Surgical Approach to Ulnar Nerve Compression at the Elbow Caused by the Epitrochleoanconeus Muscle and a Prominent Medial Head of the Triceps

Gervasio, Olga; Zaccone, C.

doi:10.1227/01.neu.0000317392.29551.aa

Cited by 22 publications

(30 citation statements)

References 21 publications

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“…[789] It has been reported that the ulnar nerve can get dynamically compressed during its course through the passage in between the epitrochleoanconeus muscle and a prominent medial head of the triceps muscle. [1011] There are also reports of abnormal insertion of medial head of triceps muscle leading to symptoms similar to cubital tunnel syndrome. [12] In the present case, compression of ulnar nerve can occur as it is passing in an osseo-musculo-fibrous tunnel leading to ulnar neuropathy around the elbow and clinical condition which may mimic the “cubital tunnel syndrome”.…”

Section: Discussionmentioning

confidence: 99%

Bilateral additional slips of triceps brachii forming osseo-musculo-fibrous tunnels for ulnar nerves

Rao

Somayaji

et al. 2013

Ann Med Health Sci Res

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Rare additional slips of triceps brachii muscle was found bilaterally in a sixty two year old South Indian male cadaver during routine dissection of upper limb for undergraduate students at Melaka-Manipal Medical College, Manipal University, Manipal, India. On left side, the variant additional muscle slip took origin from the lower part of the medial intermuscular septum about 4 cm proximal to the medial humeral epicondyle. From its origin, the muscle fibres were passing over the ulnar nerve and were joining the triceps muscle to get inserted to the upper surface of olecranon process of ulna. On right side, the additional muscle slip was larger and bulkier and was arising from the lower part of the medial border of the humerus about 4 cm proximal to the medial epicondyle in addition to its attachment to the medial intermuscular septum. On both sides, the additional slips were supplied by twigs from the radial nerve. On both sides, the ulnar nerve was passing between variant additional slip and the lower part of the shaft of the humerus in an osseo-musculo-fibrous tunnel. Such variant additional muscle slips may affect the function of triceps muscle and can lead to snapping of medial head of triceps and ulnar nerve over medial epicondyle and also can dynamically compress the ulnar nerve during the contraction of triceps leading to ulnar neuropathy around the elbow.

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Section: Discussionmentioning

confidence: 99%

Bilateral additional slips of triceps brachii forming osseo-musculo-fibrous tunnels for ulnar nerves

Rao

Somayaji

et al. 2013

Ann Med Health Sci Res

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“…In the primary form, there are no morphological abnor-malities, especially no bony changes of the elbow joint or space occupying processes. The idiopathic or primary form includes abnormalities and risk factors like luxation of the ulnar nerve (in about 16 % of the population), the anconeus epitrochlearis muscle (3 -23 % of the population) [33,48,100] , and hypertrophy or dislocation of the medial head of the triceps muscle. The anatomic abnormalities do not generally lead to clinical manifestations, but are predisposing factors.…”

Section: Incidenc / Epidemiology ▼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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“…The ulnar nerve can also be compressed in other locations of the arm, including the upper arm where the nerve passes from the posterior to anterior compartment through the arcade of Struthers, a fibrous band running from the medial head of the triceps to the medial intermuscular septum (64,65). Compression may also occur from the medial head of the triceps muscle (61,66,67), fascial bands where the nerve passes into the forearm between the two head of the flexor carpi ulnaris muscle (68), or by the deep flexor-pronator aponeurosis (69).…”

Section: Ulnar Neuropathymentioning

confidence: 99%

Magnetic resonance imaging of the elbow

Stevens

2010

Magnetic Resonance Imaging

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Elbow pain is frequently encountered in clinical practice and can result in significant morbidity, particularly in athletes. Magnetic resonance imaging (MRI) is an excellent diagnostic imaging tool for the evaluation of soft tissue and osteochondral pathology around the elbow. Recent advances in magnetic field strength and coil design have lead to improved spatial resolution and superior soft tissue contrast, making it ideal for visualization of complex joint anatomy. This article describes the normal imaging appearances of anatomy around the elbow and reviews commonly occurring ligamentous, myotendinous, neural, and bursal pathology around the elbow.

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Surgical Approach to Ulnar Nerve Compression at the Elbow Caused by the Epitrochleoanconeus Muscle and a Prominent Medial Head of the Triceps

Abstract: The simple decompression of the ulnar nerve with myotomy or removal of epitrochleoanconeus muscle and the prominent portion of the medial head of the triceps achieved good postoperative results. Experiences from the literature and alternative surgical options are reported.

Cited by 22 publications

References 21 publications

Bilateral additional slips of triceps brachii forming osseo-musculo-fibrous tunnels for ulnar nerves

Bilateral additional slips of triceps brachii forming osseo-musculo-fibrous tunnels for ulnar nerves

Cubital Tunnel Syndrome – A Review and Management Guidelines

Magnetic resonance imaging of the elbow

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