Skip to main content

Advertisement

SpringerLink
Log in

Osseous morphology of the medial epicondyle: an anatomoradiological study with potential clinical implications

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

The cubital tunnel is limited anteriorly by the medial epicondyle (ME), laterally by the medial collateral ligament, and superiorly by Osborne’s fascia and the cubital tunnel retinaculum. Previous studies were mostly dedicated to the roof of the cubital tunnel, in the way that the study of the groove for ulnar nerve and ME anatomy is relatively scarce in the literature. We sought to describe the radiological anatomy of the groove for ulnar nerve and ME in healthy volunteers with multiplanar computed tomography (CT).

Methods

We analyzed 3D CT images of 30 healthy volunteers (mean age 39 years, range 18–66 years). Nine variables were measured from the right elbow, including sizes, areas and angles in two different planes (coronal and axial).

Results

Mean ME width and length were 17.3 ± 3.5 mm and 31.7 ± 4.5 mm, respectively. According to categorical correlation studies, ME width (X) was deemed the most representative morphological characteristic because of the positive correlation to five other different anatomical measurements. A three-tiered anatomical classification was proposed based on data distribution.

Conclusion

Large individual variation is found in the shape of ME, both in coronal and axial planes. The knowledge of individual osseous morphology is of great value potentially contributing to the surgical decision-making in patients affected by cubital tunnel syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Amadio PC, Beckenbaugh RD (1986) Entrapment of the ulnar nerve by the deep flexor–pronator aponeurosis. J Hand Surg Am 11:83–87. https://doi.org/10.1016/s0363-5023(86)80110-1

    Article  CAS  PubMed  Google Scholar 

  2. Apfelberg DB, Larson SJ (1973) Dynamic anatomy of the ulnar nerve at the elbow. Plast Reconstr Surg 51:76–81

    Article  CAS  Google Scholar 

  3. Bartels RH (2001) History of the surgical treatment of ulnar nerve compression at the elbow. Neurosurgery 49:391–400. https://doi.org/10.1097/00006123-200108000-00023

    Article  CAS  PubMed  Google Scholar 

  4. Caliandro P, La Torre G, Padua R, Giannini F, Padua L (2016) Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev 11:CD006839. https://doi.org/10.1002/14651858.CD006839.pub4

    Article  PubMed  Google Scholar 

  5. Feindel W, Stratford J (1958) Cubital tunnel compression in tardy ulnar palsy. Can Med Assoc J 78:351–353

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Feindel W, Stratford J (1958) The role of the cubital tunnel in tardy ulnar palsy. Can J Surg 1:287–300

    CAS  PubMed  Google Scholar 

  7. Gonzalez MH, Lotfi P, Bendre A, Mandelbroyt Y, Lieska N (2001) The ulnar nerve at the elbow and its local branching: an anatomic study. J Hand Surg Br 26:142–144. https://doi.org/10.1054/jhsb.2000.0532

    Article  CAS  PubMed  Google Scholar 

  8. Granger A, Sardi JP, Iwanaga J et al (2017) Osborne’s ligament: a review of its history, anatomy, and surgical importance. Cureus 9:e1080. https://doi.org/10.7759/cureus.1080

    Article  PubMed  PubMed Central  Google Scholar 

  9. Huang JH, Samadani U, Zager EL (2004) Ulnar nerve entrapment neuropathy at the elbow: simple decompression. Neurosurgery 55:1150–1153. https://doi.org/10.1227/01.neu.0000140841.28007.f2

    Article  PubMed  Google Scholar 

  10. Imamura K, Beppu M, Shimizu H, Aoki H (1996) An anatomical study of the medial epicondyle of the humerus. J Jpn Soc Hand Surg 12:977–981 (Japanese)

    Google Scholar 

  11. Imamura K, Shimizu H, Beppu M, Aoki H (2000) Anatomical study of ulnar nerve groove of the medial humeral epicondyle. J Jpn Soc Hand Surg 17:264–268

    Google Scholar 

  12. Inserra S, Spinner M (1986) An anatomic factor significant in transposition of the ulnar nerve. J Hand Surg Am 11:80–82. https://doi.org/10.1016/s0363-5023(86)80109-5

