Regional anatomic structures of the elbow that may potentially compress the ulnar nerve

Karataş, Ayşe; Apaydın, Nihal; Uz, Aysun; Tubbs, Shane; Loukas, Marios; Gezen, Ferruh

doi:10.1016/j.jse.2009.03.004

Cited by 60 publications

(60 citation statements)

References 18 publications

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“…Multiple muscle bundles of the FDS arising from the IMA between the FDS and FCU have been reported previously in 4 of 12 limbs, with these bundles overlying the ulnar nerve [13]. In the present study, there were between 1 and 5 separate FDS bundles in 76% of 50 limbs.…”

Section: Discussionsupporting

confidence: 74%

“…The structures thought to be responsible for ulnar nerve compression below the cubital tunnel are the muscular fascia under the FCU [20] and the intermuscular aponeurosis (IMA) between the FCU and the FDS [2,5]. The muscle bundles of the FDS attached to the IMA between the FCU and the FDS reportedly create a muscle tunnel over the ulnar nerve [13]. The muscle bundle overlying the ulnar nerve may cause compressive neuropathy [7,22].…”

Section: Introductionmentioning

confidence: 99%

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Separate muscle bundles of the flexor digitorum superficialis overlying the ulnar nerve

et al. 2015

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Separate muscle bundles of the flexor digitorum superficialis overlying the ulnar nerve

et al. 2015

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“…1 Common areas of ulnar nerve compression are the arcade of Struthers, the medial intermuscular septum, the medial epicondyle, the narrow cubital tunnel, the arcade of Osborne (fibro-aponeurotic tissue connecting the humeral and ulnar heads of the flexor carpi ulnaris), and the aponeurosis of the deep flexor and pronator teres. 2 Furthermore, during elbow flexion, traction forces on the ulnar nerve are major causes of increased intraneural pressure. 3 The cubital tunnel changes from an oval to a flattened ellipse, 4 where flexion pressures within the tunnel may increase by 7 times.…”

mentioning

confidence: 99%

Endoscopic Robotic Decompression of the Ulnar Nerve at the Elbow

Garcia

Montero

2014

Arthroscopy Techniques

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Ulnar nerve entrapment can be treated by a number of surgical techniques when necessary. Endoscopic techniques have recently been developed to access the ulnar nerve by use of a minimally invasive approach. However, these techniques have been considered difficult and, many times, dangerous procedures, reserved for experienced elbow arthroscopic surgeons only. We have developed a new endoscopic approach using the da Vinci robot (Intuitive Surgical, Sunnyvale, CA) that may be easier and safer. Standardization of the technique was previously developed in cadaveric models to achieve the required safety, reliability, and organization for this procedure, and the technique was then used in a live patient. In this patient the nerve entrapment symptoms remitted after the surgical procedure. The robotic surgical procedure presented a cosmetic advantage, as well as possibly reduced scar formation. This is the first note on this surgical procedure; the procedure needs to be tested and even evolved until a state-of-the-art standard is reached.

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“…1). Thereafter, the patient was consulted for a possible surgical treatment.Cubital tunnel syndrome (CuTS) is the second most frequent peripheral nerve entrapment syndrome only after carpal tunnel syndrome [1]. Other than factors related with overuse, some anatomical predisposition may also be present in CuTS.…”

mentioning

confidence: 99%

“…Other than factors related with overuse, some anatomical predisposition may also be present in CuTS. This encompasses several anatomic variations, such as the arcade of Struthers, cubital tunnel retinaculum, the humeroulnar aponeurotic arcade, the epitrochleoanconeus muscle and the ligament of Osborne [1]. Although very few, dilated veins or recurrent great vein compressing the ulnar nerve within the tunnel have been also mentioned [2].…”

mentioning

confidence: 99%

Ulnar nerve compression possibly due to aberrant veins: sonography is elucidatory for idiopathic cubital tunnel syndrome

Kılıç

Özçakar

2010

Rheumatol Int

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A 38-year-old man (waiter) was seen due to right elbow pain for the last 6 months. He declared that the pain was mainly localized on the medial side of the joint and sometimes radiated to the right fifth finger (worse with physical activity especially after carrying trays for long duration). The patient had been given a forearm splint with a diagnosis of medial epicondylitis; but his complaint had not improved despite 1 month of splint use. He denied having any trauma or neck pain, and the medical history was otherwise unremarkable.On physical examination, neck range of motions and spurling tests were normal. The right elbow joint motions were free and painless. The right cubital tunnel was tender to palpation with a positive Tinnel sign. Sensory examination revealed hypoesthesia on the right fifth digit. The rest of the neurological examination was unremarkable. Cervical X-rays were noncontributory. Segmental ulnar nerve conduction studies were performed bilaterally. Motor conduction velocities (belowabove elbow, wrist-below elbow) were 52 and 65 m/s on the right; 62 and 63 m/s on the left side, respectively. Amplitude drop was not observed and sensory conductions were also normal. Thereafter, comparative sonographic imaging of the cubital tunnels was performed. While the ulnar nerves were similar on both sides, venous structures were detected on the right side (Fig. 1). Thereafter, the patient was consulted for a possible surgical treatment.Cubital tunnel syndrome (CuTS) is the second most frequent peripheral nerve entrapment syndrome only after carpal tunnel syndrome [1]. Other than factors related with overuse, some anatomical predisposition may also be present in CuTS. This encompasses several anatomic variations, such as the arcade of Struthers, cubital tunnel retinaculum, the humeroulnar aponeurotic arcade, the epitrochleoanconeus muscle and the ligament of Osborne [1]. Although very few, dilated veins or recurrent great vein compressing the ulnar nerve within the tunnel have been also mentioned [2]. However, these findings are almost always observed during surgery. In our case, along with the electrodiagnostic testing, we tried to image the cubital tunnel by sonography. Interestingly, we have observed two veins very close to the ulnar nerve in the tunnel. Keeping in mind the history of the patient, we have considered that intermittent venous compression might have possibly caused his complaints. Yet, venous stasis/ dilatation can ensue during isometric contraction of the upper limb muscles [3]. We also believe that the mild decrease in the nerve conduction velocity at the right cubital tunnel from 65 to 52 m/s could support our hypothesis. Herewith, we underscore the diagnostic role of sonographic imaging in CuTS patients who would otherwise be classified as idiopathic. Once again, we caution physicians to always rule out disorders of the cervical spine before they establish a diagnosis regarding entrapment of the peripheral nerves. This would especially be true for those planned to undergo surgery.

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Regional anatomic structures of the elbow that may potentially compress the ulnar nerve

Cited by 60 publications

References 18 publications

Separate muscle bundles of the flexor digitorum superficialis overlying the ulnar nerve

Separate muscle bundles of the flexor digitorum superficialis overlying the ulnar nerve

Endoscopic Robotic Decompression of the Ulnar Nerve at the Elbow

Ulnar nerve compression possibly due to aberrant veins: sonography is elucidatory for idiopathic cubital tunnel syndrome

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