尺骨神経管症候群
2年ほどの経過で徐々に右手筋萎縮と筋力低下が進行してきた30代男性例。右利きで仕事上よくOA機器のマウスを使っている。右背側骨間筋に筋萎縮を認めたが, 小指球には明らかな筋萎縮は認めなかった。深部腱反射には特記すべき異常はなく, 尺骨神経領域を含め感覚障害は認めなかった。右尺骨運動神経伝導検査では, 被検筋を小指外転筋 (ADM) にすると伝導遅延は認めなかったが, 被検筋を第一背側骨間筋 (FDI) にすると手根部より遠位での著明な伝導障害を認めた。右尺骨感覚神経伝導検査には異常を認めなかった。Zone・で手掌深枝が障害された尺骨神経管症候群 (UTS) と診断し, 整形外科手術を施行したと...
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| Published in | 臨床神経生理学 Vol. 43; no. 4; pp. 183 - 188 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本臨床神経生理学会
2015
|
| Online Access | Get full text |
| ISSN | 1345-7101 2188-031X |
| DOI | 10.11422/jscn.43.183 |
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| Abstract | 2年ほどの経過で徐々に右手筋萎縮と筋力低下が進行してきた30代男性例。右利きで仕事上よくOA機器のマウスを使っている。右背側骨間筋に筋萎縮を認めたが, 小指球には明らかな筋萎縮は認めなかった。深部腱反射には特記すべき異常はなく, 尺骨神経領域を含め感覚障害は認めなかった。右尺骨運動神経伝導検査では, 被検筋を小指外転筋 (ADM) にすると伝導遅延は認めなかったが, 被検筋を第一背側骨間筋 (FDI) にすると手根部より遠位での著明な伝導障害を認めた。右尺骨感覚神経伝導検査には異常を認めなかった。Zone・で手掌深枝が障害された尺骨神経管症候群 (UTS) と診断し, 整形外科手術を施行したところ豆状有鉤裂孔近位部での右尺骨神経の絞扼が明らかとなった。末梢神経伝導検査はUTSの障害部位を同定するために非常に有用な方法であり, 絞扼部位の除圧を行う術前検査として必須である。 |
|---|---|
| AbstractList | 2年ほどの経過で徐々に右手筋萎縮と筋力低下が進行してきた30代男性例。右利きで仕事上よくOA機器のマウスを使っている。右背側骨間筋に筋萎縮を認めたが, 小指球には明らかな筋萎縮は認めなかった。深部腱反射には特記すべき異常はなく, 尺骨神経領域を含め感覚障害は認めなかった。右尺骨運動神経伝導検査では, 被検筋を小指外転筋 (ADM) にすると伝導遅延は認めなかったが, 被検筋を第一背側骨間筋 (FDI) にすると手根部より遠位での著明な伝導障害を認めた。右尺骨感覚神経伝導検査には異常を認めなかった。Zone・で手掌深枝が障害された尺骨神経管症候群 (UTS) と診断し, 整形外科手術を施行したところ豆状有鉤裂孔近位部での右尺骨神経の絞扼が明らかとなった。末梢神経伝導検査はUTSの障害部位を同定するために非常に有用な方法であり, 絞扼部位の除圧を行う術前検査として必須である。 |
| Author | 今井, 富裕 |
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| Copyright | 2015 一般社団法人 日本臨床神経生理学会 |
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| References | 26) Liguori R, Donadio V, Di Stasi V, et al: Palmaris brevis spasm: An occupational syndrome. Neurology 60: 1705–1707, 2003. 8) Zahrawi F: Acute compression ulnar neuropathy at Guyon’s canal resulting from lipoma. J Hand Surg Am 9: 238–239, 1984. 11) Budny PG, Regan PJ, Roberts AH: Localized nodular synovitis: a rare cause of ulnar nerve compression in Guyon’s canal. J Hand Surg Am 17: 663–664, 1992. 6) Maroukis BL, Ogawa T, Rehim SA, et al: Guyon canal: the evolution of clinical anatomy. J Hand Surg Am 39: 571–579, 2014. 9) Olney RK, Hanson M: AAEE case report #15: ulnar neuropathy at or distal to the wrist. Muscle Nerve 11: 828–832, 1988. 3) Kimura J: Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. 4th ed. Oxford University Press, New York, pp 772–773, 2013. 32) Kothari MJ, Preston DC, Logigian EL: Lumbrical-interossei motor studies localize ulnar neuropathy at the wrist. Muscle Nerve 19: 170–174, 1996. 31) Padua L, LoMonaco M, Valente EM, et al: A useful electrophysiologic parameter for diagnosis of carpal tunnel syndrome. Muscle Nerve 19: 48–53, 1996. 25) Brown CK, Stainsby B, Sovak G: Guyon canal syndrome: lack of management in a case of unresolved handlebar palsy. J Can Chiropr Assoc 58: 413–420, 2014. 12) Segal R, Machiraju U, Larkins M: Tortuous peripheral arteries: A cause of focal neuropathy. J Neurosurg 76: 701–704, 1992. 