Surgical treatment for severe cubital tunnel syndrome with absent sensory nerve conduction

Abstract OBJECTIVE To report the outcomes of cubital tunnel surgery for patients with absent ulnar sensory nerve conduction. METHODS The charts of 34 patients who exhibited clinical symptoms of ulnar nerve entrapment at the elbow and who had electromyography-confirmed prolonged motor nerve conduction across the cubital tunnel in association with absent sensory nerve conduction were reviewed. The mean age was 63 years, and the mean symptom duration was 17 months. Four patients had bilateral symptoms. Surgery was performed for 38 limbs, i.e., neurolysis for 21 limbs and subcutaneous transposition for 17 limbs. Fifteen limbs demonstrated associated ulnar nerve-related motor weakness. The mean postoperative follow-up period was 4 years (range, 3 mo to 11 yr). RESULTS Sensory symptoms (i.e., pain, paresthesia, and two-point discrimination) improved in 20 limbs (53%), and muscle strength improved in 2 limbs (13%). Improvements in sensory symptoms were not related to patient age, symptom duration, cause, severity of prolonged motor nerve conduction, select psychological factors, associated medical diseases, associated cervical pathological conditions, or type of surgery. Improvements in sensory symptoms were significantly decreased among patients who had experienced cervical disease for more than 1 year and patients with bilateral symptoms. CONCLUSION Patients with cubital tunnel syndrome who have absent sensory nerve conduction seem to experience less improvement of sensory symptoms after surgery, compared with all patients with cubital tunnel syndrome described in the literature. Bilateral symptoms and delayed surgery secondary to associated cervical spine disease seem to be significant negative factors for postoperative improvement of sensory symptoms. Sensory symptoms improved similarly among patients who underwent neurolysis or subcutaneous transposition

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Ulnar Nerve Enlargement at the Medial Epicondyle Negatively Correlates With Nerve Conduction Velocity in Cubital Tunnel Syndrome

Hand ◽

10.1177/1558944718792275 ◽

2018 ◽

Vol 15 (2) ◽

pp. 165-169

Author(s):

T. David Luo ◽

Amy P. Trammell ◽

Luke P. Hedrick ◽

Ethan R. Wiesler ◽

Francis O. Walker ◽

...

Keyword(s):

Ulnar Nerve ◽

Nerve Conduction ◽

Nerve Conduction Velocity ◽

Motor Nerve ◽

Cubital Tunnel Syndrome ◽

Medial Epicondyle ◽

Cubital Tunnel ◽

Motor Nerve Conduction ◽

Nerve Enlargement ◽

Tunnel Syndrome

Background: In cubital tunnel syndrome (CuTS), chronic compression often occurs at the origin of the flexor carpi ulnaris at the medial epicondyle. Motor nerve conduction velocity (NCV) across the elbow is assessed preoperatively to corroborate the clinical impression of CuTS. The purpose of this study was to correlate preoperative NCV to the direct measurements of ulnar nerve size about the elbow at the time of surgery in patients with clinical and/or electrodiagnostic evidence of CuTS. Methods: Data from 51 consecutive patients who underwent cubital tunnel release over a 2-year period were reviewed. Intraoperative measurements of the decompressed nerve were taken at 3 locations: at 4 cm proximal to the medial epicondyle, at the medial epicondyle, and at the distal aspect of Osborne fascia at the flexor aponeurotic origin. Correlation analysis was performed comparing nerve size measurements to slowing of ulnar motor nerve conduction velocities (NCV) below the normal threshold of 49 m/s across the elbow. Results: Enlargement of the ulnar nerve at the medial epicondyle and nerve compression at the flexor aponeurotic origin was a consistent finding. The mean calculated cross-sectional area of the ulnar nerve was 0.21 cm2 above the medial epicondyle, 0.30 cm2 at the medial epicondyle, and 0.20 cm2 at the flexor aponeurotic origin ( P < .001). There was an inverse correlation between change in nerve diameter and NCV slowing ( r = −0.529, P < .001). Conclusions: For patients with significantly reduced preoperative NCV and clinical findings of advanced ulnar neuropathy, surgeons can expect nerve enlargement, all of which may affect their surgical decision-making.

