Lesões do nervo cubital em costureiras de calçados: abordagem medico-social

Renck, Lutero Arno

doi:10.1590/S0004-282X1981000400001

Resumos

Foram estudadas 19 pacientes que apresentavam lesão traumática do nervo cubital. Todas eram costureiras de calçados e apoiavam o cotovelo sobre a mesa de trabalho, causando microtraumatismos ao nervo cubital. Os exames eletromiográficos revelaram lesão do neurônio motor periférico. A velocidade de condução nervosa estava diminuída em todos os casos. O tratamento constou de afastamento do serviço, uso de analgésicos, complexo B, corticóide e fisioterapia. Não havendo melhora era preconizada cirurgia, com transposição do nervo cubital. São esplanadas medidas preventivas para este acidente profissional.

An unexampled nosologic entity in the literature is described. Nineteen patients with atrophies in the hands are studied. The occupation is shoe stitching. The etiology of disease is due to microtraumatisms of the ulnar nerve at the elbow, during the work. Research for Hansen disease in patients was negative. Electromiographic-tests in 11 patients showed lesion on the periferic motor neron. Nervous conduction speed was diminished in all cases. The treatment consisted of analgesics, B complex vitamin, prednizone, surgery with transposition of the ulnar nerve at the elbow level. Preventive measures are analysed.

Lesões do nervo cubital em costureiras de calçados: abordagem medico-social

Ulnar nerve lesions in shoe stitching workers: study of 19 cases

Lutero Arno Renck

Neurologista dos hospitais de Novo Hamburgo, RS - Brasil

RESUMO

Foram estudadas 19 pacientes que apresentavam lesão traumática do nervo cubital. Todas eram costureiras de calçados e apoiavam o cotovelo sobre a mesa de trabalho, causando microtraumatismos ao nervo cubital. Os exames eletromiográficos revelaram lesão do neurônio motor periférico. A velocidade de condução nervosa estava diminuída em todos os casos. O tratamento constou de afastamento do serviço, uso de analgésicos, complexo B, corticóide e fisioterapia. Não havendo melhora era preconizada cirurgia, com transposição do nervo cubital. São esplanadas medidas preventivas para este acidente profissional.

SUMMARY

An unexampled nosologic entity in the literature is described. Nineteen patients with atrophies in the hands are studied. The occupation is shoe stitching. The etiology of disease is due to microtraumatisms of the ulnar nerve at the elbow, during the work.

Research for Hansen disease in patients was negative. Electromiographic-tests in 11 patients showed lesion on the periferic motor neron. Nervous conduction speed was diminished in all cases. The treatment consisted of analgesics, B complex vitamin, prednizone, surgery with transposition of the ulnar nerve at the elbow level. Preventive measures are analysed.

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Rua Julio de Castilhos 109 - 93300 Novo Hamburgo, RS - Brasil.

