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Ulnar Neuropathy Treatment & Management
- Author: Charles F Guardia, III, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE more...
Approach Considerations
Nonsurgical therapy may be helpful in many cases of ulnar neuropathy. If conservative therapy fails, surgical treatment is warranted, typically involving one of the following procedures[137, 141, 142, 143, 144, 145, 146] :
Decompression in situ
Decompression with anterior transposition (subcutaneous, intramuscular, or submuscular)
Medial epicondylectomy
More specifically, indications for surgery for ulnar nerve entrapment include the following:
No improvement in presenting symptoms after 6-12 weeks of conservative treatment
Progressive palsy or paralysis
Clinical evidence of a long-standing lesion (eg, muscle wasting or clawing of the fourth and fifth digits)
If a fracture of the hook of the hamate is noted in the wrist, cast immobilization or splinting is required for 4-6 weeks. Surgery is indicated if symptoms progress during this time. On the other hand, as swelling subsides, pressure on the nerve may abate and symptoms may disappear. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also valuable for reducing swelling in the tunnel.
Depending upon etiology, symptoms, and signs, referral to a neurosurgeon, hand surgeon, pain specialist, internist, physiatrist, rheumatologist, occupational therapist, or alternative medicine specialist may be appropriate.
Follow-up after surgery for ulnar nerve entrapment should take place at 1 month, 3 months, 6 months, and 1 year.
With appropriate decompression performed in a timely manner, the result of surgery for ulnar nerve entrapment should be a return to normal function. If decompression in situ is performed appropriately, return to normal function is almost immediate. With transposition of the nerve following decompression, postoperative immobilization, and the rehabilitative process, 3-6 months may pass before the patient regains normal function.[147]
In chronic palsy (lasting >3-4 months) associated with pain, muscle weakness, or atrophy, surgical outcome is less certain. The duration of entrapment and the severity of numbness and muscle weakness are key factors influencing the prognosis. In these chronic cases, improvement may be limited or even absent after decompression and transposition, but further progression can be halted with proper decompression.
An important pitfall in treatment is to lead the patient to believe that full recovery can be expected in cases where recovery is actually uncertain. Of course, few doctors today promise perfection, and physicians often downplay the likelihood of complete recovery so as not to raise expectations unduly. Even so, many physicians, even neurologists and physiatrists, do not realize that an operation for ulnar entrapment has much less chance of a highly satisfactory result than an operation for carpal tunnel syndrome does. The reason for this is unclear.
Nonsurgical Therapy
Medical and other nonsurgical treatments can provide significant help in cases of ulnar neuropathy. Conservative measures are most likely to be successful when paresthesias are transient and caused by malposition of the elbow or blunt trauma. Vasculitic and metabolic causes can be evaluated and diagnosed to facilitate treatment of the underlying condition.
The physician can address pain or other sensory symptoms by trying various pain medications, including the following:
Tricyclic (and related) antidepressants
Narcotics (generally considered to be a last resort)
Oral vitamin B-6 supplements may be helpful for mild symptoms. This treatment should be carried out for 6-12 weeks, depending on patient response.
Occupational therapy and work hardening programs are also beneficial. Therapists may use and design splints to restrict the range of joint motion and cushions to ameliorate the effects of pressure.[148] They may also use nerve gliding, sliding, or tensioning exercises aimed at promoting smoother movement of the nerve within the cubital tunnel and reducing adhesions and other causes of physical nerve compression.[149]
With nonoperative treatment, strengthening the elbow's flexors and extensors both isometrically and isotonically within 0-45° of range of motion is helpful. To avoid ulnar nerve impingement in the cubital tunnel, the arc of elbow motion should be limited to an extended range.[150, 151] The patient should be advised to decrease repetitive activities that may exacerbate symptoms. The ulnar nerve should be protected from prolonged elbow flexion during sleep and protected during the day through avoidance of direct pressure or trauma.
For initial conservative treatment of cubital tunnel syndrome, use of an elbow pad or night splinting for a 3-month trial period is recommended.[152, 153] If symptoms do not improve with splinting, daytime immobilization for 3 weeks should be considered. Surgical release may be warranted if the symptoms do not improve with conservative treatment. If the symptoms do improve, conservative treatment should be continued for at least 6 weeks beyond symptom resolution to prevent recurrence.[154]
For mild cubital tunnel symptoms, a reversed elbow pad that covers the antecubital fossa, rather than the olecranon, helps remind the patient to maintain the elbow in an extended position and to avoid pressure on the nerve. At night, a pillow or folded towel may be placed in the antecubital fossa to keep the elbow in an extended position. Another option is to apply a commercial soft elbow splint, with a thermoplastic insert, for persistent symptoms.
For constant pain and paresthesia, one should consider using a rigid thermoplastic splint positioned in 45° of flexion to decrease pressure on the ulnar nerve. Initially, patients should wear this splint at all times; as symptoms subside, they can wear it only at night.
Patient education and insight are important. Resting on elbows at work, using elbows to lift the body from bed, and resting elbows on car windows while driving all are causes of paresthesia that can be corrected without surgical treatment. Patient education, anterior elbow extension splinting (if necessary), and correction of ergonomics at work should correct these transient palsies.
A randomized, controlled study of conservative methods to treat mild and moderate ulnar neuropathy at the elbow indicated that simply giving patients information about how to avoid injuring the ulnar nerve by avoiding or reducing movements or positions that compromise the nerve led to significant symptomatic improvement.[97, 155] It is noteworthy that in this study, adding splinting or nerve-gliding treatments to the program of providing information did not yield a significant further benefit.
Options for Surgical Intervention
If nonsurgical methods fail and the patient has severe or progressive weakness or atrophy, specific surgical techniques (eg, decompression in situ, decompression with anterior transposition, and medial epicondylectomy) are often beneficial in cases of ulnar neuropathy at the elbow.[156, 157] Entrapments in the canal of Guyon are also amenable to surgical treatment.[1] Surgery is also valuable for correction or stabilization of traumatic injuries, resection of masses or cysts, and sectioning of fibrous bands.
Preoperatively, appropriate blood work, chest radiography (if indicated), and a careful clinical examination are required (see Presentation and Workup). The usual surgical preparation of the affected extremity from fingers to neck is indicated. This is followed by the application of a tourniquet, if necessary.
