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Musculoskeletal
Diagnosis
Trauma
Elbow
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Ulnar Nerve Injury, Elbow
Ulnar Nerve Injury, Elbow
Donna G. Blankenbaker, MD, FACR; Kirkland W. Davis, MD, FACR; Andrew Sonin, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Cubital tunnel syndrome
            • Osborne (arcuate) ligament = retinaculum of cubital tunnel

          • Definitions

            • Ulnar neuropathy due to entrapment &/or trauma to nerve at level of elbow, within or around cubital tunnel
            • Cubital tunnel: anatomic space in posteromedial elbow through which ulnar nerve (UN) passes
            • Osborne ligament: fibrous sheath forming roof of cubital tunnel
              • a.k.a. cubital tunnel retinaculum
              • a.k.a. humeroulnar arcade
              • Described by Osborne as fibrous band between 2 heads of flexor carpi ulnaris (FCU)
            • Arcade of Struthers: thin fibrous band extending from medial head of triceps to medial intermuscular septum ~ 6-10 cm above medial humeral epicondyle

          IMAGING

          • General Features

            • Radiographic Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Kalia V et al: Imaging of peripheral nerves of the upper extremity. Radiol Clin North Am. 57(5):1063-71, 2019
                                    2. Rhodes NG et al: MR imaging of the postsurgical cubital tunnel: an imaging review of the cubital tunnel, cubital tunnel syndrome, and associated surgical techniques. Skeletal Radiol. 48(10):1541-4, 2019
                                    3. Andrews K et al: Cubital tunnel syndrome: anatomy, clinical presentation, and management. J Orthop. 15(3):832-6, 2018
                                    4. Staples JR et al: Cubital tunnel syndrome: current concepts. J Am Acad Orthop Surg. 25(10):e215-24, 2017
                                    5. De Maeseneer M et al: Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves. Eur J Radiol. 84(4):671-81, 2015
                                    6. Howe BM et al: MR Imaging of the nerves of the upper extremity: elbow to wrist. Magn Reson Imaging Clin N Am. 23(3):469-78, 2015
                                    7. Harris JD et al: Nerve injuries about the elbow in the athlete. Sports Med Arthrosc. 22(3):e7-15, 2014
                                    8. Zbojniewicz AM: US for diagnosis of musculoskeletal conditions in the young athlete: emphasis on dynamic assessment. Radiographics. 34(5):1145-62, 2014
                                    9. Kroonen LT: Cubital tunnel syndrome. Orthop Clin North Am. 43(4):475-86, 2012
                                    10. Cummins CA et al: Peripheral nerve injuries in baseball players. Neurol Clin. 26(1):195-215; x, 2008
                                    11. Gellman H: Compression of the ulnar nerve at the elbow: cubital tunnel syndrome. Instr Course Lect. 57:187-97, 2008
                                    12. Macadam SA et al: Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a meta-analysis. J Hand Surg Am. 33(8):1314, 2008
                                    13. Elhassan B et al: Entrapment neuropathy of the ulnar nerve. J Am Acad Orthop Surg. 15(11):672-81, 2007
                                    14. Kim S et al: Role of magnetic resonance imaging in entrapment and compressive neuropathy--what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity. Eur Radiol. 17(2):509-22, 2007
                                    15. Szabo RM et al: Natural history and conservative management of cubital tunnel syndrome. Hand Clin. 23(3):311-8, v-vi, 2007
                                    16. Andreisek G et al: Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics. 26(5):1267-87, 2006
                                    17. Bordalo-Rodrigues M et al: MR imaging of entrapment neuropathies at the elbow. Magn Reson Imaging Clin N Am. 12(2):247-63, vi, 2004
                                    18. Huang JH et al: Ulnar nerve entrapment neuropathy at the elbow: simple decompression. Neurosurgery. 55(5):1150-3, 2004
                                    19. Martinoli C et al: Sonography of entrapment neuropathies in the upper limb (wrist excluded). J Clin Ultrasound. 32(9):438-50, 2004
                                    20. Bartels RH: History of the surgical treatment of ulnar nerve compression at the elbow. Neurosurgery. 49(2):391-9; discussion 399-400, 2001
                                    21. Grana W: Medial epicondylitis and cubital tunnel syndrome in the throwing athlete. Clin Sports Med. 20(3):541-8, 2001
                                    22. Folberg CR et al: Cubital tunnel syndrome. Part I: presentation and diagnosis. Orthop Rev. 23(2):136-44, 1994
                                    23. Folberg CR et al: Cubital tunnel syndrome. Part II: treatment. Orthop Rev. 23(3):233-41, 1994
                                    24. McPherson SA et al: Cubital tunnel syndrome. Orthop Clin North Am. 23(1):111-23, 1992
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Pathology

