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Cubital tunnel syndrome caused by ganglion cysts: a review of 59 cases

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Abstract

Background

Cubital tunnel syndrome caused by ganglion cysts is rare and reports are few. This study aimed to review a patient cohort with ganglion cysts in the cubital tunnel and identify prognostic factors.

Methods

Fifty-seven patients (59 extremities; McGowan grade I, 4; IIa, 4; IIb, 3; III, 48) were evaluated retrospectively with a minimum follow-up of 2 years. Extraneural cysts were excised completely, while intraneural cysts were incised and drained. All cases underwent subcutaneous transposition. Spearman’s rank correlation and the ordinal logistic regression model were used to assess the effect of independent variables on the postoperative McGowan grade.

Results

VAS pain and weakness, 2-PD, key-pinch strength, grip strength, first dorsal interosseous muscle strength, Wartenberg sign, and claw hand all improved significantly. DASH scores improved from an average of 43.8 points preoperatively to 10.7 points postoperatively. According to the modified Bishop scoring system, 55 extremities (93.2%) were graded good or excellent. At the last follow-up, 29 hands (49.2%) returned to normal, and improvement by at least one McGowan grade was reached in 51 cases (86.4%). Older age, smoking, and shorter postoperative follow-up were associated with a higher postoperative McGowan grade.

Conclusions

Satisfactory surgical outcomes could be expected in these patients following subcutaneous transposition with excision of extraneural cysts and draining of intraneural cysts. Older age, smoking, and shorter postoperative follow-up were found to be independent risk factors for poor outcomes.

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References

  1. Adelaar RS, Foster WC, McDowell C (1984) The treatment of the cubital tunnel syndrome. J Hand Surg Am 9A:90–95

    Article  CAS  PubMed  Google Scholar 

  2. Assmus H (1994) Simple decompression of the ulnar nerve in cubital tunnel syndrome with and without morphologic changes. Report of experiences based on 523 cases. Nervenarzt 65:846–853

    CAS  PubMed  Google Scholar 

  3. Charles YP, Coulet B, Rouzaud JC, Daures JP, Chammas M (2009) Comparative clinical outcomes of submuscular and subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg Am 34A:866–874

    Article  Google Scholar 

  4. Dawson DM (1993) Entrapment neuropathies of the upper extremities. New Engl J Med 329:2013–2018

    Article  CAS  PubMed  Google Scholar 

  5. Dellon AL, Coert JH (2003) Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow. J Bone Joint Surg Am 85A:1314–1320

    Article  Google Scholar 

  6. Foster RJ, Edshage S (1981) Factors related to the outcome of surgically managed compressive ulnar neuropathy at the elbow level. J Hand Surg Am 6:181–192

    Article  CAS  PubMed  Google Scholar 

  7. Gay JR, Love JG (1947) Diagnosis and treatment of tardy paralysis of the ulnar nerve. Based on a study of 100 cases. J Bone Joint Surg Am 29:1087–1097

    CAS  PubMed  Google Scholar 

  8. Gervasio O, Gambardella G, Zaccone C, Branca D (2005) Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: a prospective randomized study. Neurosurgery 56:108–117 discussion 117

    Article  PubMed  Google Scholar 

  9. Goldberg BJ, Light TR, Blair SJ (1989) Ulnar neuropathy at the elbow: results of medial epicondylectomy. J Hand Surg Am 14:182–188

    Article  CAS  PubMed  Google Scholar 

  10. Høgh J (1988) Benign cystic lesions of peripheral nerves. Int Orthop 12:269–271

    Article  PubMed  Google Scholar 

  11. Kato H, Hirayama T, Minami A, Iwasaki N, Hirachi K (2002) Cubital tunnel syndrome associated with medial elbow ganglia and osteoarthritis of the elbow. J Bone Joint Surg Am 84-A:1413–1419

    Article  PubMed  Google Scholar 

  12. Kleinman WB, Bishop AT (1989) Anterior intramuscular transposition of the ulnar nerve. J Hand Surg Am 14:929–979

    Google Scholar 

  13. Kojima T, Kurihara K, Nagano T (1979) A study on operative findings and pathogenic factors in ulnar neuropathy at the elbow. Hand 11:99–104

    CAS  Google Scholar 

  14. Ledderhose G (1893) Die Aetiologie der Carpalen Ganglion. Deutsche Zeit Chir 37:102

    Article  Google Scholar 

  15. Matsuzaki H, Yoshizu T, Maki Y, Tsubokawa N, Yamamoto Y, Toishi S (2004) Long-term clinical and neurologic recovery in the hand after surgery for severe cubital tunnel syndrome. J Hand Surg Am 29:373–378

    Article  PubMed  Google Scholar 

  16. Mondelli M, Giannini F, Ballerini M, Ginanneschi F, Martorelli E (2005) Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci 234:5–10

    Article  PubMed  Google Scholar 

  17. Nouhan R, Kleinert JM (1997) Ulnar nerve decompression by transposing the nerve and Z-lengthening the flexor-pronator mass: clinical outcome. J Hand Surg Am 22:127–131

