Hostname: page-component-7479d7b7d-wxhwt Total loading time: 0 Render date: 2024-07-11T11:34:49.729Z Has data issue: false hasContentIssue false
  • English
  • Français

Progress in Clinical Neurosciences: Perioperative Ulnar Neuropathies: A Medicolegal Review

Published online by Cambridge University Press:  02 December 2014

John D. Stewart  and
Stephen H. Shantz
John D. Stewart
Affiliation:
Montreal Neurological Hospital and Institute, and McGill University, Montreal QC, and McCarthy Tetrault, London, ON Canada
Stephen H. Shantz
Affiliation:
Montreal Neurological Hospital and Institute, and McGill University, Montreal QC, and McCarthy Tetrault, London, ON Canada
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Perioperative ulnar neuropathies have long been attributed to inappropriate arm positioning and padding during operations and have resulted in many lawsuits.

Methods:

A recent Canadian lawsuit is described and the literature regarding perioperative ulnar and other focal neuropathies reviewed.

Results:

The evidence strongly suggests that ulnar nerve damage is usually sustained in the postoperative rather than the intraoperative period. There is no evidence that positioning or padding of the arm during the operation prevents perioperative ulnar neuropathies.

Conclusions:

There should generally be no basis for a claim against medical or nursing staff or hospitals when an ulnar neuropathy develops following anesthesia and surgery.

Résumé:

RÉSUMÉ:Contexte:

Les neuropathies cubitales périopératoires ont longtemps été attribuées à un positionnement et à un matelassage inadéquats du bras pendant la chirurgie et ont donné lieu à de nombreuses poursuites.

Méthodes:

Nous décrivons une poursuite récente au Canada et nous présentons une revue de la littérature sur la neuropathie cubitale périopératoire et sur d’autres neuropathies focales.

Résultats:

Les données suggèrent fortement que le dommage du nerf cubital survient en postopératoire plutôt que pendant la chirurgie. Il n’y a pas d’observation suggérant que le positionnement ou le matelassage du bras pendant la chirurgie prévient les neuropathies cubitales périopératoires.

Conclusions:

Il ne devrait généralement pas exister de fondement à une réclamation contre le personnel médical ou infirmier ou l’hôpital quand une neuropathie cubitale survient après une anesthésie et une chirurgie.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 1 , February 2003 , pp. 15 - 19
Copyright
Copyright © The Canadian Journal of Neurological 2003