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Synonyms

                                              • Cubital tunnel syndrome
                                              • Osborne (arcuate) ligament = retinaculum of cubital tunnel

                                            • Definitions

                                              • Ulnar neuropathy due to entrapment &/or trauma to nerve at level of elbow, within or around cubital tunnel
                                              • Cubital tunnel: anatomic space in posteromedial elbow through which ulnar nerve (UN) passes
                                              • Osborne ligament: fibrous sheath forming roof of cubital tunnel
                                                • a.k.a. cubital tunnel retinaculum
                                                • a.k.a. humeroulnar arcade
                                                • Described by Osborne as fibrous band between 2 heads of flexor carpi ulnaris (FCU)
                                              • Arcade of Struthers: thin fibrous band extending from medial head of triceps to medial intermuscular septum ~ 6-10 cm above medial humeral epicondyle

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • MR Findings

                                                  • Ultrasonographic Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Kalia V et al: Imaging of peripheral nerves of the upper extremity. Radiol Clin North Am. 57(5):1063-71, 2019
                                                                      2. Rhodes NG et al: MR imaging of the postsurgical cubital tunnel: an imaging review of the cubital tunnel, cubital tunnel syndrome, and associated surgical techniques. Skeletal Radiol. 48(10):1541-4, 2019
                                                                      3. Andrews K et al: Cubital tunnel syndrome: anatomy, clinical presentation, and management. J Orthop. 15(3):832-6, 2018
                                                                      4. Staples JR et al: Cubital tunnel syndrome: current concepts. J Am Acad Orthop Surg. 25(10):e215-24, 2017
                                                                      5. De Maeseneer M et al: Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves. Eur J Radiol. 84(4):671-81, 2015
                                                                      6. Howe BM et al: MR Imaging of the nerves of the upper extremity: elbow to wrist. Magn Reson Imaging Clin N Am. 23(3):469-78, 2015
                                                                      7. Harris JD et al: Nerve injuries about the elbow in the athlete. Sports Med Arthrosc. 22(3):e7-15, 2014
                                                                      8. Zbojniewicz AM: US for diagnosis of musculoskeletal conditions in the young athlete: emphasis on dynamic assessment. Radiographics. 34(5):1145-62, 2014
                                                                      9. Kroonen LT: Cubital tunnel syndrome. Orthop Clin North Am. 43(4):475-86, 2012
                                                                      10. Cummins CA et al: Peripheral nerve injuries in baseball players. Neurol Clin. 26(1):195-215; x, 2008
                                                                      11. Gellman H: Compression of the ulnar nerve at the elbow: cubital tunnel syndrome. Instr Course Lect. 57:187-97, 2008
                                                                      12. Macadam SA et al: Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a meta-analysis. J Hand Surg Am. 33(8):1314, 2008
                                                                      13. Elhassan B et al: Entrapment neuropathy of the ulnar nerve. J Am Acad Orthop Surg. 15(11):672-81, 2007
                                                                      14. Kim S et al: Role of magnetic resonance imaging in entrapment and compressive neuropathy--what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity. Eur Radiol. 17(2):509-22, 2007
                                                                      15. Szabo RM et al: Natural history and conservative management of cubital tunnel syndrome. Hand Clin. 23(3):311-8, v-vi, 2007
                                                                      16. Andreisek G et al: Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics. 26(5):1267-87, 2006
                                                                      17. Bordalo-Rodrigues M et al: MR imaging of entrapment neuropathies at the elbow. Magn Reson Imaging Clin N Am. 12(2):247-63, vi, 2004
                                                                      18. Huang JH et al: Ulnar nerve entrapment neuropathy at the elbow: simple decompression. Neurosurgery. 55(5):1150-3, 2004
                                                                      19. Martinoli C et al: Sonography of entrapment neuropathies in the upper limb (wrist excluded). J Clin Ultrasound. 32(9):438-50, 2004
                                                                      20. Bartels RH: History of the surgical treatment of ulnar nerve compression at the elbow. Neurosurgery. 49(2):391-9; discussion 399-400, 2001
                                                                      21. Grana W: Medial epicondylitis and cubital tunnel syndrome in the throwing athlete. Clin Sports Med. 20(3):541-8, 2001
                                                                      22. Folberg CR et al: Cubital tunnel syndrome. Part I: presentation and diagnosis. Orthop Rev. 23(2):136-44, 1994
                                                                      23. Folberg CR et al: Cubital tunnel syndrome. Part II: treatment. Orthop Rev. 23(3):233-41, 1994
                                                                      24. McPherson SA et al: Cubital tunnel syndrome. Orthop Clin North Am. 23(1):111-23, 1992