OBJECTIVE: To evaluate the value of high-resolution ultrasound the diagnosis and prognosis of cubital tunnel syndrome. METHODS: From January 2018 to June 2019, 47 patients with cubital tunnel syndrome were treated with ulnar nerve release and anterior subcutaneous transposition. There were 41 males and 6 females, aged from 27 to 73 years old. There were 31 cases on the right, 15 cases on the left, and 1 case on both sides. The diameter of ulnar nerve was measured by high-resolution ultrasound pre-and post-operatively, and measured directly during the operation. The recovery status of the patients was evaluated by the trial standard of ulnar nerve function assessment, and the satisfaction of the patients was assessed. RESULTS: All the 47 cases were followed up for an average of 12 months and the incisions healed well. The diameter of ulnar nerve at the compression level was (0.16±0.04) cm pre-operatively, and the diameter of ulnar nerve was (0.23±0.04) cm post-operatively. The evaluation of ulnar nerve function:excellent in 16 cases, good in 18 cases and fair in 13 cases. Twelve months post-operatively, 28 patients were satisfied, 10 patients were general and 9 patients were dissatisfied. CONCLUSION The preoperative examination of ulnar nerve by high-resolution ultrasound is consistent with the intuitive measurement during operation, and the result of postoperative examination of ulnar nerve by high-resolution ultrasound is consistent with follow-up results. High-resolution ultrasound is an effective auxiliary method for the diagnosis and treatment of cubital tunnel syndrome.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Cubital Tunnel Syndrome/surgery* ; Ulnar Nerve/surgery* ; Neurosurgical Procedures/methods* ; Decompression, Surgical/methods* ; Prognosis

Cubital tunnel syndrome (CuTS) is the second most common nerve compression neuropathy in the upper extremity. Intraneural ganglion cyst (IGC) within the ulnar nerve around the elbow, might present as CuTS. A 51-year-old Chinese man presented with paresthesia at the ulnar two digits of the left hand for one year. He was clinically diagnosed as severe CuTS. Nerve conduction study revealed marked axonal damage of the left ulnar nerve and ultrasonography showed a mass along the ulnar nerve, three centimetres proximal to the medial epicondyle, which was highly suggestive of Schwannoma. The mass was explored by a longitudinal incision. Intraoperatively, multiple cystic lesions were found within the epineurium of the ulnar nerve. Communication was seen between the elbow joint and the cyst. Swellings were partially excised under microscope. Decompression or partial excision of the cyst along with ligation of the articular branch should be the treatment of choice to prevent recurrence in case of IGC.
Ganglion Cysts ; Cubital Tunnel Syndrome ; Ulnar Nerve

Distal humerus fractures require stable fixation and early joint motion, similar to other intra-articular fractures, but are difficult to treat adequately because of the anatomical complexity, severe comminution, and accompanying osteoporosis. In most cases, surgical treatment is performed using two supporting plates. Plate fixation can be divided into right angle plate fixation and parallel plate fixation. In addition, depending on the type of fracture, surgical procedures can be performed differently, and autologous bone grafting can be required in the case of severe bone loss. The elbow joint is vulnerable to stiffness, so it is important to start joint movement early after surgery. Postoperative complications, such as nonunion, ulnar nerve compression, and heterotopic ossification, can occur. Therefore, accurate and rigid fixation and meticulous manipulation of soft tissues are required during surgery.
Bone Transplantation ; Elbow Joint ; Humerus ; Intra-Articular Fractures ; Joints ; Ossification, Heterotopic ; Osteoporosis ; Postoperative Complications ; Rehabilitation ; Ulnar Nerve ; Ulnar Nerve Compression Syndromes

