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Hussein M, Hanumanthu MM, Shirodkar K, Papineni VRK, Rahij H, Velicheti S, Iyengar KP, Botchu R. Cubital tunnel syndrome: anatomy, pathology, and imaging. Skeletal Radiol 2024:10.1007/s00256-024-04705-4. [PMID: 38760642 DOI: 10.1007/s00256-024-04705-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/19/2024]
Abstract
Cubital tunnel syndrome (CuTS) is the second most common peripheral neuropathy in the upper limb. It occurs due to ulnar nerve compression within the fibro-osseous cubital tunnel at the elbow joint. Although CuTS is typically diagnosed clinically and with electrodiagnostic studies, the importance of imaging in evaluating the condition is growing. Knowing the typical imaging findings of ulnar nerve entrapment is necessary for precise diagnosis and proper treatment. In this article, we focus on the clinical features, workup and complex imaging of the "anatomic" cubital tunnel and relevant pathological entities.
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Affiliation(s)
- Mohsin Hussein
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Manasa Mayukha Hanumanthu
- Department of Radiology, Dr.Pinnamaneni, Siddhartha Institute of Medical Sciences & Research Foundation, Vijayawada, India
| | - Kapil Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Hasan Rahij
- Imperial College School of Medicine, London, UK
| | - Sandeep Velicheti
- Department of Radiology, Dr.Pinnamaneni, Siddhartha Institute of Medical Sciences & Research Foundation, Vijayawada, India
| | - Karthikeyan P Iyengar
- Department of Radiology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
- Department of Trauma & Orthopaedics, Southport and Ormskirk Hospitals, Mersey and West Lancashire NHS Trust, Southport, PR8 6PN, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
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Chaudhary RK, Karkala N, Nepal P, Gupta E, Kaur N, Batchala P, Sapire J, Alam SI. Multimodality imaging review of ulnar nerve pathologies. Neuroradiol J 2024; 37:137-151. [PMID: 36961518 PMCID: PMC10973834 DOI: 10.1177/19714009231166087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
The ulnar nerve is the second most commonly entrapped nerve after the median nerve. Although clinical evaluation and electrodiagnostic studies remain widely used for the evaluation of ulnar neuropathy, advancements in imaging have led to increased utilization of these newer / better imaging techniques in the overall management of ulnar neuropathy. Specifically, high-resolution ultrasonography of peripheral nerves as well as MRI has become quite useful in evaluating the ulnar nerve in order to better guide treatment. The caliber and fascicular pattern identified in the normal ulnar nerves are important distinguishing features from ulnar nerve pathology. The cubital tunnel within the elbow and Guyon's canal within the wrist are important sites to evaluate with respect to ulnar nerve compression. Both acute and chronic conditions resulting in deformity, trauma as well as inflammatory conditions may predispose certain patients to ulnar neuropathy. Granulomatous diseases as well as both neurogenic and non-neurogenic tumors can also potentially result in ulnar neuropathy. Tumors around the ulnar nerve can also lead to mass effect on the nerve, particularly in tight spaces like the aforementioned canals. Although high-resolution ultrasonography is a useful modality initially, particularly as it can be helpful for dynamic evaluation, MRI remains most reliable due to its higher resolution. Newer imaging techniques like sonoelastography and microneurography, as well as nerve-specific contrast agents, are currently being investigated for their usefulness and are not routinely being used currently.