Indications for ulnar nerve decompression in situ at the elbow are as follows:
Mild ulnar nerve compression
Documented mild slowing on electromyography (EMG) as the ulnar nerve passes into and through the proximal flexor carpi ulnaris
Absence of pain around the medial epicondyle
Nerve that does not sublux with elbow flexion
Normal osseous anatomy and epicondylar (ulnar) groove at the elbow and findings at surgery that are consistent with compression under the fibrous arcade [158]
Indications for ulnar nerve decompression with anterior transposition include the following:
Unsuitable bed for the nerve secondary to the presence of osteophytes
Accessory anconeus epitrochlearis
Heterotopic bone
Significant bursal tissue or other mass
Significant tension on the ulnar nerve as indicated by a positive elbow flexion test result or symptoms aggravated by activities requiring flexion
Subluxation of the ulnar nerve with elbow flexion
Deformity at the elbow secondary to a valgus elbow or a tardy ulnar palsy [159, 3]
Valgus instability at the elbow
Indications for medial epicondylectomy include the following[160, 161] :
Nonunion of an epicondyle fracture with ulnar nerve symptoms (best indication)
Poor bed for the ulnar nerve in the epicondylar groove
Ulnar nerve subluxation
Contraindications for the various operative procedures used to decompress the ulnar nerve are as follows:
Decompression in situ - This procedure should not be used in cases of severe posttraumatic neuropathy with scarring, chronic subluxation, or dislocation of the ulnar nerve from the epicondylar groove and soft-tissue masses in the epicondylar groove
Decompression with anterior subcutaneous transposition - This procedure does not release the ulnar nerve completely, leaving the distal course from the cubital tunnel as a possible site of compression; thus, it may not be the best choice for transposition in a thin person who lacks significant adipose tissue at the site of transposition, because of the possibility of repeated trauma to the nerve at the elbow [18]
Decompression with anterior intramuscular transposition - This is the most controversial of the procedures because of the claim of severe postoperative scarring
Decompression with anterior submuscular transposition - This procedure is contraindicated in the presence of scarring of the joint capsule or irregularity of the elbow joint due to malunited fracture, severe arthritis, or previous excisional arthroplasty
Medial epicondylectomy - This procedure is not used when double-crush syndrome with entrapment at the distal end of the cubital tunnel or soft-tissue masses in the epicondylar groove are suspected
A Cochrane review examined two meta-analyses of five randomized, controlled clinical trials of surgery for idiopathic ulnar neuropathy at the elbow,[97] four of which compared simple decompression with decompression plus transposition.[162, 163, 164, 165] These studies found no significant difference between simple decompression of the nerve and decompression with either submuscular or subcutaneous transposition.
The inability to detect a significant difference between simple decompression and decompression with transposition applied both to clinical outcomes and to neurophysiologic outcomes (ie, nerve conduction studies and EMG).[97] However, one difference between the two surgical approaches was that decompression with transposition produced more superficial and deep wound infections.
Two additional meta-analyses, using somewhat different methods, were also unable to find any significant differences between the outcomes of simple decompression and those of decompression plus transposition.[137, 166] However, one of these studies detected a trend in favor of decompression plus transposition, and the authors raised the possibility that a more highly powered study might be able to detect a difference.[137]
The aforementioned Cochrane review also examined one study that compared medial epicondylectomy with decompression plus anterior transposition and concluded that no significant differences could be found with respect to either clinical or neurophysiologic outcomes.[97] However, patient satisfaction was higher in patients treated with epicondylectomy.[92]
A more recent study of 480 patients reported in 2014 showed that for ulnar nerve compression at the cubital tunnel, both approaches were effective in improving clinical outcome.[167] However, the decompression (neurolysis) alone showed greater effectiveness in relieving pain at the elbow.
Decompression in Situ
Decompression in situ is essentially a localized decompression of the nerve, accomplished by incising the Osborne ligament and opening the tunnel beneath the two heads of the flexor carpi ulnaris by incising the fascia holding them together. It is easy to perform, and the complication rate is low. In contrast to other methods, ulnar nerve decompression in situ avoids damage to the vascular supply of the nerve. It is less traumatic to the patient than other decompression procedures, and it has been shown to be equally successful.[168, 142, 169]
The main advantage of decompression in situ is the ability to release the ulnar nerve in areas of compression with minimal disturbance of the blood supply. This procedure avoids subluxation of the ulnar nerve, which may lead to a recurrence of symptoms secondary to repeated contusion of the nerve as it snaps over the medial epicondyle.
The disadvantages of simple decompression are the potentially higher recurrence rate and the risk of continued subluxation of the ulnar nerve over the medial epicondyle, if that was present preoperatively.
An incision about 6-10 cm in length is made along the course of the ulnar nerve, midway between the medial epicondyle and the tip of the olecranon. This posterior incision is recommended to avoid damage to the medial brachial and medial antebrachial cutaneous nerves,[170] which must be identified and protected if encountered.
Tourniquet control is employed to facilitate visualization of the nerve. The ulnar nerve is identified proximally. The medial intermuscular septum is released; in some cases, it may be advisable to excise part of the thickened distal medial intermuscular septum to prevent kinking.
The cubital tunnel retinaculum is sharply divided in a proximal-to-distal direction. The ulnar nerve is exposed as it passes between the two heads of the flexor carpi ulnaris. The fascia over the flexor carpi ulnaris is incised, and the nerve is exposed as it passes through the muscle. The deep flexor-pronator aponeurosis is released. Neurolysis is not necessary.
The elbow is taken through its range of motion (ROM), and the ulnar nerve is examined for subluxation; if subluxation is noted, medial epicondylectomy or decompression with anterior transposition should be considered. The tourniquet is dropped, and hemostasis is obtained. Subcutaneous and skin layers are closed. A simple soft compressive dressing is applied. Postoperatively, no or only minimal immobilization is needed, and early active use of the extremity is encouraged.
Some, out of concern over possible resultant subluxation and new compression, believe that the nerve should not be decompressed proximally.[171] The risk of these adverse outcomes can be greatly reduced by limiting the decompression distal to a line drawn from the medial epicondyle to the tip of the olecranon. Proximal decompression is recommended when compression is secondary to a hypertrophied medial head of the triceps or to a snapping of the medial head of the triceps with elbow flexion.
Decompression With Anterior Transposition
Decompression with anterior transposition is usually the operation of choice for ulnar nerve compression at the elbow. Its main advantage is that it moves the ulnar nerve from an unsuitable bed to one that is less scarred. The nerve is effectively lengthened a few centimeters with transposition, and this decreases the tension placed on the nerve with elbow flexion.[37]
The primary disadvantage of an anterior transposition is that it is more technically demanding than a simple ulnar nerve decompression. The risk of complications is increased when the nerve is moved from its natural bed, and there is a potential for devascularization of the ulnar nerve.
There are three types of anterior transposition, as follows:
Each type has its advocates, and specific indications, advantages, and disadvantages differ from one type to the next.
Subcutaneous transposition
Subcutaneous transposition is the most commonly used method of transposition. It may be the procedure of choice in athletes who throw and do not have muscular atrophy. These athletes may lose forearm strength from a submuscular transposition and a simple decompression may not provide adequate relief of symptoms.
The main advantage of a subcutaneous transposition is that it is easy to perform. It is a good procedure when subluxation and traction on the nerve are contributing to the patient's symptoms.[172] The primary disadvantage is that the nerve may be hypersensitive after surgery because of its new superficial location. The potential exists for disruption of the ulnar nerve blood supply with the transposition.
A longitudinal incision approximately 15 cm in length is made over the course of the ulnar nerve. Once the nerve is visualized from about 8 cm proximal to the medial epicondyle to 6 cm distal to the epicondyle, the distal portion of the medial intermuscular septum, the fibroaponeurotic roof of the epicondylar groove, the Osborne ligament, and the flexor carpi ulnaris fascia are incised, freeing the nerve. About 3-4 cm of the medial intermuscular septum proximal to the medial epicondyle is excised to prevent postoperative kinking of the nerve.
Distally, the additional common aponeurosis between the flexor digitorum superficialis to the ring finger and the humeral head of the flexor carpi ulnaris is sought and, if present, excised to prevent kinking. Motor branches to the flexor carpi ulnaris and flexor digitorum profundus are identified, protected, and preserved. The first motor branch to the flexor carpi ulnaris from the ulnar nerve proper is dissected out if necessary to prevent kinking.
The nerve is transposed into the subcutaneous plane. A search is made for any remaining sites of constriction or tethering. Several different modifications are used to maintain the ulnar nerve in the transposed position. One is to hold the nerve to the muscle fascia with a few sutures through the epineurium. However, the more popular approach is to use some form of sling.[173, 174] .
