Abstract
Purpose of Review
Compressive neuropathy of the ulnar nerve across the elbow is a common diagnosis encountered frequently within a hand and upper extremity clinical practice. Appropriate and timely evaluation, diagnosis, objective testing, and evidence-based decisions regarding treatment options are paramount in the optimal care of the patient with this pathology. An understanding of current literature is critical in determining and understanding best practices.
Recent Findings
A thorough review of the recent literature regarding physical examination, diagnostic testing, and nonoperative versus operative results was performed. Regarding physical examination, the glenohumeral internal rotation test and scratch collapse test are more effective and sensitive than traditional maneuvers such as Tinel’s testing and the elbow flexion test. Electrodiagnostic testing, magnetic resonance imaging, and ultrasound evaluation have all been shown to be effective in diagnosing cubital tunnel syndrome. However, no single test has proven itself to be superior. Nonoperative treatment can be successful for mild cases of cubital tunnel syndrome. Surgical release techniques comparing open with endoscopic release are equivocal, and in situ release versus transposition techniques show that transposition should not be performed routinely.
Summary
The diagnosis and treatment of cubital tunnel syndrome do not have a well-defined algorithm based on current literature. The treating physician must therefore utilize the available information to determine a diagnostic and treatment plan individualized to the patient. More rigorous scientific studies are needed to determine the most effective surgical approaches for cubital tunnel syndrome.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2012:CD006839.
Staples JR, Calfee R. Cubital tunnel syndrome: current concepts. J Am Acad Orthop Surg. 2017;25:e215–e24.
Ochi K, Horiuchi Y, Tanabe A, Waseda M, Kaneko Y, Koyanagi T. Shoulder internal rotation elbow flexion test for diagnosing cubital tunnel syndrome. J Shoulder Elb Surg. 2012;21:777–81.
Cheng CJ, Mackinnon-Patterson B, Beck JL, Mackinnon SE. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. J Hand Surg Am. 2008;33:1518–24.
• Dy CJ, Mackinnon SE. Ulnar neuropathy: evaluation and management. Curr Rev Musculoskelet Med. 2016;9:178–84 This paper reviews the evaluation of patients with cubital tunnel syndrome and discusses physician examination and diagnostic techniques. It also reviews surgical treatment decision processes.
Chung T, Prasad K, Lloyd TE. Peripheral neuropathy: clinical and electrophysiological considerations. Neuroimaging Clin N Am. 2014;24:49–65.
American Association of Electrodiagnostic M, Campbell WW. Guidelines in electrodiagnostic medicine. Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow. Muscle Nerve Suppl. 1999;8:S171–205.
Yoon JS, Walker FO, Cartwright MS. Ulnar neuropathy with normal electrodiagnosis and abnormal nerve ultrasound. Arch Phys Med Rehabil. 2010;91:318–20.
Landau ME, Campbell WW. Clinical features and electrodiagnosis of ulnar neuropathies. Phys Med Rehabil Clin N Am. 2013;24:49–66.
Wiesler ER, Chloros GD, Cartwright MS, Shin HW, Walker FO. Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel. J Hand Surg Am. 2006;31:1088–93.
Volpe A, Rossato G, Bottanelli M, Marchetta A, Caramaschi P, Bambara LM, et al. Ultrasound evaluation of ulnar neuropathy at the elbow: correlation with electrophysiological studies. Rheumatology (Oxford). 2009;48:1098–101.
Vucic S, Cordato DJ, Yiannikas C, Schwartz RS, Shnier RC. Utility of magnetic resonance imaging in diagnosing ulnar neuropathy at the elbow. Clin Neurophysiol. 2006;117:590–5.
Baumer P, Dombert T, Staub F, et al. Ulnar neuropathy at the elbow: MR neurography--nerve T2 signal increase and caliber. Radiology. 2011;260:199–206.
• Osei DA, Groves AP, Bommarito K, Ray WZ. Cubital tunnel syndrome: incidence and demographics in a national administrative database. Neurosurgery. 2017;80:417–20 This large, database-driven study examined patients over a 6-year period, identifying the incidence of cubital tunnel syndrome across the US population and any demographic associations.
