J Korean Neurosurg Soc.  2018 Sep;61(5):618-624. 10.3340/jkns.2018.0033.

Cubital Tunnel Syndrome Caused by Anconeus Epitrochlearis Muscle

Affiliations
  • 1Department of Orthopaedic Surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.
  • 2Department of Orthopaedic Surgery, Good Samsun Hospital, Busan, Korea.
  • 3Department of Orthopaedic Surgery, St. Mary’s Spine & Joint Hospital, Suwon, Korea.
  • 4Department of Orthopaedic Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea. gamjang@catholic.ac.kr

Abstract


OBJECTIVE
We evaluated the clinical manifestation and surgical results following operative treatment of cubital tunnel syndrome (CuTS) caused by anconeus epitrochlearis (AE) muscle.
METHODS
Among 142 patients who underwent surgery for CuTS from November 2007 to October 2015, 12 were assigned to the AE group based on discovery of AE muscle; 130 patients were assigned to the other group. We analyzed retrospectively; age, sex, dominant hand, symptom duration, and weakness in hand. Severity of the disease was evaluated using the Dellon classification and postoperative symptom were evaluated using disability of arm shoulder and hand (DASH) and visual analogue scale (VAS) scores. Surgery consisted of subfascial anterior transposition following excision of AE muscle.
RESULTS
AE muscle was present in 8.5% of all patients, and was more common in patients who were younger and with involvement of their dominant hand; the duration of symptom was shorter in patients with AE muscle. All patients showed postoperative improvement in symptoms according to DASH and VAS scores.
CONCLUSION
The possibility of CuTS caused by AE muscle should be considered when younger patients have rapidly aggravated and activity-related cubital tunnel symptoms with a palpable mass in the cubital tunnel area. Excision of AE muscle and anterior ulnar nerve transposition may be considered effective surgical treatment.

Keyword

Ulnar nerve; Cubital tunnel syndrome; Anconeus epitrochlearis; Anterior subfascial transposition

MeSH Terms

Arm
Classification
Cubital Tunnel Syndrome*
Hand
Humans
Retrospective Studies
Shoulder
Ulnar Nerve

Figure

  • Fig. 1. A and B : A 23-year-old male patient had surgery for cubital tunnel syndrome. The radiograph showed no definitive abnormality. C and D : Transverse and sagittal T2-weighted magnetic resonance imaging of the elbow showed anconeus epitrochlearis (AE) muscle (asterisk). E : Intraoperative finding revealed AE muscle (asterisk) above the cubital tunnel. F : After resection of the AE muscle, the compressed ulnar nerve was shown (G). H : Subfascial anterior transposition of the ulnar nerve was performed. ME : medial epicondyle, Ole : olecranon, Ulnar N : ulnar nerve.

  • Fig. 2. Intra-operative findings. A : An anconeus epitroclearis (AE) ligament (arrow). B : After resection of AE ligament. ME : medial epicondyle, Ole : olecranon.


