A Dynamic Anatomical Study of Ulnar Nerve Motion After Anterior Transposition for Cubital Tunnel Syndrome

Nikitins, M. D.; Griffin, Phyllis; Ch’ng, Sydney; Rice, N. J.

doi:10.1142/s0218810402001114

Cited by 11 publications

(5 citation statements)

References 9 publications

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“…The nerve can also be " kinked " in cases of anterior submuscular or subcutaeneous transposition if proximal dissection does not extend far enough to release the arcade of Struthers, which connects the medial head of the triceps to the medial intermuscular septum [45] . Distal kinking can occur if the deep fl exor fascia was not incised properly at the entry of the nerve into the fl exor pronator muscles [31,51,79,97,128] . Perineural scar formation and insuffi cient resection of the septum intermusculare mediale and the deep fl exor fascia have most frequently been the cause for revision surgery [128] .…”

Section: Complications ▼mentioning

confidence: 99%

Cubital Tunnel Syndrome – A Review and Management Guidelines

et al. 2011

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Cubital tunnel syndrome (CuTS) is the second most common peripheral nerve compression syndrome. In German-speaking countries, cubital tunnel syndrome is often referred to as sulcus ulnaris syndrome (retrocondylar groove syndrome). This term is anatomically incorrect, since the site of compression comprises not only the retrocondylar groove but the cubital tunnel, which consists of 3 parts: the retrocondylar groove, partially covered by the cubital tunnel retinaculum (lig. arcuatum or Osborne ligament), the humeroulnar arcade, and the deep flexor/pronator aponeurosis. According to Sunderland , cubital tunnel syndrome can be differentiated into a primary form (including anterior subluxation of the ulnar nerve and compression secondary to the presence of an anconeus epitrochlearis muscle) and a secondary form caused by deformation or other processes of the elbow joint. The clinical diagnosis is usually confirmed by nerve conduction studies. Recently, the use of ultrasound and MRI have become useful diagnostic tools by showing morphological changes in the nerve within the cubital tunnel. A differential diagnosis is essential in atypical cases, and should include such conditions as C8 radiculopathy, Pancoast tumor, and pressure palsy. Conservative treatment (avoiding exposure to external noxes and applying of night splints) may be considered in the early stages of cubital tunnel syndrome. When nonoperative treatment fails, or in patients who present with more advanced clinical findings, such as motor weakness, muscle atrophy, or fixed sensory changes, surgical treatment should be recommended. According to actual randomized controlled studies, the treatment of choice in primary cubital tunnel syndrome is simple in situ decompression, which has to be extended at least 5-6 cm distal to the medial epicondyle and can be performed by an open or endoscopic technique, both under local anesthesia. Simple decompression is also the therapy of choice in uncomplicated ulnar luxation and in most post-traumatic cases and other secondary forms. When the luxation is painful, or when the ulnar nerve actually "snaps" back and forth over the medial epicondyle of the humerus, subcutaneous anterior transposition may be performed. In cases of severe bone or tissue changes of the elbow (especially with cubitus valgus), the anterior transposition of the ulnar nerve may again be indicated. In cases of scarring, submuscular transposition may be preferred as it provides a healthy vascular bed for the nerve as well as soft tissue protection. Risks resulting from transposition include compromise in blood flow to the nerve as well as kinking of the nerve caused by insufficient proximal or distal mobilization. In these cases, revision surgery is necessary. Epicondylectomy is not common, at least in Germany. Recurrence of compression on the ulnar nerve at the elbow may occur. This review is based on the German Guideline "Diagnose und Therapie des Kubitaltunnelsyndroms" ( www.leitlinien.net ).

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Section: Complications ▼mentioning

confidence: 99%

Cubital Tunnel Syndrome – A Review and Management Guidelines

et al. 2011

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“…4 The dynamic anatomy of the cubital tunnel with elbow motion has previously been investigated using a variety of methods. Investigators have used injectable acrylic molds, 5 stereography, 6 ultrasonography, 7 fluoroscopy, 8 magnetic resonance imaging, 9 pressure transducers, 2 strain gauges, 3 retrospective case reports, 10 and cadaveric anatomical dissections 11 to elucidate the precise anatomic relationships during elbow motion.…”

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confidence: 99%

Morphology of the Cubital Tunnel: An Anatomical and Biomechanical Study With Implications for Treatment of Ulnar Nerve Compression

James¹,

Sutton²,

Werner³

et al. 2011

The Journal of Hand Surgery

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“…The ulnar nerve then continues down the forearm within the enveloping fascia of the FDS, separate from the FCU. 2,18,23,26 The narrow aperture of these structures may participate as a primary cause of cubital tunnel syndrome, as a distinct location from the retrocondylar retinaculum. 8,9 Similar to the retrocondylar retinaculum, the ulnar nerve is compressed by the fascial structures of the FCU in elbow flexion.…”

Section: Consistent Anatomy Of the Fibrous Arcadementioning

confidence: 99%

Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited

Mahan

Gasco

Mokhtee³

et al. 2015

JNS

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OBJECT Surgical transposition of the ulnar nerve to alleviate entrapment may cause otherwise normal structures to become new sources of nerve compression. Recurrent or persistent neuropathy after anterior transposition is commonly attributable to a new distal compression. The authors sought to clarify the anatomical relationship of the ulnar nerve to the common aponeurosis of the humeral head of the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) muscles following anterior transposition of the nerve. METHODS The intermuscular septa of the proximal forearm were explored in 26 fresh cadaveric specimens. The fibrous septa and common aponeurotic insertions of the flexor-pronator muscle mass were evaluated in relation to the ulnar nerve, with particular attention to the effect of transposition upon the nerve in this region. RESULTS An intermuscular aponeurosis associated with the FCU and FDS muscles was present in all specimens. Transposition consistently resulted in angulation of the nerve during elbow flexion when this fascial septum was not released. The proximal site at which the nerve began to traverse this fascial structure was found to be an average of 3.9 cm (SD 0.7 cm) from the medial epicondyle. CONCLUSIONS The common aponeurosis encountered between the FDS and FCU muscles represents a potential site of posttransposition entrapment, which may account for a subset of failed anterior transpositions. Exploration of this region with release of this structure is recommended to provide an unconstrained distal course for a transposed ulnar nerve.

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A Dynamic Anatomical Study of Ulnar Nerve Motion After Anterior Transposition for Cubital Tunnel Syndrome

Cited by 11 publications

References 9 publications

Cubital Tunnel Syndrome – A Review and Management Guidelines

Cubital Tunnel Syndrome – A Review and Management Guidelines

Morphology of the Cubital Tunnel: An Anatomical and Biomechanical Study With Implications for Treatment of Ulnar Nerve Compression

Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited

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