The elbow flexion test. A clinical test for the cubital tunnel syndrome

The elbow flexion test is a little known, inadequately standardized, and poorly understood clinical test for the cubital tunnel syndrome. To evaluate and define this test, 13 patients with clinical and electrophysiologic evidence of cubital tunnel syndrome were tested with elbow flexion in a standardized manner. This consisted of full elbow flexion with full extension of the wrists for three minutes. All patients noted the onset of or the increase in one or more of the symptoms of pain, numbness, or tingling with this test. Numbness and tingling followed the sensory distribution of the ulnar nerve, but pain was not limited to the ulnar nerve distribution. The symptom complex, rapid onset, and rapid resolution of symptoms support a locally induced segmental ulnar nerve ischemia as the cause of symptoms. This study demonstrates the elbow flexion test to be a useful, reliable, and provocative test for the cubital tunnel syndrome.     

Surgical approach to cubital tunnel syndrome in the symptomatic osteoarthritic elbow

Objective  Decompression of the ulnar nerve and removal of osteophytes and free bodies to improve function, to relieve symptoms, and to lessen signs of cubital tunnel syndrome through a single incision. Indications  Cubital tunnel syndrome secondary to a progressing osteoarthritis, with chronic pain, impaired function and grade II or III symptoms of an ulnar entrapment neuropathy. Contraindications  Neglected cubital tunnel syndrome with advanced muscle atrophy and marked sensory disturbances. Severe osteoarthritis of elbow joint. Surgical Technique  Single posteromedial skin incision with longitudinal splitting of the common tendon of the triceps brachii muscle. To perform these procedures in a combined fashion: medial epicondylectomy; fenestration of the olecranon fossa to debride osteophytes; medial capsulotomy to resect loose bodies or osteophytes. Postoperative Care  The elbow is immobilized in 90° of flexion in a cast for 2 weeks. After removal of the sutures, hydrotherapy and active and passive range of motion exercises. Results  Between 1978 and 1992, 25 patients (23 men and two women, age range 15–70 years with a mean of 53 years) underwent combined cubital tunnel decompression and surgical debridement of the elbow joint. Follow-up assessments of all patients were completed after an average of 68 (26–170) months following surgery. Based on the criteria proposed by the British Nerve Injuries Committee, the clinical results were graded as excellent in six patients, good in 14, fair in four, and failure in one patient. The activity- related pain had improved markedly in ten patients, slightly in four, and was unchanged in six patients. Paresthesia improved in 20 patients and remained unchanged in five patients. The average preoperative grip strength was 26.4 kg and improved to an average of 29 kg.     

Reoperation for cubital tunnel syndrome]

We discussed the problems operative treatment of recurrent cubital tunnel syndrome. Indications to operative treatment of neuropathies were also described.     

腕管综合征与肘管综合征功能评定标准的现状与建议

腕管综合征与肘管综合征是周围神经卡压中最常见的疾病,近年来报道日渐增多.在这些临床报道中由于疗效评定的方法各异,很难对各种治疗方法做出客观、科学、全面的评定,能否制定结合国情的统一标准是本文的目的,供全国同道讨论.     

肘管综合征的显微外科治疗

目的探讨肘管综合征显微外科治疗的临床效果。方法选择42例肘管综合征患者施行带血供的尺神经显微松解并前置术，术中观察尺神经肘管段的血供分支及分布特点，术后观察其疗效。结果36例肘管综合征临床症状全部消失，功能恢复正常；6例感觉功能完全恢复，运动功能大部恢复。结论带血供的尺神经显微松解并前置术是治疗肘管综合征的一种有效方法。     

Current approach to cubital tunnel syndrome

The choice for surgical treatment of cubital tunnel syndrome is no clearer today than when it was reviewed 10 years ago. There continue to be no significant prospective randomized trials to adequately compare the different surgical techniques. Even if such a trial were performed, most hand surgeons would probably continue to be skeptical. In the end, each surgeon must rely on his or her own personal experience or judgment. Based on the authors' experience in the treatment of cubital tunnel syndrome, they are confident that anterior transmuscular transposition of the ulnar nerve obtains the best results when the preoperative algorithm is properly applied and early postoperative physical therapy is instituted.     