Reference

References

1. Assmus H, Antoniadis G, Bischoff C, Hoffmann R, Martini AK, Preissler P, et al. Cubital tunnel syndrome - a review and management guidelines. Cent Eur Neurosurg. 72:90–98. 2011.
Article
2. Boero S, Sénès FM, Catena N. Pediatric cubital tunnel syndrome by anconeus epitrochlearis: a case report. J Shoulder Elbow Surg. 18:e21–e23. 2009.
Article
3. Bozentka DJ. Cubital tunnel syndrome pathophysiology. Clin Orthop Relat Res. 351:90–94. 1998.
Article
4. Byun SD, Kim CH, Jeon IH. Ulnar neuropathy caused by an anconeus epitrochlearis: Clinical and electrophysiological findings. J Hand Surg Eur Vol. 36:607–608. 2011.
Article
5. Capdarest-Arest N, Gonzalez JP, Türker T. Hypotheses for ongoing evolution of muscles of the upper extremity. Med Hypotheses. 82:452–456. 2014.
Article
6. Chalmers J. Unusual causes of peripheral nerve compression. Hand. 10:168–175. 1978.
Article
7. Cho YJ, Cho SM, Sheen SH, Choi JH, Huh DH, Song JH. Simple decompression of the ulnar nerve for cubital tunnel syndrome. J Korean Neurosurg Soc. 42:382–387. 2007.
Article
8. Dekelver I, Van Glabbeek F, Dijs H, Stassijns G. Bilateral ulnar nerve entrapment by the M. anconeus epitrochlearis. A case report and literature review. Clin Rheumatol. 31:1139–1142. 2012.
Article
9. Erdem Bagatur A, Yalcin MB, Ozer UE. Anconeus epitrochlearis muscle causing ulnar neuropathy at the elbow: clinical and neurophysiological differential diagnosis. Orthopedics. 39:e988–e991. 2016.
Article
10. Fernandez J, Camuzard O, Gauci MO, Winter M. A rare cause of ulnar nerve entrapment at the elbow area illustrated by six cases: the anconeus epitrochlearis muscle. Chir Main. 34:294–299. 2015.
Article
11. Gervasio O, Zaccone C. Surgical approach to ulnar nerve compression at the elbow caused by the epitrochleoanconeus muscle and a prominent medial head of the triceps. Neurosurgery. 62(3 Suppl 1):186–192. 2008.
Article
12. Hirasawa Y, Sawamura H, Sakakida K. Entrapment neuropathy due to bilateral epitrochleoanconeus muscles: a case report. J Hand Surg Am. 4:181–184. 1979.
Article
13. Hodgkinson PD, McLean NR. Ulnar nerve entrapment due to epitrochleo-anconeus muscle. J Hand Surg Br. 19:706–708. 1994.
Article
14. Kato H, Hirayama T, Minami A, Iwasaki N, Hirachi K. Cubital tunnel syndrome associated with medial elbow ganglia and osteoarthritis of the elbow. J Bone Joint Surg Am. 84:1413–1419. 2002.
Article
15. Lee SU, Kim MW, Kim JM. Ultrasound diagnosis of double crush syndrome of the ulnar nerve by the anconeus epitrochlearis and a ganglion. J Korean Neurosurg Soc. 59:75–77. 2016.
Article
16. Masear VR, Hill JJ Jr, Cohen SM. Ulnar compression neuropathy secondary to theanconeus epitrochlearis muscle. J Hand Surg Am. 13:720–724. 1988.
Article
17. Morgenstein A, Lourie G, Miller B. Anconeus epitrochlearis muscle causing dynamic cubital tunnel syndrome: a case series. J Hand Surg Eur Vol. 41:227–229. 2016.
Article
18. Nellans K, Galdi B, Kim HM, Levine WN. Ulnar neuropathy as a result of anconeus epitrochlearis. Orthopedics. 37:e743–e745. 2014.
Article
19. O’Driscoll SW, Horii E, Carmichael SW, Morrey BF. The cubital tunnel and ulnar neuropathy. J Bone Joint Surg Br. 73:613–617. 1991.
20. O’Hara JJ, Stone JH. Ulnar nerve compression at the elbow caused by a prominent medial head of the triceps and an anconeus epitrochlearis muscle. J Hand Surg Br. 21:133–135. 1996.
Article
21. Posner MA. Compressive ulnar neuropathies at the elbow: I. Etiology and diagnosis. J Am Acad Orthop Surg. 6:282–288. 1998.
Article
22. Tiong WH, Kelly J. Ulnar nerve entrapment by anconeus epitrochlearis ligament. Hand Surg. 17:83–84. 2012.
Article
23. Uscetin I, Bingol D, Ozkaya O, Orman C, Akan M. Ulnar nerve compression at the elbow caused by the epitrochleoanconeus muscle: a case report and surgical approach. Turk Neurosurg. 24:266–271. 2014.
24. Wilson TJ, Tubbs RS, Yang LJ. The anconeus epitrochlearis muscle may protect against the development of cubital tunnel syndrome: a preliminary study. J Neurosurg. 125:1533–1538. 2016.
Article
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