A commonly used technique involves the creation of a fasciodermal sling. A 1- to 1.5-cm square flap of antebrachial fascia based on the apex of the medial epicondyle is raised and reflected medially. The nerve is transposed anterior to this flap, and the apex is then sutured to the dermal tissue approximately 1 cm anterior to the medial epicondyle.
Another technique is to use a subcutaneous-to-fascial sling. About 2 cm of the subcutaneous fascia of the anterior skin flap is sutured to the flexor-pronator fascia, just anterior to the epicondyle, to keep the nerve in the transposed position.
A third technique is to create a fascial sling by using the medial intermuscular septum. The intermuscular septum is divided 3-4 cm proximal to its insertion on the medial epicondyle, with the distal attachment kept intact. The nerve is transposed. The septum is then used as either a myofascial or a fasciodermal sling to prevent posterior subluxation of the nerve. Care must be taken to prevent kinking of the nerve at the sling. Finally, a simple soft compressive dressing is applied, and early active ROM is instituted.
Postoperatively, the elbow must be immobilized in 45° of flexion for 2 weeks. Active mobilization with muscle stretching and strengthening is then carried out for 2-3 months.
Intramuscular transposition
Intramuscular transposition is the least popular decompression method. It yields the lowest rate of excellent results and is associated with the most recurrences with severe ulnar nerve compression.
The main advantage of an intramuscular transposition is that it buries the nerve deeply while providing a tunnel through which the nerve can pass. It also allows the nerve to be entirely surrounded by vascularized muscle tissue. The primary disadvantage is that it is a complicated procedure, involving substantial soft-tissue dissection. The risk of perineural scarring is increased, and the procedure may expose the nerve to repeated muscular contractions.
A longitudinal incision 15-20 cm in length is made over the course of the ulnar nerve, and the nerve is decompressed in the same manner as for subcutaneous transposition. The proximal border of the pronator teres and the medial intermuscular septum are excised from the midhumerus to the elbow. The nerve is then temporarily transposed, and the position of the nerve on the flexor-pronator mass is noted.
The ulnar nerve is replaced in the epicondylar groove, and a 5 mm deep trough is made in line with the nerve in its transposed position on the flexor-pronator mass. The fibrous septum separating the flexor-pronator muscles is then excised to provide a soft vascularized muscle bed. The nerve is transposed. The flexor-pronator fascia is closed over the nerve with the forearm fully pronated and the elbow flexed 90°. Finally, a simple soft compressive dressing is applied.
Postoperative management involves 3 weeks of immobilization at 90° of elbow flexion with the forearm in full pronation. This is followed by gradual active ROM exercises, stretching, and muscle strengthening.
Submuscular transposition
A submuscular transposition offers the best results with the fewest recurrences with severe ulnar nerve compression.[175] It is the best salvage procedure when previous surgery has failed because it places the nerve in an unscarred bed. It also works well for patients who are very thin, in whom a subcutaneous transposition may result in an area of hypersensitivity over the transposed nerve. Many consider an anterior submuscular transposition the procedure of choice for symptomatic athletes who throw.
The disadvantage of a submuscular transposition is that it is a technically demanding procedure. Because of the extensive dissection involved, postoperative recovery is more difficult, and there is a 5-10% risk of elbow flexion contracture. Patients may also develop extensive scar formation from the procedure, and revision is difficult if the patient has a recurrence.
In a submuscular transposition, the origin of the flexor-pronator muscle group must be released. This can be accomplished in a number of ways, and the most important part of any of these releases is to be able to reattach the muscle origin securely. Once the nerve has been transposed to its new bed deep to the flexor-pronator muscle group and on the brachialis, the flexor carpi ulnaris fascia is closed, as is the roof of the epicondylar groove.
A longitudinal incision 15-20 cm in length is made over the course of the ulnar nerve, and the nerve is decompressed in the same manner as for subcutaneous transposition. The anterior skin flap is raised until the bicipital aponeurosis is visualized. The overlying fascia is incised, with care taken to identify and protect the median nerve. Because of the extensive venous system in this area, meticulous hemostasis is important.[176]
With the nerves protected, the margins of the flexor-pronator mass are delineated. A plane is developed with blunt dissection between the flexor-pronator mass and the flexor digitorum superficialis and the ulnar collateral ligament. A hemostat is passed in this plane, with care taken to protect the nerves. The flexor-pronator mass is incised in a Z-cut fashion 1-2 cm distal to the medial epicondyle, and then reflected distally. The ulnar collateral ligament must be protected.
The tourniquet is then released and hemostasis obtained. The ulnar nerve is transposed adjacent and parallel to the median nerve. The lengthened flexor-pronator mass is reattached with nonabsorbable sutures with the elbow flexed and the arm pronated.
Postoperatively, the elbow is immobilized in a post mold or cast in 45° of flexion, with slight pronation and the wrist in neutral position, for 3-4 weeks. Active ROM exercises, stretching, and strengthening are then carried out for 3-4 months.
Surgical outcomes
In a retrospective study by Charles et al, 49 patients who underwent ulnar nerve transposition were followed to assess clinical sensory and motor recovery in cubital tunnel syndrome and to determine whether recovery is influenced by such factors as preoperative McGowan stage, age, and symptom duration.[141] Submuscular transposition was used in 25 patients, and subcutaneous transposition was applied in 24 patients.
Obvious improvement was reported in 20 of the 25 patients in the submuscular group and in 17 of the 24 patients in the subcutaneous group.[141] Both groups showed significant improvement in sensory and motor function, with 17 patients in each group recovering sensory function and 19 in each group recovering motor function. Patients with symptoms lasting longer than 6 months had a poor prognosis, regardless of the surgical technique used.
Jaddue et al compared operative technique (incision length and operating time), postoperative care (postoperative pain and complications), and outcome between subcutaneous and submuscular surgical techniques for anterior transposition of the ulnar nerve after decompression in moderate cubital tunnel syndrome.[177] Subcutaneous transposition was found to be associated with a shorter incision, reduced operating time, less postoperative pain, fewer postoperative complications, and better outcome.
Medial Epicondylectomy
Medial epicondylectomy is another technique for releasing pressure on the ulnar nerve at the elbow. Removal of the epicondyle removes a compressive area. Excision of the proper amount of bone is critical to the success of the procedure. If too much bone is excised, damage to the medial collateral ligament of the elbow with valgus instability may occur; if too little is removed, the procedure fails because the compressive area remains.
The main advantage of medial epicondylectomy is that it provides a more thorough decompression of the ulnar nerve than a simple release does. This results in a minitransposition of the ulnar nerve. Compared with decompression plus anterior transposition, medial epicondylectomy better preserves the blood supply to the nerve, causes less injury to the nerve, and preserves the small proximal nerve branches that might be sacrificed with an anterior transposition.[178]
The primary disadvantage is that it allows greater migration of the ulnar nerve with elbow flexion. There is a potential for elbow instability if the collateral ligaments are damaged. Bone pain and nerve vulnerability at the epicondylectomy site may occur. Compared with simple decompression, medial epicondylectomy is more likely to result in elbow stiffness or an elbow flexion contracture. In addition, it is often a poor choice for athletes who throw because of the significant stresses placed on the medial aspect of the elbow joint.
A longitudinal incision 10-15 cm in length is made over the course of the ulnar nerve, centered 1 cm anterior to the tip of the medial epicondyle.[179] The posterior branches of the medial brachial and antebrachial cutaneous nerves are identified and protected, and the nerve is decompressed as previously described.