30) Nakamichi K, Tachibana S: Ganglion-associated ulnar tunnel syndrome treated by ultrasonographically assisted aspiration and splinting. J Hand Surg Eur 28: 177–178, 2003. 15) Nakamichi K, Tachibana S, Kitajima I: Ultrasonography in the diagnosis of ulnar tunnel syndrome caused by an occult ganglion. J Hand Surg Eur 25: 503–504, 2000. 16) Jose RM, Bragg T, Srivastava S: Ulnar nerve compression in Guyon’s canal in the presence of a tortuous ulnar artery. J Hand Surg Eur 31: 200–202, 2006. 17) Yamazaki H, Uchiyama S, Kato H: Median nerve and ulnar nerve palsy caused by calcium pyrophosphate dihydrate crystal deposition disease: case report. J Hand Surg Am 33: 1325–1328, 2008. 20) Murata K, Shih J-T, Tsai T-M: Causes of ulnar tunnel syndrome: a retrospective study of 31 subjects. J Hand Surg Am 28: 647–651, 2003. 21) Ginanneschi F, Filippou G, Milani P, et al: Ulnar nerve compression neuropathy at Guyon’s canal caused by crutch walking: case report with ultrasonographic nerve imaging. Arch Phys Med Rehabil 90: 522–524, 2009. 14) Koch H, Haas F, Pierer G: Ulnar nerve compression in Guyon’s canal due to a haemangioma of the ulnar artery. J Hand Surg Eur 23: 242–244, 1998. 33) Kimura J: Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. 4th ed. Oxford University Press, New York, p 283, 2013. 4) Imai T, Shizukawa H, Nakanishi K, et al: Hyperexcitability of cervical motor neurons during neck flexion in patients with Hirayama disease. Electromyogr Clin Neurophysiol 40: 11–15, 2000. 5) 今井富裕, 津田笑子, 山内理香ら: 平山病の病期診断における正中神経のF波所見の有用性. 臨床神経生理学 38: 165–171, 2010. 34) 木村 淳, 幸原伸夫: 神経伝導検査と筋電図を学ぶ人のために. 第2版. 医学書院, 東京, pp 109–113, 2010. 29) Ruocco MJ, Walsh JJ, Jackson JP: MR imaging of ulnar nerve entrapment secondary to an anomalous wrist muscle. Skeletal Radiol 27: 218–221, 1998. 13) Chammas M, Meyer Zu Reckendorf G, et al: Compression of the ulnar nerve in Guyon’s canal by pseudotumoral calcinosis in systemic scleroderma. J Hand Surg Eur 20: 794–796, 1995. 1) Dupont C, Cloutier GE, Prevost Y, et al: Ulnar tunnel syndrome at the wrist. J Bone Joint Surg Am 47: 757–761, 1965. 10) Thurman RT, Jindal P, Wolff TW: Ulnar nerve compression in Guyon’s canal caused by calcinosis in scleroderma. J Hand Surg Am 16: 739–741, 1991. 24) Akuthota V, Plastaras C, Lindberg K, et al: The effect of long-distance bicycling on ulnar and median nerves: an electrophysiologic evaluation of cyclist palsy. Am J Sports Med 33: 1224–1230, 2005. 2) Chen SH, Tsai TM: Ulnar tunnel syndrome. J Hand Surg Am 39: 571–579, 2014. 27) Iyer VG: Palmaris brevis sign in ulnar neuropathy. Muscle Nerve 21: 675–677, 1998. 28) Subin GD, Mallon WJ, Urbaniak JR: Diagnosis of ganglion in Guyon’s canal by magnetic resonance imaging. J Hand Surg Am 14: 640–643, 1989. 23) Patterson JM, Jaggars MM, Boyer MI: Ulnar and median nerve palsy in long-distance cyclists. A prospective study. Am J Sports Med 31: 585–589, 2003. 