Back to Search Start Over

Morphology of the Cubital Tunnel: An Anatomical and Biomechanical Study With Implications for Treatment of Ulnar Nerve Compression

Authors :
Andrew K. Palmer
Mari A. Allison
Levi G. Sutton
Jaison James
Niladri Basu
Frederick W. Werner
Source :
The Journal of Hand Surgery. 36:1988-1995
Publication Year :
2011
Publisher :
Elsevier BV, 2011.

Abstract

Purpose The purpose of this study is to provide a thorough understanding of the anatomy of the cubital tunnel and to outline specific anatomical parameters of the cubital tunnel retinaculum (CuTR) that might aid in the management of ulnar nerve problems. The hypotheses of this study are (1) that the nerve elongates with elbow flexion and (2) that the cross-sectional area of the cubital tunnel is inversely proportional to the degree of elbow flexion. Methods Eleven fresh-frozen cadaver arms were dissected at the medial elbow. The CuTR was identified, and its thickness was measured. After excising the CuTR, we measured the elongation of the anterior and posterior aspects of the ulnar nerve, as well as the length of the CuTR origin/insertion, at increasing intervals of elbow flexion (15°, 30°, 45°, 90°, 120°, and 135°). Using 3-dimensional digitization technology, the surface of the cubital tunnel was recorded at 4 positions of elbow flexion (15°, 45°, 90°, and 135°) and analyzed to define the tunnel geometry. Results The CuTR origin-to-insertion length and the ulnar nerve length both increased significantly with increasing flexion angle. Both lengths at 90°, 120°, and 135° of elbow flexion were greater than at 15° or 30°. The cubital tunnel area was significantly less at 135° compared to either 45° or 90° of flexion. There was a linear relationship between the cubital tunnel area of the different arms with the corresponding nerve cross-sectional area when measured at the level of the epicondyle and when the arm was at 90° of elbow flexion. Conclusions The CuTR begins to stretch at 60° of flexion and continues to stretch with increasing flexion. Similarly, the ulnar nerve is more taut in flexion. The area within the cubital tunnel decreases beyond 90° of elbow flexion. Clinical relevance Understanding the dynamic anatomical relationships of the cubital tunnel might help in the safe treatment of cubital tunnel syndrome when using minimally invasive techniques and instrumentation.

Details

ISSN :
03635023
Volume :
36
Database :
OpenAIRE
Journal :
The Journal of Hand Surgery
Accession number :
edsair.doi.dedup.....88fa3bb6656d2f486cdbbdb1be751548
Full Text :
https://doi.org/10.1016/j.jhsa.2011.09.014