1. BAKKE, J. L. & WOLF, H. G. - Occupational pressure neuritis of the deep palmar branch of the ulnar nerve. Arch. Neurol. Psychiat. (Chicago) 60:549, 1948.
2. BARAKS-DILIDSKY - Les névrites professionnelles. Thesis Paris, 1901.
3. BIGLIARDI, A. & DEL GIOVANE - La paralisi da compresione del nervo uinare nei tagliatori del cristallo. Med. d. Lavoro 57:291, 1966.
4. BRUNS, L. - Partielle Lähmung des linken N. ulnaris durch am Ellenbogen bei einem Xylographen. Neurol. Zbl. (Leipzig) 14 : 932, 1895.
5. CABELLA, G.; ISCH-TREUSSARD, G.; JESEL, M. & ISCH, I. - Etude de la vitesse de conduction nerveuse dans les névrites du nerf cubital au coude d'origine professionnelle. Arch. Mal. Prof. (Paris) 27:771, 1966.
6. CARNEVALE, V.; BAUM, M. & PETRI, N. - Compresión del nervio cubital a nivel del canal de Guyon en la lepra. Pren. méd. argent. 56:1189, 1968.
7. CHUSID, J. G. & McDONALD, J. J. - Correlative Neuroanatomy and Functional Neurology. 13a edition. Longe Medical Publications, Los Altos, Califórnia, 1967, pp. 123, 125, 172, 173, 203.
8. DE JONG, J. G. T. & GEERLING, J. C. - Beroepsverlamming van de n. ulnaris. Ned. T. Geneesk (Amsterdam) 95:192, 1951.
9. DESTOT, M. - Paralysie cubitale par lusage de la bicyclete. Gaz. Hôp. (Paris) 69:1176, 1896.
10. DUPONT, C; CLOUTIER, G. E.; PRÉVOST, Y. & DION, M. A. - Ulnar tunnel syndrome at the wrist: a report of four cases. J. Bone Jt. Surg. 47:757, 1965.
11. DWYER, F. C. - An unusual lesion of the ulnar nerve. J. Bone Jt. Surg. 33:604, 1951.
12. EBELING, P.; GILLIAT, R. W. & THOMAS, P. K. - A clinical and electrical study of ulnar nerve lesions in the hand. J. Neurol. Neurosurg. Psychiat. (London) 23;1, 1960.
13. FEINDEL, W. & STRATFORD, J. - Cubital tunnel compression in tardy ulnar palsy. Canad. med. Ass. J. 78:351, 1958.
14. FENNING, J. B. - Deep ulnar nerve paralysis from an anatomical abnormality. J. Bone Jt. Surg. 47:1381, 1965.
15. GAT, J. R. & LOVE, J. G. - Diagnosis and treatment of tardy paralysis of the ulnar nerve. J. Bone Jt. Surg. 29:1087, 1947.
16. GRANATI, A. & ANGELERI, F. - La paralisi dell'ulnare in operai orafi. Folia med. (Napoli) 46:281, 1961.
17. GUILLAIN, G.; BOURGUIGNON, G. & CORRE, L. - Les paralisies du nerf cubital chez les cyclistes. Bull. Soe. Méd. Hôp. Paris, 56:489, 1940.
18. GURDJIAN, E. S.; LARSEN, R. D. & LINDNER, D. W. - Intraneural cyst of the peroneal and ulnar nerves. J. Neurosurg. 23:76, 1965.
19. HARRIS, W. - Occupational pressure neuritis of the deep palmar branch of the ulnar nerve. British, med. J. 1:98, 1929.
20. HARRISON, M. J. G. & NURICK, S. - Results of anterior transposition of the ulnar nerve for ulnar neuritis. British med. J. 1:27, 1970.
21. HIGHET, W. B. - Innervation and function of thenar muscles. Lancet 1:227, 1943.
22. HUET, M. E. - Sur un cas de névrites professionnelles du nerf médian et du nerf cubital chez un ouvrier menuisier, porteur d'une ancienne fracture du coude. Rev. neurol. (Paris) 8:433, 1900.
23. HUET, M. E. & GUILLAIN, G. - Névrite cubitale professionneles chez un boulan-ger. Rev. neurol. (Paris) 8:266, 1900.
24. HUNT, J. R. - Occupation neurits of the deep palmar branch of the ulnar nerve: a well defined clinical type of professional palsy of the hand. J. nerv. ment. Die. 35:673, 1908.
25. HUNT, J. L. - The thenar and hypothenar types of neural atrophy of the hand. Amer. J. med. Sci. 116:224, 1911.
26. INSAUST, T.; CHARCHAFLIE, R. & SOTO, E. - Atrofia tenar parcial. An. Neurocir. (Buenos Aires) 1:57, 1956.
27. KEMPE, L. G. - Operative Neurosurgery. Vol. 2, Springer-Verlag New York-Heidelberg-Berlin, 1970, pp. 196-199.
28. LAURENÇON, A. - De la griffe cubitale chez les tailleurs de cristaux. Thesis, Lyon, 1894.