A longitudinal incision is made over the medial epicondyle, which is then exposed by means of subperiosteal dissection. The flexor-pronator origin is detached from the epicondyle and reflected distally. With care taken to protect the nerve, the medial epicondyle, or a portion of it, is removed with an osteotome. It is important not to enter the elbow joint or cut the ulnar collateral ligament. Sharp edges of bone are smoothed with a rongeur or rasp.
The periosteum is then closed to prevent tethering of the nerve to the raw bone surface. The flexor-pronator origin is reattached with the elbow in extension to help prevent the development of a flexion contracture. The ulnar nerve is allowed to slide anteriorly.[180] Finally, a simple soft compressive dressing is applied.
No postoperative immobilization is necessary, and active ROM exercises are started as soon as the patient is able to tolerate them. Within 1-2 months, normal activities should be resumed.
Surgical outcomes
Seradge found flexion contractures after medial epicondylectomy in 5% of patients who started rehabilitation at an average of postoperative day 3 and in 52% of patients who started rehabilitation at an average of postoperative day 14.[89, 90] Patients in the early mobilization group returned to work twice as early as those in the late mobilization group did, and they experienced no adverse effects on their grip strength or other hand functions.
Weirich studied 36 patients who underwent subcutaneous transposition and found no differences in pain relief, weakness, patient satisfaction, grip strength, lateral pinch, or two-point discrimination between patients who were started on immediate active ROM exercises and those who started rehabilitation an average of 14 days postoperatively.[181] Patients in the immediate-mobilization group returned to work and performed activities of daily living earlier (median, 1 month) than those in the delayed-mobilization group (median, 2.75 months).
Endoscopic Cubital Tunnel Release
Endoscopy of nonjoint cavities is widely performed, and endoscopic carpal tunnel release is a popular, though still debated, method of releasing the median nerve at the wrist.[38] With this experience in mind, some authors have attempted endoscopic cubital tunnel release. This technique allows local decompression while offering the ability to decompress the nerve at all potential sites of compression. The possible advantages of this technique include limited invasiveness, reduced complication rates, and quicker rehabilitation.[182, 183]
Tsu-Min Tsai et al, after performing an endoscopic cubital tunnel release on 85 elbows in 76 patients and monitoring them for an average of 32 months, found that 42% had excellent results, 45% had good results, 11% had fair results, and 2% had poor results.[184] These results are comparable to those achieved with the other decompressive techniques, for which the overall rate of good-to-excellent results is 85-90%.
Complications of Surgical Intervention
The most serious complications of surgical decompression of the ulnar nerve are the following[185] :
Failure to decompress the nerve adequately, causing a new area of entrapment with the decompression
Injury to the nerve during decompression or transposition
Neuromata of the medial antebrachial cutaneous nerve
Failure to recognize a double-crush syndrome
Infection, failure to heal, thrombophlebitis, atelectasis, and failure of the operation due to an unknown cause
The creation of a new compressive site at the time of surgery can occur with any of the decompressive methods.[186, 187] Injury to the posterior branches of the medial antebrachial cutaneous nerves at dissection is common. This nerve laceration results in loss of sensibility in an area of skin posterior and distal to the incision. Some patients develop a resultant dysesthesia in the nerve distribution; others develop an amputation neuroma.
Recurrent ulnar nerve subluxation and elbow instability can result from damage to the elbow collateral ligaments.[188] A postoperative flexion contracture can occur, most commonly following a submuscular transposition; it is seen after 5-10% of submuscular transpositions. Medial epicondylitis can occur from detachment of the flexor-pronator mass or as a result of a medial epicondylectomy. In addition, the symptoms may recur after an incomplete anterior transposition. Infection can occur with any surgical procedure.
After decompression with anterior transposition, complications can include recurrent subluxation of the ulnar nerve. Incomplete release of fascial slings may result in new areas of compression. In one series of subcutaneous transpositions, 90% of the failures were secondary to incomplete release of the medial intermuscular septum. An ineffective sling may not maintain the position of the transposed nerve and prevent resubluxation.
In addition, scarring may occur in the new muscular channel for the nerve. Perineural fibrosis may result from an intraneural injury or from a nerve transfer to a hypovascular bed. Injury to the flexor carpi ulnaris motor branches during nerve mobilization may result in weakness. Ligation of the posterior ulnar recurrent artery during nerve mobilization may result in nerve devascularization. A postoperative elbow flexion contracture may occur.
After medial epicondylectomy, medial instability may occur. To prevent this complication, the flexor-pronator origin is carefully detached to preserve the fibers of the medial collateral ligament. According to O'Driscoll et al, excision of more than 20% (1-4 mm) of the width of the medial epicondyle in the coronal plane violates the important anterior band of the ligament.[12]
Removal of the optimal amount of medial epicondyle, without creating instability, also improves results. Heithoff and Millender found in their series that a complete osteotomy resulted in 81% good and excellent results.[87] A partial osteotomy yielded a 67% rate of good or excellent results, and a minimal osteotomy yielded a 50% rate of good or excellent results.
Tenderness at the operative site can occur after medial epicondylectomy, sometimes resulting in prolonged and persistent discomfort during bone healing. In addition, loss of the protection afforded by the medial epicondyle may render the ulnar nerve more susceptible to trauma. To prevent the nerve from adhering to the osteotomy site postoperatively, it is important to preserve and close the periosteum at the end of the procedure.
Detachment of the flexor-pronator origin can result in weakness. Patients may develop an elbow flexion contracture that is often attributed to reattachment of the flexor-pronator muscle origin while the elbow is flexed or to delayed or inadequate postoperative mobilization.
Finally, postoperative ulnar neuropathies frequently give rise to lawsuits. Although such neuropathies appear to be most common after cardiac procedures, a Mayo Clinic study cited a rate of 0.5% even after noncardiac procedures.[189] Often, the neuropathy does not appear immediately after the operation, which suggests that the nerve trauma may occur in the postoperative period. Careful attention to protecting the ulnar nerve both during and after the procedure may reduce both the injury rate and the number of ensuing legal claims.
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Eaton RG, Crowe JF, Parkes JC 3rd. Anterior transposition of the ulnar nerve using a non-compressing fasciodermal sling. J Bone Joint Surg Am. 1980 Jul. 62(5):820-5. [Medline].
Pribyl CR, Robinson B. Use of the medial intermuscular septum as a fascial sling during anterior transposition of the ulnar nerve. J Hand Surg Am. 1998 May. 23(3):500-4. [Medline].
Janes PC, Mann RJ, Farnworth TK. Submuscular transposition of the ulnar nerve. Clin Orthop Relat Res. 1989 Jan. 225-32. [Medline].
Dellon AL. Operative technique for submuscular transposition of the ulnar nerve. Contemp Orthop. 1988. 16:17-24.
Jaddue DA, Saloo SA, Sayed-Noor AS. Subcutaneous vs Submuscular Ulnar Nerve Transposition in Moderate Cubital Tunnel Syndrome. Open Orthop J. 2009 Aug 27. 3:78-82. [Medline]. [Full Text].
Baek GH, Kwon BC, Chung MS. Comparative study between minimal medial epicondylectomy and anterior subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Shoulder Elbow Surg. 2006 Sep-Oct. 15(5):609-13. [Medline].
Craven PR Jr, Green DP. Cubital tunnel syndrome. Treatment by medial epicondylectomy. J Bone Joint Surg Am. 1980 Sep. 62(6):986-9. [Medline].
