Journal List > J Korean Soc Surg Hand > v.21(1) > 1106552

TOOLS
Yoon, Yoo, Kim, Paeng, Kim, and Woo: Comparison of Cubital Tunnel Syndrome with or without Anconeus Epitrochlearis: Are They Different?
ORIGINAL ARTICLE

J Korean Soc Surg Hand 2016;21(1):8-15.

Published online: 11 March 2016

DOI: https://doi.org/10.12790/jkssh.2016.21.1.8

Comparison of Cubital Tunnel Syndrome with or without Anconeus Epitrochlearis: Are They Different?

Min Geun Yoon1, Myung Jae Yoo2, Jong Min Kim2, Jung Wook Paeng2, Young Woo Kim2, Sang Hyun Woo2,

1Department of Orthopedic Surgery, Cheju Halla General Hospital, Jeju

2W Institute for Hand and Reconstructive Microsurgeyr, W Hospital, Daegu, Korea

Correspondence to: Sang-Hyun Woo, W institute for Hand and Reconstructive Microsurgery, W Hospital, 1632 Dalgubeol-daero, Dalseo-gu, Daegu 42642, Korea, TEL: +82-53-550-5000, FAX: +82-53-552-4000, E-mail: handwoo@hotmail.com

Received 12 September 201527 December 2015       Accepted 7 January 2016

Copyright © 2016 The Korean Society for Surgery of the Hand

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

Purpose:

To assess the clinical difference between cubital tunnel syndrome with anconeus epitrochlearis (AE) and idiopathic cubital tunnel syndrome without known other causes.

Methods:

This cross-sectional study included the 326 patients who were subjected to surgery because of cubital tunnel syndrome from 2008 to 2014. After exclusion of patients with other known causes of cubital tunnel syndrome, a total of 107 patients were divided into two groups; patients with and without AE. The clinical differences between two groups were analyzed retrospectively; age, sex, presence of intrinsic muscle atrophy, interval from symptom development to surgery, pinch power, the disabilities of the arm, shoulder and hand score and the nerve conduction velocity (NCV).

Results:

Thirty four (10.4%) patients, being subjected to surgery had the AE. Among 107 patients who had no other known causes, 26 patients had AE. 19 out of 26 patients with AE was male. Average age of patients with AE was significantly younger. The interval from symptom development to surgery in AE patients was significantly shorter. Motor NCV of ulnar nerve at above elbow joint in comparison with that at below elbow joint in AE patient was more significantly decreased (14.3 m/sec vs. 8.3 m/sec).

Conclusion:

The AE in cubital tunnel syndrome is no more rare structure. In younger male patients with rapidly progressive worsening cubital tunnel symptoms, and if there is significant decrease of ulnar motor nerve velocity at above elbow in comparison with at below elbow, the AE should be considered as cause of ulnar neuropathy.