29. LEARMOUTH, J. R. - A technique for transplanting ulnar nerve. Surg. Gynec, Obstet. 75:792, 1942.
30. LEREBOULLET, J. & LINDEUX, S. - La paralysie cubitale des cyclistes. Paris mod. 40/41:315, 1942.
31. LEUDET, E. - Etude clinique de la névrite cubitale provoquée par les contusions et compressions répétées result de l'exercice de quelques professions. Ass. Franc. Avanc. Sci. 12 me session. 766, 1884.
32. LEVY, J. A. - Sindromes das raizes, plexos e nervos periféricos. In Tolosa, A. P. M. & Canelas, H. M. - Propedęutica Neurológica. Procienx, Săo Paulo, 1969, pág. 313.
33. LUZIO, J. - Neuralgias do tronco e membros. In Canelas, H. M. & Pereira, W. C. - Dor: Fisiopatologia e Clinica. Sarvier, Săo Paulo, 1969.
34. MAGEE, R. K. - Neuritis of deep palmar branch of ulnar nerve. Arch. Neurol. Psychiat. (Chicago) 73:200, 1955.
35. MALLET, B. L. & ZILKHA, K. J. - Compression of the ulnar nerve at the wrist by a ganglion. Lancet 1:890, 1955.
36. McGOWAN, A. J. - The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J. Bone Joint Surg. 32B :293, 1950.
37. MENZ, E. - Isolierte Ulnarislähmung: ein Beitrag den professionnellen Erkran-kungen. Wien. Klin. Wdsch. 14:411, 1900.
38. MUMENTHALER, M. - Die Ulnarisparesen. Stuttgart. Georg Thieme, 1961.
39. NISTRI, M. - Osservazioni e considerazioni sulla insufficienza professionale del ramo volare profondo dell'ulnare. Riv. Infort. Mai. Prof. 38:1041, 1951.
40. NOEL, G. - Sur un cas de paralysie cubitale bilaierale consécutive ŕ une ostéochondromatose des coudes. Acta neurol. belg. 49:467, 1949.
41. PANAS, P. - Sur une cause peu connue de paralysie du nerf cubital. Arch. gén. Méd. Paris 11/142:5, 1879.
42. POPPEN, J. L. - An Atlas of Neurosurgical Techniques. W. B. Saunders Company, Philadelphia - London, 1960.
43. RICHARDS, R. L. - Traumatic ulnar neuritis: the results of anterior transplantation of the ulnar nerve. Edinburg med. J. 52:14, 1945.
44. ROUVIČRE, H. - Compendio de Anatomia y Diseccion. 3a ed. castelhana. Salvat Editores S.A., Barcelona - Rio de Janeiro, 1959.
45. RUSSELL, W. R. & WHITTY, C. W. M. - Traumatic neuritis of the deep palmar branch of the ulnar nerve. Lancet 1:828, 1947.
46. SCHUSTER, P. - Beiträge zur Pathologie der traumatischen Nervenläthmungen; Drücklahmung beider Nn. ulnares bei der Bedienung des Scherenfernrohrs. Neurol. CB1. (Leipzig) 36:752, 1917.
47. SPAANS, F. - Occupational nerve lesion In Vinken, P. J. & Bruyn, G. W. - Diseases of Nerves, Part I. Handbook of Clinical Neurology. North-Holland Publishing Company, Amsterdam, 1970, pp. 326-340.
48. STALL, A. - The entrapment neuropaties, In Vinken, P. J. & Bruyn, G. W. - Diseases of Nerves - Part I. Handbook of Clinical Neurology. North-Holland Publishing Company, Amsterdam, 1970, pp. 285-318.
49. STIEFLER, G. - Ueber die Radfahrerlähmung des Nervus Ulnaris. Münchner med. Wschr. 42:1727, 1927.
50. TESTUT, L. & LATARJET, A. - Tratado de Anatomia Humana. Versăo castelhana. Salvat Editores, Barcelona-Rio de Janeiro, 1951, pp. 300.362.
51. TOROK, G. & GIORA, A. - Ulnar nerve lesion in the palm: entrapment neuropathy of deep branch of ulnar nerve. Israel med. J. 23:121, 1964.
52. VAN MANSVELT, J. & POSTHUMUS MEYES, F. E. - Compressive neuritis van de ramus palmaris profund s van de nervus ulnaris. Ned. T. Geneesk, (Amsterdam) 106:1489, 1962.
53. VAN VEELEN, C. - Beroepsverlamming van de nervus ulnaris. T. soc. Geneesk. (Amsterdam) 45:499, 1967.
54. VERNOIS, M. - De la main des ouvriers et des artisans au point de vue de l´hygične et de la medicine légale. Ann. Hyg. publ. (Paris) 17:104, 1862.
55. VTKLICKY, L. - Paresis r. volaris manus n. ulnaris. Plzensky lék. Sborn. Praga 8:29, 1959.
56. WERTHEIN SALOMONSON, J. K. A. - De beroepsatrophie der diamantsjders. Ned. T. Geneesk. (Amsterdam) 33:866, 1897.

