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As hand therapists, we commonly treat cubital tunnel syndrome in patients both conservatively
and postoperatively. It is interesting to learn that questions still arise regarding
the cause of this nerve entrapment. Is it due to compression of the cubital tunnel
wall, stretching of the nerve itself, or a combination of these factors? Previous
studies have examined interstitial pressure within the cubital tunnel and have shown
increased pressure with increased elbow flexion. However, these studies have all been
performed in the cadaver lab. In this present study from Japan, pressure around the
ulnar nerve was measured during surgery and a link was found to the duration of the
disease and the severity of the neuropathy.
Method: The study looked at eight patients undergoing decompression of the cubital tunnel.
All of the patients complained of pain, numbness and parathesias of the ulnar hand,
and loss of strength. The patients also demonstrated a positive Tinel's sign at the
elbow, atrophy of the intrinsic muscles, decreased motor nerve conduction velocity,
and symptom reproduction with elbow flexion. All eight patients demonstrated severe
symptoms of cubital tunnel syndrome warranting surgical decompression. The Akahori
classification system was used to grade the severity of the cubital tunnel syndrome.
The surgical technique used is described. Pressures in each elbow were recorded at
three locations: 1 cm, 2 cm, and 3 cm distal to the proximal edge of the cubital tunnel retinaculum. Measurements at
each location were performed with the elbow flexed to 130° and in full extension.
The measurements were taken three times and an average of the three was recorded.
Statistical Analysis: The Student's t-test was used to evaluate the difference in pressures between elbow
flexion and elbow extension and the differences in pressure between elbow flexion
and the stages of ulnar nerve palsy. The Pearson's correlation analysis was used to
study the relationship between age and pressure, motor nerve conduction velocity and
pressure, and disease duration and pressure.
Results: The statistical analysis indicates a statistically significant difference in the
measurement of extraneural pressure with elbow flexion over elbow extension and increased
pressure more proximally to the cubital tunnel than distally. Results of the statistical
analysis also show a positive correlation between extraneural pressure with elbow
flexion and the severity of the disease at each location in the cubital tunnel. The
pressures also correlated positively with motor nerve conduction velocity.
Conclusions: Previous studies on pressure around the ulnar nerve in cubital tunnel have been performed
in the cadaver lab. This study measures pressure around the ulnar nerve during surgery
and finds correlations with the amount of pressure and the severity of the nerve entrapment.
A transducer-tipped fiberoptic probe is used to for intraoperative pressure measurement.
This device was created for intracranial pressure monitoring. It is simple to use
and has a rapid response to pressure changes.
Reviewer's Commentary: This study makes no statement regarding the causative factors leading to cubital
tunnel syndrome. However, the authors suggest that external compression plays a significant
role in the development of ulnar nerve entrapment. They conclude that simple decompression
of the ulnar nerve is insufficient and selected anterior transposition of the ulnar
nerve as the surgical technique in all eight patients.
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Article info
Publication history
Iba K, Wada T, Aoki M, Tsuji H, Oda T, Yamashita T. J Hand Surg. 2006;31A:553–8.
Footnotes
Abstracts from the Literature editor is Greg Hritzo, MPT CHT [email protected]
Identification
Copyright
© 2006 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