Keywords: Cubital tunnel syndrome, Ulnar nerve, Anconeus epitrochlearis

REFERENCES

1. Assmus H, Antoniadis G, Bischoff C, et al. Cubital tunnel syndrome: a review and management guidelines. Cent Eur Neurosurg. 2011; 72:90–8.
2. Morgenstein A, Lourie G, Miller B. Anconeus epitrochlearis muscle causing dynamic cubital tunnel syndrome: a case series. J Hand Surg Eur Vol. 2016; 41:227–9.
crossref
3. Nellans K, Galdi B, Kim HM, Levine WN. Ulnar neuropathy as a result of anconeus epitrochlearis. Orthopedics. 2014; 37:e743–5.
crossref
4. Cheriyan T, Neuhaus V, Mudgal CS. Velocity drop in anconeus epitrochlearis-associated cubital tunnel syndrome. Am J Orthop (Belle Mead NJ). 2014; 43:227–9.
5. Yalcin E, Demir SO, Dizdar D, Buyukvural S, Akyuz M. Hypertrophic ancenous epitrochlearis muscle as a cause of ulnar neuropathy at elbow. J Back Musculoskelet Rehabil. 2013; 26:155–7.
crossref
6. Li X, Dines JS, Gorman M, Limpisvasti O, Gambardella R, Yocum L. Anconeus epitrochlearis as a source of medial elbow pain in baseball pitchers. Orthopedics. 2012; 35:e1129–32.
crossref
7. Dekelver I, Van Glabbeek F, Dijs H, Stassijns G. Bilateral ulnar nerve entrapment by the M. anconeus epitrochlearis: a case report and literature review. Clin Rheumatol. 2012; 31:1139–42.
crossref
8. Guidicelli T, Londner J, Gonnelli D, Magalon G. Two anomalous muscles of a forearm revealed by ulnar nerve compressions, a Double Crush syndrome. Ann Chir Plast Esthet. 2014; 59:208–11.
9. Tiong WH, Kelly J. Ulnar nerve entrapment by anconeus epitrochlearis ligament. Hand Surg. 2012; 17:83–4.
crossref
10. Byun SD, Kim CH, Jeon IH. Ulnar neuropathy caused by an anconeus epitrochlearis: clinical and electrophysiological findings. J Hand Surg Eur Vol. 2011; 36:607–8.
crossref
11. Boero S, Senes FM, Catena N. Pediatric cubital tunnel syndrome by anconeus epitrochlearis: a case report. J Shoulder Elbow Surg. 2009; 18:e21–3.
crossref
12. Jeon IH, Fairbairn KJ, Neumann L, Wallace WA. MR imaging of edematous anconeus epitrochlearis: another cause of medial elbow pain? Skeletal Radiol. 2005; 34:103–7.
crossref
13. Hsu RW, Chen CY, Shen WJ. Ulnar nerve palsy due to concomitant compression by the anconeus epitrochlearis muscle and a ganglion cyst. Orthopedics. 2004; 27:227–8.
crossref
14. O'Hara JJ, Stone JH. Ulnar nerve compression at the elbow caused by a prominent medial head of the triceps and an anconeus epitrochlearis muscle. J Hand Surg Br. 1996; 21:133–5.
15. Masear VR, Hill JJ Jr, Cohen SM. Ulnar compression neuropathy secondary to the anconeus epitrochlearis muscle. J Hand Surg Am. 1988; 13:720–4.
crossref
16. Dahners LE, Wood FM. Anconeus epitrochlearis, a rare cause of cubital tunnel syndrome: a case report. J Hand Surg Am. 1984; 9:579–80.
crossref
17. Uscetin I, Bingol D, Ozkaya O, Orman C, Akan M. Ulnar nerve compression at the elbow caused by the epitrochleoanconeus muscle: a case report and surgical approach. Turk Neurosurg. 2014; 24:266–71.
18. Gervasio O, Zaccone C. Surgical approach to ulnar nerve compression at the elbow caused by the epitrochleoanconeus muscle and a prominent medial head of the triceps. Neurosurgery. 2008; 62:186–92.
crossref
19. Gessini L, Jandolo B, Pietrangeli A, Occhipinti E. Ulnar nerve entrapment at the elbow by persistent epitrochleoanconeus muscle: case report. J Neurosurg. 1981; 55:830–1.
20. Hirasawa Y, Sawamura H, Sakakida K. Entrapment neuropathy due to bilateral epitrochleoanconeus muscles: a case report. J Hand Surg Am. 1979; 4:181–4.
crossref
21. Capdarest-Arest N, Gonzalez JP, Turker T. Hypotheses for ongoing evolution of muscles of the upper extremity. Med Hypotheses. 2014; 82:452–6.
crossref
22. Mirza A, Mirza JB, Lee BK, Adhya S, Litwa J, Lorenzana DJ. An anatomical basis for endoscopic cubital tunnel release and associated clinical outcomes. J Hand Surg Am. 2014; 39:1363–9.
crossref
23. Babusiaux D, Laulan J, Bouilleau L, et al. Contribution of static and dynamic ultrasound in cubital tunnel syndrome. Orthop Traumatol Surg Res. 2014; 100:S209–12.
crossref
24. Girtler MT, Krasinski A, Dejaco C, et al. Feasibility of 3D ultrasound to evaluate upper extremity nerves. Ultraschall Med. 2013; 34:382–7.
crossref
25. Husarik DB, Saupe N, Pfirrmann CW, Jost B, Hodler J, Zanetti M. Elbow nerves: MR findings in 60 asymptomatic subjects: normal anatomy, variants, and pitfalls. Radiology. 2009; 252:148–56.
26. O'Driscoll SW, Horii E, Carmichael SW, Morrey BF. The cubital tunnel and ulnar neuropathy. J Bone Joint Surg Br. 1991; 73:613–7.
27. Dellon AL. Musculotendinous variations about the medial humeral epicondyle. J Hand Surg Br. 1986; 11:175–81.
crossref
28. Campbell WW, Pridgeon RM, Riaz G, Astruc J, Sahni KS. Variations in anatomy of the ulnar nerve at the cubital tunnel: pitfalls in the diagnosis of ulnar neuropathy at the elbow. Muscle Nerve. 1991; 14:733–8.
crossref
29. Kleinman WB, Bishop AT. Anterior intramuscular transposition of the ulnar nerve. J Hand Surg Am. 1989; 14:972–9.
crossref

