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The cubital tunnel: anatomic, histologic, and biomechanical study
1Department of Orthopaedic Surgery and Rehabilitation, University of Oklahoma Health Science Center, Oklahoma City, USA.
Journal of Shoulder and Elbow Surgery
|October 30, 1999
Summary
Cubital tunnel pressure increases with elbow flexion, particularly at the common flexor aponeurosis (CFA). The CFA contributes to ulnar nerve compression, and releasing the arcuate ligament does not decompress the distal tunnel.
Area of Science:
- Orthopedics
- Anatomy
- Nerve Compression Syndromes
Background:
- Cubital tunnel syndrome is a common nerve entrapment.
- Understanding the anatomical factors influencing ulnar nerve compression is crucial.
Purpose of the Study:
- To investigate the anatomical relationship between the ulnar nerve and the common flexor aponeurosis (CFA) in the cubital tunnel.
- To assess pressure dynamics within the cubital tunnel under various elbow flexion angles.
Main Methods:
- Human cadaveric elbow dissection (n=19).
- Cubital tunnel pressure measurements at medial epicondyle and distal to it.
- Histological examination of the ulnar nerve.
- Assessment of pressure changes after arcuate ligament release.
Main Results:
- A common flexor aponeurosis (CFA) was consistently identified.
- Distal cubital tunnel pressures were higher than proximal pressures.
- Elbow flexion significantly increased cubital tunnel pressure.
- Arcuate ligament release reduced proximal but not distal pressure.
- Ulnar nerve showed an oligofascicular pattern at the CFA level.
Conclusions:
- The CFA has an intimate anatomical relationship with the ulnar nerve, contributing to distal nerve compression.
- Elbow flexion exacerbates cubital tunnel pressure.
- Distal cubital tunnel decompression requires addressing the CFA, not solely the arcuate ligament.