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

Min Geun Yoon; Myung Jae Yoo; Jong Min Kim; Jung Wook Paeng; Young Woo Kim; Sang Hyun Woo

doi:10.12790/jkssh.2016.21.1.8

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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 Woo^2,

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

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

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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.

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.

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