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Affiliation(s)
| | - Nikitha Karkala
- Department of Radiology, Northwell North Shore University Hospital, Long Island Jewish Medical Center, Queens, NY, USA
| | - Pankaj Nepal
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Elina Gupta
- Department of Radiology, St. Vincent’s Medical Center, Bridgeport, CT, USA
| | - Neeraj Kaur
- Department of Radiology, University Hospital of Northern British Columbia, Prince George, BC, Canada
| | - Prem Batchala
- Department of Radiology, University of Virginia, Charlottesville, VA, USA
| | - Joshua Sapire
- Department of Radiology, St. Vincent’s Medical Center, Bridgeport, CT, USA
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Kelley N, Hubbard J, Belton M. Cubital tunnel compression neuropathy in the presence of an anomalous venous complex: a case study. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:427-430. [PMID: 37588498 PMCID: PMC10426564 DOI: 10.1016/j.xrrt.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Naomi Kelley
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - James Hubbard
- Department of Orthopedic Surgery, Mercy Hospital St. Louis, St. Louis, MO, USA
| | - Matthew Belton
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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Li X, Fu J, Zhou H, Dong Y, Alhaskawi A, Wang Z, Lai J, Yao C, Ezzi SHA, Kota VG, Abdulla MHAH, Guan M, Lou X, Lu H. The effects of melatonin in the treatment of acute brachial plexus compression injury in rats. Front Neurol 2023; 14:1111101. [PMID: 36937512 PMCID: PMC10015383 DOI: 10.3389/fneur.2023.1111101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/30/2023] [Indexed: 03/05/2023] Open
Abstract
Introduction Brachial plexus injury (BPI) is one of the most destructive peripheral nerve injuries and there is still a lack of effective treatment. Methods This study was conducted to evaluate the effects of melatonin in the treatment of acute brachial plexus compression injury in rats using histopathological, histomorphometric, immunohistochemical and electrophysiological methods. Forty-eight adult male Sprague Dawley rats were randomly allocated into three groups: sham, melatonin and vehicle groups. The brachial plexus compression injury model was performed by a vascular clamp. Melatonin group received intraperitoneal injection of melatonin at doses of 10 mg/kg for 21 days after crush injury. The conduction velocity and amplitude of compound muscle action potential (CAMP) in the regenerated nerve, and nerve histomorphometry, as well as levels of myelin protein zero (P0) protein of the crush region were assessed. Results Compared with the vehicle group, the melatonin group which reported significant increased CMAP conduction velocity and amplitude also showed thicker myelin sheath and lower levels of P0 protein. Discussion Our results suggest that melatonin effectively promotes nerve regeneration and improves the function of damaged nerves. Melatonin treatment is a promising strategy for the treatment of acute brachial plexus compression injury.
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Affiliation(s)
- Xigong Li
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jing Fu
- Department of Stomatology, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zewei Wang
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jingtian Lai
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chengjun Yao
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Sohaib Hasan Abdullah Ezzi
- Department of Orthopaedics of the 3rd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Vishnu Goutham Kota
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | | | - Ming Guan
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xianfeng Lou
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Zhejiang University, Hangzhou, Zhejiang, China
- *Correspondence: Hui Lu
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Lenartowicz KA, Murthy NK, Desy NM, De La Pena NM, Wolf AS, Wilson TJ, Amrami KK, Spinner RJ. Does complete regression of intraneural ganglion cysts occur without surgery? Acta Neurochir (Wien) 2022; 164:2689-2698. [PMID: 35877047 DOI: 10.1007/s00701-022-05311-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/01/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE The dynamic nature of intraneural ganglion cysts, including spontaneous expansion and regression, has been described. However, whether these cysts can regress completely in the absence of surgical management has important therapeutic implications. Therefore, we aim to review the literature for cyst regression without surgical intervention. METHODS We reviewed our database of 970 intraneural ganglion cysts in the literature to search for evidence of complete regression based on strict radiologic confirmation, either spontaneously, or after percutaneous cyst aspiration or steroid injection. RESULTS We did not find any examples of complete regression without surgical treatment that met inclusion criteria. Spontaneous regression was reported in four cases; however, only two cases had follow-up imaging, both of which demonstrated residual cysts. Nineteen cases of percutaneous intervention were found in the literature, 13 of which reported clinical improvement following aspiration/steroid injection; however, only seven cases had available imaging. Only two cases reported complete resolution of cyst on MR imaging at follow-up, but reinterpretation found residual intraneural cyst in both cases. CONCLUSION We believe that pathology (structural abnormalities and/or increased joint fluid) always exists at the joint origin of intraneural ganglion cysts which persist even with regression of the cyst. The persistence of a capsular abnormality or defect can lead to recurrence of the cyst in the future, and while imaging may show dramatic decreases in cyst size, truly focused assessment of images will show a tiny focus of persistent intraneural cyst at the joint origin. Thus, expectant management or percutaneous intervention may lead to regression, but not complete resolution, of intraneural ganglion cysts.
