• 대한정형외과학회지
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• 제56권1호
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• pp.98-101
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• 2021

비정상 근육에 의한 척골관 증후군의 발생은 소지외전근의 부근육, 장장근에 의한 것으로 알려져 있고 증상을 유발하는 경우가 드물기 때문에 국내에서는 아직 보고되지 않았다. 저자들은 척골관 증후군을 주소로 내원한 환자에서 소지외전근 부근육을 발견하고 수술적 치료를 시행한 사례를 경험하였다. 척골관 증후군을 호소하는 환자에서 비정상 근육이 척골관 증후군의 원인이 될 수 있음을 염두해 두고 접근하는 것이 중요하겠다.

• Clinics in Shoulder and Elbow
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• 제27권1호
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• pp.131-135
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• 2024

Cubital tunnel syndrome refers to compression neuropathy caused by pressure on the ulnar nerve pathway around the elbow. A 63-year-old male patient visited the clinic complaining of decreased sensation and weakness in his left ring finger and little finger, stating that the symptoms first began 6 months prior. He had undergone surgery to remove a ganglion cyst from his left elbow joint about 5 years prior in Mongolia. Magnetic resonance imaging revealed a cystic mass located at the previous surgical site, which was compressing the ulnar nerve within the cubital tunnel. Ulnar nerve decompression and anterior transposition were performed, and the cystic mass was excised. Upon pathological examination, the mass was diagnosed as a ganglion cyst. The patient's symptoms including sensory dysfunction and weakness improved over the 1-year follow-up period. This report describes a rare case of ganglion cyst recurrence compressing the ulnar nerve in the cubital tunnel after previous ganglion cyst excision.

• Journal of Korean Neurosurgical Society
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• 제59권1호
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• pp.75-77
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• 2016

Double compression of the ulnar nerve, including Guyon's canal syndrome associated with cubital tunnel syndrome caused by the anconeus epitrochlearis muscle, is a very rare condition. We present a case of double crush syndrome of the ulnar nerve at the wrist and elbow in a 55-year-old man, as well as a brief review of the literature. Although electrodiagnostic findings were consistent with an ulnar nerve lesion only at the elbow, ultrasonography revealed a ganglion compressing the ulnar nerve at the hypothenar area and the anconeus epitrochlearis muscle lying in the cubital tunnel. Careful physical examination and ultrasound assessment of the elbow and wrist confirmed the clinical diagnosis prior to surgery.

• Journal of Korean Neurosurgical Society
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• 제42권2호
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• pp.141-144
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• 2007

The association of medial elbow ganglion cyst with cubital tunnel syndrome has been rarely reported. A 61-year-old man presented with progressive right hypothenar atrophy and paresthesia for 7 months. Ultrasonography and magnetic resonance imaging revealed ulnar nerve entrapment with a cystic ganglion in cubital tunnel. Decompression of ulnar nerve and excision of the ganglion were performed. Motor function of the ulnar nerve showed an improvement four months later after surgery. Because most ganglia are occult, imaging study is warranted especially in case with osteoarthritis. Excision of the ganglion performed concurrently with decompression of the ulnar nerve provide satisfactory results.

• Journal of Medicine and Life Science
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• 제15권2호
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• pp.101-104
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• 2018

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by focal compression of the median nerve in the carpal tunnel. However, many patients with CTS, who are diagnosed clinically and confirmed with electrophysiological studies, complain of the sensory symptoms extends to the ulnar nerve territory. The aim of this study was to evaluate whether a dysfunction in sensory fibers of the ulnar nerve was present or not in hands with CTS patients who had extramedian spread of sensory symptoms over the hand. We retrospectively analyzed the recording of the subjects who were diagnosed with CTS within a one-year-period of time. After exclusions, 136 hands recordings of 87 patient were included. We compared the results of median and ulnar nerve sensory conduction studies between normal hands and hands with CTS. We did not detect statistically significant difference on all parameters of ulnar nerve sensory conduction studies between the normal hands and the hands with CTS. The parameters of the obtained in median nerve sensory conduction studies were statistically different between the healthy control and CTS patients. The hands with CTS showed similar rate of ulnar sensory conduction abnormalities compared with the normal hands. In conclusion, our study showed that none of the parameters in ulnar sensory nerve conduction studies differ between two groups. Accordingly, our study revealed that ulnar nerve involvement does not contribute in CTS patients underlying the spread of paresthesia extends to the ulnar nerve territory.

