cubital tunnel syndrome
Introduction
Introduction to the elbow syndrome The cubital tunnel syndrome (cubitaltunnelsyndrome) has ulnar nerve compression due to elbow traumatic arthritis. There is a thickened fibrous band between the ulnar wrist flexor muscles, which compresses the ulnar nerve and is called the elbow syndrome. There is an arc-shaped narrow and deep bone groove between the upper iliac crest and the ulna eagle, and a deep fascia is placed on the upper to form a bony fiber sheath, that is, a ulnar nerve groove, also called an elbow rule tube. Inside the tube are the ulnar nerve and the ulnar side of the anterior movement and vein. 1957. Osborne first reported the disease and called it delayed ulnar neuritis. In 1958, Feined and Stratford called the disease an elbow syndrome. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: elbow valgus
Cause
Causes of cubital syndrome
(1) Causes of the disease
Any factor that causes the absolute or relative decrease in the volume of the elbow can cause compression of the ulnar nerve. Common causes are:
Chronic injury (30%):
In the humerus, the external malleolar fracture, the supracondylar fracture and the radial head fracture can produce elbow valgus or other deformities due to malformation, which increases the carrying angle and shortens the ulnar nerve, thus causing the ulnar nerve to be pulled, compressed and rubbed.
Rheumatism (26%):
Elbow joint rheumatism or rheumatoid arthritis, rheumatism or rheumatoid lesions invade the synovial membrane of the elbow joint, making it hypertrophic and hypertrophic, causing deformation of the elbow joint and osteophyte hyperplasia in the late stage, which may also cause the volume of the elbow to decrease.
Lump (15%):
Such as ganglion cysts, lipomas, etc., but less common.
Congenital factors (12%):
Such as congenital elbow valgus, ulnar nerve groove shallow and repeated ulnar nerve dislocation, Struthers arched tissue.
Other (15%):
Long-term elbow work, cardio pressure caused by iatrogenic factors, "sleep sputum" caused by elbow and elbow sleep.
(two) pathogenesis
The elbow is a fibrous fibrous tube. The ulnar nerve with the ulnar artery passes through the elbow from the back of the humerus to the flexion of the forearm. The bottom of the elbow is the medial ligament of the elbow. The deep side of the medial ligament of the elbow is the medial lip and tibia of the trochlear. The ulnar nerve groove in the lower part of the upper iliac crest; the top is the triangular arch ligament that connects the upper iliac crest and the inner side of the olecranon, so the arched ligament is also bridged between the humeral head and the ulnar head of the ulnar wrist flexor, elbow The size of the tube varies with the flexion and extension of the elbow joint: when the elbow is extended, the bow ligament is loose, and the volume of the elbow is enlarged; when the elbow is bent to 90°, the bow ligament is tense, and each flexion is 45°. The distance between the olecranons will be widened by 0.5cm. In addition, when the elbow is flexed in a 0.5cm widening state, the ulnar ligament bulge also reduces the volume of the elbow, so the ulnar nerve is susceptible to compression. The pressure in the elbow is 0.93 kPa when the joint is straightened and 1.5 to 3.2 kPa when the elbow is bent to 90°.
The ulnar nerve sends out 2 to 3 fine branches to the elbow joint when passing through the elbow joint; within 4 cm of the upper jaw of the humerus, the ulnar nerve sends out a branch of the ulnar wrist flexor muscle, usually 2 muscles. Deep into, dominate the ring, the little finger refers to the branch of the deep flexor muscle slightly distal to the ulnar wrist flexor, from the front of the muscle enters and dominates the two muscles.
Prevention
Elbow syndrome prevention
Disease prevention: avoid traumatic factors. The ulnar nerve presurgery is the basic treatment. If the ulnar nerve is hard in the operation, the epicardium should be removed, and the inter-beam release can completely solve the problem. After the operation, the normal feeling can be restored quickly. Atrophic muscles are more difficult to restore normal volume.
Complication
Tracheal syndrome complications Complications elbow valgus
Can be complicated by delayed ulnar neuritis.
Symptom
Elbow syndrome symptoms common symptoms weakness upper limb numbness nerve pain
1. The ulnar side of the hand, the small fish, the little finger and the ring finger sensation first occur abnormally, usually numbness or tingling.
2, following the occurrence of paresthesia for a certain period of time, there may be a small finger on the palm and the finger is not flexible.
3, check the hand small fish muscle, interosseous muscle atrophy, and the ring, small finger positive claw deformity, the aforementioned areas of skin pain loss, positive paper test and Tinel sign at the ulnar nerve groove.
4. Electrophysiological examination revealed that the ulnar nerve conduction velocity of the elbow was slowed down, and the electromyogram of the intermuscular and interosseous muscles was abnormal.
5, the basic disease manifestations such as elbow valgus, ulnar nerve groove thickening black with mass. X-ray films show localized displaced bone or abnormal ossification.
Examine
Elbow syndrome examination
1. Electromyography: It is helpful to perform electromyography on patients whose specific part of the ulnar nerve compression is not determined or whose diagnosis is unclear. It may be characterized by slower ulnar nerve conduction velocity, prolonged incubation period, and ulnar nerve innervation. The muscle has a denervated self-generating position.
2. X-ray film: Bone changes around the elbow joint can be found and should be routinely applied to patients suspected or diagnosed with cubital syndrome.
Diagnosis
Diagnosis and diagnosis of cubital tunnel syndrome
According to the medical history, clinical manifestations of symptoms, signs, Tinel sign positive, EMG examination and X-ray examination, can establish a diagnosis.
Differential diagnosis
There are many diseases that need to be distinguished from cubital tunnel syndrome, including ulnar nerve compression in other parts, systemic diseases and granulomatous diseases such as cervical spondylosis (neural root type), thoracic outlet syndrome, diabetes, leprosy, elbow joint tuberculosis Wait.
1. Cervical spondylosis (neural root type): Low neck nerve root compression is easily confused with this disease, but the pain of cervical spondylosis, numbness is mainly neck and shoulder, pain is radiated to the upper arm and forearm, and the intervertebral foramen is squeezed. Pressure test can induce pain. In addition, the cervical intervertebral space stenosis and osteophyte hyperplasia can be seen on the X-ray film and CT film.
2. Guyon tube syndrome: The palmar branch of the ulnar nerve is caused by compression of the Guyon tube in the wrist, which is characterized by small intermuscular muscle, interosseous muscle, atrophy of the sacral muscle, claw-shaped hand, but dominates the short-extension muscle of the little finger. Most of the muscle branches are issued on the proximal side of the Guyon tube, so the function is normal. Some patients have shallow branches of the ulnar nerve palm branch and are not tired without hand sensory disturbance.
3. Thoracic outlet syndrome: as described above.
4. Leprosy: The ulnar nerve is more involved, the ulnar nerve is abnormally large, and the hand sensation area does not sweat.