Froimson AI, Anouchi YS, Seitz WH Jr, Winsberg DD. Ulnar nerve decompression with medial epicondylectomy for neuropathy at the elbow. Clin Orthop Relat Res. 1991 Apr. 200-6. [Medline].
Weirich SD, Gelberman RH, Best SA, Abrahamsson SO, Furcolo DC, Lins RE. Rehabilitation after subcutaneous transposition of the ulnar nerve: immediate versus delayed mobilization. J Shoulder Elbow Surg. 1998 May-Jun. 7(3):244-9. [Medline].
Yoshida A, Okutsu I, Hamanaka I. Endoscopic anatomical nerve observation and minimally invasive management of cubital tunnel syndrome. J Hand Surg Eur Vol. 2009 Feb. 34(1):115-20. [Medline].
Mariani PP, Golanò P, Adriani E, Llusà M, Camilleri G. A cadaveric study of endoscopic decompression of the cubital tunnel. Arthroscopy. 1999 Mar. 15(2):218-22. [Medline].
Tsai TM, Chen IC, Majd ME, Lim BH. Cubital tunnel release with endoscopic assistance: results of a new technique. J Hand Surg Am. 1999 Jan. 24(1):21-9. [Medline].
Ruchelsman DE, Lee SK, Posner MA. Failed surgery for ulnar nerve compression at the elbow. Hand Clin. 2007 Aug. 23(3):359-71, vi-vii. [Medline].
Bednar MS, Blair SJ, Light TR. Complications of the treatment of cubital tunnel syndrome. Hand Clin. 1994 Feb. 10(1):83-92. [Medline].
Jackson LC, Hotchkiss RN. Cubital tunnel surgery. Complications and treatment of failures. Hand Clin. 1996 May. 12(2):449-56. [Medline].
Broudy AS, Leffert RD, Smith RJ. Technical problems with ulnar nerve transposition at the elbow: findings and results of reoperation. J Hand Surg Am. 1978 Jan. 3(1):85-9. [Medline].
Warner MA, Warner DO, Matsumoto JY, Harper CM, Schroeder DR, Maxson PM. Ulnar neuropathy in surgical patients. Anesthesiology. 1999 Jan. 90(1):54-9. [Medline].
|Most Characteristic Finding
|Additional Verification
|Potential Clinical Confusion
|Crossover fibers innervate hypothenar muscles
|Ulnar stimulation at wrist* produces larger hypothenar CMAP than stimulation at elbow
|Stimulation of median nerve at elbow† produces response at hypothenar muscles
|Hypothenar CMAP from ulnar stimulation at wrist is equal to hypothenar CMAP from ulnar stimulation at elbow plus hypothenar CMAP from median stimulation at elbow
|Smaller response from proximal stimulation could be mistaken for conduction block
|Crossover fibers innervate FDI muscle
|Ulnar stimulation at wrist produces larger FDI CMAP than stimulation at elbow
|Stimulation of median nerve at elbow produces response at FDI
|FDI CMAP from ulnar stimulation at wrist is equal to FDI CMAP from ulnar stimulation at elbow plus FDI CMAP from median stimulation at elbow
|Usually none, because FDI muscle is not usually recording site; if it is used, conduction block could be suspected, as in type I
|Crossover fibers innervate thenar muscles (typically ADP and FPB)
|Elbow stimulation of median nerve produces greater thenar response than wrist stimulation
|Ulnar stimulation produces thenar CMAP with initial positive deflection; it is higher with wrist stimulation than with elbow stimulation
|For thenar CMAP amplitudes, median elbow stimulation amp is equal to median wrist stimulation amplitude plus ulnar wrist stimulation amplitude minus ulnar elbow stimulation amplitude
|Can complicate median nerve studies, especially when carpal tunnel syndrome is involved
|ADP—adductor pollicis; CMAP—compound motor (or muscle) action potential; FDI—first dorsal interosseous; FPB—flexor pollicis brevis.
*Ulnar stimulation at wrist yields larger CMAP at hypothenar muscles, FDI, or thenar muscles (or sometimes combination of these) than does stimulation at elbow.
†Median stimulation at the elbow yields larger CMAP at hypothenar muscles, FDI, or thenar muscles (or sometimes combination of these) than does stimulation at wrist.
Note: "Larger" and "smaller" generally mean amplitude difference ≥1.0 mV.


text:
Running the vechicle with a fresh charge on the battery. After a day or so the problem starts. While driving the abs light come on than the tach, speed dometer drops to zero. Then its starts bucking than cuts out.I than have to jump start to restart. It only lasts for so many miles.I put my actron on it and read a P500 code.I, m wondering if the speed sensor could cause this much problem.
Friday, August 31st, 2007 AT 5:35 AM

subset: commoncrawl


text: ROAR is Available NOW and on SALE ($1 off) through July 2! Currently available on Apple, Amazon, Barnes & Noble Nook, Google Play, and we hope coming soon to Kobo! ROAR is a bittersweet, gut-wrenching Romance with a Happily Ever After like no other! This standalone includes glimpses of familiar Rescue Me Saga characters and there's even a visit to the Masters at Arms Club!


text:
Photos: Fatal crash on Kansas Turnpike
According to the Kansas Turnpike Authority, the crash happened around 1:57 a.m. Tuesday south of Emporia.
According to the Kansas Turnpike Authority, the crash happened around 1:57 a.m. Tuesday south of Emporia.
A 39-year-old Kansas man has been charged with two counts of raping a child under 14 years old while they were in day care.
KSN met with two Wichita teens credited with helping bring attention to a disturbing viral video that shows a kitten being abused.
According to the USGS, five earthquakes occured in northern Oklahoma just 130 miles south of Wichita.
On Monday a man kicked in the door to his residence after a no contact order was issued to protect his wife.
Three people were arrested and 11 more were cited in connection with an underage drinking party northeast of Arkansas City.
A Wellington man was sentenced Monday to 100 months in federal prison for distributing child pornography.
Rhonda J. Simmons pleaded guilty to one count of presenting a false tax claim and one count of unlawful possession of a firearm.
A Lawrence resident has announced plans to step down as chief judge of the 10th Circuit Court of Appeals.
Jon Bieker died after the January shooting at his Shawnee, Kansas, store called She's a Pistol.
Loren Wade celebrated his 103rd birthday on Saturday. He has worked at the Winfield Wal-Mart for 32 years.
A judge has ruled that Galena's mayor and six other city officials accused of misusing public funds will be tried together.
The body of a missing 16-year-old Sumner County boy has been found about a half-mile from the Drury Dam on the Chikaskia River.
A man who gunned down a Topeka police officer last year will spend the rest of his life in prison.
Hutchinson residents who went to the city's law enforcement center during a July tornado were not allowed to go to the basement.


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Save Big On Open-Box & Pre-owned: Buy "The Magnificent Seven (Special Edition)" from Amazon Warehouse Deals and save 60% off the $14.98 list price. Product is eligible for Amazon's 30-day returns policy and Prime or FREE Shipping. See all Open-Box & Pre-owned offers from Amazon Warehouse Deals.
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Many of the Seven's actors had seen the Kurosawa film, and they were very excited about transferring it to the American West. Eli Wallach, as Calvera, in just a few short scenes, found both the humor and the cruelty in the bandit chieftan. His accent and speech pattern were fairly authentic; more so certainly than the young German actor, Horst Buchholz, endeavoring to find a southwestern/Texan/Mexican drawl. Director, John Sturges, had great hopes for Horst; the camera loved him. But it was the trio of studs, Steve McQueen as Vin, Charles Bronson as O'Reilly, and James Coburn as Britt, that dominated the frame.