Datas de Publicação

Publicação nesta coleção
23 Ago 2012
Data do Fascículo
Dez 1981

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BAKKE, J. L. & WOLF, H. G. - Occupational pressure neuritis of the deep palmar branch of the ulnar nerve. Arch. Neurol. Psychiat. (Chicago) 60:549, 1948.

[2] 2. BARAKS-DILIDSKY - Les névrites professionnelles. Thesis Paris, 1901.

[3] 3. BIGLIARDI, A. & DEL GIOVANE - La paralisi da compresione del nervo uinare nei tagliatori del cristallo. Med. d. Lavoro 57:291, 1966.

[4] 4. BRUNS, L. - Partielle Lähmung des linken N. ulnaris durch am Ellenbogen bei einem Xylographen. Neurol. Zbl. (Leipzig) 14 : 932, 1895.

[5] 5. CABELLA, G.; ISCH-TREUSSARD, G.; JESEL, M. & ISCH, I. - Etude de la vitesse de conduction nerveuse dans les névrites du nerf cubital au coude d'origine professionnelle. Arch. Mal. Prof. (Paris) 27:771, 1966.

[6] 6. CARNEVALE, V.; BAUM, M. & PETRI, N. - Compresión del nervio cubital a nivel del canal de Guyon en la lepra. Pren. méd. argent. 56:1189, 1968.

[7] 7. CHUSID, J. G. & McDONALD, J. J. - Correlative Neuroanatomy and Functional Neurology. 13a edition. Longe Medical Publications, Los Altos, Califórnia, 1967, pp. 123, 125, 172, 173, 203.

[8] 8. DE JONG, J. G. T. & GEERLING, J. C. - Beroepsverlamming van de n. ulnaris. Ned. T. Geneesk (Amsterdam) 95:192, 1951.

[9] 9. DESTOT, M. - Paralysie cubitale par lusage de la bicyclete. Gaz. Hôp. (Paris) 69:1176, 1896.

[10] 10. DUPONT, C; CLOUTIER, G. E.; PRÉVOST, Y. & DION, M. A. - Ulnar tunnel syndrome at the wrist: a report of four cases. J. Bone Jt. Surg. 47:757, 1965.

[11] 11. DWYER, F. C. - An unusual lesion of the ulnar nerve. J. Bone Jt. Surg. 33:604, 1951.

[12] 12. EBELING, P.; GILLIAT, R. W. & THOMAS, P. K. - A clinical and electrical study of ulnar nerve lesions in the hand. J. Neurol. Neurosurg. Psychiat. (London) 23;1, 1960.

[13] 13. FEINDEL, W. & STRATFORD, J. - Cubital tunnel compression in tardy ulnar palsy. Canad. med. Ass. J. 78:351, 1958.

[14] 14. FENNING, J. B. - Deep ulnar nerve paralysis from an anatomical abnormality. J. Bone Jt. Surg. 47:1381, 1965.

