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DOI: 10.1055/s-0029-1185287
© Georg Thieme Verlag KG Stuttgart · New York
Aktueller Stand der Diagnostik und Therapie des Kubitaltunnelsyndroms[*]
Diagnosis and Therapy of Cubital Tunnel Syndrome – State of the ArtPublication History
eingereicht 27.9.2008
akzeptiert 3.10.2008
Publication Date:
17 February 2009 (online)
![](https://www.thieme-connect.de/media/hamipla/200901/lookinside/thumbnails/10.1055-s-0029-1185287-1.jpg)
Zusammenfassung
Das Kubitaltunnelsyndrom (KuTS) ist das zweithäufigste Kompressionssyndrom eines peripheren Nervs. Die im deutschsprachigen Raum übliche Bezeichnung Sulcus-ulnaris-Syndrom ist anatomisch inkorrekt, da der Kubitaltunnel über den retrokondylären Sulkus hinausgeht und zusätzlich den Bereich des Kubitaltunnelretinakulums (Lig. arcuatum oder Osborne-Band), der Faszie zwischen den Flexorenköpfen und der tiefen Flexorenfaszie, umfasst. Nach Sunderland [159] wird es eingeteilt in eine primäre Form, zu der auch die Ulnarisluxation und der M. epitrochleoanconaeus zählen, und eine sekundäre Form infolge knöcherner Veränderungen des Ellenbogengelenks und anderweitiger raumfordernder Prozesse. Zur Diagnose ist eine differenzierte neurologische Untersuchung durch eine elektrophysiologische Untersuchung zu ergänzen. Neurosonografie und MRT gewinnen durch die verbesserte Auflösung zunehmend an Bedeutung und erlauben den direkten Nachweis morphologischer Veränderungen. Wichtigste Differenzialdiagnose sind das C8-Syndrom und die Ulnarisdruckparese. Überschneidungen kommen als Doppelkompressionssyndrom („double crush“) nicht selten vor. Die operative Behandlung ist wirksamer als die konservative, die sich im Wesentlichen auf eine Verminderung der Exposition beschränkt. Aufgrund neuerer randomisiert-kontrollierter Studien ist die Dekompression bei der primären Form einschließlich der meisten Fälle einer nicht schmerzhaften Ulnarisluxation und einem M. epitrochleoanconaeus der Verlagerung vorzuziehen. Die Dekompression muss bis auf eine Strecke von mindestens 5 cm distal des medialen Epikondylus ausgedehnt werden und kann auch endoskopisch erfolgen – beide Techniken in Lokalanästhesie oder Leitungsanästhesie. Eine Verlagerung des N. ulnaris ist bei schweren narbigen und knöchernen Veränderungen wie zum Beispiel Kubitus valgus zu empfehlen. Als Primäreingriff ist jedoch auch die In-situ-Dekompression möglich. Es kommen für die Verlagerung sowohl subkutane als auch submuskuläre Techniken infrage. Risiken der Verlagerung sind neben der Beeinträchtigung der Durchblutung vor allem das Abknicken des Nervs durch ungenügende proximale und distale Mobilisierung. Die Epikondylektomie spielt hierzulande keine Rolle. Rezidive sind nicht ungewöhnlich.
Abstract
The cubital tunnel syndrome is one of the most widespread compression syndromes of a peripheral nerve. In German-speaking countries it is known as the sulcus ulnaris syndrome (retrocondylar groove syndrome), which is anatomically incorrect. The cubital tunnel consists of the retrocondylar groove, the cubital tunnel retinaculum (Lig. arcuatum or Osborne band), the humeroulnar arcade and the deep flexor/pronator aponeurosis. According to Sunderland [159] it can be divided into a primary form (including the ulnar luxation and the epitrocheoanconaeus muscle) and a secondary form caused by deformation or other processes of the elbow joint. The diagnosis has to be confirmed by a thorough clinical examination and nerve conduction studies. Neurosonography and MRI are becoming more and more important with improving resolution and enable the direct identification of morphological changes. Differential diagnosis is essential in atypical cases, especially C8 syndrome and pressure palsy. Double crush (double compression syndrome) may occur. Operative treatment is more effective than conservative treatment, which consists primarily of the prevention of exposure to external noxes. According to actual randomised controlled studies the therapy of choice of the primary form in most cases is the simple in situ decompression of the ulnar nerve in the cubital tunnel. This has to be extended at least up to 5–6 cm distally of the medial epicondyle and can be performed in the open or endoscopic technique, both under local anesthesia. Simple decompression is also the therapy of choice in uncomplicated ulnar luxation and in most post-traumatic cases and other secondary forms. In cases of severe bony or tissue changes of the elbow (especially cubitus valgus) the volar transposition of the ulnar nerve may be indicated. This can be performed in a subcutaneous or submuscular technique. Risks of transposition are impairment of perfusion and, above all, kinking caused by insufficient proximal or distal mobilisation of the nerve has to be avoided. In these cases revision surgery is necessary. The epicondylectomy is not common in our country. Recurrences may occur.
