J Korean Orthop Assoc.  2012 Oct;47(5):382-386. 10.4055/jkoa.2012.47.5.382.

A Fusiform Epineural Ganglion Encompassing the Ulnar Nerve in the Cubital Tunnel

• Cha SM
• Shin HD
• Kim KC
• Kang DH

• KMID: 2185323
• DOI: http://doi.org/10.4055/jkoa.2012.47.5.382

Abstract

Cubital tunnel syndrome, caused by a ganglion, is rare and most ganglion cysts originate from the medial aspect of the ulnohumeral joint. We present an extremely rare case of a fusiform epineural ganglion, encompassing the ulnar nerve in the cubital tunnel. A 48-year-old man complained of a 6-month history of typical cubital tunnel syndrome symptoms. Electrophysiological studies were compatible with the compressive neuropathy of the ulnar nerve. A fusiform epineural ganglion cyst (1.4 cm in diameter and 7.2 cm in length), which encompasses the ulnar nerve in the cubital tunnel, was found with no connection to the elbow joint. The ganglion cyst was excised and the ulnar nerve anterior transmuscular transposition was performed. Six months postoperatively, the patient was free of pain, tingling sensations, and numbness. In addition, his grip and pinch strength improved, the muscle wasting showed recovery, and an electrophysiological study demonstrated some improvement.

Keyword

cubital tunnel syndrome; ganglion cyst; ulnar nerve

MeSH Terms

Cubital Tunnel Syndrome
Elbow Joint
Ganglion Cysts
Hand Strength
Humans
Hypesthesia
Joints
Middle Aged
Muscles
Pinch Strength
Sensation
Ulnar Nerve

Figure

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  Figure 1 A fusiform epineural ganglion cyst (1.4 cm in diameter and 7.2 cm in length) was identified encompassing the ulnar nerve in the cubital tunnel. The proximal portion of the cyst was 1.4 cm superior to Struthers' ligament and the distal portion extended into the right superior segment of Osborne's ligament.

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  Figure 2 The ganglion cyst was excised and the ulnar nerve was completely released and decompressed both proximally and distally.

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  Figure 3 The ulnar nerve was transposed anteriorly in a trough made in the flexor-pronator muscle by electrocautery without any tension. The fan-shape fascia flap of the flexor-pronator was loosely sutured to its own origin.

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