Fig. 1.
A fifty-eight year-old patient had surgery for cubital tunnel syndrome. The interval from symptom development to surgery was about 12 months and she had no atrophy of intrinsic muscle of her left hand. The anconeus epitrochlearis (white arrow) was noted as intermediate signal on T1 (A), T2 (B)-weighted magnetic resonance imaging of her elbow. (C) Thick anconeus epitrochlearis (black arrows) cover the ulnar nerve (black arrow head) and make a roof of cubital tunnel of her left elbow. (D) After excision of the muscle, swollen ulnar nerve (black arrow head) is exposed with tension free in the tunnel.
jkssh-21-8f1.tif
Table 1.
Demographic data in AE induced and idiopathic cubital tunnel syndrome patients
Parameter AE patients (n=26) Idiopathic patients (n=81) p-value
Age (yr) 44±12 51±11 0,005
Sex (male:female) 19:7 40:41 0,042

AE, anconeus epitrochlearis.

Table 2.
The clinical differences between AE Induced and Idiopathic cubital tunnel syndrome patients
Parameter AE patients Idiopathic patients p-value
Interval (mo) 4.3±3.5 13.9±20.2 -
Preop. DASH score 40.4±16.4 42.8±14.9 0.551
Postop. change of DASH score -0.5±16.2 -1.7±20.3 0.834
Preop. pinch power (lb) 12.6±6.1 11.5±5.6 0.437
Postop. change of pinch power (lb) 0,4±4,9 1.4±4.2 0.375

Values are presented as mean±standard deviation.

AE, anconeus epitrochlearis; Interval, the interval from symptom development to surgery; Preop., preoperative; DASH, disabilities of the arm, shoulder and hand; Postop., postoperative.

Table 3.
The preoperative and postoperative values of nerve conduction velocity In AE induced and idiopathic cubital tunnel syndrome patients
Parameter AE Patients Idiopathic patients p-value
Preop. motor NCV (A)* (m/sec) 34.3±19.3 41.9±17.7 0.086
Preop. sensory NCV (A)* (m/sec) 23.8±25.6 30.5±25.8 0.285
Preop. motor NCV (B)† (m/sec) 51.3±13 50.8±16.8 0.907
Preop. sensory NCV (B)† (m/sec) 34.6±30.5 38.6±29.2 0.579
Postop. change of motor NCV (A)* (m/sec) 22.6±23.0 8.1±13.0 0.088
Postop. change of motor NCV (B)† (m/sec) 6.9±17.0 5.8±10.3 0.855
Difference of preop. motor NCV between (A)* and (B)† (m/sec) -14.3±16.2 -8.3±12.2 0.047
Difference of preop. sensory NCV between (A)* and (B)† (m/sec) -9.1±18.1 -7.5±14.5 0.652

AE, anconeus epitrochlearis; Preop., preoperative; NCV, nerve conduction velocity; Postop., postoperative.

* (A), at above elbow;

† (B), at below elbow.

TOOLS
Similar articles