Schlüsselwörter
Kubitaltunnelsyndrom - Sulcus‐ulnaris‐Syndrom - Ulnarisneuropathie am Ellenbogen (UNE) - Elektrodiagnostik - endoskopische Dekompression - Ulnarisverlagerung
Key words
cubital tunnel syndrome - sulcus ulnaris syndrome - ulnar neuropathy at the elbow - nerve conduction studies - endoscopic release - transposition
1 Die Übersicht basiert auf der S3-Leilinie der beteiligten 7 Fachgesellschaften, die – ergänzt durch Empfehlungsgrade – unter www.leitlinien.net abrufbar ist.
Literatur
- 1 AAEM . Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement. Muscle Nerve. 1999; 22 (Suppl. 8) 171-174
- 2 Abdel-Salam A, Eyres K S, Cleary J. Drivers' elbow: a cause of ulnar neuropathy. J Hand Surg [Br]. 1991; 16 436-437
- 3 Ahcan U, Zorman P. Endoscopic decompression of the ulnar nerve at the elbow. J Hand Surg [Am]. 2007; 32 1171-1176
- 4 Alp M, Akkin S M, Yalcin L. et al . Cubital tunnel release with two limited incisions: a cadaver study. Surg Radiol Anat. 2004; 26 259-262
- 5 Amadio P C, Beckenbaugh R D. Entrapment of the ulnar nerve by the deep flexor-pronator aponeurosis. J Hand Surg [Am]. 1986; 11 83-87
- 6 Amako M, Nemoto K, Kawaguchi M. et al . Comparison between partial and minimal medial epicondylectomy combined with decompression for the treatment of cubital tunnel syndrome. J Hand Surg [Am]. 2000; 25 1043-1050
- 7 Andreisek G, Crook D W, Burg D. et al . Peripheral neuropathies of the median, radial, and ulnar nerves. Radiographics. 2006; 26 1267-1287
- 8 Antoniadis G, Richter H P. Pain after surgery for ulnar neuropathy at the elbow: A continuing challenge. Neurosurg. 1997; 41 585-591
- 9 Apfelberg D, Larson S J. Dynamic anatomy of the ulnar nerve at the elbow. Plastic & Reconstructive Surgery. 1973; 51 76-81
- 10 Artico M, Pastore F S, Nucci F. et al . 290 surgical procedures for ulnar nerve entrapment at the elbow: Physiopathology, clinical experience and results. Acta Neurochir. 2000; 142 303-308
- 11 Asamoto S, Boker D K, Jodicke A. Surgical treatment for ulnar nerve entrapment at the elbow. Neurol Med Chir (Tokyo). 2005; 45 240-244
- 12 Assmus H. New aspects of pathogenesis and therapy of the cubital tunnel syndrome. Adv Neurosurg. 1981; 9 391-395
- 13 Assmus H. Die einfache Dekompression des N. ulnaris beim Kubitaltunnelsyndrom mit und ohne morphologische Veränderungen. Erfahrungsbericht anhand von 523 Fällen. Nervenarzt. 1994; 65 846-885
- 14 Assmus H, Antoniadis G Hrsg.. Nervenkompressionssyndrome. Heidelberg; Steinkopff/Springer 2008
- 15 Assmus H, Hoffmann R. Ulnarisneuropathie am Ellenbogen – Rinnen- oder Tunnelsyndrom? Ein Beitrag zur Pathogenese, Nomenklatur und Behandlung des Kubitaltunnelsyndroms. Obere Extremität. 2007; 2 90-95
- 16 Baek G H, Kwon B C, Chung M S. Comparative study between minimal medial epicondylectomy and anterior subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Shoulder Elbow Surg. 2006; 15 609-613
- 17 Bain G I, Bajhau A. Endoscopic release of the ulnar nerve at the elbow using the Agee device: a cadaveric study. Arthroscopy. 2005; 21 691-695
- 18 Bartels R H, Menovsky T, Van Overbeeke J J. et al . Surgical management of ulnar nerve compression at the elbow: an analysis of the literature. J Neurosurg. 1998; 89 722-727
- 19 Bartels R H. History of the surgical treatment of ulnar nerve compression at the elbow. Neurosurgery. 2001; 49 391-400
- 20 Bartels R H, Grotenhuis J A, Kauer J M. The arcade of Struthers: an anatomical study. Acta Neurochir (Wien). 2003; 145 295-300
- 21 Bartels R H, Verhagen W I, van der Wilt G J. et al . Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: Part 1. Neurosurgery. 2005; 56 522-530
- 22 Bartels R H, Termeer E H, van der Wilt G J. et al . Simple decompression or anterior subcutaneous transposition for ulnar neuropathy at the elbow: A cost-minimization analysis: Part 2. Neurosurgery. 2005; 56 531-536
- 23 Bartels R H, Verbeek A L. Risk factors for ulnar nerve compression at the elbow: a case control study. Acta Neurochirurgica. 2007; 149 669-674
- 24 Bednar M S, Blair S J, Light T R. Complications of the treatment of cubital tunnel syndrome. Hand Clin. 1994; 10 83-92
- 25 Beekmann R, Schoenmaker M C, van der Plas J P. et al . Diagnostic value of high-resolution sonography in ulnar neuropathy at the elbow. Neurology. 2004; 62 767-773
- 26 Beekman R, van der Plas J P, Uitdehaag B M. et al . Clinical, electrodiagnostic, and sonographic studies in ulnar neuropathy at the elbow. Muscle Nerve. 2004; 30 202-208
- 27 Beekman R, Wokke J H, Schoenmaker M C. et al . Ulnar neuropathy at the elbow: follow-up and prognostic factors determining outcome. Neurology. 2005; 64 1664-1665