小切口单纯肘管松解术治疗肘管综合征

目的 通过临床研究分析小切口单纯肘管松解术治疗肘管综合征的适应证。选择病程平均为2．5人月,无肘部骨折或畸形的9例男性患者进行手术。于尺神经沟作2－3cm长的小切口,仅切开肘管及其远端的弓状韧带,在尺神经鞘膜内注射1ml确炎舒松－A。结果 9例的手尺侧麻木感于术后1个月内消失,刺痛觉减退在术后半年恢复正常。2例骨间肌蚓关肌有轻度肌萎缩者在术后1年半完全恢复。结论 对肘部无骨折畸形,病程短,无明显肌萎缩,爪形手畸形的肘管综合征可以采用小切口单纯肘管松解要治疗。     

肘管综合征如何治疗

查阅文献,对肘管综合征的治疗有两种意见.一种强调一旦诊断确定应及早进行手术探查,理由是肘部压迫与牵拉因素的存在影响局部神经内循环,造成充血、水肿,随后成纤维细胞浸润,当神经内形成纤维化再作神经松解或前移,不能使症状消失,所以延迟手术效果不良.     

Endoscopic approach to cubital tunnel syndrome

The cubital tunnel syndrome is one of the most common entrapment neuropathy of the upper limb. The ulnar nerve can be compressed in the oteofibrous tunnel by the bone structures, the Osborne's ligament, the fascia of the ulnar flexor muscle of the carpus or of the aponeurosis of the deep flexor of the fingers. Pressure values in the cubital tunnel >50 mm Hg induce blocking of intraneural circulation with electrodiagnostic modifications, clinical signs and histological changes including demyelinazion of the nerve proximal to the cubital tunnel. Surgery becomes essential in case of failure of conservative and physical therapy. Various surgical techniques have been described in the literature for the treatment of the ulnar neuropathy at the elbow. In this paper the authors report a new endoscopic technique for the treatment of ulnar nerve entrapment at the elbow which requires respect of specific electrodiagnostic and clinical criteria of inclusion. The restored joint active motion following elbow arthroscopy in osteoarthritis can induce or get worse a ulnar nerve neuropathy; endoscopy neurolysis is essential to remove perineural adherences and reduces the nerve stress. Immediate well-being of the patient, lesser invasiveness and minimum vascular complications are clear advantages of the endoscopic approach, while the treatment of the pathologies proximal and distal to the Struther's arcade is a limit of the technique.     

肘管综合征研究进展

肘管综合征发病原因多种多样,包括肘管自身解剖结构的潜在卡压因素、占位性病变、外伤、肘外翻畸形等,对尺神经造成了不同程度的卡压或牵拉,引起一系列病理生理改变,产生相应的临床症状。电生理检查是诊断该病最常用方法。手术方式多种多样,有对传统术式的改进,也有新术式提出。该文就肘管综合征相关应用解剖、病因、病理生理、诊断与鉴别诊断、治疗与预后研究进展作一综述。     

The diagnostic role of ultrasound in cubital tunnel syndrome for patients with a previous cubital tunnel surgery

BackgroundUltrasound is widely used in the diagnosis of peripheral nerve compressions. Nevertheless, the role of ultrasound, and in particular the cross-sectional area (CSA) measurements, in the diagnosis of cubital tunnel syndrome (CuTS) is debatable, especially in patients who have had previous surgeries. We evaluated the diagnostic value of ultrasound and CSA measurements in a heterogenous group of CuTS patients suffering from persisting or recurrent CuTS after a previous surgical intervention.MethodsAll patients with persisting or recurrent CuTS after previous surgery, who received a nerve ultrasound with or without CSA measurements in a tertiary referral center between 2015 and 2022, were included. Median CSA was calculated at five locations from the upper arm to the wrist. The sensitivity of ultrasound and electrodiagnostic studies and the correlation between both diagnostic tools were calculated.ResultsThirty-seven nerves from 35 patients who received nerve ultrasound, of which 21 nerves from 19 patients who received additional CSA measurements, were included. Ultrasound indicated signs of persisting or recurrent compression in 73.0% of patients, and ulnar swelling based on CSA measurements was found in 71.4% of patients. Electrodiagnostic testing was positive in 40.7% of patients. CuTS diagnosis was supported by both electrodiagnostic studies and CSA in only 34.6% of patients.ConclusionsCSA and electrodiagnostic testing in patients with persistent or recurrent symptoms after previous surgery did not correlate well, and the sensitivity of both tests was lower than in diagnostic accuracy studies. Ultrasound was found to be useful in evaluating ulnar nerves after previous surgery.