19) Chen WA, Barnwell JC, Li Y, et al: An ulnar intraneural ganglion arising from the pisotriquetral joint: case report. J Hand Surg Am 36: 65–67, 2011. 7) Dell PC: Compression of the ulnar nerve at the wrist secondary to a rheumatoid synovial cyst: case report and review of the literature. J Hand Surg Am 4: 468–473, 1979. 22) Capitani D, Beer S: Handlebar palsy—a compression syndrome of the deep terminal (motor) branch of the ulnar nerve in biking. J Neurol 249: 1441–1445, 2002. 18) Miyamoto W, Yamamoto S, Kii R, et al: Vascular leiomyoma resulting in ulnar neuropathy: case report. J Hand Surg Am 33: 1868–1870, 2008. |
| References_xml | – reference: 19) Chen WA, Barnwell JC, Li Y, et al: An ulnar intraneural ganglion arising from the pisotriquetral joint: case report. J Hand Surg Am 36: 65–67, 2011. – reference: 9) Olney RK, Hanson M: AAEE case report #15: ulnar neuropathy at or distal to the wrist. Muscle Nerve 11: 828–832, 1988. – reference: 22) Capitani D, Beer S: Handlebar palsy—a compression syndrome of the deep terminal (motor) branch of the ulnar nerve in biking. J Neurol 249: 1441–1445, 2002. – reference: 16) Jose RM, Bragg T, Srivastava S: Ulnar nerve compression in Guyon’s canal in the presence of a tortuous ulnar artery. J Hand Surg Eur 31: 200–202, 2006. – reference: 7) Dell PC: Compression of the ulnar nerve at the wrist secondary to a rheumatoid synovial cyst: case report and review of the literature. J Hand Surg Am 4: 468–473, 1979. – reference: 31) Padua L, LoMonaco M, Valente EM, et al: A useful electrophysiologic parameter for diagnosis of carpal tunnel syndrome. Muscle Nerve 19: 48–53, 1996. – reference: 14) Koch H, Haas F, Pierer G: Ulnar nerve compression in Guyon’s canal due to a haemangioma of the ulnar artery. J Hand Surg Eur 23: 242–244, 1998. – reference: 3) Kimura J: Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. 4th ed. Oxford University Press, New York, pp 772–773, 2013. – reference: 27) Iyer VG: Palmaris brevis sign in ulnar neuropathy. Muscle Nerve 21: 675–677, 1998. – reference: 13) Chammas M, Meyer Zu Reckendorf G, et al: Compression of the ulnar nerve in Guyon’s canal by pseudotumoral calcinosis in systemic scleroderma. J Hand Surg Eur 20: 794–796, 1995. – reference: 5) 今井富裕, 津田笑子, 山内理香ら: 平山病の病期診断における正中神経のF波所見の有用性. 臨床神経生理学 38: 165–171, 2010. – reference: 33) Kimura J: Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. 4th ed. Oxford University Press, New York, p 283, 2013. – reference: 2) Chen SH, Tsai TM: Ulnar tunnel syndrome. J Hand Surg Am 39: 571–579, 2014. – reference: 15) Nakamichi K, Tachibana S, Kitajima I: Ultrasonography in the diagnosis of ulnar tunnel syndrome caused by an occult ganglion. J Hand Surg Eur 25: 503–504, 2000. – reference: 11) Budny PG, Regan PJ, Roberts AH: Localized nodular synovitis: a rare cause of ulnar nerve compression in Guyon’s canal. J Hand Surg Am 17: 663–664, 1992. – reference: 26) Liguori R, Donadio V, Di Stasi V, et al: Palmaris brevis spasm: An occupational syndrome. Neurology 60: 1705–1707, 2003. – reference: 