Arch Hand Microsurg.  2025 Mar;30(1):80-85. 10.12790/ahm.24.0061.

Cubital tunnel syndrome caused by an intraneural ganglion cyst treated with epineurectomy: a report of three cases

• Kang HT
• Kang HJ

• KMID: 2565472
• DOI: http://doi.org/10.12790/ahm.24.0061

Abstract

The potential causes of cubital tunnel syndrome include trauma, bone deformity, and space-occupying lesions such as tumors. An intraneural ganglion is a cystic tumor composed of a fibrous capsule containing mucinous material within the epineurium of a peripheral nerve, and it most commonly occurs in the peroneal nerve. However, cases of intraneural ganglion cysts occurring at the elbow, leading to cubital tunnel syndrome in the ulnar nerve, have been rarely reported. Cubital tunnel syndrome caused by an intraneural ganglion differs in its pathogenesis from idiopathic nerve entrapment syndrome; thus, it requires distinct approaches for diagnosis and treatment. In this context, the authors report three cases of cubital tunnel syndrome caused by intraneural ganglia. Favorable outcomes were achieved through partial epineurectomy and in situ decompression. Additionally, a review of the literature is presented.

Keyword

Cubital tunnel syndrome; Epineurium; Intraneural ganglion cysts; Ulnar nerve

Figure

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  Fig. 1. (A) After a 2-mm incision into the intraneural ganglion, mucinous fluid was drained. (B) Partial epineurectomy was performed, taking care not to damage the nerve tissue.

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  Fig. 2. A probe was used to confirm the border of the intraneural ganglion.

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  Fig. 3. Coronal (A), sagittal (B), and axial (C) magnetic resonance imaging scans. On T2-weighted fat-suppressed magnetic resonance imaging, an intraneural ganglion measuring approximately 8×1×0.8 cm (red asterisks) was found distal to the medial condyle of the humerus.

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  Fig. 4. A branch of the ulnar nerve connecting to the surrounding muscles (white arrowhead) was identified.

Reference

References

1. Chang WK, Li YP, Zhang DF, Liang BS. The cubital tunnel syndrome caused by the intraneural or extraneural ganglion cysts: case report and review of the literature. J Plast Reconstr Aesthet Surg. 2017; 70:1404–8. DOI: 10.1016/j.bjps.2017.05.006. PMID: 28803901.

2. 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. 2002; 84:1413–9. DOI: 10.2106/00004623-200208000-00018. PMID: 12177272.

3. Desy NM, Wang H, Elshiekh MA, et al. Intraneural ganglion cysts: a systematic review and reinterpretation of the world’s literature. J Neurosurg. 2016; 125:615–30. DOI: 10.3171/2015.9.jns141368. PMID: 26799306.

4. Spinner RJ, Scheithauer BW, Amrami KK. The unifying articular (synovial) origin of intraneural ganglia: evolution-revelation-revolution. Neurosurgery. 2009; 65(4 Suppl):A115–24. DOI: 10.1227/01.neu.0000346259.84604.d4. PMID: 19927056.

5. Li P, Lou D, Lu H. The cubital tunnel syndrome caused by intraneural ganglion cyst of the ulnar nerve at the elbow: a case report. BMC Neurol. 2018; 18:217. DOI: 10.1186/s12883-018-1229-7. PMID: 30579340.

6. Alsaygh EF, Abduh WK, Alshahir AA. Cubital tunnel syndrome due to multiple intraneural cysts at elbow: a case report and review of literature. Cureus. 2023; 15:e36449. DOI: 10.7759/cureus.36449. PMID: 37090347.

7. Ming Chan K, Thompson S, Amirjani N, Satkunam L, Strohschein FJ, Lobay GL. Compression of the ulnar nerve at the elbow by an intraneural ganglion. J Clin Neurosci. 2003; 10:245–8. DOI: 10.1016/s0967-5868(02)00339-9. PMID: 12637062.

8. Papadopoulos DV, Kostas-Agnantis I, Kosmas D, et al. Ulnar intraneural cysts as a cause of cubital tunnel syndrome: presentation of a case and review of the literature. Eur J Orthop Surg Traumatol. 2019; 29:1559–63. DOI: 10.1007/s00590-019-02475-7. PMID: 31222541.

9. Son BC, Choi JG, Ko HC. Ulnar neuropathy due to intraneural ganglion cyst of the ulnar nerve at the elbow. Indian J Neurosurg. 2018; 7:260–4. DOI: 10.1055/s-0038-1639385.

10. Heithoff SJ. Cubital tunnel syndrome does not require transposition of the ulnar nerve. J Hand Surg Am. 1999; 24:898–905. DOI: 10.1053/jhsu.1999.0898. PMID: 10509266.