- 28 Benecke R, Conrad B. The value of electrophysiological examination of the flexor carpi ulnaris muscle in the diagnosis of ulnar nerve lesions at the elbow. J Neurol. 1980; 223 207-217
- 29 Biggs M, Curtis J A. Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition. Neurosurgery. 2006; 58 296-304
- 30 Bimmler D, Meyer V E. Surgical treatment of the ulnar nerve entrapment neuropathy: submuscular anterior transposition or simple decompression of the ulnar nerve? Long-term results in 79 cases. Ann Chir Main Memb Super. 1996; 15 148-157
-
31 Bischoff C.
Neurophysiologische Methoden und Ergebnisse bei ausgewählten Erkrankungen. Bischoff C, Dengler R, Hopf HC, Hrsg. EMG – NLG. Stuttgart, New York; Thieme 2003 - 32 Black B T, Barron O A, Townsend P F. et al . Stabilized subcutaneous ulnar nerve transposition with immediate range of motion. Long-term follow-up. J Bone Surg [Am]. 2000; 82 1544-1551
- 33 Bozenka D J. Cubital tunnel syndrome pathophysiology. Clini Ortho. 1998; 351 90-94
- 34 Brauer C A, Graham B. The surgical treatment of cubital tunnel syndrome: a decision analysis. J Hand Surg Eur. 2007; 32 654-662
- 35 Britz G W, Haynor D R, Kuntz C. et al . Ulnar nerve entrapment at the elbow: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. Neurosurgery. 1996; 38 458-465
- 36 Campbell W W, Pridgeon R M, Sahni S K. Entrapment neuropathy of the ulnar nerve at its point of exit from the flexor carpi ulnaris muscle. Muscle Nerve. 1988; 11 467-470
- 37 Campbell W W, Pridgeon R M, Riaz G. et al . Variations in anatomy of the ulnar nerve at the cubital tunnel: pitfalls in the diagnosis of ulnar neuropathy at the elbow. Muscle Nerve. 1991; 14 733-738
- 38 Caputo A E, Watson H K. Subcutaneous anterior transposition of the ulnar nerve for failed decompression of cubital tunnel syndrome. J Hand Surg [Am]. 2000; 25 544-551
- 39 Casscells C D, Lindsey R W, Ebersole J. et al . Ulnar neuropathy after median sternotomy. Clin Orthop Rel Res. 1993; 291 259-265
- 40 Center of evidence based medicine, Oxford 2001; http://www.cebm.net/levels_of_evidence.asp .
- 41 Chan R C, Paine K WE, Varughese G. Ulnar neuropathy at the elbow: comparison of simple decompression and anterior transposition. Neurosurgery. 1980; 7 545-550
- 42 Contreras M G, Warner M A, Charboneau W J. et al . Anatomy of the ulnar nerve at the elbow: potential relationship of acute ulnar neuropathy to gender differences. Clin Anat. 1998; 11 372-378
- 43 Dagregorio G, Saint-Cast Y. Simple neurolysis for failed anterior submuscular transposition of the ulnar nerve at the elbow. Int Orthop. 2004; 28 342-346
- 44 Davis G A, Bulluss K J. Submuscular transposition of the ulnar nerve: review of safety, efficacy and correlation with neurophysiological outcome. J Clin Neurosci. 2005; 12 524-548
- 45 Degeorges R, Masquelet A C. The cubital tunnel: anatomical study of its distal part. Surg Radiol Anat. 2002; 24 169-176
- 46 De Jesus R, Dellon A L. Historic origin of the “Arcade of Struthers”. J Hand Surg [Am]. 2003; 28 528-531
- 47 Dellon A L. Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg [Am]. 1989; 14 688-700
- 48 Dellon A L. Techniques for successful management of ulnar nerve entrapment at the elbow. Neurosurg Clin N Am. 1991; 2 57-73
- 49 Dellon A L, Coert J H. Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow. J Bone Joint Surg [Am]. 2004; 86 169-179
- 50 Dellon A L, Hament W, Gittelshon A. Nonoperative management of cubital tunnel syndrome: an 8-year prospective study. Neurology. 1993; 43 1673-1677
- 51 Dellon A L, Mackinnon S E, Hudson A R. et al . Effect of submuscular versus intramuscular placement of ulnar nerve: experimental model in the primate. J Hand Surg [Br]. 1986; 11 117-119
- 52 Descatha A, Leclerc A, Chastang J F. et al. . Incidence of ulnar nerve entrapment at the elbow in repetitive work. Scand J Work Environ Health. 2004; 30 234-240
- 53 Dinh P T, Gupta R. Subtotal medial epicondylectomy as a surgical option for treatment of cubital tunnel syndrome. Tech Hand Up Extrem Surg. 2005; 9 52-59
- 54 Don Griot J P, Hage J J, de Groot P J. Digital innervation patterns following median or ulnar nerve laceration and their correlation to anatomic variations of the communicating branch between these nerves. J Hand Surg [Br]. 2004; 29 351-355
- 55 Doyle J R, Botte M J. Surgical anatomy of the hand and upper extremity. Philadelphia, Baltimore, New York; Lippincott Williams & Wilkins 2003: 391
- 56 Efstathopoulos D G, Themistocleous G S, Papagelopoulos P J. et al . Outcome of partial medial epicondylectomy for cubital tunnel syndrome. Clin Orthop Relat Res. 2006; 444 134-139
