Cause Of Cubital Tunnel Syndrome Research Articles

Intraneural or extraneural ganglion cysts as a cause of cubital tunnel syndrome: A retrospective observational study.

PurposeCubital tunnel syndrome caused by ganglion cysts has rarely been reported. The purpose of this study was to evaluate the surgical treatment outcomes of a patient diagnosed with cubital tunnel syndrome caused by intraneural or extraneural cysts and to summarize our experience.MethodIn total, 34 patients were evaluated retrospectively from January 2011 to January 2020 with a follow-up of more than 24 months. Preoperative data, such as demographic data, clinical symptoms, physical examination findings, and laboratory tests, were all recorded and pre-operative and post-operative data were compared. The function was evaluated by the modified Bishop scoring system and the McGowan grade at the last follow-up.ResultsImprovement of interosseous muscle strength, the Visual Analog Scale (VAS), 2-point discrimination (2-PD), electromyogram (EMG) result, Wartenberg sign, claw hand, and weakness could be clearly observed in all patients. Extraneural cysts were completely removed and the pedicles of the cysts were ligated. Intraneural cysts were incised and drained, and part of their cyst walls were removed using a microsurgical technique. All patients underwent anterior subcutaneous transposition (AST). At the last follow-up, McGowan's (0-IIa) grade increased from seven patients (20.6%) preoperatively to 27 patients (79.4%); the excellent and good rate according to the modified Bishop scoring system was 82.4% (28 patients), and all patients had no symptoms of recurrence after surgery.ConclusionThe treatment of cubital tunnel syndrome caused by intraneural or extraneural cysts achieved good long-term results through extraneural cyst resection or intraneural cyst incision and drainage combined with subcutaneous transposition. Early diagnosis and surgical treatment are essential for the patient's postoperative recovery.

Ultrasound Diagnosis of Cubital Tunnel Syndrome in the Accessory Anconeus Epitrochlearis Muscle (Case Report)

Summary. A case of diagnosing the accessory anconeus epitrochlearis muscle, which caused compression of the ulnar nerve and was the cause of cubital tunnel syndrome, is presented. Ultrasound is an important diagnostic method, which allows preventing unnecessary medical manipulations and choosing the right treatment algorithm.

Treatment of Anconeus Epitrochlearis- Induced Cubital Tunnel Syndrome With Ultrasound-Guided Hydrodissection

BACKGROUND: Cubital tunnel syndrome is the second most common cause of peripheral nerve entrapment in the upper extremity, trailing only carpal tunnel neuropathy. While the roof of the cubital tunnel is most often formed by Osborne’s ligament, the anomalous, evolutionary remnant muscle, the anconeus epitrochlearis, has been previously identified as a potential cause of cubital tunnel syndrome. CASE REPORT: A 45-year-old female physical education coach noted bilateral upper extremity pain, numbness, paresthesias, and early onset exercise fatigue originating at the medial elbow and radiating down the ulnar nerve distribution. Sonographic evaluation showed evidence of a hypertrophic anconeus epitrochlearis in the right upper extremity causing compression of an enlarged, bifid ulnar nerve. The patient was treated with 3 separate ultrasound-guided hydrodissection injections, which resulted in complete resolution of her symptoms and a decrease in the ulnar nerve cross-sectional area on sonographic evaluation at 24-week follow-up. CONCLUSION: A hypertrophic anconeus epitrochlearis can cause cubital tunnel syndrome and ultrasound-guided hydrodissection is a potentially efficacious surgery-sparing treatment option. KEY WORDS: Cubital tunnel syndrome, hydrodissection, ulnar neuralgia, ultrasound

Validity of computed tomographic measurements and morphological comparison of cubital tunnel in idiopathic cubital tunnel syndrome

BackgroundUlnar neuropathy is a common reason for referral to hand surgeons, and 10 to 30% of cubital tunnel syndrome (CuTS) is idiopathic. We hypothesized that the cause of idiopathic CuTS is in the bony structure.MethodsWe analyzed 79 elbows (39 idiopathic CuTS and 40 without CuTS symptom) using computed tomography and Materialize Mimics software to compare the differences between the two groups. We proposed a new bony cubital tunnel with a new boundary that could play a role in ulnar nerve compression symptom.ResultsThe mean cubital tunnel volume was 1245.6 mm3 in all patients, 1180.6 mm3 in CuTS patients, and 1282.3 mm3 in the control group. A significant difference (p = 0.015) between two groups was found. Bony cubital tunnel cross-sectional area, cubital tunnel depth, and cubital tunnel angle also showed significant differences.ConclusionThe shape of the bony cubital tunnel is an important cause of CuTS, and the normal variation of the volume and cross-sectional area of the cubital tunnel and cubital tunnel angle could influence the occurrence of idiopathic CuTS.