[15] 15. GAT, J. R. & LOVE, J. G. - Diagnosis and treatment of tardy paralysis of the ulnar nerve. J. Bone Jt. Surg. 29:1087, 1947.

[16] 16. GRANATI, A. & ANGELERI, F. - La paralisi dell'ulnare in operai orafi. Folia med. (Napoli) 46:281, 1961.

[17] 17. GUILLAIN, G.; BOURGUIGNON, G. & CORRE, L. - Les paralisies du nerf cubital chez les cyclistes. Bull. Soe. Méd. Hôp. Paris, 56:489, 1940.

[18] 18. GURDJIAN, E. S.; LARSEN, R. D. & LINDNER, D. W. - Intraneural cyst of the peroneal and ulnar nerves. J. Neurosurg. 23:76, 1965.

[19] 19. HARRIS, W. - Occupational pressure neuritis of the deep palmar branch of the ulnar nerve. British, med. J. 1:98, 1929.

[20] 20. HARRISON, M. J. G. & NURICK, S. - Results of anterior transposition of the ulnar nerve for ulnar neuritis. British med. J. 1:27, 1970.

[21] 21. HIGHET, W. B. - Innervation and function of thenar muscles. Lancet 1:227, 1943.

[22] 22. HUET, M. E. - Sur un cas de névrites professionnelles du nerf médian et du nerf cubital chez un ouvrier menuisier, porteur d'une ancienne fracture du coude. Rev. neurol. (Paris) 8:433, 1900.

[23] 23. HUET, M. E. & GUILLAIN, G. - Névrite cubitale professionneles chez un boulan-ger. Rev. neurol. (Paris) 8:266, 1900.

[24] 24. HUNT, J. R. - Occupation neurits of the deep palmar branch of the ulnar nerve: a well defined clinical type of professional palsy of the hand. J. nerv. ment. Die. 35:673, 1908.

[25] 25. HUNT, J. L. - The thenar and hypothenar types of neural atrophy of the hand. Amer. J. med. Sci. 116:224, 1911.

[26] 26. INSAUST, T.; CHARCHAFLIE, R. & SOTO, E. - Atrofia tenar parcial. An. Neurocir. (Buenos Aires) 1:57, 1956.

[27] 27. KEMPE, L. G. - Operative Neurosurgery. Vol. 2, Springer-Verlag New York-Heidelberg-Berlin, 1970, pp. 196-199.

[28] 28. LAURENÇON, A. - De la griffe cubitale chez les tailleurs de cristaux. Thesis, Lyon, 1894.

[29] 29. LEARMOUTH, J. R. - A technique for transplanting ulnar nerve. Surg. Gynec, Obstet. 75:792, 1942.

[30] 30. LEREBOULLET, J. & LINDEUX, S. - La paralysie cubitale des cyclistes. Paris mod. 40/41:315, 1942.

[31] 31. LEUDET, E. - Etude clinique de la névrite cubitale provoquée par les contusions et compressions répétées result de l'exercice de quelques professions. Ass. Franc. Avanc. Sci. 12 me session. 766, 1884.

[32] 32. LEVY, J. A. - Sindromes das raizes, plexos e nervos periféricos. In Tolosa, A. P. M. & Canelas, H. M. - Propedęutica Neurológica. Procienx, Săo Paulo, 1969, pág. 313.

[33] 33. LUZIO, J. - Neuralgias do tronco e membros. In Canelas, H. M. & Pereira, W. C. - Dor: Fisiopatologia e Clinica. Sarvier, Săo Paulo, 1969.

[34] 34. MAGEE, R. K. - Neuritis of deep palmar branch of ulnar nerve. Arch. Neurol. Psychiat. (Chicago) 73:200, 1955.

[35] 35. MALLET, B. L. & ZILKHA, K. J. - Compression of the ulnar nerve at the wrist by a ganglion. Lancet 1:890, 1955.

[36] 36. McGOWAN, A. J. - The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J. Bone Joint Surg. 32B :293, 1950.

