Surgical and Radiologic Anatomy

, Volume 39, Issue 11, pp 1215–1221 | Cite as

Ultrasound biomechanical anatomy of the soft structures in relation to the ulnar nerve in the cubital tunnel of the elbow

  • Paul Michelin
  • Grégoire Leleup
  • Mourad Ould-Slimane
  • Marie Caroline Merlet
  • Benjamin Dubourg
  • Fabrice Duparc
Original Article
  • 193 Downloads

Abstract

Background

Chronic ulnar nerve entrapment worsened by elbow flexion is the most common injury, but rare painful conditions may also be related to ulnar nerve instability. The posterior bundle of the medial collateral ligament (pMCL) and the retinaculum, respectively form a soft floor and a ceiling for the cubital tunnel. The aim of our study was to dynamically assess these soft structures of the cubital tunnel focusing on those involved in the biomechanics of the ulnar nerve.

Methods

Forty healthy volunteers had a bilateral ultrasonography of the cubital tunnel. Elbows were scanned in full extension, 45° and 90°, and maximal passive flexion. Morphological changes of the nerve and related structures were dynamically assessed on transverse views.

Results

Both the pMCL and the retinaculum tightened with flexion. During elbow flexion, the tightening of the pMCL superficially moved the ulnar nerve remote from the osseous floor of the retroepicondylar groove. A retinaculum was visible in all 69 tunnels with stable nerves (86.3%), tightened in flexion, but absent in 11 tunnels with unstable nerves (13.7%). The retinaculum was fibrous in 60 elbows and muscular in nine, the nine muscular variants did not significantly influence the biomechanics of stable nerves. Stable nerves flattened in late flexion between the tightened pMCL and retinaculum, whereas unstable nerves transiently flattened when translating against the anterior osseous edge of the groove.

Conclusion

The retinaculum and the pMCL are key structures in the biomechanics of the ulnar nerve in the cubital tunnel of the elbow.

Keywords

Elbow Ulnar nerve entrapment Ulnar nerve instability Cubital tunnel Ultrasound Anatomy 

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Copyright information

© Springer-Verlag France 2017

Authors and Affiliations

  1. 1.Department of Radiology, University Hospital of RouenHopital Charles NicolleRouen Cedex 1France
  2. 2.Laboratory of Anatomy, Faculty of MedicineUniversity of RouenRouenFrance
  3. 3.CETAPS Laboratory, EA3832, Faculty of Sport SciencesUniversity of RouenRouenFrance
  4. 4.Department of Orthopaedic Surgery and TraumatologyUniversity Hospital of RouenRouenFrance

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