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

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

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

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*

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

Double compression of the ulnar nerve, including Guyon's canal syndrome associated with cubital tunnel syndrome caused by the anconeus epitrochlearis muscle, is a very rare condition. We present a case of double crush syndrome of the ulnar nerve at the wrist and elbow in a 55-year-old man, as well as a brief review of the literature. Although electrodiagnostic findings were consistent with an ulnar nerve lesion only at the elbow, ultrasonography revealed a ganglion compressing the ulnar nerve at the hypothenar area and the anconeus epitrochlearis muscle lying in the cubital tunnel. Careful physical examination and ultrasound assessment of the elbow and wrist confirmed the clinical diagnosis prior to surgery.
Crush Syndrome* ; Cubital Tunnel Syndrome ; Deception ; Diagnosis* ; Elbow ; Ganglion Cysts* ; Humans ; Middle Aged ; Physical Examination ; Ulnar Nerve* ; Ultrasonography* ; Wrist

PURPOSE: To assess the clinical difference between cubital tunnel syndrome with anconeus epitrochlearis (AE) and idiopathic cubital tunnel syndrome without known other causes. METHODS: This cross-sectional study included the 326 patients who were subjected to surgery because of cubital tunnel syndrome from 2008 to 2014. After exclusion of patients with other known causes of cubital tunnel syndrome, a total of 107 patients were divided into two groups; patients with and without AE. The clinical differences between two groups were analyzed retrospectively; age, sex, presence of intrinsic muscle atrophy, interval from symptom development to surgery, pinch power, the disabilities of the arm, shoulder and hand score and the nerve conduction velocity (NCV). RESULTS: Thirty four (10.4%) patients, being subjected to surgery had the AE. Among 107 patients who had no other known causes, 26 patients had AE. 19 out of 26 patients with AE was male. Average age of patients with AE was significantly younger. The interval from symptom development to surgery in AE patients was significantly shorter. Motor NCV of ulnar nerve at above elbow joint in comparison with that at below elbow joint in AE patient was more significantly decreased (14.3 m/sec vs. 8.3 m/sec). CONCLUSION: The AE in cubital tunnel syndrome is no more rare structure. In younger male patients with rapidly progressive worsening cubital tunnel symptoms, and if there is significant decrease of ulnar motor nerve velocity at above elbow in comparison with at below elbow, the AE should be considered as cause of ulnar neuropathy.
Arm ; Cross-Sectional Studies ; Cubital Tunnel Syndrome* ; Elbow ; Elbow Joint ; Hand ; Humans ; Male ; Muscular Atrophy ; Neural Conduction ; Retrospective Studies ; Shoulder ; Ulnar Nerve ; Ulnar Neuropathies

PURPOSE: Simple decompression of the ulnar nerve has outcomes similar to anterior transposition for cubital tunnel syndrome; however, there is no consensus on the proper technique for patients with an unstable ulnar nerve. We hypothesized that 1) simple decompression or anterior ulnar nerve transposition, depending on nerve stability, would be effective for cubital tunnel syndrome and that 2) there would be determining factors of the clinical outcome at two years. MATERIALS AND METHODS: Forty-one patients with cubital tunnel syndrome underwent simple decompression (n=30) or anterior transposition (n=11) according to an assessment of intra-operative ulnar nerve stability. Clinical outcome was assessed using grip and pinch strength, two-point discrimination, the mean of the disabilities of arm, shoulder, and hand (DASH) survey, and the modified Bishop Scale. RESULTS: Preoperatively, two patients were rated as mild, another 20 as moderate, and the remaining 19 as severe according to the Dellon Scale. At 2 years after operation, mean grip/pinch strength increased significantly from 19.4/3.2 kg to 31.1/4.1 kg, respectively. Two-point discrimination improved from 6.0 mm to 3.2 mm. The DASH score improved from 31.0 to 14.5. All but one patient scored good or excellent according to the modified Bishop Scale. Correlations were found between the DASH score at two years and age, pre-operative grip strength, and two-point discrimination. CONCLUSION: An ulnar nerve stability-based approach to surgery selection for cubital tunnel syndrome was effective based on 2-year follow-up data. Older age, worse preoperative grip strength, and worse two-point discrimination were associated with worse outcomes at 2 years.
Adult ; Cubital Tunnel Syndrome/*diagnosis/physiopathology/*surgery ; Decompression, Surgical/*methods ; Female ; Follow-Up Studies ; Hand/surgery ; Hand Strength ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures/*methods ; Prospective Studies ; Recovery of Function ; Surveys and Questionnaires ; Treatment Outcome ; Ulnar Nerve/physiopathology/*surgery ; Young Adult