    Article  CAS  PubMed  Google Scholar 

  18. Novak CB, Mackinnon SE, Stuebe AM (2002) Patient self-reported outcome after ulnar nerve transposition. Ann Plast Surg 48:274–280

    Article  PubMed  Google Scholar 

  19. Ochiai N, Honmo J, Tsunjino A, Nisiura Y (2000) Electrodiagnosis in entrapment neuropathy by the arcade of Struthers. Clin Orthop Relat Res 378:129–135

    Article  Google Scholar 

  20. Palmer BA, Hughes TB (2010) Cubital tunnel syndrome. Journal Hand Surg Am 35:153–163

    Article  Google Scholar 

  21. Seddon HJ (1954) Peripheral Nerve Injuries, London

  22. Sheldon WD (1921) Tardy paralysis of the ulnar nerve. Med Clin North Am 5:499–509

    Google Scholar 

  23. Shi Q, MacDermid JC, Santaguida PL, Kyu HH (2011) Predictors of surgical outcomes following anterior transposition of ulnar nerve for cubital tunnel syndrome: a systematic review. J Hand Surg Am 36(1996–2001):e1–e6

    Google Scholar 

  24. Spinner RJ, Atkinson JL, Scheithauer BW, Rock MG, Birch R, Kim TA, Kliot M, Kline DG, Tiel RL (2003) Peroneal intraneural ganglia: the importance of the articular branch. Clinical series. J Neurosurg 99:319–329

    Article  PubMed  Google Scholar 

  25. Spinner RJ, Atkinson JL, Tiel RL (2003) Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory. J Neurosurg 99:330–343

    Article  PubMed  Google Scholar 

  26. Stout A (1935) The peripheral manifestations of the specific nerve sheath tumor (neurilemmoma). Am J Cancer 24:751–796

    Article  Google Scholar 

  27. Taha A, Galarza M, Zuccarello M, Taha J (2004) Outcomes of cubital tunnel surgery among patients with absent sensory nerve conduction. Neurosurgery 54:891–895 discussion 895–896

    Article  PubMed  Google Scholar 

  28. Tong J, Xu B, Dong Z, Zhang C, Gu Y (2017) Surgical outcomes for severe cubital tunnel syndrome in patients aged >70 years: a mean follow-up of 4.5 years. Acta Neurochir (Wein). doi:10.1007/s00701-017-3113-4

    Google Scholar 

  29. Verdú E, Ceballos D, Vilches JJ, Navarro X (2000) Influence of aging on peripheral nerve function and regeneration. J Peripher Nerv Syst 5:191–208

    Article  PubMed  Google Scholar 

  30. Weyns F, Bringmans T, Vandevenne J, Daenekindt T, Van Goethem A, Wuyts J, Vanormelingen L, Vandersteen M (2012) Peripheral neuropathy caused by joint-related cysts: a review of 17 cases. Acta Neurochir (Wein) 154:1741–1753

    Article  CAS  Google Scholar 

  31. Xu Q, Chen Z, Dellon AL, Zhang F (2014) Microsurgical principles related to excision of intraneural ganglion at the elbow. Hand (N Y) 9:214–216

    Article  Google Scholar 

  32. Yamamoto K (1996) Study of postoperative results in cubital tunnel syndrome. J Jpn Soc Surg Hand 13:704–707

    Google Scholar 

  33. Yamamoto K, Shishido T, Masaoka T, Katori Y, Tanaka S (2006) Postoperative clinical results in cubital tunnel syndrome. Orthopedics 29:347–353

    PubMed  Google Scholar 

Download references

Acknowledgements

This study was funded by a grant from National Natural Science Foundation of China, grant no. 81371374.

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Authors and Affiliations

  1. Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Rd, Shanghai, 200040, People’s Republic of China

    Jinsong Tong, Bin Xu, Zhen Dong, Jingbo Liu, Chenggang Zhang & Yudong Gu

  2. Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People’s Republic of China

    Jinsong Tong, Bin Xu, Zhen Dong, Jingbo Liu, Chenggang Zhang & Yudong Gu

  3. Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People’s Republic of China

    Jinsong Tong, Bin Xu, Zhen Dong, Jingbo Liu, Chenggang Zhang & Yudong Gu

Authors
  1. Jinsong Tong
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  2. Bin Xu
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  3. Zhen Dong
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  4. Jingbo Liu
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  5. Chenggang Zhang
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  6. Yudong Gu
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Corresponding author

Correspondence to Jingbo Liu.

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Funding

The National Natural Science Foundation of China provided financial support in the form of the General Program of National Natural Science Foundation, grant no. 81371374. The sponsor had no role in the design or conduct of this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving humanparticipants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Informed consent was obtained from all individualparticipants included in the study.

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None.

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Comments

An interesting article describing the successful surgical treatment of a relatively unusual cause of ulnar neuropathy, ganglion cysts involving the nerve across the elbow.

Michel Kliot

Stanford, California

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Tong, J., Xu, B., Dong, Z. et al. Cubital tunnel syndrome caused by ganglion cysts: a review of 59 cases. Acta Neurochir 159, 1265–1271 (2017). https://doi.org/10.1007/s00701-017-3180-6

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  • DOI: https://doi.org/10.1007/s00701-017-3180-6

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