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Affiliation(s)
| | - Nikhil K Murthy
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Nicholas M Desy
- Department of Orthopedics, University of Calgary, Alberta, Calgary, Canada
| | | | - Alexandre S Wolf
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | | | | | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Shin N, Kim HS, Lee JH, Cha SY, Cha MJ. Juxtaneural ganglia arising from the hip joint: focus on magnetic resonance imaging findings and clinical manifestations. Skeletal Radiol 2022; 51:1439-1452. [PMID: 35006278 DOI: 10.1007/s00256-022-03989-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To present cases of juxtaneural ganglia arising from the hip with a discussion of the magnetic resonance imaging (MRI) findings, presenting symptoms, and possible treatment option. MATERIALS AND METHODS Two radiologists performed a consensus review of MRI scans obtained between January 2013 and March 2021 to identify patients with juxtaneural ganglia around the hip. A total of 11 patients with 11 juxtaneural ganglia were identified. Medical records and MRI findings were retrospectively reviewed. RESULTS Eight patients had lesions involving the sciatic nerve, and three patients had lesions involving the obturator nerve. Sciatic ganglia arose from a paralabral cyst in the posteroinferior quadrant and continued through a narrow channel running along the posterior acetabulum, showing increased diameter in the sciatic foramen and intrapelvic portion. Obturator ganglia showed a J- or reverse J-shape on the coronal imaging plane and extended from a paralabral cyst in the anteroinferior quadrant via the obturator canal. Nine patients (9/11, 81.8%) had symptoms resembling those of lumbosacral radiculopathy. Four patients underwent arthroscopic surgery, and one patient underwent ultrasound-guided aspiration, all of whom showed partial improvement. Spontaneous decrease in the extent of the ganglion was observed in three patients (3/11, 27.3%). CONCLUSION This article describes rare cases of juxtaneural ganglia arising from the hip joint and involving the sciatic and obturator nerves. The lesions share similar MRI findings, and each type of cyst (sciatic or obturator ganglia) involves a specific labral quadrant.
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Affiliation(s)
- Nari Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Ji Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Yeon Cha
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Zacharia B, Poulose SP, Madhu M. Intraneural ganglion cyst of the ulnar nerve causing cubital tunnel syndrome masquerading a peripheral nerve abscess of a neuritic leprosy. J Clin Orthop Trauma 2021; 24:101692. [PMID: 34820263 PMCID: PMC8591488 DOI: 10.1016/j.jcot.2021.101692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/15/2022] Open
Abstract
Cubital tunnel syndrome is a common entrapment neuropathy affecting the ulnar nerve. Intraneural ganglion cyst and nerve abscess due to leprosy can cause cubital tunnel syndrome. In this article, we are presenting a case of cubital tunnel syndrome caused due to an intraneural ganglion cyst in a 48-year-old lady. It had produced some diagnostic confusion due to its clinical similarity with nerve abscess. This is the first report of a case of an intraneural ganglion cyst of the ulnar nerve masquerading the diagnosis of a nerve abscess.
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Affiliation(s)
- Balaji Zacharia
- Dept of Orthopedics, Government Medical College, Kozhikkode, Kerala, PIN 673008, India,Corresponding author. Kakkathottam (H), Chevayoor (PO), Pin – 673017, India.
| | | | - Midhun Madhu
- Jubilee Mission Medical College and Research Center, Thrissur, Kerala, India
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Wang GH, Mao T, Chen YL, Xu C, Xing SG, Ni XJ, Deng AD. An intraneural ganglion cyst of the ulnar nerve at the wrist: a case report and literature review. J Int Med Res 2021; 49:300060520982701. [PMID: 33459091 PMCID: PMC7816534 DOI: 10.1177/0300060520982701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Intraneural ganglion cysts of the ulnar nerve at the wrist are rare and poorly understood. We report a case of an intraneural ganglion cyst at the level of the wrist. Case presentation: A 48-year-old man presented with the complaints of weakness for 6 months and serious aggravation for 1 month in his right hand. After examinations, including ultrasound, the patient was diagnosed with an intraneural ganglion cyst. Intraoperatively, with exposure of the ulnar nerve, we found that the intraneural ganglion cyst was at the level of Guyon’s canal and extended approximately 6 cm proximally. Postoperatively, sensation of the fingers was normal, but atrophy of his muscles and limited straightening of his ring and little fingers were similar to those preoperatively. Conclusions Diagnosis of an intraneural cyst before surgery is mostly based on ultrasound and magnetic resonance imaging. Transection of the articular branch is an important measure to prevent recurrence of this cyst. If the ulnar nerve is compressed and causes symptoms, nerve decompression, including removal/aspiration of the cyst, and sometimes external neurolysis of the nerve, are necessary to relieve the symptoms and allow regeneration of the nerve. However, these should be performed without damaging the nerve fascicles.