• Journal of Korean Neurosurgical Society
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• 제50권4호
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• pp.377-380
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• 2011

Objective : The purpose of this study was to determine the anatomic relationships between neurovascular structures and the transverse carpal ligament so as to avoid complications during endoscopic carpal tunnel surgery. Methods : Twenty-eight patients (age range, 35-69 years) with carpal tunnel syndrome were entered into the study. We examined through wrist magnetic resonance imaging in three different positions (neutral, radial flexion, and ulnar flexion) and determined several anatomic landmark (distance from the hamate hook to the median nerve, ulnar nerve, and ulnar vessel) based on the lateral margin of the hook of the hamate. The median nerve and ulnar neurovascular structure were studied with the wrist in the neutral, ulnar, and radial flexion positions. Results : The ulnar neurovascular structures usually passed just over or ulnar to the hook of the hamate. However, in 12 hands, a looped ulnar artery coursed 0.6-3.3 mm radial to the hook of the hamate and continued to the superficial palmar arch. The looped ulnar artery migrates on the ulnar side of Guyon's canal (-5.2-1.8 mm radial to the hook of the hamate) with the wrist in radial flexion. During ulnar flexion of the wrist, the ulnar artery shifts more radially beyond the hook of the hamate (-2.5-5.7 mm). Conclusion : It is appropriate to transect the ligament greater than 4 mm apart from the lateral margin of the hook of the hamate without placing the edge of the scalpel toward the ulnar side. We would also recommend not transecting the transverse carpal ligament in the ulnar flexed wrist position to protect the ulnar neurovascular structure.

• Journal of Korean Neurosurgical Society
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• 제66권1호
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• pp.90-94
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• 2023

Objective : Cubital tunnel syndrome, the most common ulnar nerve entrapment neuropathy, is usually managed by simple decompression or anterior transposition. One of the concerns in transposition is damage to the nerve branches around the elbow. In this study, the location of ulnar nerve branches to the flexor carpi ulnaris (FCU) was assessed during operations for cubital tunnel syndrome to provide information to reduce operation-related complications. Methods : A personal series (HJY) of cases operated for cubital tunnel syndrome was reviewed. Cases managed by transposition and location of branches to the FCU were selected for analysis. The function of the branches was confirmed by intraoperative nerve stimulation and the location of the branches was assessed by the distance from the center of medial epicondyle. Results : There was a total of 61 cases of cubital tunnel syndrome, among which 31 were treated by transposition. Twenty-one cases with information on the location of branches were analyzed. The average number of ulnar nerve branches around the elbow was 1.8 (0 to 3), only one case showed no branches. Most of the cases had one branch to the medial head, and one other to the lateral head of the FCU. There were two cases having branches without FCU responses (one branch in one case, three branches in another). The location of the branches to the medial head was 16.3±8.6 mm distal to the medial epicondyle (16 branches; range, 0 to 35 mm), to the lateral head was 19.5±9.5 mm distal to the medial epicondyle (19 branches; range, -5 to 30 mm). Branches without FCU responses were found from 20 mm proximal to the medial condyle to 15 mm distal to the medial epicondyle (five branches). Most of the branches to the medial head were 15 to 20 mm (50% of cases), and most to the lateral head were 15 to 25 mm (58% of cases). There were no cases of discernable weakness of the FCU after operation. Conclusion : In most cases of cubital tunnel syndrome, there are ulnar nerve branches around the elbow. Although there might be some cases with branches without FCU responses, most branches are to the FCU, and are to be saved. The operator should be watchful for branches about 15 to 25 mm distal to the medial epicondyle, where most branches come out.

