Cubital tunnel

Cubital
tunnel
syndrome
H J Van der Westhuizen MBChB
MMed(DomXPret) MFGP(SA)
KEYWORDS: Cubitaltunnelslmdrome;
Diagnosis;Treatment;
Ulnar nerve;Compression;
Paresthesia;
Headache
HENDRIK JOHANNESVAN DER WESTHUIZEN 15Vanat
1 Maart 1984EersteHuisarts/Senior
Lektor in die
DepartementHuisartskunde
te MEDUNSA enonsheet
hombaiewelkomin dieAkademie.
Hy hetin 1955opBritsgematrikuleerenis daarnanadie
UniversiteitvanPretoriawaarhy die MB ChBverwerf in
7962.Yanaf1969tot 1973washy deeltydslektor in die
Departement
Huisartskunde
teUP. In di6tyd washy ook
behr.rlpsaam
by diestudentesePolikliniekte Daspoort.In
1973verwerf hy ook die MFAP van die Kollegevan
van SA. Hiernahet hy 'n jaar assenior
Geneeskunde
mediesebeamptete Ga-Rankuwahospitaalgewerk.
Sedert1974isDrHein(sooshybekendis)huisarts
opBrits
waar hy baie betrokke was by verskeiegemeenskapsdienste.
Hy stelintensbelangin geneeskundeen die bevordering
vanHuisartskunde
as'nberoep.Onswenshom'nsuksesvolieloopbaantoe.
Redakteur
SAHUISARTSPRAKTYK APRIL19B.]
A simple surgical procedure to cure
acroparesthesiais described - and
its association with headache
noted. Reports of 72 patients are
gMen.
QiNCE 1979 I have decompressed12 patients with
rJCubital TunnelSyndrome.As a countryphysician,these
operationswere done on clinical diagnosis.Specialinvestigations for neurological conditions are not readily
available.
All the patientswere StageOne,accordingto Mooijl-ie.
patientswithoutanyneurologicaldeficit.
In searchingthe literature,the excellentwork by Pechan
and Kredbazcoversthe wholefield. The paperby Clark3
sumsup the srmdromeverv neatlv.
116
cubital tunnel svndrome
SYMPTOMSOF STAGE ONE
Simpledecompression
wasper{ormedunderbloodless
field
and generalanaesthesia,
or by local intravenous70cc2Vo
Lignocaine,dilutedwith 30ccsaline.Operativefindingsand
clinical presentationwere similar to those of Miller and
HummelT'8.No splintingor specialtreatmentwas given.
Simpledressingof the wound was doneand patientswere
usuallysenthomethe sameday.
It is very important to note that patientsseldomvolunteer
the symptoms of ulnar nerve paresthesia (ulnar
acroparesthesia).They seem to accept it as a normal
phenomenonand passit off astheir hand is sleepingdue to
poor positioning.The ignoranceof this sy.ndromeis wellillustratedby Hdjer-Pedersenand Haasen,and in a leading
article in theBr Medf . The symptomsare both distal and
proximalto the nervecompression.
(i) Headache:usuallyverysevere.Sometimessocontinuous that nothing relieves it completely.When
carefulquestioningand clinical examinationrevealed nothing,I usuallyaskedwhethertherewasulnar
acroparesthesia.
Other causesof sucha neuropathy
-usl be excluded6.No referencesto the association
betweencubital tunnel compressionand headache
couldbe found in the literature.
RESULTS
The outcomeof this simple procedurewas astonishingly
dramatic.Especiallythe patientswith severeheadachehad
dramatic immediate relief. Ulnar acroparesthesia
sometimesdid not subsideimmediately,but wasof no concern to the patients.All pain was always immediatelyrelieved.Biopsydoneat all caseswas consistentwith Tunnel
Q--r]rn-a
6il
(iii)
Pain in the shoulder
Pain in the shoulder-blade area
The findings in the twelve patientsare presentedbelow in
tabularform:
(iv)
Pain in the upper arm
Pain in the chest - usuallvlateral3
COMMENT
(v)
(vi)
(vii)
This operationis so simpleand givessuchdramaticresults
that it canbe usedasa diagnosticprocedure.
Painintheneck
Ulnar acroparesthesia
REFERENCES
1. Mooij J J A, LTlnarNerve Pathologyat the Elbow:The Placeof Anterior
TranspositionToday.A ctaNeurochirurgifu(1982\,M 75-85.
2.(a)PechanJ, KredbaJ, CubitalTunnel Syndrome- 1. GeneralAspects.
Acta UniwrsitasCarolineMedim), (7987):28 516. 267-320.
(b) PechanJ, Kredba J, CubitalTunnel SS,ndrome- 2. Clinicalaspects.
Acta Uniuersitas
CarolitteMedim), (1981):27 5I6.321-390.
(c) PechanJ, IGedbaJ,Treatmentof CubitalTunnelSyndromebyMeans
of L,ocalAdministration of Cortisonoids-1. Short-Term Follow-up.
Actn Uniwsitns CarolineMedim), (1980):26 314:125-133.
3. Clark Charles B,'Cubital Tunnel Syndrome.IAMA, (1979):241 6,
801-802.
4. Hdjer-PedersenElse, Haase J, The t-Ilnar-Tr:nnelSyndrome.Acta
Neuroc
hirurgim(1980),52 \21-I27.
5. Editorial,CubitalTunnelSyndrome,
Br Md I (1979)2,460.
6. Cecil,J, Mononeuropathy.
Twtbookof Medbine,(1979)W.B. Saunders
Company(1979),900-902.
7. Miller RG, Hummel Errett E, The Cubibl Trmnel Syndrome:Treat-9.
ment of SimpleDecompression.,4zn
Neurol(1980)J:ur:r;
7(6):567
8. Miller RG, The Cubital Tunnel Slmdrome: Diagnosisand Precise
Localisation.
4zn Neurol(1979)Jul:6(1):56-9.
FINDINGS IN TWELVE PATIENTS
a
F
a
a
z
5
3
a
Fr
a
E
F
z
X
a
I
Fl
z
z
Fl
=
7
p
O
a
F1
Fl
frJ
E
F)
Ff
tr
a
a
a
F
F
z
A
z
z
?
E
a
an
()
z
a
6
z
p
O
4
z
E
F
B
-l
Fl
Completecure
cureat first. A-fter1 vearsmDtoms reruned. A secondbilatera.l
ssionwasdoneandaJter24 mbnthsstill comDlet€cure
2
3
Completecure
4
All symptomsdisappeared,
but recLrrencesafter t 6 monthsand
sraduaxvworseneo
c
Completenre
6
All
After 4 monthsheadacheandneckpainstill
siaandshoulderoainrecru,ed
Completecure
Left sidecompletecure.Right sideslightuJrnracroparesthesia
Completecure
10
Completecure
l1
Headache and neck pain, and shoulder blade pain and upper
am
-airooare
and upper arm pain Staned asain a-fier 5 mon{hs. Ulrnr
L2
Completecure
tt7
gone.Neck pain
a gone.
SAFAMILYPRACTICE APRIL 1984