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MR imaging of the postsurgical cubital tunnel: an imaging review of the cubital tunnel, cubital tunnel syndrome, and associated surgical techniques

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Abstract

Ulnar nerve compression at the elbow, specifically the cubital tunnel, is the second most common upper extremity compression neuropathy. Many patients presenting with compression symptoms will subsequently undergo surgical intervention. We review the open surgical treatment of cubital tunnel syndrome and review the expected postoperative imaging appearance of those treatments on magnetic resonance imaging (MR), including: simple or in situ decompression, medial epicondylectomy, and anterior transposition, including subcutaneous, intramuscular, and submuscular variants. We discuss the relevant anatomy of the presurgical cubital tunnel and common sites and causes of ulnar nerve compression at and about the cubital tunnel. The imaging appearance of the preoperative and postoperative ulnar nerve and postoperative complications are reviewed.

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References

  1. Mondelli M, Giannini F, Ballerini M, Ginanneschi F, Martorelli E. Incidence of ulnar neuropathy at the elbow in the province of Siena. J Neurol Sci. 2005;234:5–10.

    Article  PubMed  Google Scholar 

  2. Dellon AL. Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg Am. 1989;14(4):688–700.

    Article  CAS  PubMed  Google Scholar 

  3. Broudy AS, Leffert RD, Smith RJ. Technical problems with ulnar nerve transposition at the elbow: findings and results of reoperation. J Hand Surg Am. 1978;3(1):85–9.

  4. Spinner M, Kaplan EB. The relationship of the ulnar nerve to the medial intermuscular septum in the arm and its clinical significance. Hand. 1976;8(3):239–42.

    Article  CAS  PubMed  Google Scholar 

  5. Wehli L, Oberlin C. The internal brachial ligament versus the arcade of Struthers: an anatomical study. Plast Reconstr Surg. 2004;115(2):471–7.

    Article  Google Scholar 

  6. Caetano EB, Sabongi Neto JJ, Vierira LA, Caetano MF. The arcade of Struthers: an anatomical study and clinical implications. Rev Bras Ortop. 2017;52(3):331–6.

  7. Dellon AL. Musculotendinous variations about the medial humeral epicondyle. J Hand Surg Br. 1986;11(2):175–81.

    CAS  PubMed  Google Scholar 

  8. James J, Sutton LG, Werner FW, Basu N, Allison MA, Palmer AK. Morphology of the cubital tunnel: an anatomical and biomechanical study with implications for treatment of ulnar nerve compression. J Hand Surg Am. 2011;36(12):1988–95.

    Article  PubMed  Google Scholar 

  9. 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(1):148–56.

    Article  PubMed  Google Scholar 

  10. Mahan MA, Gasco J, Mokhtee DB, Brown JM. Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited. J Neurosurg. 2015;123:1216–22.

    Article  PubMed  Google Scholar 

  11. Amadio PC, Beckenbaugh RD. Entrapment of the ulnar nerve by the deep flexor-pronator aponeurosis. J Hand Surg Am. 1985;11:83–7.

    Article  Google Scholar 

  12. Gellman H. Compression of the ulnar nerve at the elbow: cubital tunnel syndrome. Instr Course Lect. 2008;57:187–97.

    PubMed  Google Scholar 

  13. Wright TW, Glowczewskie F, Cowin D, Wheeler DL. Ulnar nerve excursion and strain at the elbow and wrist associated with upper extremity motion. J Hand Surg Am. 2001;26(4):655–62.

    Article  CAS  PubMed  Google Scholar 

  14. Miller TT, Reinus WR. Nerve entrapment syndromes of the elbow, forearm, and wrist. AJR Am J Roentgenol. 2010;195(3):585–94.

    Article  PubMed  Google Scholar 

  15. Spinner RJ, Goldner RD. Snapping of the medial head of the triceps and recurrent dislocation of the ulnar nerve. Anatomical and dynamic factors. J Bone Joint Surg Am. 1998;80(2):239–47.

    Article  CAS  PubMed  Google Scholar 

  16. Spinner RJ. In: Morrey BF, editor. The elbow. Third ed. Philadelphia: Wolters Kluwer; 2015.

    Google Scholar 

  17. Howe BM, Spinner RJ, Felmlee JP, Frick MA. MR imaging of the nerves of the upper extremity: elbow to wrist. Magn Reson Imaging Clin N Am. 2015;23(3):469–78.

