Park, Il-Jung
(Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
,
Kim, Hyoung-Min
(Department of Orthopaedic Surgery, Good Samsun Hospital)
,
Lee, Jae-Young
(Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
,
Jeong, Changhoon
(Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
,
Kang, Younghoon
(Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
,
Hwang, Sunwook
(Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
,
Sung, Byung-Yoon
(Department of Orthopaedic Surgery, St. Mary's Spine & Joint Hospital)
,
Kang, Soo-Hwan
(Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea)
Objective : We evaluated the clinical manifestation and surgical results following operative treatment of cubital tunnel syndrome (CuTS) caused by anconeus epitrochlearis (AE) muscle. Methods : Among 142 patients who underwent surgery for CuTS from November 2007 to October 2015, 12 were assigned to ...
Objective : We evaluated the clinical manifestation and surgical results following operative treatment of cubital tunnel syndrome (CuTS) caused by anconeus epitrochlearis (AE) muscle. Methods : Among 142 patients who underwent surgery for CuTS from November 2007 to October 2015, 12 were assigned to the AE group based on discovery of AE muscle; 130 patients were assigned to the other group. We analyzed retrospectively; age, sex, dominant hand, symptom duration, and weakness in hand. Severity of the disease was evaluated using the Dellon classification and postoperative symptom were evaluated using disability of arm shoulder and hand (DASH) and visual analogue scale (VAS) scores. Surgery consisted of subfascial anterior transposition following excision of AE muscle. Results : AE muscle was present in 8.5% of all patients, and was more common in patients who were younger and with involvement of their dominant hand; the duration of symptom was shorter in patients with AE muscle. All patients showed postoperative improvement in symptoms according to DASH and VAS scores. Conclusion : The possibility of CuTS caused by AE muscle should be considered when younger patients have rapidly aggravated and activity-related cubital tunnel symptoms with a palpable mass in the cubital tunnel area. Excision of AE muscle and anterior ulnar nerve transposition may be considered effective surgical treatment.
Objective : We evaluated the clinical manifestation and surgical results following operative treatment of cubital tunnel syndrome (CuTS) caused by anconeus epitrochlearis (AE) muscle. Methods : Among 142 patients who underwent surgery for CuTS from November 2007 to October 2015, 12 were assigned to the AE group based on discovery of AE muscle; 130 patients were assigned to the other group. We analyzed retrospectively; age, sex, dominant hand, symptom duration, and weakness in hand. Severity of the disease was evaluated using the Dellon classification and postoperative symptom were evaluated using disability of arm shoulder and hand (DASH) and visual analogue scale (VAS) scores. Surgery consisted of subfascial anterior transposition following excision of AE muscle. Results : AE muscle was present in 8.5% of all patients, and was more common in patients who were younger and with involvement of their dominant hand; the duration of symptom was shorter in patients with AE muscle. All patients showed postoperative improvement in symptoms according to DASH and VAS scores. Conclusion : The possibility of CuTS caused by AE muscle should be considered when younger patients have rapidly aggravated and activity-related cubital tunnel symptoms with a palpable mass in the cubital tunnel area. Excision of AE muscle and anterior ulnar nerve transposition may be considered effective surgical treatment.
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문제 정의
The literature describes the AE muscle as one of the causes of CuTS, but its prevalence in actual clinical settings is very rare8-10,18). The objective of the present study was to report the incidene, clinical features and surgical outcomes of 12 patients with AE muscle who underwent surgery for CuTS.
제안 방법
The ulnar nerve was transposed to a position anterior to the medial epicondyle and placed superficial to the flexor-pronator muscle group but deep to its fascia which wraps the ulnar nerve (subfascial anterior transposition of the ulnar nerve). The patients were allowed joint movement without any restriction starting at 2 weeks postoperative, and improvement in symptoms was evaluated during the final follow-up using disability of arm shoulder and hand (DASH) and visual analogue scale (VAS) scores. The DASH is a 30-item self-report questionnaire designed to evaluate musculoskeletal disorders of the upper limbs and measure symptoms and function of the patients.
The two groups were compared in terms of age, gender, dominant hand, symptom duration (duration from onset of symptoms to surgery), and hand weakness. The surgery used a medial retroepicondylar approach to excise the AE muscle or ligament, and released all compressive structures around the ulnar nerve. The ulnar nerve was transposed to a position anterior to the medial epicondyle and placed superficial to the flexor-pronator muscle group but deep to its fascia which wraps the ulnar nerve (subfascial anterior transposition of the ulnar nerve).
대상 데이터
A 23-year-old male patient was admitted for chief complaints of muscle weakness and numbness in the right ring and little finger, which began a year earlier and became worse 3 months prior to presentation. The patient’s occupation was a health trainer and he complained that the symptoms became more aggravated when force was applied to the arms during exercise or the elbow was bent for a prolonged period.
PC17RESI0025). The present study initially reviewed 142 patients who underwent surgery for CuTS from November 2007 to October 2015. Among 142 patients who underwent surgery, AE muscle was discovered in 12 patients; these patients were assigned to the AE group and the remaining 130 patients were assigned to the other group.
데이터처리
Comparative analysis of age and symptom duration between the AE and the other group was performed using Mann-Whitney U test, while comparative analysis of gender, dominant hand, and hand weakness was performed using Fisher’s extract test.
성능/효과
This suggests that CuTS caused by AE muscle is a dynamic compressive neuropathy. At final follow-up, DASH and VAS scores were significantly improved (Table 3).
First, differences in severity did exist, but the fact that two patients showed normal electromyographic findings despite all cases having distinct symptoms of ulnar neuropathy supports the above claim. Second, in all 12 cases, relatively distinct findings of ulnar nerve compression were suspected from the surgical field of view, but actual nerve abnormalities such as nerve indentation and pseudo-tumor formation were found in only three cases. We believe that in such cases, measuring grip/ pinch strength or measuring nerve conduction velocity in the elbow area during rest and after exercise may be helpful in making the diagnosis10,17).
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