Ulnar neuropathy

Bong Cheol Kwon

doi:10.5124/jkma.2017.60.12.951

J Korean Med Assoc > Volume 60(12); 2017 > Article

Kwon: Ulnar neuropathy

Focused Issue of this Month

Common peripheral neuropathies of the upper extremity

Journal of the Korean Medical Association 2017; 60(12): 951-957.

Published online: December 14, 2017

DOI: http://dx.doi.org/10.5124/jkma.2017.60.12.951

Ulnar neuropathy

Bong Cheol Kwon, MD

Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea.

Corresponding author: Bong Cheol Kwon. cartilage11@hotmail.com

Received October 20, 2017 Accepted November 03, 2017

Korean Medical Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Ulnar nerve; Cubital tunnel syndrome; Therapeutics; Surgery

References

1. Bartels RH, Verbeek AL. Risk factors for ulnar nerve com-pression at the elbow: a case control study. Acta Neurochir (Wien) 2007;149:669-674.

2. Descatha A, Leclerc A, Chastang JF, Roquelaure Y. Incidence of ulnar nerve entrap-ment at the elbow in repetitive work. Study Group on Repetitive Work. Scand J Work Environ Health 2004;30:234-240.

3. An TW, Evanoff BA, Boyer MI, Osei DA. The prevalence of cubital tunnel syndrome: a cross-sectional study in a US metropolitan cohort. J Bone Joint Surg Am 2017;99:408-416.

4. Calfee RP, Manske PR, Gelberman RH, Van Steyn MO, Steffen J, Goldfarb CA. Clinical assessment of the ulnar nerve at the elbow: reliability of instability testing and the association of hypermobility with clinical symptoms. J Bone Joint Surg Am 2010;92:2801-2808.

5. Apfelberg DB, Larson SJ. Dynamic anatomy of the ulnar nerve at the elbow. Plast Reconstr Surg 1973;51:79-81.

6. Gelberman RH, Yamaguchi K, Hollstien SB, Winn SS, Heidenreich FP Jr, Bindra RR, Hsieh P, Silva MJ. Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow: an experimental study in human cadavera. J Bone Joint Surg Am 1998;80:492-501.

7. Lundborg G, Rydevik B. Effects of stretching the tibial nerve of the rabbit: a preliminary study of the intraneural circulation and the barrier function of the perineurium. J Bone Joint Surg Br 1973;55:390-401.

8. Watanabe M, Yamaga M, Kato T, Ide J, Kitamura T, Takagi K. The implication of repeated versus continuous strain on nerve function in a rat forelimb model. J Hand Surg Am 2001;26:663-669.

9. Werner CO, Ohlin P, Elmqvist D. Pressures recorded in ulnar neuropathy. Acta Orthop Scand 1985;56:404-406.

10. Iba K, Wada T, Aoki M, Tsuji H, Oda T, Yamashita T. Intra-operative measurement of pressure adjacent to the ulnar nerve in patients with cubital tunnel syndrome. J Hand Surg Am 2006;31:553-558.

11. Lundborg G. Structure and function of the intraneural micro-vessels as related to trauma, edema formation, and nerve func-tion. J Bone Joint Surg Am 1975;57:938-948.

12. Roy J, Henry BM, PĘkala PA, Vikse J, Saganiak K, Walocha JA, Tomaszewski KA. Median and ulnar nerve anastomoses in the upper limb: a meta-analysis. Muscle Nerve 2016;54:36-47.

13. Buehler MJ, Thayer DT. The elbow flexion test: a clinical test for the cubital tunnel syndrome. Clin Orthop Relat Res 1988;(233):213-216.

14. Novak CB, Lee GW, Mackinnon SE, Lay L. Provocative testing for cubital tunnel syndrome. J Hand Surg Am 1994;19:817-820.

15. Rayan GM, Jensen C, Duke J. Elbow flexion test in the normal population. J Hand Surg Am 1992;17:86-89.

16. Iyer VG. Understanding nerve conduction and electromyo-graphic studies. Hand Clin 1993;9:273-287.

17. Wiesler ER, Chloros GD, Cartwright MS, Shin HW, Walker FO. Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel. J Hand Surg Am 2006;31:1088-1093.

18. Yalcin E, Unlu E, Akyuz M, Karaahmet OZ. Ultrasound diagnosis of ulnar neuropathy: comparison of symptomatic and asymptomatic nerve thickness. J Hand Surg Eur Vol 2014;39:167-171.

19. Britz GW, Haynor DR, Kuntz C, Goodkin R, Gitter A, Maravilla K, Kliot M. Ulnar nerve entrapment at the elbow: correlation of magnetic resonance imaging, clinical, electro-diagnostic, and intraoperative findings. Neurosurgery 1996;38:458-465.

20. Grant GA, Britz GW, Goodkin R, Jarvik JG, Maravilla K, Kliot M. The utility of magnetic resonance imaging in evaluating peripheral nerve disorders. Muscle Nerve 2002;25:314-331.

21. Vucic S, Cordato DJ, Yiannikas C, Schwartz RS, Shnier RC. Utility of magnetic resonance imaging in diagnosing ulnar neuropathy at the elbow. Clin Neurophysiol 2006;117:590-595.

22. Dellon AL, Hament W, Gittelshon A. Nonoperative manage-ment of cubital tunnel syndrome: an 8-year prospective study. Neurology 1993;43:1673-1677.

23. Shah CM, Calfee RP, Gelberman RH, Goldfarb CA. Out-comes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome. J Hand Surg Am 2013;38:1125-1130.

24. Svernlov B, Larsson M, Rehn K, Adolfsson L. Conservative treatment of the cubital tunnel syndrome. J Hand Surg Eur Vol 2009;34:201-207.

25. Osterman AL, Spiess AM. Medial epicondylectomy. Hand Clin 2007;23:329-337.

26. Shi Q, MacDermid JC, Santaguida PL, Kyu HH. Predictors of surgical outcomes following anterior transposition of ulnar nerve for cubital tunnel syndrome: a systematic review. J Hand Surg Am 2011;36:1996-2001.

27. Biggs M, Curtis JA. Randomized, prospective study compa-ring ulnar neurolysis in situ with submuscular transposition. Neurosurgery 2006;58:296-304.

28. Gervasio O, Gambardella G, Zaccone C, Branca D. Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: a pro-spective randomized study. Neurosurgery 2005;56:108-117.

29. Macadam SA, Gandhi R, Bezuhly M, Lefaivre KA. Sim-ple decompression versus anterior subcutaneous and submus-cular transposition of the ulnar nerve for cubital tunnel syndrome: a meta-analysis. J Hand Surg Am 2008;33:1314.

30. Soltani AM, Best MJ, Francis CS, Allan BJ, Panthaki ZJ. Trends in the surgical treatment of cubital tunnel syndrome: an analysis of the national survey of ambulatory surgery database. J Hand Surg Am 2013;38:1551-1556.

31. Gaspar MP, Kane PM, Putthiwara D, Jacoby SM, Osterman AL. Predicting revision following in situ ulnar nerve decom-pression for patients with idiopathic cubital tunnel syndrome. J Hand Surg Am 2016;41:427-435.

32. Krogue JD, Aleem AW, Osei DA, Goldfarb CA, Calfee RP. Predictors of surgical revision after in situ decompression of the ulnar nerve. J Shoulder Elbow Surg 2015;24:634-639.

33. Baek GH, Kwon BC, Chung MS. Comparative study between minimal medial epicondylectomy and anterior subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Shoulder Elbow Surg 2006;15:609-613.