Olga Gervasio1, Claudio Zaccone. 1. Department of Neurosurgery, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy. olgage@tin.it
Abstract
OBJECTIVE: We sought to describe the operative technique in ulnar nerve compression caused by the epitrochleoanconeus muscle and a prominent medial head of the triceps. These anatomic features make the approach to the ulnar nerve at the elbow peculiar and may create technical difficulties during surgical treatment of this area. METHODS: We reviewed patients who underwent surgery for cubital tunnel syndrome between November 1997 and December 2004. The presence of the epitrochleoanconeus muscle with prominent medial head of the triceps occurred in 3.2% of patients. A detailed and illustrated description of the surgical anatomy and the peculiarities of the surgical approach are provided. RESULTS: Epitrochleoanconeus muscle and the prominent portion of the medial head of the triceps were sectioned and removed, and simple decompression of the ulnar nerve was performed. This treatment achieved complete recovery in all of the patients affected by moderate-grade syndrome (Dellon Grade 2 syndrome) who had not shown severe-grade syndrome preoperatively. CONCLUSION: The simple decompression of the ulnar nerve with myotomy or removal of epitrochleoanconeus muscle and the prominent portion of the medial head of the triceps achieved good postoperative results. Experiences from the literature and alternative surgical options are reported.
OBJECTIVE: We sought to describe the operative technique in ulnar nerve compression caused by the epitrochleoanconeus muscle and a prominent medial head of the triceps. These anatomic features make the approach to the ulnar nerve at the elbow peculiar and may create technical difficulties during surgical treatment of this area. METHODS: We reviewed patients who underwent surgery for cubital tunnel syndrome between November 1997 and December 2004. The presence of the epitrochleoanconeus muscle with prominent medial head of the triceps occurred in 3.2% of patients. A detailed and illustrated description of the surgical anatomy and the peculiarities of the surgical approach are provided. RESULTS:Epitrochleoanconeus muscle and the prominent portion of the medial head of the triceps were sectioned and removed, and simple decompression of the ulnar nerve was performed. This treatment achieved complete recovery in all of the patients affected by moderate-grade syndrome (Dellon Grade 2 syndrome) who had not shown severe-grade syndrome preoperatively. CONCLUSION: The simple decompression of the ulnar nerve with myotomy or removal of epitrochleoanconeus muscle and the prominent portion of the medial head of the triceps achieved good postoperative results. Experiences from the literature and alternative surgical options are reported.