Steve McQueen, wearing skin-tight leather stovepipe chaps, spent a lot of time finding ways to upstage Yul Brynner. There was a rumor that he would have preferred playing Chico, the Buchholz character. McQueen's manic physical performance, lightning fast with a pistol and a quip, seemed to work well for him, and it gave him more than his share of focus.Read more ›
This movie is a classic and set a very high standard for all Westerns to come. With that said, this review is going to deal with the actual Blu Ray transfer , both video and audio , and not the plot or performances contained in it.
This being another 'quickie' catalog release from MGM, a studio in bankruptcy, I was not expecting too much here and afraid the technicians would just slather the image with tons of DNR, Edge Enhancement and call it a day. Luckily for me and all fans of this film I was wrong! Phew!
Here is the good news: This film has not been DNR'd to death at all. I can't see any actually, and as for edge enhancement, I just don't see that either. GREAT! A pretty natural looking image, nothing spectacular, but solid color and an almost fully stable image. There are a few very short instances of 'image/telecine wobble' but nothing too severe and only a few times. Chances are most folks won't even notice it.
Generally the image is pleasing,. Although there are SOME soft shots, a few horrible looking grainy shots, a bit of mosquito noise on certain blue sky shots and a grainy blurriness every single time the picture dissolves/fades into another scene, rather than a clean cut. I watched this carefully and noticed that most of the video problems occur in the first 50 minutes of the film, with the remaining hour and 18 minutes being just about issue free and VERY nice to look at for a 1960 film. Seriously, unless you are picking it apart, you will just notice a few soft grainy shots and everything else should look pretty good to you, bordering on very good.Read more ›
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I have not seen "The Seven Samurai", so I cannot compare that movie with this. But on its own, I find it quite the satisfactory Western. Read morePublished 4 days ago by Long Tom
This movie is just fine, but the original, Seven Samurai, directed by Akira Kurosawa is superior in every way: story, writing, acting, camerawork, music, and of course direction. Read morePublished 6 days ago by Wizkid
Classic western with great actors. One of the best made western movies, good guys beat the bad guys.Published 7 days ago by Amazon Customer
One of the better old westerns. The entire cast did a terrific job.Published 8 days ago by Esther F. Moss
Forever a classic......anxious to see if Denzel and the new crew can measure up, in their up coming version.Published 27 days ago by Ann P. Graves
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"In the beginning is the relationship." -Martin Buber
My name is Richard Baughan and I am a Senior Accredited Registered Member of the Bristish Association for Counselling and Psychotherapy and have over 25 years experience of offering counselling / psychotherapy to individuals, couples and groups in private practice and universities
I have also been studying and practicing mindfulness meditation for 25 years and more recently have been offering 'insight mindfulness' sessions to individuals and small groups.
I offer a safe, non-judgmental and confidential space where you can look into issues, develop understanding and make changes affecting you life and relationships. It is also a safe space to learn and practice mindfulness and develop calmness, equanimity and self compassion.
Counselling/psychotherapy and mindfulness are different ways of learning to be easier on yourself and can lead to better relationships with self and others.
I now live and work in Blakeney, North Norfolk and offer the following services in Norfolk and elsewhere:
Counselling / Psychotherapy
Hopefully these pages may give you enough information to help decide whether you think counselling / psychotherapy is for you and enough info about me to enable you to determine if we might be able to form a productive therapeutic relationship.
I am committed to respecting the rights and authority of all clients.
For more information, a no obligation chat or to make an appointment please do not hesitate to
Telephone: 07980 619246
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The bud
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for everything flowers, from within, of self-blessing;
though sometimes it is necessary
to reteach a thing its loveliness,
to put a hand on the brow
of the flower
and retell it in words and in touch
it is lovely
until it flowers again from within, of self-blessing
[From St Francis and the Sow – Galway Kinnell]
© Copyright Richard Law and licensed for reuse under this Creative Commons Licence


text:
Fiat has served up a few more tidbits on the upcoming 500L five-door expected to debut at the Geneva Motor Show in March. According to Automotive News, the vehicle will feature a taller roof than the thee-door Fiat 500, and while the two sill share a front fascia, the larger vehicle will ride on a widened version of the same chassis that underpins the Fiat Punto. All told, the Fiat 500L will be around 163.38 inches long, which is around 2.36 inches longer than the current 500.
2012 Fiat 500: First Drive
2012 Dodge Journey, Fiat 500 recalled over contaminated brake fluid
- Steven J. Ewing
- Nov 28, 2011
Chrysler has issued a recall affecting a small number of 2012 Dodge Journey and 2012 Fiat 500 models built between October 24 and 26 of this year. These models – about 340 in total – are being recalled due to contaminated brake fluid that was put in during the vehicles' assembly. According to a report from the National Highway Traffic Safety Administration, these vehicles "may experience a degradation of the sealing components within the brake system."
- Volvo shoots for self-drivers by 2021
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text:
College football's 2011 season is a month old, and plenty of questions have already been answered.
There have also been a whole host of new questions posed, such as who will emerge as the top players by season's end.
We're only a quarter of the way through the season, but we've already seen some amazing performances from young and veteran players alike. As the nation moves into the start of conference play, who are the top performers thus far? Who is likely to lead his team towards a conference title and BCS berth?
Here are our picks for the top 50 players thus far in the 2011 college football season.


text:
Guys, I need your help: i just did a fresh install of Ubuntu 9.10, with no changes (i dl the live cd yesterday, and installed it, didnt upgrade it yet). I also installed ffplay (sudo apt-get install ffplay) and melt, and testet both of them with a .dv file that works: no luck, they both crash immediately.
Could you pls help me and get them to work? The thing is, that neither kdenlive (not the one installed from Karmics Softare Center, 0.75, and also not the 0.76 isntalled from the net) works (the preview monitor doesnt show the video when i press play, but if i move the cursor back and forth, i see the video)...
Sun, 11/08/2009 - 13:42
try installing:
and test again
make sure that kdenlive audio prefs are set to pulseaudio
Sun, 11/08/2009 - 17:21
Contrary to rico's advice, I would suggest removing pulseaudio using synaptic if it is installed as discussed elsewhere on this forum. Agreed you probably want to make sure libsdl1.2debian-all is installed.
Test the file in ffplay and melt.
I set kdenlive preferences to default (which presumably uses alsa).
Hope this helps. As discussed in several posts, I've had numerous weird problems with ffplay/melt/kdenlive when using pulseaudio. However, some have been okay with pulse.
Sun, 11/08/2009 - 21:07
deb http://ppa.launchpad.net/sunab/ppa/ubuntu karmic main
to your /etc/apt/sources.list
remove melt/mlt/kdenlive/pulseaudio
update and upgrade your system
then install kdenlive/mlt/melt/frei0r
This worked for me on fresh 9.10 Ubuntu 64bit., didn't work without the system upgrade.
Mon, 11/09/2009 - 14:56
don't set audio to automatic, set it to pulseaudio or alsa (depending which one you are using)
Wed, 11/11/2009 - 14:28
I have tried all good ideas about the sound, but they are not working. Video works fine.
I have set it to Automatic, OSS, ALSA and PulseAudio. OSS crashes, and the other three sounds like a trans-atlactic phonecall in the forties = 90 % noise.
