive surgery of the ulnar nerve remains the primary treatment of cubital tunnel syndrome. The aim of our study was to look at:

The correlation between the results of NCS and the subsequent outcome from surgery

Method: A retrospective study of 75 cases of CTS was undertaken. All patients had clinical examination with documentation of features, followed by NCS if indicated. If NCS were carried out, the results of the study was graded (negative, mild, moderate or severe). All patients had decompressive surgery of the ulnar nerve at the elbow. Operative functional outcomes was evaluated pre and post operatively using standard DASH score. A successful outcome was defined as resolution of symptoms.

Results: There were 53 men and 22 women. Patient age showed a normal distribution (range 26–84, mean 49 years). Overall, 65 patients (87%) had resolution of symptoms postoperatively and 10 patients (13%) had unresolved symptoms (5 sensory, 1 pain, 2 sensory & pain, 2 sensory & motor). Outcomes of patients that did not undergo NCS showed a resolution rate of 89% (24/27). Those that had a negative NCS, showed a resolution rate of 100% (12/12), whilst those that had a positive NCS showed a resolution rate of 81% (29/36).

Discussion: Our study highlighted that patients with electro-negative CTS can be effectively and safely treated by simple decompression. Surgical outcome can be correlated to the severity of the pre-operative NCS. There would seem no reason to refer patients for NCS prior to offering operative treatment.

Introduction: Leg length discrepancy (LLD) following hip arthroplasty can produce abnormal loading leading to pain, increased wear and loosening of implants. The aim of this study was to investigate the relationship between LLD and static limb loading.

Methods: A pedobarograph was used to measure the limb loading of 19 normal volunteers aged 18 to 58. Each volunteer was asked to stand on the Pedobarograph with both feet so that their weight could be recorded. The load through the left leg was then recorded with the right leg on a platform level beside it. The platform was then raised in 1 cm increments to 6 cm, to simulate different levels of LLD. In each position 3 readings were taken with the right knee flexed (pelvis level), and straight (pelvis tilted).

Results: When the feet were level the left leg took 53 % of the load. As the height of the right foot was increased the load through the left leg increased in a non-linear fashion.

With the knee flexed, a 1 cm difference produced a 3 % increase in loading. This was significant (P< 0.05). All subsequent increases were also significant. The largest increase in load was observed between 1 cm & 2 cm (+5 %). At 6cm the left leg load was 70.9 %.

With the pelvis tilted, there were smaller increases in loading. These did not become significant until a difference of 5 cm. The maximum load was 62.1 % at 6 cm.

Discussion: The length-loading relationship was non-linear. The pelvis tilted stance produced less loading asymmetry, but more discomfort than the flexed knee stance.