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 Wysłany: Wto 22:56, 22 Lut 2011 Temat postu: Cubital tunnel syndrome of the anatomy and etiolog |
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Cubital tunnel syndrome and etiology of the anatomic
Abstract of the anatomical characteristics of cubital tunnel syndrome and etiology. [Method] 65 patients with cubital tunnel syndrome in patients with clinical data and intraoperative findings, and of which 25 patients before the results of EMG comprehensive research and analysis. [Result] see 60 patients in the existence of the arcuate ligament hypertrophy elbow proliferation, ulnar nerve compression wear and tear caused inflammation; preoperative electromyographic examination revealed 25 cases of ulnar nerve conduction velocity were slower, the average conduction speed of 27.97 m / s; motor response amplitude decreased, the average voltage is 1.95 mv; latency, the average time is 5.41 ms; 65 patients with cubital tunnel syndrome, secondary to trauma in the elbow in 25 cases, 15 cases of chronic fatigue, chronic osteoarthritis in 14 cases, lesions in 5 cases, 6 cases of congenital anomaly. [Conclusion] The elbow injury and chronic fatigue can lead to elbow arcuate ligament hypertrophy hyperplasia, ulnar nerve compression caused by wear and tear, cubital tunnel syndrome is the most common cause; other causes include chronic osteoarthritis, occupying disease and congenital anomalies; ulnar nerve entrapment can be mechanical and wear, to chronic ischemia and hypoxia, leading to the occurrence of cubital tunnel syndrome; detailed physical examination and preoperative EMG is diagnosis of cubital tunnel syndrome the main means of diagnosis should pay attention to other parts of the disease and delayed the identification of the ulnar nerve paralysis.
Key words elbow ulnar arcuate ligament
Abstract: [Objective] To discuss the anatomy and etiology of cubital tunnel syndrome. [Method] The clinical data and surgical findings of sixty five cubital tunnel syndrome cases were analyzed, and the per? Operative electromyogram results of twenty five cases were studied. [Result] Hypertrophy of arcuate ligament resulted in compression and abrasion of ulnar nerve in sixty patients; we found that the ulnar nerve conduct velocity decreased (the average speed was 27.97 m / s), motional amplitude also decreased (the average voltage was 1.95 mv), and latent period prolonged (the average time was 5.41 ms) after pre? operative electromyogram. [Conclusion] The major etiology of cubital tunnel syndrome is chronic injury with sustained compression of ulnar nerve around elbow joint . Careful physical examination of ulnar nerve function and pre? operative electromyogram will help us to diagnose the cubital tunnel syndrome.Cubital tunnel syndrome should be differentiated from tardy ulnar nerve palsy of other sites.
Key words: cubital tunnel; ulnar nerve; arcuate ligament
Cubital tunnel syndrome (Cubital tunnel syndrome) is caused by a variety of reasons elbow ulnar nerve caused by compression to progressive muscle weakness and atrophy of intrinsic hand and hand numbness in the ulnar The clinical symptoms mainly group. In 1958, Feindel and Stratford first named the disease, has been forty years of history. More common in clinical practice, the high incidence of peripheral nerve entrapment syndrome of the Home (Entrapment syndrome) in the first two. For the cause of cubital tunnel syndrome and diagnostic study more, but the conclusions vary ��1��. Is in our hospital were treated from 1998 to 2005 65 patients with cubital tunnel syndrome were analyzed.
1 Clinical data and methods:
65 cases of this group of patients, 60 patients were male, 5 females; aged 27 to 67 years, mean 51 years; course of 1 month to 5 years, the average 1 year and 2 months; 42 patients with simple lesions on the right, left alone 14 cases of lesions, bilateral lesions in 9 cases; 30 cases of occupational workers and farmers in 23 cases, 12 cases of cadres; lesions graded according to the believers of State: �� level for mild ulnar nerve damage 8 cases, only sensory disturbances, muscle atrophy was not obvious; �� level is moderate damage to the ulnar nerve in 45 cases, with sensory disturbances and muscle atrophy; �� grade 12 cases of severe damage to the ulnar nerve, with sensory disturbances, muscle atrophy evident.