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Affiliation(s)
- Gu Heng Wang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, P.R. China.,Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Tian Mao
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, P.R. China
| | - Ya Lan Chen
- Department of Medical Informatics, School of Medicine, Nantong University, Nantong, P.R. China
| | - Cheng Xu
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, P.R. China
| | - Shu Guo Xing
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, P.R. China
| | - Xue Jun Ni
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, P.R. China
| | - Ai Dong Deng
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, P.R. China
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Abstract
Objective This study was performed to analyze the clinical, radiographic, and pathological features of hand angioleiomyoma causing nerve compression and assess the outcomes of surgical excision. Methods This case series included three men and one woman (mean age, 53.3 years; range, 49–56 years). The patients’ chief complaint was numbness of the fingers. The patients’ medical histories were reviewed, and the diagnosis of angioleiomyoma with nerve compression was confirmed by means of imaging examination and pathological analysis. Results Three tumors occurred in the palm and one in the finger, and the average maximum tumor diameter was 1.8 cm (range, 0.8–2.6 cm). Preoperative magnetic resonance imaging demonstrated well-defined masses with isointense signals on T1 sequences, hyperintense signals on T2 sequences, and strong heterogeneous enhancement after injection of contrast material. All tumors were located near nerves, leading to nerve compression. The diagnosis of angioleiomyoma was confirmed by postoperative pathology. Finger sensation recovered and no recurrence was found during an average follow-up of 37 months (range, 25–59 months). Conclusions Angioleiomyoma should be considered among the differential diagnoses of hand tumors and timely resection should be performed, particularly if the mass is causing numbness and/or pain with positive Tinel’s sign and/or tenderness.
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Affiliation(s)
- Qianjun Jin
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, P.R. China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, P.R. China
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Abstract
Neurofibroma is a rare nerve sheath tumor of neuroectodermal origin, especially the huge and isolated neurofibroma located in the inguinal region. To our knowledge, no such case has previously been reported. We report a case of 34-year-old male patient with a 4-year history of progressive enlargement of the medial root mass in his left thigh with sitting and standing disorders along with pain. The tumor was completely removed by operation, and pathological diagnosis showed neurofibroma. There was no obvious neurologic defect after surgery, and no recurrence tendency was found in the follow-up of 2 years. For a large solitary mass with slow growth and no malignant clinical manifestations for a long time, clinicians cannot rule out the hypothetical diagnosis of neurofibroma, even though its growth site is very rare, such as this case of a huge tumor located in the groin. For neurogenic tumors, early operation should be performed, and the prognosis of patients after tumor resection is excellent.
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Affiliation(s)
- Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China
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Zhou HY, Jiang S, Ma FX, Lu H. Peripheral nerve tumors of the hand: Clinical features, diagnosis, and treatment. World J Clin Cases 2020; 8:5086-5098. [PMID: 33269245 PMCID: PMC7674743 DOI: 10.12998/wjcc.v8.i21.5086] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 02/05/2023] Open
Abstract
The majority of the tumors arising from the peripheral nerves of the hand are relatively benign. However, a tumor diagnosed as malignant peripheral nerve sheath tumor (MPNST) has destructive consequences. Clinical signs and symptoms are usually caused by direct and indirect effects of the tumor, such as nerve invasion or compression and infiltration of surrounding tissues. Definitive diagnosis is made by tumor biopsy. Complete surgical removal with maximum reservation of residual neurologic function is the most appropriate intervention for most symptomatic benign peripheral nerve tumors (PNTs) of the hand; however, MPNSTs require surgical resection with a sufficiently wide margin or even amputation to improve prognosis. In this article, we review the clinical presentation and radiographic features, summarize the evidence for an accurate diagnosis, and discuss the available treatment options for PNTs of the hand.
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Affiliation(s)
- Hai-Ying Zhou
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Shuai Jiang
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Fei-Xia Ma
- Department of Breast Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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12
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Abstract
Although ganglions are the most common cause of ulnar tunnel syndrome, they are one of the rare causes of cubital tunnel syndrome (CuTS). In this article, we report a 49-year-old female patient admitted to the outpatient clinic complaining of numbness and tingling in the ring and little fingers of the right hand. There was no history of systemic disease or previous trauma. The patient was diagnosed with CuTS in the light of clinical examination and nerve conduction studies. Simple cubital tunnel decompression was performed under general anesthesia and microsurgical exploration revealed a 2x2 cm epineural ganglion cyst compressing the ulnar nerve. The cyst was excised without damaging the ulnar nerve and cutaneous nerves. Histopathology also confirmed the ganglion cyst. In the postoperative period, the patient's clinical improvement was more satisfactory than nerve conduction studies. The diagnosis of CuTS is established by physical examination, provocative test, and nerve conduction studies. In patients who cannot achieve a satisfactory outcome by conservative treatment, the cyst should be kept in mind among etiologic factors. Magnetic resonance imaging should be requested for accurate diagnosis and preoperative surgical planning.