-
57 Eversmann W W.
Entrapment and compression neuropathies. Green DP, ed. Operative hand surgery. 2nd ed. Philadelphia; Churchill Livingstone 1988: 1441-1454 - 58 Eisen A, Danon J. The mild cubital tunnel syndrome. Its natural history and indications for surgical intervention. Neurology. 1974; 24 608-613
- 59 Feindel W, Stratford J. The role of the cubital tunnel in tardy ulnar palsy. Can J Surg. 1958; 1 287-300
- 60 Filippi R, Charalampaki P, Reisch R. et al . Recurrent cubital tunnel syndrome. Etiology and treatment. Minim Invas Neurosurg. 2001; 44 197-201
- 61 Filippi R, Farag S, Reisch R. et al . Cubital tunnel syndrome. Treatment by decompression without transposition of ulnar nerve. Minim Invas Neurosurg. 2002; 45 164-168
- 62 Gervasio O, Gambardella G. Anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome. Personal experience. J Neurosurg Sci. 2004; 48 113-116
- 63 Gervasio O, Gambardella G, Zaccone C. et al . Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: a prospective randomized study. Neurosurgery. 2005; 56 108-117
- 64 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. 2008; 62 186-192
- 65 Geutjens G G, Langstaff R J, Smith N J. Medial epicondylectomy of ulnar-nerve transposition for ulnar neuropathy at the elbow?. J Bone Joint Surg [Br]. 1996; 78 777-779
- 66 Gonzalez M H, Lotfi P, Bendre A. et al . The ulnar nerve at the elbow and ist local branching: an anatomic study. J Hand Surg [Br]. 2001; 26 142-144
- 67 Graham B. Strategies for nonrandomized clinical research in hand surgery. Clin Plast Surg. 2005; 32 529-536
- 68 Green J R, Rayan G M. The cubital tunnel: Anatomic, histologic, and biomechanical study. J Shoulder Elbow Surg. 1999; 8 466-470
- 69 Greenwald D, Blum 3rd L C, Adams D. et al . Effective surgical treatment of cubital tunnel syndrome based on provocative clinical testing without electrodiagnostics. Plast Reconstr Surg. 2006; 117 87e-91e
- 70 Grewal R, Varitimidis S E, Vardakas D G. et al . Ulnar nerve elongation and excursion in the cubital tunnel after decompression and anterior transposition. J Hand Surg [Br]. 2000; 25 457-460
- 71 Harmon R L. Bilaterality of ulnar neuropathy at the elbow. Electromyogr Clin Neurophysiol. 1991; 31 195-198
- 72 Hashiguchi H, Ito H, Sawaizumi T. Stabilized subcutaneous transposition of the ulnar nerve. Int Orthop. 2003; 27 232-234
- 73 Heise C O, Toledo S M. Mixed latency difference for diagnosis of ulnar neuropathy at the elbow. Arch Phys Med Rehabil. 2006; 87 408-410
- 74 Heithoff S J, Millender L H, Nalebuff E A. et al . Medial epicondylectomy for the treatment of ulnar nerve compression at the elbow. J Hand Surg [Am]. 1990; 15 22-29
- 75 Herrmann D N, Preston D C, McIntosh K A. et al . Localization of ulnar neuropathy with conduction block across the elbow. Muscle Nerve. 2001; 24 698-700
- 76 Hicks D, Toby E B. Ulnar nerve strains at the elbow: the effect of in situ decompression and medial epicondylectomy. J Hand Surg [Am]. 2002; 27 1026-1031
- 77 Hilburn J W. General principles and use of electrodiagnostics studies in carpal and cubital tunnel syndromes. With special attention to pitfalls and interpretation. Hand Clin. 1996; 12 205-221
- 78 Höllerhage H G, Stolke D. Ergebnisse der volaren Transposition des Nervus ulnaris bei Sulcus-ulnaris-Syndrom. Neurochirurgia. 1985; 28 64-67
- 79 Hoffmann R, Siemionow M. The endoscopic management of cubital tunnel syndrome. J Hand Surg [Br]. 2006; 31 23-29
- 80 Holtzman R N, Mark M H, Patel M R. et al . Ulnar nerve entrapment neuropathy in the forearm. J Hand Surg [Am]. 1984; 9 576-578
- 81 Hong C Z, Long H A, Kanakamedala R V. et al . Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation. Arch Phys Med Rehabil. 1996; 77 573-577