    Article  PubMed  Google Scholar 

  18. Keen NN, Chin CT, Engstrom JW, Saloner D, Steinbach LS. Diagnosing ulnar neuropathy at the elbow using magnetic resonance neurography. Skelet Radiol. 2012;41(4):401–7.

    Article  Google Scholar 

  19. Bao HJ, Wang SS, Wang GB, Yang L, Hasan M-u, Yao B, et al. Diffusion-weighted MR neurography of median and ulnar nerves in the wrist and palm. Eur Radiol. 2017;27(6):2359–66.

    Article  PubMed  Google Scholar 

  20. Britz GW, Haynor DR, Kuntz C, Goodkin R, Gitter A, Maravilla K, et al. Ulnar nerve entrapment at the elbow: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. Neurosurgery. 1996;38(3):458–65. discussion 65.

    CAS  PubMed  Google Scholar 

  21. Baumer P, Dombert T, Staub F, Kaestel T, Bartsch AJ, Heiland S, et al. Ulnar neuropathy at the elbow: MR neurography-nerve T2 signal increase and caliber. Radiology. 2011;260(1):199–206.

    Article  PubMed  Google Scholar 

  22. Terayama Y, Uchiyama S, Ueda K, Iwakura N, Ikegami S, Kato Y, et al. Optimal measurement level and ulnar nerve cross-sectional area cutoff threshold for identifying ulnar neuropathy at the elbow by MRI and ultrasonography. J Hand Surg Am. 2018;43(6):529–36.

    Article  PubMed  Google Scholar 

  23. Andreisek G, Crook DW, Burg D, Marincek B, Weishaupt D. Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics. 2006;26(5):1267–87.

    Article  PubMed  Google Scholar 

  24. Schertz M, Mutschler C, Masmejean E, Silvera J. High-resolution ultrasound in etiological evaluation of ulnar neuropathy at the elbow. Eur J Radiol. 2017;95:111–7.

    Article  PubMed  Google Scholar 

  25. Jacobson JA, Fessell DP, Lobo Lda G, Yang LJ. Entrapment neuropathies I: upper limb (carpal tunnel excluded). Semin Musculoskelet Radiol. 2010;14(5):473–86.

    Article  PubMed  Google Scholar 

  26. Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2012(7):1–35.

  27. Elhassan B, Steinmann SP. Entrapment neuropathy of the ulnar nerve. J Am Acad Orthop Surg. 2007;15(11):672–81.

    Article  PubMed  Google Scholar 

  28. Curtin CM, Ladd AL. Operative techniques in hand, wrist, and elbow surgery. 2nd ed. In: Hunt TR, Wiesel SW, editors. Chapter 90, Surgical treatment of cubital tunnel syndrome. Philadelphia: Wolters Kluwer; 2016. p. 841–8.

  29. Gabel GT, Amadio PC. Reoperation for failed decompression of the ulnar nerve in the region of the elbow. J Bone Joint Surg Am. 1990;72(2):213–9.

    Article  CAS  PubMed  Google Scholar 

  30. Vosbikian MM, Tarity TD, Nazarian LN, Ilyas AM. Does the ulnar nerve enlarge after surgical transposition? J Ultrasound Med. 2014;33(9):1647–52.

    Article  PubMed  Google Scholar 

  31. Subhawong TK, Wang KC, Thawait SK, Williams EH, Hashemi SS, Machado AJ, et al. High resolution imaging of tunnels by magnetic resonance neurography. Skelet Radiol. 2012;41(1):15–31.

    Article  Google Scholar 

  32. Chhabra A, Wadhwa V, Thakkar RS, Carrino JA, Dellon AL. Recurrent ulnar nerve entrapment at the elbow: correlation of surgical findings and 3-Tesla magnetic resonance neurography. Can J Plast Surg. 2013;21(3):186–9.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Nicholas G. Rhodes, Benjamin M. Howe & Matthew A. Frick

  2. Department of Surgery, Division of Plastic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Steven L. Moran

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  1. Nicholas G. Rhodes
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  2. Benjamin M. Howe
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  4. Steven L. Moran
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Correspondence to Nicholas G. Rhodes.

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Rhodes, N.G., Howe, B.M., Frick, M.A. et al. MR imaging of the postsurgical cubital tunnel: an imaging review of the cubital tunnel, cubital tunnel syndrome, and associated surgical techniques. Skeletal Radiol 48, 1541–1554 (2019). https://doi.org/10.1007/s00256-019-03203-2

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  • DOI: https://doi.org/10.1007/s00256-019-03203-2

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