Ganglion cyst is considered to be a usual cause of peripheral nerve compression. In this report, we present a rare case of ulnar nerve compression by a multi-septated ganglion cyst in the cubital tunnel. A 33-year-old left-handed male amateur tennis player developed progressive numbness and weakness in his right elbow, forearm, and hand for 1 year. Decrease of grip power was apparent in left hand. Clinical examination revealed a cystic mass at the posterior side of the elbow. Magnetic resonance imaging identified a ganglion cyst at the elbow. During surgery about 3 cm diameter epineural ganglion was observed compressing the ulnar nerve and was excised using microsurgery techniques. Three months postoperatively, the clinical recovery of the patient was very satisfactory and he restored his original performance in tennis match.
Adult ; Cubital Tunnel Syndrome ; Elbow ; Forearm ; Ganglion Cysts ; Hand ; Hand Strength ; Humans ; Hypesthesia ; Magnetic Resonance Imaging ; Male ; Microsurgery ; Peripheral Nerves ; Tennis ; Ulnar Nerve ; Ulnar Nerve Compression Syndromes

Ulnar neuropathy at the wrist is an uncommon disease and pure ulnar sensory neuropathy at the wrist is even rarer. It is difficult to diagnose pure ulnar sensory neuropathy at the wrist by conventional methods. We report a case of pure ulnar sensory neuropathy at the hypothenar area. The lesion was localized between 3 cm and 5 cm distal to pisiform using orthodromic inching test of ulnar sensory nerve to stimulate at three points around the hypothenar area. Ultrasonographic examination confirmed compression of superficial sensory branch of the ulnar nerve. Further, surgical exploration reconfirmed compression of the ulnar nerve. This case report demonstrates the utility of orthodromic ulnar sensory inching test.
Diagnosis* ; Electrodiagnosis ; Neural Conduction* ; Ulnar Nerve ; Ulnar Nerve Compression Syndromes ; Ulnar Neuropathies ; Wrist

BACKGROUND: The aim of this study was to assess the consistency between preoperative ultrasonographic and intraoperative measurements of the ulnar nerve in patients with cubital tunnel syndrome. METHODS: Twenty-six cases who underwent anterior transposition of the ulnar nerve for cubital tunnel syndrome were enrolled prospectively. On preoperative ultrasonography, largest cross-sectional diameters of the ulnar nerve were measured at the level of medial epicondyle (ME) and 3 cm proximal (PME) and distal (DME) to the ME on the transverse scan by a single experienced radiologist. Intraoperative direct measurements of the largest diameter at the same locations were performed by a single surgeon without knowledge of the preoperative values. The consistency between ultrasonographic and intraoperative values including the largest diameter and swelling ratio were assessed. RESULTS: Significant differences between ultrasonographic and intraoperative values of the largest diameter were found at all levels. The mean difference was 1.29 mm for PME, 1.38 mm for ME, and 1.12 mm for DME. The mean ME-PME swelling ratio for ultrasonographic and intraoperative measurements was 1.50 and 1.39, respectively, showing significant difference. The mean ME-DME swelling ratio for ultrasonographic and intraoperative measurements was 1.53 and 1.43, respectively, showing no significant difference. CONCLUSIONS: Ultrasonographically measured largest diameters of the ulnar nerve at any levels were smaller than the real values determined intraoperatively. The ME-DME swelling ratio of the ulnar nerve measured by ultrasonography was consistent with the intraoperative measurement.
Cubital Tunnel Syndrome* ; Humans ; Prospective Studies ; Ulnar Nerve ; Ultrasonography*

OBJECTIVE: We evaluated the clinical manifestation and surgical results following operative treatment of cubital tunnel syndrome (CuTS) caused by anconeus epitrochlearis (AE) muscle.METHODS: Among 142 patients who underwent surgery for CuTS from November 2007 to October 2015, 12 were assigned to the AE group based on discovery of AE muscle; 130 patients were assigned to the other group. We analyzed retrospectively; age, sex, dominant hand, symptom duration, and weakness in hand. Severity of the disease was evaluated using the Dellon classification and postoperative symptom were evaluated using disability of arm shoulder and hand (DASH) and visual analogue scale (VAS) scores. Surgery consisted of subfascial anterior transposition following excision of AE muscle.RESULTS: AE muscle was present in 8.5% of all patients, and was more common in patients who were younger and with involvement of their dominant hand; the duration of symptom was shorter in patients with AE muscle. All patients showed postoperative improvement in symptoms according to DASH and VAS scores.CONCLUSION: The possibility of CuTS caused by AE muscle should be considered when younger patients have rapidly aggravated and activity-related cubital tunnel symptoms with a palpable mass in the cubital tunnel area. Excision of AE muscle and anterior ulnar nerve transposition may be considered effective surgical treatment.
Arm ; Classification ; Cubital Tunnel Syndrome ; Hand ; Humans ; Retrospective Studies ; Shoulder ; Ulnar Nerve