Cubital tunnel syndrome: An entrapment neuropathy which may arise from vascular malformation

Vascular malformation as a cause of cubital tunnel syndrome has not yet been reported. Cubital tunnel syndrome (CuTS), the most common entrapment neuropathy of the ulnar nerve at elbow level, is also the second most common entrapment neuropathy in the upper extremity, regardless of carpal tunnel syndrome. Here, we report CuTS due to vascular malformation in a 63-year-old woman. The ulnar nerve at the distal part of tunnel was markedly compressed. There was no connection between the lesion and the ulnar nerve. The diagnosis was made by using histopathology, and thereafter the lesion was fully resected. Pain in her ring and little fingers disappeared one month after resection of the malformation.

Acute Cubital Tunnel Syndrome Secondary to Anconeus Epitrochlearis Muscle: 由肘肌滑車上肌導致的急性肘管綜合症

Cubital tunnel syndrome is the most common type of ulnar nerve entrapment that usually associates with chronic sensory and motor symptoms. Having anconeus epitrochlearis muscle is an uncommon cause of cubital tunnel syndrome. In this paper, the author introduces a case of cubital tunnel syndrome due to anconeus epitrochlearis muscle presenting with acute sensory, motor, and sympathetic symptoms. For such cases, there has been much controversy over the choices of surgical treatment, which can be excision of the muscle alone or together with ulnar nerve anterior transposition.

Outcome analysis of cubital tunnel decompression.

Cubital tunnel decompression is a commonly undertaken upper limb procedure. Most studies compare the different techniques of decompression; however, only a few have specifically investigated the outcome of ulnar nerve decompression. The aim of this study was to investigate the outcome of ulnar nerve decompression following cubital tunnel syndrome. A total of 174 ulnar nerve decompression cases were identified from the upper limb surgery database with complete data available for 136 cases. Simple decompression was performed in 110 (80.88%) cases, and in 26 (19.12%), anterior subcutaneous transposition was also supplemented. These operations were performed at three different hospitals by surgeons of different levels of experience. The most common cause of cubital tunnel syndrome was idiopathic. The outcome was satisfactory in 86% of cases. No obvious association was demonstrated between the outcome of surgery and duration of symptoms, presence of co-morbidities or the type of surgery performed. This is the largest outcome analysis of the results of ulnar nerve decompression at the elbow. Good results following nerve decompression were attained in 86% of cases without any significant effect of duration of symptoms or co-morbidities on the outcome of surgery. It is hoped that the findings of the current study will help general practitioners, junior doctors and surgeons in their management and pre-operative consultation with patients having cubital tunnel syndrome.

Anconeus Epitrochlearis as a Source of Medial Elbow Pain in Baseball Pitchers

Medial elbow pain is reported in 18% to 69% of baseball players aged of 9 and 19 years. This is due to the large valgus stresses focused on the medial side of the elbow during overhead activities. In overhead throwers and pitchers, pain can be attributed to valgus extension overload with resultant posteromedial impingement, overuse of the flexor-pronator musculature resulting in medial epicondylitis, or occasional muscle tears or ruptures. The anconeus epitrochlearis is a known cause of cubital tunnel syndrome and has been postulated as a source of medial elbow pain in overhead athletes. This article describes the cases of 3 right-handed baseball pitchers with persistent right-sided medial elbow pain during throwing despite a prolonged period of rest, physical therapy, and nonsteroidal anti-inflammatory drugs. Two patients had symptoms of cubital tunnel syndrome as diagnosed by electromyogram and nerve conduction studies and the presence of the anconeus epitrochlearis muscle per magnetic resonance imaging. All patients underwent isolated release of the anconeus muscle without ulnar nerve transposition and returned to their previous levels of activity. The diagnosis and treatment of pitchers who present with medial-sided elbow pain can be complex. The differential should include an enlarged or inflamed anconeus epitrochlearis muscle as a possible cause. Conservative management should be the first modality. However, surgical excision with isolated release of the muscle can be successful in returning patients with persistent pain despite a trial of conservative management to their previous levels of function.