25 patients with a preoperative for EMG (Electromyogram, referred to as EMG) examination, the use of U.S. imports Nicolet Viking �� type of EMG, surface electrodes placed on the hypothenar muscle belly to do recording electrode measured wrist to elbow, elbow to elbow and elbow to the axillary nerve conduction velocity, latency and amplitude of evoked potentials.
The patients were surgical repair. Supine position, brachial plexus anesthesia satisfaction of the patients taking the elbow incision medial longitudinal line, elbows and ulnar nerve membrane completely cut release decompression; subcutaneous fat thick skin forward underwent surgery, those thin muscle under the forward; 3 weeks after sling suspension brake instead of cast immobilization.
2 results
This group of 65 trauma cases are secondary to the elbow in 25 cases, fatigue in 15 cases, 14 cases of chronic bone and joint diseases, lesions in 5 cases, 6 cases of congenital anomalies. Elbow injuries in the secondary to the 25 cases, 10 cases of supracondylar fracture of humerus, medial epicondyle fractures in 5 cases, 4 cases of olecranon fractures,[link widoczny dla zalogowanych], soft tissue laceration in 3 cases,[link widoczny dla zalogowanych], lateral condyle fracture of the elbow caused valgus in 3 cases.
Intraoperative findings: 60 patients with cubital tunnel there arcuate ligament hypertrophy hyperplasia, accounting for 92.3% of cases in this group; other 5 cases found lesions within the elbow: ganglion cyst in 3 cases, bone cartilage tumor in 1 case, 1 case of hemangioma of fat. In cases of congenital dysplasia, epiphyseal dysplasia caused elbow valgus deformity in 4 cases, 2 cases of ulnar nerve subluxation.
25 patients with a preoperative EMG were both found to varying degrees of ulnar nerve damage: the lesion of ulnar nerve conduction velocity, an average of 27.97 m / s; motor response amplitude decreased, the average to 1.95 mv; latency, with an average 5.41 ms; when severe ulnar nerve damage occurs when the axons can be seen breaking is the phenomenon of phase waves and fibrillation.
Typical case 1: The patient, male, aged 43, right elbow tunnel syndrome; 7 years ago, the Ministry of right elbow trauma, preoperative examination found that the ulnar hand numbness, claw means between the muscle atrophy and bone deformities (fig. 1), the line moved forward releasing the right ulnar nerve surgery, elbow surgery that there is hypertrophy of the arcuate ligament proliferation of ulnar nerve compression (Figure 2).
Typical case 2: The patient, male, aged 52, left elbow tunnel syndrome; preoperative examination found the ulnar hand numbness, muscle atrophy between the bone (Figure 3), the right line ulnar nerve release and move forward with intraoperative found within the ganglion cyst elbow, ulnar nerve compression (Figure 4).
3 Discussion
3.1 cubital tunnel and ulnar nerve anatomy
Inner elbow in the back of the elbow is a bony oval - fiber channel, its lumen was pointed down the funnel-shaped, ulnar, and the next vice artery and vein, ulnar back side of the ulnar nerve artery and vein, and through this tube ��2,3��. Tube filled with a small amount of fat tissue. Anterior wall of the tube by the end of the ulnar collateral ligament of elbow, elbow capsule, humeral trochlea, olecranon and the medial margin of the crown form; lateral wall is the flexor carpi ulnaris of the foot bones; medial is the medial epicondyle and the flexor carpi ulnaris of the humerus head; the posterior wall of the top is arched across the bones in the flexor carpi ulnaris ulnar aponeurosis between the humeral head and the bow is also known as Osborne? s ligament arcuate ligament or triangular, divided into 4 types according to their morphology: �� type is arcuate ligament proximal 1 / 2 absence; �� type is covered elbow ligament length; �� type is a ligament hypertrophy; �� type is the ligament proximal 1 / 3 of a fiber cable with, and muscle fibers. The catchy elbow ulnar collateral ligament is the starting point, the culmination of the medial epicondyle, the arcuate ligament of the proximal edge of the olecranon and the coronoid process of the medial vertex surrounded nodules; the exit from the ulnar wrist flexors, refers to the superficial flexor, ulnar collateral ligament of the dead surrounded.
