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Tuesday 15 May 2018



  • compression neuropathies of ulnar N in about the elbow
Compression sites of ulnar n at elbow
  • Arcade of Struthers
  • medial intermuscular septum
  • medial epicondyle
  • cubital tunnel
  • Osborne's fascia
Image result for cubital tunnel syndrome

Pathophysiology and anatomy
  • mid arm – ulnar n pierces inter muscular septum – runs distally posterior to it – approx 8cm proximal to medial epicondyle – pass through arcade of struthers
  • continues posterior to intermuscular septum – edge of septum can cause compression
  • lies in retro condylar groove of medial epicondyle – potential to cause compression
  • cubital tunnel – fibro osseous tunnel – anteriorly medial epicondyle – ulno humeral ligament posterolaterally and roof formed by cubitus tunnel retinaculam
  • Osbourne's fascia – connects the heads of FCU to medial epicondyle and olecranon – confused with cubital tunnel retinaculam
  • flexion of elbow – increased intraneural pressure in Ulnar n – decreased volume of cubital tunnel – normally glides to accommodate elbow flexion -if tethered by scar / fibrosis – nerve experiences traction – affects function
  • trauma, deformity, malunion/ non union of medial epicondyle – elbow instability – spur or bony fragments in floor of cubital tunnel – abnormal muscles – tumors
Clinical features
  • numbness and paraesthesia along ulnar N distribution – small finger, ulnar half of ring, ulnar aspect of hand – exacerbated by leaning on elbow or flexion
  • atrophy of interossei, hypothenar, add.pollicis
  • grip weakness – weakness of FDP to small and ring fingers
  • loss of dexterity of fingers
  • decreased ability to cross fingers
  • Froment's sign – hyper flexion of IP jt
  • Learner's sign – hyper extension of MCP of thumb
    • both elicited by key pinch
  • Waterberg's sign – abduction of the small finger with extension of fingers at MCP – interossei dysfunction
  • confrontation test – hands with palmar surface towards face of patient – small fingers brought together – asymmetrical collapse of weak small finger to side of ring finger
  • Provocative tests
    • Tinel's sign
    • elbow 900 flexion with forearm supination – wrist extension
    • flexion compression test – elbow maximum flexion – simultaneous finger compression proximal to cubitus tunnel
Differential diagnosis
  • ulnar tunnel syndrome
  • thoracic outlet syndrome
  • cervical radiculopathy
  • Non surgical
    • education and splinting
    • avoidance of repetitive elbow flexion and extension or prolonged elbow flexion
    • occupational adjustments
    • elbow pad, pillow extension splints – hold elbow in 30-450 flexion during sleep to prevent hyperflexion of elbow
  • Surgical
    • medial epicondylectomy
    • anterior transposition of ulnar N (sub cutaneous, intra muscular, sub muscular)
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