I have a 3 minute sound-clip from a park. it is a wav-file. In Audacity it sounds perfect, but in Kdenlive it is 90 % noise. Without changing the settings in between.
Any suggestions?
The sound on my Ubuntu 9.10 seems to work fine - except in Kdenlive.
I have installed OpenShot, which is another editor like Kdenlive. It is based on GTK, MLT and programmed in Python. OpenShot has same audio-problem. It sucks.
I have tried to remove audiopulse. No effect, so I installed it again.
So: I still have a fresh Ubuntu 9.10 install. Audio works perfect, except in Kdenlive and OpenShot - the two pieces of software that use MLT.
Is there a problem in MLT, or in the combination Karmic Koala and MLT?
Any suggestions? Help, please...
Wed, 11/11/2009 - 19:13
It seems like nobody has any suggestions, so I have made my own solution.
I have made a Ubuntu dual-boot installation on my PC.
1) I have a 180 Gbyte installation with Ubuntu 9.10. Here everything works, except Kdenlive
2) I have a 100 Gbyte installation with Ubuntu 9.04. Here everything works, including Kdenlive.
They are installed on the same harddisc, with the same soundcard, and standard settings. I have not made any special settings.
I would be very nice, if someone could explain why it is so...
Thu, 11/12/2009 - 07:21
David, I am the MLT developer. I have not reproduced your problem with Ubuntu 9.10 on 2 installations (one in a VM). What I do get is a little crackling on one system using PulseAudio and libsdl1.2debian-pulseaudio, but you describe problem as much worse. Here are some tests for you on 9.10.
Do you get the same problem if you play a clip with ffplay?
If not, in Kdenlive, render a small clip or portion of a clip and play the result with ffplay, vlc, totem or whatever that you know is good. Does it have this heavy distortion?
Thu, 11/12/2009 - 14:39
Hi All,
I have very similar experiences to many of the posts here. Most notably:
Fresh install: Ubuntu 9.10 and kdenlive (using sunab ppa) = problems with kdenlive
Fresh install: Ubuntu 9.04 and kdenlive (using sunab ppa) = kdenlive works fine
(By the way I am using Sun VirtualBox to run virtual machines and try these things out. Usually it works very well.)
My problems with 9.10 and kdenlive are, I think, related to MLT (but I am a novice in this area so I am willing to be proved wrong!).
Basic problem:
Since (fresh) installing Ubuntu 9.10 and kdenlive 0.7.6 using the ppa, the project & clips monitor view works when searching single frames but when asked to play the video file, they show the video squashed up into the top 1/10th of the frame with either a green block underneath or a mass of coloured lines. The project monitor then appears to hang at some point.
Tests done:
ffplay plays the original video file fine, as does Movie Player.
melt does not play the original video file OK but shows the same as the project monitor in kdenlive and then crashes with a segmentation fault at some point.
A short clip rendered from the original video file plays fine with Movie Player but not with ffplay which now shows something similar to the project monitor in kdenlive and then crashes with a segmentation fault error. When played with melt then the result is the same except that it seems to just hang instead of crash.
The sound when played in Movie Player is fine but when using melt the soundtrack sounds "cut up".
Does all this give any clues as to what's going on?
Apart from this, I like Kdenlive very much!
Thu, 11/12/2009 - 15:01
I was having audio problems/program locking up on a clean Ubuntu 9.10 install. I performed step A below and that corrected my probelms.
Thu, 11/12/2009 - 17:52
After a lot of removals and installations, it finally works - almost perfect.
DDennedy: I tried your suggestions. ffplay played a .wav file perfectly. Same file in Kdenlive sounded awful. I then tried to render a portion of a clip, and with the same problem.
After that I removed ffmpeg, Kdenlive and pulseaudio. I tried to install Kdenlive again, and suddenly (after a reboot) it worked. It must be the absence of pulseaudio, that made it work, but I have tried that once before, without any luck.
I'm back on the track, and I've been at the library to borrow some C++ books. I hope that I, sometime in the future, can be helpfull in the development of great software like Kdenlive, and the like...
Thu, 11/19/2009 - 18:15
TandJ, the version of SDL in Ubuntu 9.10 is incompatible with some X server drivers or X itself and a particular feature of SDL that MLT uses. I confirmed this is fixed in the latest version of SDL I built from source tarball, but I do not know when it will appear in Debian or Ubuntu. Looks like we need to start a campaign to request that upgrade if it has not already started. I will look around or file a ticket somewhere.
Sun, 11/22/2009 - 20:39
I think I'm having the same problem.
ffplay, melt, kdenlive and openshot all show a few frames (variable 3 > 20 frames ) seconds of what appears to be squashed video in the top 5% of the window with vertical lines and blocks of unrelated colour in the rest of the screen. Then it (all of them) exits with segmentation fault. I've tried with different audio configurations but to no avail. I've tried compiling SDL 1.2.14 but am complete novice at such things and got no result (I followed instructions at http://www.libsdl.org/cgi/docwiki.cgi/FAQ_Compiling_on_Linux but get nothing for sdl-config).
Looking forward to 1.2.14 being in karmic.
Sun, 11/22/2009 - 23:39
I have the same problem. If clicking play the audio is awful and the video is having a hard time, and 50% of the times Kdenlive simply crash. I have tried for a week now making changes to pulseaudio/ALSA and so on, but it doesn't work. I use ubuntu 9.10 (GNOME) and Kdenlive 0.7.6
Mon, 11/23/2009 - 16:22
Hello, thank you for the description of the problem and your trials. On my system I had almost exactly the same difficulties with the sound as you described it. I'm not good at Linux, and as a learner I appreciate people who can help out. I like kdenlive, it is a really fine tool. In the end, after exactly doing what you described in your last posting it worked again with 9.10 - after some frustrating trials of my own. Of course I also want to thank all the developers of the software and those who gave you the hint how to do it.
Mon, 11/23/2009 - 22:28
Kim Wikström
Thu, 11/26/2009 - 22:46
Fresh 9.10: I've been trying to get this to work and, following your advise (removing pulseaudio and kdenlive), I got rid of the crashing and sound problems. This is the first time I do any kind of Linux -debugging in my entire life, so it felt pretty rewarding. Thank you. Annoying though: removing pulseaudio removes the volume -switch on the desktop interface and I don't know how to get it back. Thankfully there's sound in kdenlive and vlc, but if anyone can help with this please tell!
Sat, 11/28/2009 - 03:19
As a followup to the problem with the squeezed and green video, I confirmed that this is a bug in the 1.2.13 version of SDL provided in Ubuntu 9.10 and some X server drivers. I also confirmed that the newer 1.2.14 version of SDL fixes this problem on the X server where I was able to reproduce this problem and there is no workaround or fix I can make in MLT to make it work with 1.2.13.
Sat, 11/28/2009 - 09:35
Could you guys open a bug on Ubuntu and various distros trancking systems.
Wed, 12/02/2009 - 12:53
Thanks ddennedy for researching my problem and finding the cause - much appreciated.
jmpoure: I have followed your example and posted a bug report on Ubuntu's system: https://bugs.launchpad.net/ubuntu/+source/libsdl1.2/+bug/491335
Watch this space...
Sun, 12/13/2009 - 20:25
My first posting here on the forum, so let me begin by saying a huge Thank You to all the developers of kdenlive! It is truly a wonderful thing.
I also got problems after upgrading to Ubuntu 9.10.
Kdenlive crashes immediately when i try to playback anything. (with some green screen and/or squeezed picture for a little while)
I upgraded my libsdl to 1.2.14:
- removed kdenlive, melt, ffmpeg libsdl ...
