Cubital tunnel syndrome

Introduction Cubital tunnel syndrome is a symptom and sign caused by the ulnar nerve being crushed at the elbow. 1957. Osborne first reported the disease and called it a delayed ulnar neuritis. In 1958, Feined and Stratford called the disease an elbow syndrome. The ulnar nerve presurgery is the basic treatment. If the ulnar nerve is hard in the operation, the epicardium should be removed, and the inter-beam release can completely solve the problem. After the operation, the normal feeling can be restored quickly. Atrophic muscles are more difficult to restore normal volume.

Cause

(1) Causes of the disease:

Any factor that causes the absolute or relative decrease in the volume of the elbow can cause compression of the ulnar nerve. Common causes are:

1. Chronic injury: internal and external humerus fractures and supracondylar fractures and humeral head fractures can produce elbow valgus or other malformations due to malformation, resulting in increased traction angle and relative shortening of the ulnar nerve, thus causing the ulnar nerve to be pulled. , oppression and friction.

2. Elbow joint rheumatism or rheumatoid arthritis: rheumatism or rheumatoid lesions invade the synovial membrane of the elbow joint, making it hypertrophic and hypertrophic, causing elbow joint deformation and osteophyte hyperplasia in the late stage, which may also cause the volume of the elbow to decrease.

3. Lumps: such as ganglion cysts, lipomas, etc., but less common.

4. Congenital factors: such as congenital elbow valgus, ulnar nerve sulcus caused by repeated dislocation of the ulnar nerve, Struthers arched tissue.

5. Others: long-term elbow work, card pressure caused by iatrogenic factors. "Sleep sleep" caused by sleep in the elbow.

(2) Pathogenesis:

The elbow is a fibrous fibrous duct with the ulnar nerve with the ulnar side arteries passing through the elbow from the back of the tibia to the flexion of the forearm. The bottom of the elbow is the medial ligament of the elbow. The deep side of the medial ligament of the elbow is the medial lip of the trochlear and the ulnar nerve groove in the posterior and posterior aspect of the humerus. The top is the triangular arch ligament that connects the medial epicondyle of the humerus and the inner side of the olecranon. Therefore, the arcuate ligament is also bridged between the humeral head and the ulnar head of the ulnar wrist flexor. The size of the elbow varies with the flexion and extension of the elbow joint: when the elbow is extended, the bow ligament is loose, and the volume of the elbow is enlarged; when the elbow is 90°, the bow ligament is tense, and each flexion is 45°. The distance between the olecranon and the olecranon is widened by 0.5 cm. In addition, when the elbow is flexed in a state of 0.5 cm widening, the ligament of the medial ligament of the elbow also reduces the volume of the elbow, and the ulnar nerve is susceptible to compression. It has been determined that the pressure in the elbow is 0.93 kPa when the elbow is extended and 1.5 to 3.2 kPa when the elbow is bent to 90°.

The ulnar nerve sends out 2 to 3 fine branches to the elbow joint when passing through the elbow joint; within 4 cm of the upper jaw of the humerus, the ulnar nerve sends out a branch of the ulnar wrist flexor muscle, usually 2 muscles. Enter deeper. The branch of the inner ring, the little finger, the deep flexor is slightly distal to the ulnar wrist flexor, and enters and dominates the muscle from the front of the muscle.

an examination

Related inspection

Limbs and joints of limbs and joints

1. There is an elbow on the ulnar side of the elbow joint, and the ulnar nerve passes through the tube. When elbow fractures, dislocations, small pieces of avulsion, congenital or acquired elbow valgus, or tumors in the elbow, the ulnar nerve can be compressed to produce a series of symptoms. After the ulnar nerve is compressed, the little finger, the ring finger and the ulnar side of the hand have numbness, pain, and the feeling is reduced or disappeared.

The small muscles of the hand that are dominated by the ulnar nerve are atrophied, so there is a "claw-shaped hand" (the little finger and the ring finger cannot be straightened), the thumb cannot be on the palm, the thumb and the index finger are weak, and the fingers cannot be separated and close together. Therefore, writing, embroidering, knitting, playing the piano, etc. are all hindered.

2, physical examination: hand muscle atrophy, elbow ulnar nerve slip, thickening, tenderness, positive elbow test, elbow Tinel's sign positive and so on.

3, electrophysiological changes: slowing of the motor nerve conduction velocity (M, CV) through the elbow, which is the most valuable diagnostic basis; induced sensory potential (ESP) loss is a relatively sensitive indicator.

4, radiological examination: the elbow has a history of trauma, can be taken on the bilateral ulnar nerve groove tangent line X-slice contrast, may be found in the affected side of the ulnar nerve groove deformation or unevenness and other changes.

Differential diagnosis

Differential diagnosis:

Many diseases that need to be distinguished from the elbow syndrome include ulnar nerve compression in other areas, systemic diseases, and granulomatous diseases such as cervical spondylosis (neural root type), thoracic outlet syndrome, diabetes, leprosy and elbow joint tuberculosis.

1. Cervical spondylosis (neural root type): Low neck nerve root compression is easily confused with this disease, but the pain and numbness of cervical spondylosis are mainly neck and shoulders, pain is radiated to the inner side of the forearm and forearm, and the intervertebral foramen is squeezed. Pressure tests can induce pain. In addition, cervical X-ray films and CT films showed changes in the corresponding intervertebral space stenosis and epiphyseal hyperplasia.

2. Guyon tube syndrome: The palmar branch of the ulnar nerve is caused by compression of the Guyon tube in the wrist, which is characterized by atrophy of the intermuscular muscle, interosseous muscle, and claw-shaped hand, but the muscle of the short-extension muscle of the little finger The branch is issued on the proximal side of the Guyon tube, so the function is normal. Some patients have shallow branches of the ulnar nerve palm branch and are not tired without hand sensory disturbance.

3. Leprosy: The ulnar nerve is more involved, the ulnar nerve is abnormally large, and the hand sensation area does not sweat.

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