Padua L, Aprile I, Caliandro P, Foschini M, Mazza S, Tonali P. Natural history of ulnar entrapment at elbow. Clin Neurophysiol. 2002;113:1980–4.
Shah CM, Calfee RP, Gelberman RH, Goldfarb CA. Outcomes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome. J Hand Surg Am. 2013;38:1125–30 e1.
•• Toirac A, Giugale JM, Fowler JR. Open versus endoscopic cubital tunnel in situ decompression: a systematic review of outcomes and complications. Hand (N Y). 2017;12:229–35 This study is a systematic review evaluating outcomes and complications of open versus endoscopic cubital tunnel release, suggesting the superiority of endoscopic techniques when complication rates and patient satisfaction were taken into account.
•• Byvaltsev VA, Stepanov IA, Kerimbayev TT. A systematic review and meta-analysis comparing open versus endoscopic in situ decompression for the treatment of cubital tunnel syndrome. Acta Neurol Belg 2019. This review systematically compared open versus endoscopic cubital tunnel surgeries and found that patients who underwent an endoscopic approach demonstrated greater improvement in scar tenderness but equivalent clinical postoperative recovery and no difference in adverse events.
Nabhan A, Ahlhelm F, Kelm J, Reith W, Schwerdtfeger K, Steudel WI. Simple decompression or subcutaneous anterior transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg Br. 2005;30:521–4.
•• Said J, Van Nest D, Foltz C, Ilyas AM. Ulnar nerve in situ decompression versus transposition for idiopathic cubital tunnel syndrome: an updated meta-analysis. J Hand Microsurg. 2019;11:18–27 By performing a meta-analysis of in situ decompression versus ulnar nerve transposition, the authors found no statistically significant differences in outcomes or revision rates. There were significantly more complications with ulnar nerve transposition.
•• Hutchinson DT, Sullivan R, Sinclair MK. Long-term reoperation rate for cubital tunnel syndrome: subcutaneous transposition versus in situ decompression. Hand (N Y) 2019:1558944719873153. The authors found a statistically higher reoperation rate for in situ decompression compared to subcutaneous transposition with a minimum five-year follow-up period.
•• Gaspar MP, Kane PM, Putthiwara D, Jacoby SM, Osterman AL. Predicting revision following in situ ulnar nerve decompression for patients with idiopathic cubital tunnel syndrome. J Hand Surg Am. 2016;41:427–35 From a retrospective review of 216 cases, this study found that the risk of revision surgery following in situ release was 3.2%. The only significant risk factor was age younger than 50.
Liu CH, Chen CX, Xu J, Wang HL, Ke XB, Zhuang ZY, et al. Anterior subcutaneous versus submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a systematic review and meta-analysis. PLoS One. 2015;10:e0130843.
Roh YH, Kim S, Gong HS, Baek GH. Clinical features affecting the patient-based outcome after minimal medial epicondylectomy for cubital tunnel syndrome. J Plast Reconstr Aesthet Surg. 2018;71:1446–52.
• O'Grady EE, Vanat Q, Power DM, Tan S. A systematic review of medial epicondylectomy as a surgical treatment for cubital tunnel syndrome. J Hand Surg Eur. 2017;42:941–5 This study evaluated 21 case series reporting on 886 medial epicondylectomies. The results were equivocal in supporting the use of medial epicondylectomy as a standard surgical approach. The study authors concluded that the existing literature is of limited methodological quality and does not allow for firm conclusions to be drawn regarding the efficacy of medial epicondylectomy compared with other techniques.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Michael N. Nakashian declares that he has no conflict of interest. Danielle Ireland declares that she has no conflict of interest. Patrick Kane declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Compressive Neuropathies in the Upper Extremity
Rights and permissions
About this article
Cite this article
Nakashian, M.N., Ireland, D. & Kane, P.M. Cubital Tunnel Syndrome: Current Concepts. Curr Rev Musculoskelet Med 13, 520–524 (2020). https://doi.org/10.1007/s12178-020-09650-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12178-020-09650-y