• Annals of Clinical Neurophysiology
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• 제4권2호
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• pp.108-113
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• 2002

Background and Objective : Carpal tunnel syndrome (CTS) is the most common mononeuropathy encountered in clinical practice. No single procedure or group of procedures has demonstrated adequate sensitivity. F-wave study in CTS is very rarely reported. To determine the diagnostic usefulness of new parameters of F-wave and comparative study of F-wave parameters of median and ulnar nerves in patients with CTS. Methods : F-wave responses of median and ulnar nerves were analyzed from 27 patients with clinically diagnosed CTS and 22 age and gender-matched normal control. Conventional F-wave parameters were studied. Also, the usefulness of new parameters such as mean and maximal ulnar-median F-wave latency differences, ulnar-median F-wave persistence and chronodispersion differences, median/ulnar F-wave amplitude ratio, and F-wave conduction velocity (FCV) using mean and maximal latency were assessed. Results : Compared with controls, median F-wave minimal, maximal and mean latencies, mean F-wave amplitude/M-wave amplitude, minimal, mean and maximal ulnar-median F-wave latency differences, and FCVs using minimal, maximal and mean latency were significant (P<0.05~0.001). Median F-wave minimal, maximal and mean latencies, mean ulnar-median F-wave latency difference, and FCVs using minimal, maximal and mean latency showed high sensitivity and specificity. Mean ulnar-median F-wave latency difference and FCVs using maximal and mean latency were new parameters. Conclusion : New F-wave parameter including mean ulnar- median F-wave latency difference and FCVs using maximal and mean latency may be a useful to assess the CTS. Also, median F-wave minimal, maximal and mean latencies, and FCV using minimal latency may be included in routine diagnostic tests in CTS.

• Journal of Korean Neurosurgical Society
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• 제42권5호
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• pp.382-387
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• 2007

Objective : Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper extremity. Although many different operative techniques have been introduced, none of them have been proven superior to others. Simple cubital tunnel decompression has numerous advantages, including simplicity and safety. We present our experience of treating cubital tunnel syndrome with simple decompression in 15 patients. Methods : According to Dellon's criteria, one patient was classified as grade 1, eight as grade 2, and six as grade 3. Preoperative electrodiagnostic studies were performed in all patients and 7 of them were rechecked postoperatively. Five patients of 15 underwent simple decompression using a small skin incision (2 cm or less). Results : Preoperative mean value of motor conduction velocity (MCV) within the segment (above the elbow-below the elbow) was $41.8{\pm}15.2\;m/s$ and this result showed a decrease compared to the result of MCV in the below the elbow-wrist segment ($57.8{\pm}6.9\;m/s$) with statistical significance (p<0.05). Postoperative mean values of MCV were improved in 6 of 7 patients from $39.8{\pm}12.1\;m/s$ to $47.8{\pm}12.1\;m/s$ (p<0.05). After an average follow-up of $4.8{\pm}5.3$ months, 14 patients of 15 (93%) reported good or excellent clinical outcomes according to a modified Bishop scoring system. Five patients who had been treated using a small skin incision achieved good or excellent outcomes. There were no complications, recurrences, or subluxation of the ulnar nerve. Conclusion : Simple decompression of the ulnar nerve is an effective and successful minimally invasive technique for patients with cubital tunnel syndrome.

• Clinics in Shoulder and Elbow
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• 제8권1호
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• pp.36-42
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• 2005

Purpose: To evaluate the clinical results of anterior subcutaneous ulnar nerve transposition operation and the factors that influence the results for cubital tunnel syndrome. Materials and Methods: Seventeen cases of cubital tunnel syndrome were treated by anterior subcutaneous transposition between March 2001 and December 2003. The mean age was 56 years and mean follow up period was 20.4 months. All patients were reviewed retrospectively. The preoperative evaluation was done by Dellon's classification and the clinical results were evaluated by Messina’s classification. We analyzed the effect of the operation and the relations between the results and the preoperative factors, for example, duration of symptom, age, cause of illness, present of association with diabetes mellitus or preoperative flexion contracture of the elbow were analyzed. Results: The results according to Messina's classification were 4 cases of excellent, 9 cases of good, 3 cases of fair, and 1 case of poor. The preoperative factors like duration of symptom, age, cause of illness and flexion contracture of the elbow didn't show any statistical difference in the result of operation, but the cases which have diabetes mellitus were unsatisfactory with statistical difference (p=0.018). Conclusion: Anterior subcutaneous ulnar nerve transposition is relatively easy and good operative method in cubital tunnel syndrome.