Cubital Tunnel Syndrome: Current Concepts

Abstract

Purpose of Review Compressive neuropathy of the ulnar nerve across the elbow is a common diagnosis encountered frequently within a hand and upper extremity clinical practice. Appropriate and timely evaluation, diagnosis, objective testing, and evidence-based decisions regarding treatment options are paramount in the optimal care of the patient with this pathology. An understanding of current literature is critical in determining and understanding best practices. Recent Findings A thorough review of the recent literature regarding physical examination, diagnostic testing, and nonoperative versus operative results was performed. Regarding physical examination, the glenohumeral internal rotation test and scratch collapse test are more effective and sensitive than traditional maneuvers such as Tinel's testing and the elbow flexion test. Electrodiagnostic testing, magnetic resonance imaging, and ultrasound evaluation have all been shown to be effective in diagnosing cubital tunnel syndrome. However, no single test has proven itself to be superior. Nonoperative treatment can be successful for mild cases of cubital tunnel syndrome. Surgical release techniques comparing open with endoscopic release are equivocal, and in situ release versus transposition techniques show that transposition should not be performed routinely. Summary The diagnosis and treatment of cubital tunnel syndrome do not have a well-defined algorithm based on current literature. The treating physician must therefore utilize the available information to determine a diagnostic and treatment plan individualized to the patient. More rigorous scientific studies are needed to determine the most effective surgical approaches for cubital tunnel syndrome. Keywords Cubital tunnel syndrome . Ulnar neuropathy . Ulnar nerve compression . Ulnar nerve transposition . Cubital tunnel release . In situ decompression This article is part of the Topical Collection on Compressive Neuropathies in the Upper Extremity

Post-Operative Assessment of Ulnar Nerve Tension Using Shear-Wave Elastography

“…Ulnar neuropathy is identified by clinical history, physical examination and electroneuromyography (ENMG), which represents a key component in this diagnosis [2,8]. For mild cases, non-surgical management is indicated [4,9]. Surgical decompression of the ulnar nerve is indicated in cases recalcitrant to conservative management and in patients who initially present a more severe neuropathy.…”

“…With an annual incidence of 24.7 per 100,000 [ 1 ], cubital tunnel syndrome is the second-most common entrapment neuropathy after carpal tunnel syndrome [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Its etiology is mostly idiopathic, although it is favored by repetitive elbow flexion, repetitive trauma, disproportionate strain, snapping triceps syndrome, degenerative arthritis and space-occupying lesions [ 3 ].…”

Ultrasound-guided musculoskeletal interventional procedures around the elbow, hand and wrist excluding carpal tunnel procedures

“…As reported in the ESSR guidelines, steroids can be injected in selected cases, for example in individuals seeking immediate pain relief or those unable to undergo physiotherapy. However, patients should be advised of the The first-line treatment for patients with mild to moderate symptoms is conservative, and consists of patient education on how to avoid provocative activities and elbow positions, splinting and local steroid injections (15) . Steroid injections may improve symptoms (16) , even though some studies reported no significant differences in terms of clinical outcomes compared to the placebo (17) .…”

“…The first-line treatment for patients with mild to moderate symptoms is conservative, and consists of patient education on how to avoid provocative activities and elbow positions, splinting and local steroid injections ( 15 ) . Steroid injections may improve symptoms ( 16 ) , even though some studies reported no significant differences in terms of clinical outcomes compared to the placebo ( 17 ) .…”

“…Steroid injections may improve symptoms ( 16 ) , even though some studies reported no significant differences in terms of clinical outcomes compared to the placebo ( 17 ) . Surgery is required in patients with severe symptoms or non-responsive to conservative treatment ( 15 ) .…”