Li Miaozhong, Yu Miao, Zhou Xiaoling, Tian Mintao, Li Xueyuan
Department of Hand Microsurgery and Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo, China.
Ningbo Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Ningbo, China.
Quant Imaging Med Surg. 2025 Jun 6;15(6):5510-5519. doi: 10.21037/qims-2024-2477. Epub 2025 May 26.
Neuralgic amyotrophy (NA) involving the ulnar nerve is frequently misdiagnosed as cubital tunnel syndrome (CuTS), leading to delayed or inappropriate treatment. This study reports aims to share our initial experiences in diagnosing and managing this underrecognized condition, highlighting the key clinical insights to improve differential diagnosis and therapeutic strategies.
A retrospective analysis was conducted on 25 participants (30 limbs) diagnosed with NA affecting the ulnar nerve between October 2016 and June 2022. Among these patients, 20 had unilateral involvement and 5 had bilateral involvement. Individualized treatment plans, including conservative management and surgical decompression, were tailored based on disease severity and patient response. Clinical outcomes were assessed using the visual analog scale (VAS), static two-point discrimination (2PD) test, and Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire scores over a follow-up period of 6 to 14 months.
All patients exhibited pain, numbness, or weakness in the region innervated by the ulnar nerve. Conservative treatment was successful in 5 participants (6 limbs) with early-stage mild disease, while 20 participants (24 limbs) underwent surgical decompression after conservative therapy failed. At final follow-up, 22 participants (26 limbs) demonstrated improvement in DASH scores. However, 3 limbs retained VAS scores above 3 points, with no significant recovery according to the static 2PD test. Additionally, 3 participants (4 limbs) exhibited poor postoperative functional recovery after 1 year.
NA involving the ulnar nerve is often misinterpreted as CuTS, complicating diagnosis and management. A thorough review of patient history, combined with electromyographic (EMG) and ultrasound evaluations, is crucial for accurate diagnosis. Patients with early-stage NA may respond well to conservative therapy, but advanced cases should be counseled on the potential limitations of surgical outcomes. Our findings emphasize the necessity of prompt, accurate diagnosis and personalized treatment to optimize patient recovery.
累及尺神经的神经性肌萎缩（NA）常被误诊为肘管综合征（CuTS），导致治疗延迟或不当。本研究报告旨在分享我们在诊断和管理这种未得到充分认识的疾病方面的初步经验，强调改善鉴别诊断和治疗策略的关键临床见解。
对2016年10月至2022年6月期间诊断为累及尺神经的NA的25名参与者（30条肢体）进行回顾性分析。在这些患者中，20例为单侧受累，5例为双侧受累。根据疾病严重程度和患者反应制定个性化治疗方案，包括保守治疗和手术减压。在6至14个月的随访期内，使用视觉模拟量表（VAS）、静态两点辨别（2PD）测试以及手臂、肩部和手部功能障碍（DASH）问卷评分评估临床结果。
所有患者在尺神经支配区域均出现疼痛、麻木或无力。5名参与者（6条肢体）早期轻度疾病采用保守治疗成功，而20名参与者（24条肢体）在保守治疗失败后接受了手术减压。在最后随访时，22名参与者（26条肢体）的DASH评分有所改善。然而，3条肢体的VAS评分仍高于3分，根据静态2PD测试无明显恢复。此外，3名参与者（4条肢体）在1年后术后功能恢复不佳。
累及尺神经的NA常被误诊为CuTS，使诊断和管理复杂化。全面回顾患者病史，结合肌电图（EMG）和超声评估，对于准确诊断至关重要。早期NA患者可能对保守治疗反应良好，但对于晚期病例，应告知其手术结果的潜在局限性。我们的研究结果强调了及时、准确诊断和个性化治疗以优化患者康复的必要性。
