PubMed · 10697210
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J L Ellstein. 2000. Operating on cubital tunnel syndrome without electrodiagnostics.. https://doi.org/10.1097/00006534-200002000-00073
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We report on a patient with an unusual anatomic variation along the course of ulnar nerve above the elbow who had cubital tunnel syndrome. The variation consisted of a cutaneous neural branch that was originating at a distance of approximately 40 mm proximal to the medial epicondyle, and from the radial aspect of the main trunk of ulnar nerve. The branch had a superficial course and it was passing distally, anterior to the medial epicondyle without penetrating the fascia of the flexor muscles origin. Anterior intramuscular transposition of the ulnar nerve was performed leaving the newly found branch over the fascia between the muscles and the adipose subcutaneous tissue.
The ulnar nerve passes posterior to the medial epicondyle and experiences longitudinal strain when subjected to elbow flexion. Furthermore, Osborne's ligament and the arcade of fibers between the 2 heads of the flexor carpi ulnaris (Osborne's fascia) compress the nerve during elbow flexion with narrowing of the cubital tunnel passageway. Some patients experience the added element of nerve subluxation over the posterior edge of the epicondyle. When changes to daytime ergonomic behavior and sleep posture prove insufficient to relieve a patient's symptoms, surgical treatment is warranted. A range of procedures exists from simple decompression, to medial epicondylectomy, to anterior transposition. Transposition has been the most widely used method of treatment with the final position of the nerve lying subcutaneous, intramuscular, or submuscular. Each of the transposition methods has proponents with a variety of arguments made in favor of specific aspects of the surgery. This article presents a form of anterior transposition that seeks to draw the best elements from previously reported techniques with the goal of optimizing results.