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Muscular atrophy in severe cases of cubital tunnel syndrome: prognostic factors and outcome after surgical treatment

Acta Neurochirurgica ◽

10.1007/s00701-017-3086-3 ◽

2017 ◽

Vol 159 (3) ◽

pp. 537-542 ◽

Cited By ~ 5

Author(s):

Markus Bruder ◽

Stephan Dützmann ◽

Nourdin Rekkab ◽

Johanna Quick ◽

Volker Seifert ◽

...

Keyword(s):

Prognostic Factors ◽

Surgical Treatment ◽

Muscular Atrophy ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Tunnel Syndrome

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Functional Outcome of Anterior Transposition of the Vascularized Ulnar Nerve for Cubital Tunnel Syndrome

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(98)80014-4 ◽

1998 ◽

Vol 23 (5) ◽

pp. 613-616 ◽

Cited By ~ 24

Author(s):

A. ASAMI ◽

K. MORISAWA ◽

T. TSURUTA

Keyword(s):

Functional Outcome ◽

Ulnar Nerve ◽

Conduction Velocity ◽

Nerve Conduction ◽

Nerve Conduction Velocity ◽

Clinical Results ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Anterior Transposition ◽

Tunnel Syndrome

Anterior transposition of the ulnar nerve is a widely used treatment for cubital tunnel syndrome, but neurolysis performed at the time of surgery may impair the blood supply to the ulnar nerve. This study compared the results of intramuscular anterior transposition of the ulnar nerve with or without preserving the extrinsic vessels of the ulnar nerve in 35 patients. The postoperative nerve conduction velocity and the clinical results were better in the group in which the extrinsic vessels were presented.

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P963: The application values of short-segment nerve conduction studies in the cubital tunnel syndrome

Clinical Neurophysiology ◽

10.1016/s1388-2457(14)50997-2 ◽

2014 ◽

Vol 125 ◽

pp. S303-S304

Author(s):

Z. Jia ◽

P. Tao ◽

T. Wang ◽

Z. Liu ◽

S. Xin ◽

...

Keyword(s):

Nerve Conduction ◽

Cubital Tunnel Syndrome ◽

Nerve Conduction Studies ◽

Cubital Tunnel ◽

Short Segment ◽

Tunnel Syndrome

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Anconeus Epitrochlearis Muscle Associated With Cubital Tunnel Syndrome: A Case Series

Hand ◽

10.1177/1558944718762566 ◽

2018 ◽

Vol 14 (4) ◽

pp. 477-482

Author(s):

Nicholas Kim ◽

Ryan Stehr ◽

Hani S. Matloub ◽

James R. Sanger

Keyword(s):

Ulnar Nerve ◽

Nerve Conduction ◽

Case Series ◽

Cubital Tunnel Syndrome ◽

Nerve Conduction Studies ◽

Cubital Tunnel ◽

Persistent Symptoms ◽

Compressive Neuropathy ◽

Tunnel Syndrome

Background: Cubital tunnel syndrome is a common compressive neuropathy of the upper extremity. The anconeus epitrochlearis muscle is an unusual but occasional contributor. We review our experience with this anomalous muscle in elbows with cubital tunnel syndrome. Methods: We retrospectively reviewed charts of 13 patients noted to have an anconeus epitrochlearis muscle associated with cubital tunnel syndrome. Results: Ten patients had unilateral ulnar neuropathy supported by nerve conduction studies. Three had bilateral cubital tunnel syndrome symptoms with 1 of those having normal nerve conduction studies for both elbows. Eight elbows were treated with myotomy of the anconeus epitrochlearis muscle and submuscular transposition of the ulnar nerve. The other 8 elbows were treated with myotomy of the anconeus epitrochlearis muscle and in situ decompression of the ulnar nerve only. All but 1 patient had either clinical resolution or improvement of symptoms at follow-up ranging from 2 weeks to 1 year after surgery. The 1 patient who had persistent symptoms had received myotomy and in situ decompression of the ulnar nerve only. Conclusions: An anomalous anconeus epitrochlearis occasionally results in compression of the ulnar nerve but is usually an incidental finding. Its contribution to compression neuropathy can be tested intraoperatively by passively ranging the elbow while observing the change in vector and tension of its muscle fibers over the ulnar nerve. Regardless of findings, we recommend myotomy of the muscle and in situ decompression of the ulnar nerve. Submuscular transposition of the ulnar nerve may be necessary if there is subluxation.

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