- 82 Huang J H, Samadani U, Zager E L. Ulnar nerve entrapment neuropathy at the elbow: simple decompression. Neurosurgery. 2004; 55 1150-1153
- 83 Iba K, Wada T, Aoki M. et al . Intraoperative measurement of pressure adjacent to the ulnar nerve in patients with cubital tunnel syndrome. J Hand Surg [Am]. 2006; 31 553-558
- 84 Iba K, Wada T, Aoki M. et al . The relationship beween the pressure adjacent to the ulnar nerve and the disease causing cubital tunnel syndrome. Shoulder Elbow surg. 2008; 17 585-588
-
85 Kele H.
Neurosonographie. Assmus H, Antoniadis G, Hrsg. Nervenkompressionssyndrome. Heidelberg; Steinkopff 2008 - 86 Kern R Z. The electrodiagnosis of ulnar nerve entrapment at the elbow. Can J Neurol Sci. 2003; 30 314-319
- 87 Kim D H, Han K, Tiel R L. et al . Surgical outcomes of 654 ulnar nerve lesions. J Neurosurg. 2003; 98 993-1004
- 88 Kim D H, Kang Y K, Hwang M. et al . Localization of ulnar neuropathy at the elbow using new stimulator for the inching test. Clin Neurophysiol. 2004; 115 1021-1026
- 89 Kim D H, Date E S, Lee S H. et al . Distance measure error induced by displacement of the ulnar nerve when the elbow is flexed. Arch Phys Med Rehabil. 2005; 86 809-812
- 90 Kim D H, Kang Y K, Hwang M. et al . Reference values of fractionated neurography of the ulnar nerve at the wrist in healthy subjects. Clin Neurophysiol. 2005; 116 2853-2857
- 91 Kim S, Choi J Y, Huh Y M. et al . Role of magnetic resonance imaging. Eur Radiol. 2007; 17 509-522
- 92 Kleinman W B. Cubital tunnel syndrome: anterior transposition as a logical approach to complete nerve decompression. J Hand Surg [Am]. 1999; 24 886-897
- 93 Kline D G, Reeves J, El-Gindi S. et al . Treatment of ulnar neuropathy. Surg Neurol. 2000; 53 524-529
- 94 Krishnan K G, Pinzer T, Schackert G. A novel endoscopic technique in treating single nerve entrapment syndromes with special attention to ulnar nerve transposition and tarsal tunnel release: clinical application. Operative Neurosurgery. 2006; 59 (Suppl. 1) ONS 89-100
- 95 Landau M E, Diaz M I, Barner K C. et al . Changes in nerve conduction velocity across the elbow due to experimental error. Muscle Nerve. 2002; 26 838-840
- 96 Landau M E, Diaz M I, Barner K C. et al . Optimal distance for segmental nerve conduction studies revisited. Muscle Nerve. 2003; 27 367-369
- 97 Landau M E, Barner K C, Campbell W W. Optimal screening distance for ulnar neuropathy at the elbow. Muscle Nerve. 2003; 27 570-574
- 98 Landau M E, Barner K C, Campbell W W. Effect of body mass index on ulnar nerve conduction velocity, ulnar neuropathy at the elbow, and carpal tunnel syndrome. Muscle Nerve. 2005; 32 360-363
- 99 Landau M E, Barner K C, Murry E D. et al . Cold elbow syndrome: spurious slowing of ulnar nerve conduction velocity. Muscle Nerve. 2005; 32 815-817
- 100 Lankester B J, Giddins G E. Ulnar nerve decompression in the cubital canal using local anaesthetica. J Hand Surg [Br]. 2001; 26 65-66
- 101 Leone J, Bhandari M, Thoma A. Anterior intramuscular transposition with ulnar nerve decompression at the elbow. Clin Orthop. 2001; 387 132-139
- 102 Le Roux P D, Ensign T D, Burchiel K J. Surgical decompression without transposition for ulnar neuropathy: factors determining outcome. Neurosurgery. 1990; 27 709-714
- 103 Lo Y L, Leoh T H, Xu L Q. et al . Short-segment nerve conduction studies in the localization of ulnar neuropathy of the elbow: use of flexor carpi ulnaris recordings. Muscle Nerve. 2005; 31 633-636
- 104 Lowe 3rd J B, Novak C B, Mackinnon S E. Current approach to cubital tunnel syndrome. Neurosurgery Clinics of North America. 2001; 12 267-284