Ultrasound diagnosis of ulnar nerve dislocation and snapping triceps syndrome

Dislocation of the ulnar nerve with snapping triceps syndrome has been implicated as a cause of cubital tunnel syndrome. Patients with this condition may clinically present with a snapping sensation at the elbow upon flexion along with ulnar neuropathic symptoms. Though demonstration of this condition is possible by static MRI images, ultrasound can be used as a more accessible and inexpensive modality for attaining diagnosis. This pictorial essay emphasises the technique, findings and role of dynamic ultrasound in the diagnosis of this entity.

Strain on the Ulnar Nerve at the Elbow and Wrist During Throwing Motion

It is well known that cubital tunnel syndrome frequently occurs in throwing athletes. The cause of cubital tunnel syndrome is considered to be mechanical stimuli on the ulnar nerve in the cubital tunnel. The hypothesis of the present cadaveric study was that the ulnar nerve is subjected to longitudinal strain in the cubital tunnel during the throwing motion. Four phases of throwing (stance, wind-up, middle cock-up, and early acceleration) were passively simulated in seven fresh-frozen transthoracic cadaveric specimens that were fixed in an upright position to allow free arm movement. In each throwing phase, the elbow was sequentially flexed from 45 degrees to 90 degrees to 120 degrees to maximum flexion. The longitudinal movement of and strain on the ulnar nerve were measured with use of a caliper and a strain gauge at the proximal aspects of both the cubital tunnel and the canal of Guyon. The movement of the ulnar nerve at the proximal aspect of the cubital tunnel was significantly increased during all throwing phases with increased elbow flexion (p < 0.05). An average maximum movement of 12.4 +/- 2.4 mm was recorded during the wind-up phase with maximum elbow flexion. The movement at the proximal aspect of the canal of Guyon was approximately two-thirds of that at the proximal aspect of the cubital tunnel. The strain on the ulnar nerve at the proximal aspect of the cubital tunnel was significantly increased with elbow flexion in the stance, wind-up, and middle cock-up phases (p < 0.05). An average maximum strain of 13.1% +/- 6.1% was recorded during the early acceleration phase with maximum elbow flexion. The strain at the proximal aspect of the canal of Guyon was approximately half of that at the proximal aspect of the cubital tunnel. In the present study, the maximum strain on the ulnar nerve during the acceleration phase was found to be close to the elastic and circulatory limits of the nerve.

Pathogenesis and treatment of cubital tunnel syndrome caused by osteoarthrosis of the elbow joint.

We consider the primary cause of cubital tunnel syndrome caused by osteoarthrosis of the elbow joint to be degenerative osteophytes originating in the humeroulnar joint underneath the ulnar nerve. In the operative procedure the ulnar nerve in the cubital tunnel is fully exposed by cutting the soft tissues covering the nerve, because some of the soft tissues often seem to compress the nerve. Internal neurolysis is performed with microscopy in cases where the constriction is severe. Osteophytes in the humeroulnar joint underneath the nerve are removed. The osteophytes and loose bodies in the anterior and the posterior parts of the joint are also removed to increase joint motion. In 75 of 77 cases recovery of the ulnar nerve palsy and improvement in the range of joint motion were obtained.

Tardy ulnar nerve palsy caused by cubitus varus deformity

Fifteen patients with tardy ulnar nerve palsy caused by cubitus varus deformity were studied. All patients had a history of previous fracture of the humerus during childhood. The mean interval between fracture and onset of symptoms was 15 years. The severity of the palsy was classified as McGowan's grade I in 12 patients, grade II in 2 patients, and grade III in 1 patient. The mean carrying angle was -2 degrees before surgery. X-ray films showed a shallow ulnar nerve groove, a dysplastic humeral trochlea, medial shift of the ulna, and deformity of the medial epicondyle. The ulnar nerve was explored in all but one patient. Operative findings suggested that the main cause of the palsy was compression by a fibrous band running between the two heads of flexor carpi ulnaris. Surgical steps included release of the fibrous band in 14 patients with anterior subcutaneous transposition of the ulnar nerve in 5 of those patients. A corrective osteotomy was done in 11 patients who requested correction of the varus deformity. Traumatic cubitus varus deformity should be recognized as another cause of cubital tunnel syndrome.

Cubital tunnel syndrome caused by abnormal insertion of triceps brachii muscle

Some cases of cubital tunnel syndrome are caused by anatomical abnormalities such as the epitrochleo-anconeus muscle or snapping and bulkiness of the medial head of the triceps brachii muscle. We report a rare cause of cubital tunnel syndrome that has not been reported previously. It was caused by an abnormal insertion of the medial head of the triceps muscle into the medial epicondyle. The clinical course and operative findings are described.