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Loreti C, Fusco A, Giovannini S, Coraci D, Padua L. Letter: Surgical Treatment of Intraneural Ganglion Cysts of the Ulnar Nerve at the Elbow: Long-Term Follow-up of 9 Cases. Neurosurgery 2020; 86:E357-E358. [PMID: 31673704 DOI: 10.1093/neuros/nyz475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/04/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Silvia Giovannini
- Rehabilitation Units Fondazione Policlinico Universitario A. Gemelli IRCCS Rome, Italy
| | - Daniele Coraci
- Neuroriabilitazione ad Alta Intensità Fondazione Policlinico Universitario A. Gemelli IRCCS Rome, Italy
| | - Luca Padua
- Neuroriabilitazione ad Alta Intensità Fondazione Policlinico Universitario A. Gemelli IRCCS Rome, Italy.,Department of Geriatrics, Neurosciences and Orthopaedics Catholic University of Sacred Heart Rome, Italy
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Wu P, Xu S, Cheng B, Chen L, Xue C, Ge H, Yu C. In Reply: Surgical Treatment of Intraneural Ganglion Cysts of the Ulnar Nerve at the Elbow: Long-Term Follow-up of 9 Cases. Neurosurgery 2020; 86:E359-E259. [PMID: 31673700 DOI: 10.1093/neuros/nyz476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peng Wu
- Department of Othorpaedics The Shanghai Tenth People's Hospital Tongji University Shanghai, China
| | - Sudan Xu
- Department of Cardiology The Shanghai General Hospital Shanghai Jiaotong University Shanghai, China
| | - Biao Cheng
- Department of Othorpaedics The Shanghai Tenth People's Hospital Tongji University Shanghai, China
| | - Lin Chen
- Department of Hand Surgery Huashan Hospital Fudan University Shanghai, China
| | - Chao Xue
- Department of Othorpaedics The Shanghai Tenth People's Hospital Tongji University Shanghai, China
| | - Heng'an Ge
- Department of Othorpaedics The Shanghai Tenth People's Hospital Tongji University Shanghai, China
| | - Cong Yu
- Department of Hand Surgery Huashan Hospital Fudan University Shanghai, China
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Spinner RJ, Desy NM, Simon NG, Amrami KK. Commentary: Surgical Treatment of Intraneural Ganglion Cysts of the Ulnar Nerve at the Elbow: Long-Term Follow-up of 9 Cases. Neurosurgery 2019; 85:E1076-E1077. [DOI: 10.1093/neuros/nyz242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/26/2019] [Indexed: 12/26/2022] Open
Affiliation(s)
- Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nicholas M Desy
- Department of Orthopedics, University of Calgary, Calgary, Alberta, Canada
| | - Neil G Simon
- St. Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Kimberly K Amrami
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Ulnar intraneural cysts as a cause of cubital tunnel syndrome: presentation of a case and review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1559-1563. [PMID: 31222541 DOI: 10.1007/s00590-019-02475-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Intraneural cysts usually involve the common peroneal nerve, and in many cases, they are causing symptoms due to neural compression. It is hypothesized that these cysts originate from the adjacent joints while articular pathology is a major contributing factor for the formation of these lesions. Although ulnar nerve is the second most commonly affected nerve, these lesions usually develop distally at the Guyon tunnel, so cubital tunnel syndrome due to epineural cysts is very rare. In such cases, elaborate preoperative work-up is mandatory and surgical treatment should follow certain well-defined principles. CASE DESCRIPTION A 60-year-old female patient presented with complaints of pain along the medial side of her elbow, forearm and hand and a tingling sensation in the same distribution for the past 2 months. The patient had sustained an injury 15 years ago, and a distal humerus fracture was diagnosed at that time. Radiological signs of posttraumatic elbow arthritis were evident at the initial evaluation. The patient was diagnosed with cubital tunnel syndrome which was further confirmed by nerve conduction studies, and she underwent surgical decompression of the nerve. During surgery, intraneural cysts were identified and addressed by excision, while dissection of the articular branch of the nerve was also performed. Pain and numbness subsided shortly after surgery, while the patient remained free of symptoms until the last follow-up.
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