- 105 Lowe J B, Mackinnon S E. Management of secondary cubital tunnel syndrome. J Reconstr Surg. 2004; 113 E1-E16
- 106 Lowe 3rd J B, Maggi S P, Mackinnon S E. The position of crossing branches of the medial antebrachial cutaneous nerve during cubital tunnel surgery in humans. Plast Reconstr Surg. 2004; 114 692-696
- 107 Lund A T, Amadio P C. Treatment of cubital tunnel syndrome: perspective for the therapist. J Hand Ther. 2006; 19 170-178
- 108 Lundborg G. Surgical treatment of ulnar nerve entrapment at the elbow. J Hand Surg [Br]. 1992; 17 245-247
- 109 Martinoli C, Bianchi S, Pugliese F. et al . Sonography of entrapment neuropathies in the upper limb (wrist excluded). J Clin Ultrasound. 2004; 32 438-450
- 110 Matei C I, Logigian E L, Shefner J M. Evaluation of patients with recurrent symptoms after ulnar nerve transposition. Muscle Nerve. 2004; 30 493-496
- 111 Matev B. Cubital tunnel syndrome. Hand Surgery. 2003; 8 127-131
- 112 Matsuzaki H, Yposhizu T, Maki Y. et al . Long-term clinical and neurologic recovery in the hand after surgery for severe cubital tunnel syndrome. J Hand Surg. 2004; 29 373-378
- 113 McGowan A J. The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Jt Surg [Br]. 1950; 32 293
- 114 Merlevede K, Theys P, van Hees J. Diagnosis of ulnar neuropathy: a new approach. Muscle Nerve. 2000; 23 478-481
- 115 Miller R G, Hummel E E. The cubital tunnel syndrome: treatment with simple decompression. Ann Neurol. 1980; 7 567-569
- 116 Mondelli M, Giannini F, Ballerini M. et al . Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci. 2005; 15 5-10
- 117 Mondelli M, Padua L, Giannini F. et al . A self-administered questionnaire of ulnar neuropathy at the elbow. Neurol Sci. 2006; 27 402-411
- 118 Mowlawi A, Andrews K, Lille S. et al . The management of cubital tunnel syndrome: a meta-analysis of clinical studies. Plast Reconstr Surg. 2000; 106 327-334
- 119 Nabhan A, Ahlhelm F, Kelm J. et al . Simple decompression or subcutaneous anterior transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg [Br]. 2005; 30 521-524
- 120 Nabhan A, Kelm J, Steudel W I. et al . Cubital tunnel syndrome – simple nerve decompression or decompression with subcutaneous anterior transposition?. Fortschr Neurol Psychiatr. 2007; 75 168-171
- 121 Nathan P A, Keniston R C, Meadows K D. Outcome study of ulnar nerve compression at the elbow treated with simple decompression and an early programme of physical therapy. J Hand surg [Br]. 1995; 20 628-637
- 122 Nathan P A, Istvan J A, Meadows K D. Intermediate and long-term outcomes following simple decompression of the ulnar nerve at the elbow. Chir Main. 2005; 24 29-34
- 123 Nawrot P, Romanowski L, Nowakowski A. Anatomical basis for a surgical treatment of cubital tunnel syndrome. Chir Narzadow Ruchu Ortop Pol. 2004; 69 207-210
- 124 Nigst H. Ergebnisse der operativen Behandlung der Neuropathie des N. ulnaris im Ellenbogenbereich. Handchirurgie. 1983; 15 212-220
- 125 Nikitins M D, Griffin P A, Ch'ng S. et al . A dynamic anatomical study of ulnar nerve motion after anterior transposition for cubital tunnel syndrome. Hand Surg. 2002; 7 177-182
- 126 Nouhan R, Kleinert J M. Ulnar nerve decompression by transposing the nerve and z-lengthening the flexor-pronator mass: clinical outcome. J Hand Surg [Am]. 1997; 22 127-131
- 127 Novak C B, Lee G W, Mackinnon S E. et al . Provokative testing for cubital tunnel syndrome. J Hand Surg [Am]. 1994; 19 817-820
- 128 Novak C B, Mackinnon S E, Stuebe A M. Patient self-reported outcome after ulnar nerve transposition. Ann Plast Surg. 2002; 48 274-280
- 129 Odabasi Z, Oh S J, Claussen G C. et al . New near-nerve needle nerve conduction technique: differentiating epicondylar from cubital tunnel ulnar neuropathy. Muscle Nerve. 1999; 22 718-723