Starting from the brachial plexus medial ulnar nerve bundles, containing C8, T1 nerve root fibers in the axillary and upper arm section of the line in the brachial artery to go inside, below the brachial vein, nerves and blood vessels in the left middle upper arm beam, walk backward line in the superficial medial septum, at the elbow to reach the forearm by the elbow down. Ulnar nerve in ulnar nerve sulcus issued an elbow support and 1 to 2 flexor carpi ulnaris muscle branch, the end of domination intrinsic muscles and hypothenar muscles. Elbow ulnar nerve nutrient vessel is concomitant ulnar upper and lower ulnar collateral artery and recurrent artery. Anastomosis between these arteries into the Network to ensure that the nutritional supply of the ulnar nerve. Advancement in the ulnar nerve surgery should be done to protect the key.
When elbow extension, the maximum volume of elbow, ulnar nerve more relaxed. However, when the elbow flexion and ulnar nerve can be stretched,[link widoczny dla zalogowanych], after the ulnar collateral ligament of the beam and angle beam (also known as Cooper? S ligament) bulge, the medial epicondyle and the increasing distance between the olecranon, elbows depth decreases, so that the elbow was significantly reduced volume, significantly increased internal pressure, nerve pressure will also increase. Full flexion when the elbow (the elbow 135 �� ~ 150 ��) when the elbow 55% of the volume will be reduced, increasing the pressure inside the elbow 4.2 Kpa, up 13.3 Kpa; pull about 10% of the ulnar nerve, Neurology than the maximum pressure 7 mmHg when elbow extension increased by 5 times. When the ulnar nerve was stretched 8%, nerve pressure continues for more than 30 mmHg, the internal structure may lead to nerve pathological changes occur. In addition, the arcuate ligament is taut when elbow straightened. Vanderpool found that: for every 45 �� elbow flexion, the flexor carpi ulnaris to increase the distance between two heads 5 mm; elbow flexion 135 ��, the arcuate ligament can be stretched 40%,[link widoczny dla zalogowanych], and its sharp edges can be directly proximal entrapment ulnar nerve and its nutrient vessels. Forearm pronation and wrist flexion may exacerbate these changes.
3.2 cause of cubital tunnel syndrome
In a variety of pathological factors and anatomical factors together, the ulnar nerve entrapment can be mechanical and wear, and to chronic ischemia and hypoxia, leading to the occurrence of cubital tunnel syndrome.
3.2.1 local trauma and strain are the most common causes of morbidity:
Medial elbow various acute, subacute and chronic fatigue damage can cause local congestion and edema of soft tissues, hematoma machine technology, neural adhesion, callus and fibrous scar tissue and other pathological changes, to further narrow elbow ulnar nerve compression wear,[link widoczny dla zalogowanych], this group of patients there were 40 cases.
Its related trauma and strain include: (1) of displaced supracondylar humerus fracture, medial epicondyle fracture, elbow dislocation, local soft tissue laceration; (2) humeral fractures, lateral condyle fractures of the elbow caused by poor valgus deformity; (3) Occupational disorders, such as athletes, drivers, manual workers, long-term office desk personnel ��4��; (4) poor sleeping habits, development of shoulder , elbow, hand elbow pad in the pillow long oppressed; (5), elbow surgery caused by improper placement of iatrogenic injury.
3.2.2 chronic bone, joint and soft tissue inflammation
Cases in this group was 14 cases of osteoarthritis secondary to elbow.
3.2.3 lesions
Including bone, joint and soft tissue tumors and tumor-like lesions. 5 patients in this group of patients.
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