- installed libsdl1.2debian-all_1.2.14-1_i386.deb
When i reinstall kdenlive using apt-get, it replaces sdl 1.2.14 with 1.2.13, so I am back where i started from. I am obviously doing it wrong. How should I do it?
thank you for your help
Thu, 01/07/2010 - 16:14
A helpful posting by bojo42 on the bug I reported (follow link above) led me to add the PPA http://ppa.launchpad.net/dnjl/games/ubuntu to my software sources as this has the SDL version 1.2.14 package.
I then installed this SDL version using Synaptic and then re-installed Kdenlive (which did not replace the new SDL version).
When I then used Kdenlive I experienced some of the problems already posted concerning crackling sound and jerky video. So I then installed libsdl1.2debian-pulseaudio using Synaptic as advised by some of the posts (e.g. mseewald http://kdenlive.org/forum/remember-remove-pulseaudio-if-using-kubuntu-ka...) and everything now seems to work fine.
Thanks very much everyone for your help.


text:
The Roleplaying Game that Kicks Logic in the Face is coming back.
Is your body ready for the Awesome?
The Roleplaying Game that Kicks Logic in the Face is coming back.
Is your body ready for the Awesome?
One of the longest running myths in RPGs is that a GM is somehow "better" than Players. Sure it's not always expressed as such, but the sentiment remains. There's always talk of the GM being the one to make the big sacrifices, that GMing is busy, thankless work. GMs should be afforded respect and admiration for taking on the burden of planning and running games to his fortunate players, who just show up on game day with their dice (and sometimes not even that!)
I'm starting to see that this is a bad point of view to have (and to encourage.) GMs are simply participants in the group activity of an RPG, the same way players are. We all come together to play the game, and each of us has a part to play in making the activity work. More traditional systems have a clear GM-Player role description, while modern systems have begun to blur the lines, giving Players more and more narrative control to the point that being a GM is almost indistinguishable as being a Player.
The real concern about the mindset of the GM as a long suffering hero is that it enables a form of inequality. Suddenly, GMs matter more by virtue of the tasks that they do. While players, being "just" players, are beholden to the GM. This is a slippery sort of situation that could easily lead to the GMs perceiving themselves as an elite subset of the RPG population… and that kind of thinking leads to a culture and mindset of entitlement.
I can't always speak for other GMs, but when I run a game, it's because I derive great personal joy from being able to craft a story from my player's actions and deliver surprising moments where they get to be big damn heroes. Sure there's work in the form of world building and such, but it's not a burden, and certainly not one that I'd blame on the players.
So given that we've identified that this sort of GM Elitism is a disservice to yourself and the people you play with, what can a GM do? Well, self awareness and reflection helps. It's easy to fall into the trap where you start dismissing Player opinions on improving the game simply on the basis that they aren't GMs.
Remember, the GM is still part of the same team. Sure you serve a different role in the activity, but that's just like saying a Goalie is more important than any other player in a football team. They do different things, but one is never more inherently important than the other.
Led by a group of stalwart D&D fans determined to put the Philippines on the map of the D&D landscape, Conclave is the first local tabletop Roleplaying Game convention to have Adventurer's League support in the form of a convention-only Epic adventure!
If you're a fan of D&D, or Roleplaying Games in general please drop by and show your support and have a great time!
Check out their website for more details: http://www.conclaveph.com/index.html
To call this a 2nd Edition feels like a bit of a misnomer. John Wick has taken the old 7th Sea, tossed the old Roll and Keep mechanics overboard, and rewrote much of the setting and history to create this new version of 7th Sea. As such, it feels more fitting to use a term more commonly applied to movies: a reboot.
A More Cinematic Experience
7th Sea's new mechanics lend itself to a style of play where the player characters are Heroes with a capital "H". Men and women with amazing skill and luck to live out larger-than-life adventures.
The new system is fairly straightforward. Upon declaring the character's action for the turn, they roll a pool of d10's determined by the sum of their Trait and Skill. Players then assemble sets of 10 from the results of the roll, with each set counting as a Raise. These are then used to "buy" narrative achievements such as successfully meeting a goal, taking advantage of an opportunity, or just avoiding harm.
On the GM's part, their job is to present the players with Opportunities and Threats within the scene, each one building towards a cinematic encounter between the Heroes and the opposition, be it a horde of goons, a devious trap, or the villain of the story.
You're not the World, but a Stage
GMs who cleave towards a more simulation-based philosophy of running a game will find themselves somewhat challenged by the chief conceit of 7th Sea second edition. The game is engineered so that your role is not that of a director rather than that of a referee.
Threats and Villains exist so that you can highlight the Heroes. And even the character creation ensures that the Heroes know exactly what they're getting into, and how they'd like each tale to end.
This eliminates a lot of the creative input from the side of the GM, and those who are used to a more open, sandbox method might find themselves lost as to how to properly run the game.
Pretty as it gets
I will say that the artwork and layout for the book is gorgeous, with full colour illustrations and easily readable text. The lack of over-sexualised images is a major plus, and I found a few pieces that took into account the LGBT fans as well, something that I feel will be very much appreciated.
7th Sea Second Edition isn't an old car with a new coat of paint. It's a familiar shade of paint on a brand new car. If you're looking for more of the old, then you might want to be prepared to be surprised.
However, if you're looking for a game that delivers rope-swinging swashbuckler-y fun with the ability to take your own story by the reins, then this is the game for you. John Wick clearly knew what he wanted to do with the game, and didn't waste time killing sacred cows to make it happen.
If you're interested in getting a copy of 7th Sea, you can grab it in PDF from DriveThruRPG for only $24.99 or roughly Php 1,200
Beast: the Primordial calls itself "A Storytelling Game of Endless Hunger" and it's easy to see why. The role you play is that of a creature driven by the unending need to feed, mechanically simulated by the Satiety system.
It is perhaps the Chronicles of Darkness game that adheres strongest to its themes. The Beasts are helpless to the call of their nature, while their opponents, the Heroes are subject to the instincts driven into them by who they are.
To side with "higher" human qualities like free will and determination in the face of your impulses is to lose, as both factions are brought together to enact an eternal cycle of hate and violence.
Let me get this out out of the way: Mechanically, Beast: the Primordial is evocative, interesting and has a lot of cool powers and options. The artwork is definitely creepy, and the layout is decent, with perhaps a few fiction pages looking a little bit too busy and distracting.
Gameplay-wise it fits perfectly withing the power levels expected of most Supernaturals, and Beasts can run with the best of Vampires and Werewolves and still be able to bring something interesting to the table.
But I can't run it.
This is where I will go firmly into opinion mode, so please bear with me. I find Beast a truly disturbing book, with the implications of the loss of control and being unable to change your place in destiny (and where transcending it only makes you a WORSE sort of creature) bothers me deeply.
I believe that the game itself is good, and for certain players, who are responsible, mature adults, can do it a great deal of justice to explore their darker sides.
However in the hands of a less mature group, this game is an invitation to commit imaginary atrocity and revel in it. There's potential here to go very, very wrong.
Can I recommend it? As a system, then yes. It's well written, creepy in all the right ways, and has potential to stick with you long after you've played it. If you and your group have the trust, and emotional fortitude to tackle some really disturbing facets of a Beast's existence then by all means, get this game.
But will I ever run Beast? I'm going to have to give this one a pass.
Interested in checking out Beast: the Primordial? You can grab a PDF for only $19.99 over at DriveThruRPG!


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