- 130 O'Driscoll S W, Horii E, Carmichael S W. et al . The cubital tunnel and ulnar neuropathy. J Bone Joint Surg [Br]. 1991; 73 613-617
- 131 Okamoto M, Abe M, Shirai H. et al . Diagnostic ultrasonography of the ulnar nerve in cubital tunnel syndrome. J Hand Surg. 2000; 25 499-502
- 132 Osborne G V. The surgical treatment of tardy ulnar neuritis. J Bone Joint Surg [Br]. 1957; 39 782
- 133 Osborne G. Compression neuritis of the ulnar nerve at the elbow. The Hand. 1970; 2 10-13
- 134 Padua L, Aprile I, Mazza O. et al . Neurophysiological classification of ulnar entrapment across the elbow. Neurol Sci. 2001; 22 11-16
- 135 Padua L, Aprile I, Caliandro P. et al . Natural history of ulnar entrapment at elbow. Clin Neurophysiol. 2002; 113 1980-1984
- 136 Park G Y, Kim J M, Lee S M. The ultrasonographic and electrodiagnostic findings of ulnar neuropathy at the elbow. Arch Phys Med Rehabil. 2004; 85 1000-1005
- 137 Pavelka M, Rhomberg M, Estermann D. et al . Decompression without anterior transposition: an effective minimally invasive technique for cubital tunnel syndrome. Minim Invas Neurosurg. 2004; 47 119-123
- 138 Popa M, Dubert T. Treatment of cubital tunnel syndrome by frontal partial medial epicondylectomy. A retrospective series of 55 cases. J Hand Surg [Br]. 2004; 29 563-567
- 139 Porcellini G, Paladini P, Campi F. et al . Arthroscopic neurolysis of the ulnar nerve at the elbow. Chir Organi Mov. 2005; 90 191-200
- 140 Posner M A. Compressive neuropathies of the ulnar nerve at the elbow and wrist. Instr Course Lect. 2000; 49 305-317
- 141 Rath T, Meissl G, Millesi H. Ist die intraneurale Neurolyse beim Sulcus nervi ulnaris-Syndrom gerechtfertigt?. Handchir Mikrochir Plast Chir. 1989; 21 294-298
- 142 Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manipulative Physiol Ther. 2005; 28 345
- 143 Robinson D, Aghasi M K, Halperin N. Medial epicondylectomy in cubital tunnel syndrome: an electrodiagnostic study. J Hand Surg [Br]. 1992; 17 255-256
- 144 Rochet S, Obert L, Lepage D. et al . Should we divide Osborne's ligament during epicondylectomy and in situ decompression of the ulnar nerve?. Chir Main. 2004; 23 131-136
- 145 Rogers M R, Bergfield T G, Aulicino P L. The failed ulnar nerve transposition. Etiology and treatment. Clin Orthop. 1991; 269 193-200
- 146 Rosenberg Z S, Beltran J, Cheung Y. et al . MR imaging of the elbow: normal variant and potential diagnostics pitfalls of the trochlear groove and cubital tunnel. AJR. 1995; 164 415-418
- 147 Sarris I, Gobel F, Gainer M. et al . Medial brachial and antebrachial cutaneous nerve injuries: effect on outcome in revision cubital tunnel sugery. J Reconstr Microsurg. 2002; 18 665-670
- 148 Schmidt A. Nervenkompressionssyndrome im Bereich des Ellenbogengelenks bei Patienten mit chronischer Polyarthritis. Handchir Mikrochir Plast Chir. 1993; 25 75-79
- 149 von Schroeder H P, Scheker L R. Redefining the “Arcade of Struthers”. J Hand Surg [Am]. 2004; 29 335
- 150 Seradge H, Owen W. Cubital tunnel release with medial epicondylectomy factors influencing the outcome. J Hand Surg [Am]. 1998; 23 483-491
- 151 Seror P. Treatment of ulnar nerve palsy at the elbow with a night splint. J Bone Jt Surg [Br]. 1993; 75 322-327
- 152 Seror P, Nathan P A. Relative frequency of nerve conduction abnormalities at carpal tunnel and cubital tunnel in France and the United States: importance of silent neuropathies and role of ulnar neuropathy after unsuccessful carpal tunnel syndrome release. Ann Chir Main Memb Super. 1993; 12 281-285
- 153 Shakir A, Micklesen P J, Robinson L R. Which nerve conduction is best in ulnar neuropathy at the elbow?. Muscle Nerve. 2004; 29 585-590