[37] 37. MENZ, E. - Isolierte Ulnarislähmung: ein Beitrag den professionnellen Erkran-kungen. Wien. Klin. Wdsch. 14:411, 1900.

[38] 38. MUMENTHALER, M. - Die Ulnarisparesen. Stuttgart. Georg Thieme, 1961.

[39] 39. NISTRI, M. - Osservazioni e considerazioni sulla insufficienza professionale del ramo volare profondo dell'ulnare. Riv. Infort. Mai. Prof. 38:1041, 1951.

[40] 40. NOEL, G. - Sur un cas de paralysie cubitale bilaierale consécutive ŕ une ostéochondromatose des coudes. Acta neurol. belg. 49:467, 1949.

[41] 41. PANAS, P. - Sur une cause peu connue de paralysie du nerf cubital. Arch. gén. Méd. Paris 11/142:5, 1879.

[42] 42. POPPEN, J. L. - An Atlas of Neurosurgical Techniques. W. B. Saunders Company, Philadelphia - London, 1960.

[43] 43. RICHARDS, R. L. - Traumatic ulnar neuritis: the results of anterior transplantation of the ulnar nerve. Edinburg med. J. 52:14, 1945.

[44] 44. ROUVIČRE, H. - Compendio de Anatomia y Diseccion. 3a ed. castelhana. Salvat Editores S.A., Barcelona - Rio de Janeiro, 1959.

[45] 45. RUSSELL, W. R. & WHITTY, C. W. M. - Traumatic neuritis of the deep palmar branch of the ulnar nerve. Lancet 1:828, 1947.

[46] 46. SCHUSTER, P. - Beiträge zur Pathologie der traumatischen Nervenläthmungen; Drücklahmung beider Nn. ulnares bei der Bedienung des Scherenfernrohrs. Neurol. CB1. (Leipzig) 36:752, 1917.

[47] 47. SPAANS, F. - Occupational nerve lesion In Vinken, P. J. & Bruyn, G. W. - Diseases of Nerves, Part I. Handbook of Clinical Neurology. North-Holland Publishing Company, Amsterdam, 1970, pp. 326-340.

[48] 48. STALL, A. - The entrapment neuropaties, In Vinken, P. J. & Bruyn, G. W. - Diseases of Nerves - Part I. Handbook of Clinical Neurology. North-Holland Publishing Company, Amsterdam, 1970, pp. 285-318.

[49] 49. STIEFLER, G. - Ueber die Radfahrerlähmung des Nervus Ulnaris. Münchner med. Wschr. 42:1727, 1927.

[50] 50. TESTUT, L. & LATARJET, A. - Tratado de Anatomia Humana. Versăo castelhana. Salvat Editores, Barcelona-Rio de Janeiro, 1951, pp. 300.362.

[51] 51. TOROK, G. & GIORA, A. - Ulnar nerve lesion in the palm: entrapment neuropathy of deep branch of ulnar nerve. Israel med. J. 23:121, 1964.

[52] 52. VAN MANSVELT, J. & POSTHUMUS MEYES, F. E. - Compressive neuritis van de ramus palmaris profund s van de nervus ulnaris. Ned. T. Geneesk, (Amsterdam) 106:1489, 1962.

[53] 53. VAN VEELEN, C. - Beroepsverlamming van de nervus ulnaris. T. soc. Geneesk. (Amsterdam) 45:499, 1967.

[54] 54. VERNOIS, M. - De la main des ouvriers et des artisans au point de vue de l´hygične et de la medicine légale. Ann. Hyg. publ. (Paris) 17:104, 1862.

[55] 55. VTKLICKY, L. - Paresis r. volaris manus n. ulnaris. Plzensky lék. Sborn. Praga 8:29, 1959.

[56] 56. WERTHEIN SALOMONSON, J. K. A. - De beroepsatrophie der diamantsjders. Ned. T. Geneesk. (Amsterdam) 33:866, 1897.