    Article  CAS  PubMed  Google Scholar 

  13. James J, Sutton LG, Werner FW, Basu N, Allison MA, Palmer AK (2011) Morphology of the cubital tunnel: an anatomical and biomechanical study with implications for treatment of ulnar nerve compression. J Hand Surg Am 36:1988–1995. https://doi.org/10.1016/j.jhsa.2011.09.014

    Article  PubMed  Google Scholar 

  14. Karatas A, Apaydin N, Uz A, Tubbs R, Loukas M, Gezen F (2009) Regional anatomic structures of the elbow that may potentially compress the ulnar nerve. J Shoulder Elbow Surg 18:627–631. https://doi.org/10.1016/j.jse.2009.03.004

    Article  PubMed  Google Scholar 

  15. Khoo D, Carmichael SW, Spinner RJ (1996) Ulnar nerve anatomy and compression. Orthop Clin N Am 27:317–338

    Article  CAS  Google Scholar 

  16. Kim DH, Han K, Tiel RL, Murovic JA, Kline DG (2003) Surgical outcomes of 654 ulnar nerve lesions. J Neurosurg 98:993–1004. https://doi.org/10.3171/jns.2003.98.5.0993

    Article  PubMed  Google Scholar 

  17. Kleinman WB (1999) Cubital tunnel syndrome: anterior transposition as a logical approach to complete nerve decompression. J Hand Surg Am 24:886–997. https://doi.org/10.1053/jhsu.1999.0886

    Article  CAS  PubMed  Google Scholar 

  18. Macchi V, Tiengo C, Porzionato A et al (2014) The cubital tunnel: a radiologic and histotopographic study. J Anat 225:262–269. https://doi.org/10.1111/joa.12206

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mahan MA, Gasco J, Mokhtee DB, Brown JM (2015) Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited. J Neurosurg 123:1216–1222. https://doi.org/10.3171/2014.10.JNS141379

    Article  PubMed  Google Scholar 

  20. Makhni EC, Khanna K, Simpson MT et al (2014) Medial epicondyle morphology in elite overhead athletes: a closer look using 3-dimensional computer simulation. Orthop J Sports Med 2:2325967113517211. https://doi.org/10.1177/2325967113517211

    Article  PubMed  PubMed Central  Google Scholar 

  21. O’Driscoll SW, Horii E, Carmichael SW, Morrey BF (1991) The cubital tunnel and ulnar neuropathy. J Bone Jt Surg Br 73:613–617

    Article  CAS  Google Scholar 

  22. Osborne G (1959) Ulnar neuritis. Postgrad Med J 35:392–396

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We are grateful to Prof. Gabriel de Araújo Serrão, MD, MSc for the thoughtful comments.

Funding

The authors have no funding to declare.

Author information

Authors and Affiliations

  1. Division of Neurosurgery, Marcílio Dias Naval Hospital, Rio de Janeiro, Brazil

    Lucas de Queiroz Chaves & Fábio Henrique Pinto da Silva

  2. Institute of Biomedical Research, Marcílio Dias Naval Hospital, Rio de Janeiro, Brazil

    Lucas de Queiroz Chaves, Giuliana Vasconcelos de Souza Fonseca, Fábio Henrique Pinto da Silva & Marcus André Acioly

  3. Post-Graduation Program in Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil

    Lucas de Queiroz Chaves

  4. Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil

    Marcus André Acioly

  5. Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil

    Marcus André Acioly

Authors
  1. Lucas de Queiroz Chaves
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giuliana Vasconcelos de Souza Fonseca
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fábio Henrique Pinto da Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marcus André Acioly
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LQC: protocol development, data collection, data analysis and manuscript writing/editing. GVSF: protocol development, data analysis. FHPS: protocol development, data analysis. MAA: protocol development, data collection, data analysis and manuscript writing/editing.

Corresponding author

Correspondence to Marcus André Acioly.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

Marcílio Dias Naval Hospital Ethical Committee—study number 58174616.5.0000.5256/2016.

Data availability and material

Material available.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chaves, L.d., Fonseca, G.V.d., da Silva, F.H.P. et al. Osseous morphology of the medial epicondyle: an anatomoradiological study with potential clinical implications. Surg Radiol Anat 43, 713–720 (2021). https://doi.org/10.1007/s00276-020-02669-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-020-02669-3

Keywords

Search

Navigation