References

1. Warner, MA, Warner, ME, Martin, JT. Ulnar neuropathy. Incidence, outcome, and risk factors in sedated or anesthetized patients. Anesthesiology 1994;81:1332–1340.Google Scholar
2. Murphy, JP, Devers, JC. Prevention of postsurgical ulnar neuropathy. JAMA 1974;227:1123–1124.CrossRefGoogle ScholarPubMed
3. Association of Operating Room Nurses, Inc. Standards, Recommended Practices & Guidelines. Deb Reno. 289-290. 1999. Denver, CO, Association of Operating Room Nurses.Google Scholar
4. Fairchild, SS. Perioperative nursing. Principles and Practice. Philadelphia: Lippincott, 1993.Google Scholar
5. Heizenroth, PA. Positioning the patient for surgery. In: Meeker, JH, Rothrock, JC, (Eds). Alexander’s Care of the Patient in Surgery. St. Louis: Mosby, 1999:153–65.Google Scholar
6. Stoelting, RK. Postoperative ulnar nerve palsy - is it a preventable complication? Anesth Analg 1993;76:7–9.CrossRefGoogle ScholarPubMed
7. Mawk, JR, Thienprasit, P. Postoperative ulnar neuropathy. JAMA 1981;246:2806–2807.CrossRefGoogle ScholarPubMed
8. Seyfer, AE. Upper extremity neuropathies after cardiac surgery. J Hand Surg 1985;10A:16–19.CrossRefGoogle Scholar
9. Alvine, FG, Schurrer, ME. Postoperative ulnar nerve palsy: Are there predisposing factors? J Bone Joint Surg Am 1987;69:255–259.Google Scholar
10. Roy, RC, Stafford, MA, Charlton, JE. Nerve injury and musculoskeletal complaints after cardiac surgery: influence of internal mammary artery dissection and left arm position. Anesth Analg 1988;67:277–279.Google Scholar
11. Wadsworth, TG, Williams, JR. Cubital tunnel external compression syndrome. Br Med J 1973;1:662–666.CrossRefGoogle ScholarPubMed
12. Apfelberg, DB, Larson, SJ. Dynamic anatomy of the ulnar nerve at the elbow. Plast Reconstr Surg 1973;51:76–81.CrossRefGoogle ScholarPubMed
13. Pechan, J, Julius, I. The pressure measurement in the ulnar nerve: a contribution to the pathophysiology of the cubital tunnel syndrome. J Biomech 1975;8:75–79.Google Scholar
14. Gelberman, RH, Yamaguchi, K, Hollstien, SB, et al. Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow. An experimental study in human cadavers. J Bone Joint Surg Am 1998;80:492–501.CrossRefGoogle Scholar
15. Lederman, RJ, Breuer, AC, Hanson, MR, et al. Peripheral nervous system complications of coronary artery bypass graft surgery. Ann Neurol 1982;12:297–301.CrossRefGoogle ScholarPubMed
16. Operating room nurses association of Canada. Recommended standards for perioperative nursing practice. 4th edition, 1998:113–114.Google Scholar
17. Williams, JR. Postoperative ulnar neuropathy. JAMA 1980;243: 1525–1526.Google Scholar
18. Kincaid, JC. The electrodiagnosis of ulnar neuropathy at the elbow. Muscle Nerve 1988;11:1005–1015.CrossRefGoogle ScholarPubMed
19. Caplan, RA, Posner, KL, Cheney, FW. Perioperative ulnar neuropathy: are we ready for shortcuts? Anesthesiology 1994;81: 1321–1323.CrossRefGoogle ScholarPubMed
20. Warner, MA, Warner, DO, Matsumoto, JY, et al. Ulnar neuropathy in surgical patients. Anesthesiology 1999;90:54–59.Google Scholar
21. Graham, JG, Pye, IF, McQueen, INF. Brachial plexus injury after median sternotomy. J Neurol Neurosurg Psychiatr 1981;44:621–625.Google Scholar
22. Warner, MA, Warner, DO, Harper, CM, Schroeder, DR, Maxson, PM. Ulnar neuropathy in medical patients. Anesthesiology 2000;92: 613–615.Google Scholar
23. Warner, MA, Warner, DO, Harper, CM, Schroeder, MS, Maxson, PM. Lower extremity neuropathies associated with lithotomy positions. Anesthesiology 2000;93:938–942.CrossRefGoogle ScholarPubMed
24. Seyfer, AE, Grammer, NY, Bogumill, GP. Upper extremity neuropathies after cardiac surgery. J Hand Surg 1985;10A:16–19.Google Scholar
25. Feindel, W, Stratford, J. The role of the cubital tunnel in tardy ulnar palsy. Can J Surg 1958;1:287–300.Google Scholar
26. Stewart, JD. Focal Peripheral Neuropathies. Philadelphia: Lippincott Williams Wilkins, 2000.Google Scholar
27. Campbell, WW, Pridgeon, RM, Riaz, G, Astruc, J, Sahni, KS. Variations in anatomy of the ulnar nerve at the cubital tunnel: pitfalls in the diagnosis of ulnar neuropathy at the elbow. Muscle Nerve 1991;14:733–738.Google Scholar
28. Vanderpool, DW, Chalmers, J, Lamb, DW. Peripheral compression lesions of the ulnar nerve. J Bone Joint Surg 1968;50B:792–802.CrossRefGoogle Scholar
29. Dawson, DM, Krarup, C. Perioperative nerve lesions. Arch Neurol 1989;46:1355–1360.Google Scholar
30. Kroll, DA, Caplan, RA, Posner, K, Ward, RJ, Cheney, FW. Nerve injury associated with anesthesia. Anesthesiology 1990;73:202–207.Google Scholar