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cubital_tunnel_syndrome [2020/01/06 11:19]
administrador [Case reports]
cubital_tunnel_syndrome [2020/01/06 11:21] (current)
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 ====== Cubital tunnel syndrome ====== ====== Cubital tunnel syndrome ======
-[[Cubital tunnel]] syndrome is the effect of pressure on the [[ulnar nerve]]. 
-====Epidemiology==== +see [[Ulnar nerve entrapment]].
-It is the second most common reason for peripheral nerve [[entrapment ​neuropathy]] in the upper limb. It is more common in certain occupations. Patients who have diabetes and those who have sustained injuries or degenerative change around the elbow are also at increased risk.+
-===== Treatment ===== 
-[[Cubital tunnel syndrome treatment]]. 
-====Case series==== 
-Between January 2010 and March 2015, 42 consecutive cases of CuTS with atrophy of the intrinsic hand muscles were surgically treated in the Department of Neurosurgery,​ Goethe University, [[Frankfurt]],​ [[Germany]]. 
-Clinical data of the treatment course and postoperative results were collected. Follow-up was prospectively assessed according to McGowen grading and Bishop outcome score. Mean follow-up time was 39.8 (±17.0) months. 
-All patients were treated with in situ decompression;​ in 33%, submuscular transposition was performed. Forty-five percent showed improvement of sensory deficits and 57% showed improvement of motor deficits 6 months after the operation. Atrophy improved in 76%. At the time of follow-up, 79% were satisfied with the postoperative result and 77% of patients reached good or excellent outcome according to modified Bishop rating scale. Patients with improvement of atrophy had significantly shorter symptom duration period (7 ± 10 months vs 26 ± 33 months; p <​ 0.05). In the case of intraoperative pseudoneuroma observation,​ atrophy improvement was less likely (p <​ 0.05). 
-In severe cases of CuTS with atrophy of the intrinsic hand muscles, surgical treatment enables improvement of sensory function, motor function and atrophy even in cases with muscular atrophy. Atrophy improvement was more likely in cases of short symptom duration and less likely in cases with pseudoneuroma 
-((Bruder M, Dützmann S, Rekkab N, Quick J, Seifert V, Marquardt G. Muscular 
-atrophy in severe cases of cubital tunnel syndrome: prognostic factors and 
-outcome after surgical treatment. Acta Neurochir (Wien). 2017 Jan 21. doi: 
-10.1007/​s00701-017-3086-3. [Epub ahead of print] PubMed PMID: 28110402. 
-54 patients underwent ulnar nerve decompression for 56 cubital tunnel syndromes from October 2008 to April 2011. All patients presented with typical clinical and neurophysiological findings and underwent preoperative nerve ultrasonography. They were randomized for either endoscopic (n = 29) or open (n = 27) surgery. Both patients and the physician performing the follow-up examinations were blinded. The follow-up took place 3, 6, 12, and 24 months postoperatively. The severity of symptoms was measured by [[McGowan classification]] and Dellon Score, and the clinical outcome by modified Bishop Score. Additionally,​ the neurophysiological data were evaluated. 
-No differences were found regarding clinical or neurophysiological outcome in both early and late follow-up between both groups. Hematomas were more frequent after endoscopic decompression (P = .05). The most frequent constrictions were found at the flexor carpi ulnaris (FCU) arch and the retrocondylar retinaculum. We found no compressing structures more than 4 cm distal from the sulcus in the endoscopic group. The outcome was classified as "​good"​ or "​excellent"​ in 46 out of 56 patients (82.1%). Eight patients did not improve sufficiently or had a relapse and underwent a second surgery. 
-The endoscopic technique showed no additional benefits to open surgery. We could not detect relevant compressions distal to the FCU arch. Therefore, an extensive far distal endoscopic decompression is not routinely required. The open decompression remains the procedure of choice at our institution 
-((Schmidt S, Kleist Welch-Guerra W, Matthes M, Baldauf J, Schminke U, Schroeder ​ 
-HW. Endoscopic vs Open Decompression of the Ulnar Nerve in Cubital Tunnel 
-Syndrome: A Prospective Randomized Double-Blind Study. Neurosurgery. 2015 
-Dec;​77(6):​960-71. doi: 10.1227/​NEU.0000000000000981. PubMed PMID: 26595347. 
-===== Case reports ===== 
-In cases of ulnar nerve compression at the cubital tunnel, both [[neurolysis]] and transposition are effective in improving clinical outcome. The only statistically significant advantage of neurolysis over transposition seems to be relief of localized elbow pain. Kamat et al,​recommend neurolysis as the preferred procedure 
-((Kamat AS, Jay SM, Benoiton LA, Correia JA, Woon K. Comparative outcomes of 
-ulnar nerve transposition versus neurolysis in patients with entrapment 
-neuropathy at the cubital tunnel: a 20-year analysis. Acta Neurochir (Wien). 2014 
-Jan;​156(1):​153-7. doi: 10.1007/​s00701-013-1962-z. Epub 2013 Dec 3. PubMed PMID: 
-There are correlation between 3-Tesla [[magnetic resonance neurography]] (MRN) and surgical findings in two patients who underwent multiple previous failed ulnar nerve surgeries. MRN correctly localized the site of the abnormality. Prospectively observed MRN findings of perineural fibrosis, ulnar nerve re-entrapment abnormalities,​ medial antebrachial cutaneous neuroma and additional median nerve entrapment were confirmed surgically ((Chhabra A, Wadhwa V, Thakkar RS, Carrino JA, Dellon AL. Recurrent ulnar nerve  
-entrapment at the elbow: Correlation of surgical findings and 3-Tesla magnetic 
-resonance neurography. Can J Plast Surg. 2013 Fall;​21(3):​186-9. PubMed PMID: 
cubital_tunnel_syndrome.txt · Last modified: 2020/01/06 11:21 by administrador