28) Subin GD, Mallon WJ, Urbaniak JR: Diagnosis of ganglion in Guyon’s canal by magnetic resonance imaging. J Hand Surg Am 14: 640–643, 1989. – reference: 1) Dupont C, Cloutier GE, Prevost Y, et al: Ulnar tunnel syndrome at the wrist. J Bone Joint Surg Am 47: 757–761, 1965. – reference: 18) Miyamoto W, Yamamoto S, Kii R, et al: Vascular leiomyoma resulting in ulnar neuropathy: case report. J Hand Surg Am 33: 1868–1870, 2008. – reference: 10) Thurman RT, Jindal P, Wolff TW: Ulnar nerve compression in Guyon’s canal caused by calcinosis in scleroderma. J Hand Surg Am 16: 739–741, 1991. – reference: 12) Segal R, Machiraju U, Larkins M: Tortuous peripheral arteries: A cause of focal neuropathy. J Neurosurg 76: 701–704, 1992. – reference: 23) Patterson JM, Jaggars MM, Boyer MI: Ulnar and median nerve palsy in long-distance cyclists. A prospective study. Am J Sports Med 31: 585–589, 2003. – reference: 29) Ruocco MJ, Walsh JJ, Jackson JP: MR imaging of ulnar nerve entrapment secondary to an anomalous wrist muscle. Skeletal Radiol 27: 218–221, 1998. – reference: 25) Brown CK, Stainsby B, Sovak G: Guyon canal syndrome: lack of management in a case of unresolved handlebar palsy. J Can Chiropr Assoc 58: 413–420, 2014. – reference: 8) Zahrawi F: Acute compression ulnar neuropathy at Guyon’s canal resulting from lipoma. J Hand Surg Am 9: 238–239, 1984. – reference: 20) Murata K, Shih J-T, Tsai T-M: Causes of ulnar tunnel syndrome: a retrospective study of 31 subjects. J Hand Surg Am 28: 647–651, 2003. – reference: 34) 木村 淳, 幸原伸夫: 神経伝導検査と筋電図を学ぶ人のために. 第2版. 医学書院, 東京, pp 109–113, 2010. – reference: 4) Imai T, Shizukawa H, Nakanishi K, et al: Hyperexcitability of cervical motor neurons during neck flexion in patients with Hirayama disease. Electromyogr Clin Neurophysiol 40: 11–15, 2000. – reference: 30) Nakamichi K, Tachibana S: Ganglion-associated ulnar tunnel syndrome treated by ultrasonographically assisted aspiration and splinting. J Hand Surg Eur 28: 177–178, 2003. – reference: 32) Kothari MJ, Preston DC, Logigian EL: Lumbrical-interossei motor studies localize ulnar neuropathy at the wrist. Muscle Nerve 19: 170–174, 1996. – reference: 24) Akuthota V, Plastaras C, Lindberg K, et al: The effect of long-distance bicycling on ulnar and median nerves: an electrophysiologic evaluation of cyclist palsy. Am J Sports Med 33: 1224–1230, 2005. – reference: 21) Ginanneschi F, Filippou G, Milani P, et al: Ulnar nerve compression neuropathy at Guyon’s canal caused by crutch walking: case report with ultrasonographic nerve imaging. Arch Phys Med Rehabil 90: 522–524, 2009. – reference: 6) Maroukis BL, Ogawa T, Rehim SA, et al: Guyon canal: the evolution of clinical anatomy. J Hand Surg Am 39: 571–579, 2014. – reference: 17) Yamazaki H, Uchiyama S, Kato H: Median nerve and ulnar nerve palsy caused by calcium pyrophosphate dihydrate crystal deposition disease: case report. J Hand Surg Am 33: 1325–1328, 2008. |
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