-
154 Siegel D B, Gelberman R H.
Ulnar nerve: applied anatomy and operative exposure. Gelberman RH, ed. Operative nerve repair and reconstruction. Philadelphia; J. B. Lippincott 1991: 413-424 - 155 Siemionow M, Agaoglu G, Hoffmann R. Anatomic characteristics of a transparent submuscular membrane and its bands overlying the ulnar nerve in the upper forearm: a cadaver study. J Hand Surg [Br]. 2007; 22
- 156 Siqueira M G, Martins R S. The controversial arcade of Struthers. Surg Neurol. 2005; 64 474
- 157 Steiner H H, von Haken M S, Steiner-Milz H G. Entrapment neuropathy at the cubital tunnel: simple decompression is the method of choice. Acta Neurochir. 1996; 138 308-313
-
158 Stöhr M, Assmus H, Bischoff C. et al .
Chronische Ulnarisneuropathie am Ellenbogen (ulnar neuropathy at the elbow, UNE) . Diener H, Hacke W, Hrsg. Leitlinien für Diagnostik und Therapie in der Neurologie. Stuttgart; Thieme 2002 - 159 Sunderland S. Nerves and nerve injuries. Edinburgh, London, New York; Churchill Livingstone 1978
- 160 Szabo R M, Kwak C. Natural history and conservative management of cubital tunnel syndrome. Hand Clin. 2007; 23 311-318
- 161 Tackmann W, Vogel P, Kaeser H E. et al . Sensitivity and localizing significance of motor and sensory electroneurographic parameters in the diagnosis of ulnar nerve lesions at the elbow. J Neurol. 1984; 231 204-211
- 162 Tackmann W, Richter H P, Stöhr M. Kompressionssyndrome peripherer Nerven. Berlin, Heidelberg, New York, London, Paris, Tokyo; Springer 1989
- 163 Tada H, Hirayama T, Katsuki M. et al . Long term results using a modified King's method for cubital tunnel syndrome. Clin Orthop. 1997; 336 107-110
- 164 Taha A, Galarza M, Zuccarello M. et al . Outcomes of cubital tunnel surgery among patients with absent sensory nerve conduction. Neurosurg. 2004; 54 891-896
- 165 Taniguchi Y, Takami M, Takami T. et al . Simple decompression with small skin incision for cubital tunnel syndrome. J Hand Surg [Br]. 2002; 28 621
- 166 Teoh L C, Yong F C, Tan S H. et al . Anterior subfascial transposition of the ulnar nerve. J Hand Surg [Br]. 2003; 28 621
- 167 Tomaino M M, Brach P J, Vansickle D P. The rationale for and efficacy of surgical intervention for electrodiagnostic-negative cubital tunnel syndrome. J Hand Surg [Am]. 2001; 26 1077-1081
- 168 Tsai T M, Chen I C, Majd M E. et al . Cubital tunnel release with endoscopic assistance: results of a new technique. J Hand Surg [Am]. 1999; 24 647
- 169 Verheyden J R, Palmer A K. Cubital tunnel syndrome. eMedicine 2007
- 170 Vogel R B, Nossaman B C, Rayan G M. Revision anterior submuscular transposition of the ulnar nerve for failed subcutaneous transposition. J Plast Surg [Br]. 2004; 57 311-316
- 171 Vucic S, Cordato D J, Yiannikas C. et al . Utility of magnetic resonance imaging in diagnosing ulnar neuropathy at the elbow. Clin Neurophysiol. 2006; 117 590-595
-
172 Watchmaker G.
Ulnar nerve compression. Allieu Y, Mackinnon SE, eds. Nerve compression syndromes of the upper limb. London; Martin Dunitz 2002: 97-115 - 173 Waugh R P, Zlotolow D A. In situ decompression of the ulnar nerve at the cubital tunnel. Hand Clin. 2007; 23 319-327
- 174 Wehrli L, Oberlin C. The internal brachial ligament versus the arcade of Struthers: an anatomical study. Plast Reconst Surg. 2005; 115 471-477
- 175 Weirich S D, Gelberman R H, Best S A. et al . Rehabilitation after subcutaneous transposition of the ulnar nerve: immediate versus delayed mobilization. J Shoulder Elbow Surg. 1998; 7 244-249
- 176 Wiesler E R, Chloros G D, Cartwright M S. et al . Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel. J Hand Surg [Am]. 2006; 31 1088-1093
- 177 Yamamoto K, Shishido T, Masaoka T. et al . Postoperative clinical results in cubital tunnel syndrome. Orthopedics. 2006; 29 347-353
- 178 Yoon J S, Kim B J, Kim S J. et al . Ultrasonographic measurements in cubital tunnel syndrome. Muscle Nerve. 2007; 36 853-855
- 179 Zlowodski M, Chan S, Bhandari M. et al . Anterior transposition compared with simple decompression for treatment of cubital tunnel syndome. A meta-analysis of randomized, controlled trials. J Bone Jt Surg [Am]. 2007; 89 2591-2598
1 Die Übersicht basiert auf der S3-Leilinie der beteiligten 7 Fachgesellschaften, die – ergänzt durch Empfehlungsgrade – unter www.leitlinien.net abrufbar ist.
Dr. Hans Assmus
Praxis für periphere Neurochirurgie
Ringstraße 3
69221 Dossenheim
Email: hans-assmus@t-online.de