Radial nerve entrapment or compression in the upper extremity is relatively rare compared to medial nerve or ulnar nerve entrapment and compression. Various syndrome types are defined according to the location of radial nerve entrapment and the pattern of symptom expression. In the upper arm, Saturday night palsy or honeymoon palsy occurs. Around the elbow, posterior interosseous nerve entrapment syndrome, which involves pure motor symptoms, and radial tunnel syndrome, which mainly involves pain symptoms, can develop. Finally, superficial radial nerve entrapment occurs in the distal forearm and has the symptom of painful or abnormal sensory disturbances of the hand. Conservative treatment is usually the first choice for radial nerve neuropathy, unless there is motor paralysis. Surgical treatment can be considered if there is no improvement after adequate conservative treatment.
Arm ; Elbow ; Forearm ; Hand ; Nerve Compression Syndromes ; Paralysis ; Radial Nerve* ; Radial Neuropathy ; Ulnar Nerve Compression Syndromes ; Upper Extremity

Cubital tunnel syndrome is the second most common compressive neuropathy. Its diagnosis is largely based on clinical findings. It has been well known that patients with mild to moderate grade of cubital tunnel syndrome have a high chance of spontaneous resolution, while those with severe degree do not. Thus, the former is treated with conservative methods initially, and the latter is indicated for surgical intervention. There are three types of surgical techniques for cubital tunnel syndrome. Of these, in-situ decompression technique has been gaining popularity as it is simpler and shows similar efficacy with less complications compared to other techniques. In this review, we deal with current concepts of the cubital tunnel syndrome pertaining to the primary clinical practice.
Cubital Tunnel Syndrome ; Decompression ; Diagnosis ; Humans ; Ulnar Nerve ; Ulnar Neuropathies*

PURPOSE: Moderate to severe cubital tunnel syndrome usually requires surgical treatment. Most surgical outcomes are evaluated 6 months after the procedure; however, subjective symptoms begin to show improvement much earlier. In this study, we explored whether patients who experience early improvement of subjective symptoms have different clinical characteristics and surgical outcomes than those without early improvement. MATERIALS AND METHODS: Between January 2012 and February 2015, 36 surgical cases of moderate- to severe-stage cubital tunnel syndrome (modified McGowan grade IIA, IIB, or III) were included. Nineteen patients (15 males and 4 females with a mean age of 54.3±12.0 years) reported subjective symptom improvements within 14 days postoperatively. Seventeen patients (15 males and 2 females with a mean age of 53.4±11.9 years) did not report any early symptom improvements. Clinical characteristics—hand dominance, sex, smoking history, type of surgery, age, symptom duration, elbow range of motion, grip strength, key pinch strength, 2 point discrimination, pain, quick disabilities of the arm, shoulder and hand (DASH) score, and modified McGowan grade—were analyzed retrospectively using a Mann-Whitney test or chi square test. Surgical outcomes were measured at postoperative 3 and 12 months using repeated-measures ANOVA, and Wilson and Krout criteria were analyzed using a chi-square test. RESULTS: There was a difference in key pinch strength (p<0.001) between the groups. At postoperative 12 months, Wilson and Krout criteria (p=0.029) were associated with early improvement of subjective symptoms. The subjects' quick DASH scores and grip strengths improved over time, but no difference was observed between the groups. CONCLUSION: After surgical treatments of moderate to severe cubital tunnel syndrome, patients who presented early improvement of subjective symptoms, compared with those who did not, had significantly higher preoperative key pinch strength and better surgical outcomes at postoperative 12 months.
Arm ; Cubital Tunnel Syndrome* ; Discrimination (Psychology) ; Elbow ; Female ; Hand ; Hand Strength ; Humans ; Male ; Outcome Assessment (Health Care) ; Pinch Strength ; Range of Motion, Articular ; Retrospective Studies ; Shoulder ; Smoke ; Smoking ; Symptom Assessment