Cubital tunnel

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Cubital tunnel
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Back of right upper extremity, showing surface markings for bones and nerves.
Anatomical terminology

The cubital tunnel is a space of the dorsal medial elbow which allows passage of the ulnar nerve around the elbow. It is bordered medially by the medial epicondyle of the humerus, laterally by the olecranon process of the ulna and the tendinous arch joining the humeral and ulnar heads of the flexor carpi ulnaris. [1] The roof of the cubital tunnel is elastic and formed by a myofascial trilaminar retinaculum (also known as the epicondyloolecranon ligament or Osborne band). [2]

Contents

Chronic compression of this nerve is known as cubital tunnel syndrome, [3] [4] a form of repetitive strain injury akin to carpal tunnel syndrome (although the role of repetitive stress in causing carpal tunnel syndrome is controversial [5] [6] ).

See also

Related Research Articles

Median nerve Nerve of the upper limb

The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus.

In human anatomy, the extensor carpi ulnaris is a skeletal muscle located on the ulnar side of the forearm. It acts to extend and adduct at the carpus/wrist from anatomical position.

Ulnar nerve

In human anatomy, the ulnar nerve is a nerve that runs near the ulna bone. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest in the human body unprotected by muscle or bone, so injury is common. This nerve is directly connected to the little finger, and the adjacent half of the ring finger, innervating the palmar aspect of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds.

Ulnar collateral ligament of elbow joint

The ulnar collateral ligament is a thick triangular band at the medial aspect of the elbow uniting the distal aspect of the humerus to the proximal aspect of the ulna.

Cubital fossa

The cubital fossa,chelidon, or elbow pit is the triangular area on the anterior view of the elbow of a human or other hominid animal. It lies anteriorly to the elbow when in standard anatomical position.

Flexor carpi ulnaris muscle

The flexor carpi ulnaris (FCU) is a muscle of the forearm that flexes and adducts at the wrist joint.

The pronator teres is a muscle that, along with the pronator quadratus, serves to pronate the forearm. It has two attachments, to the medial humeral supracondylar ridge and the ulnar tuberosity, and inserts near the middle of the radius.

Flexor retinaculum of the hand A thickened fascia over the carpal tunnel

The flexor retinaculum is a fibrous band on the palmar side of the hand near the wrist. It arches over the carpal bones of the hands, covering them and forming the carpal tunnel.

Medial epicondyle of the humerus A rounded eminence on the medial side of the humerus

The medial epicondyle of the humerus is an epicondyle of the humerus bone of the upper arm in humans. It is larger and more prominent than the lateral epicondyle and is directed slightly more posteriorly in the anatomical position. In birds, where the arm is somewhat rotated compared to other tetrapods, it is called the ventral epicondyle of the humerus. In comparative anatomy, the more neutral term entepicondyle is used.

Golfers elbow

Golfer's elbow, or medial epicondylitis, is tendinosis of the medial epicondyle on the inside of the elbow. It is in some ways similar to tennis elbow, which affects the outside at the lateral epicondyle.

Supratrochlear lymph nodes

One or two supratrochlear lymph nodes are placed above the medial epicondyle of the humerus, medial to the basilic vein.

Ulnar tunnel syndrome

Ulnar tunnel syndrome, also known as Guyon's canal syndrome or Handlebar palsy, is caused by entrapment of the ulnar nerve in the Guyon canal as it passes through the wrist. Symptoms usually begin with a feeling of pins and needles in the ring and little fingers before progressing to a loss of sensation and/or impaired motor function of the intrinsic muscles of the hand which are innervated by the ulnar nerve. Ulnar tunnel syndrome is commonly seen in regular cyclists due to prolonged pressure of the Guyon's canal against bicycle handlebars. Another very common cause of sensory loss in the ring and pink finger is due to ulnar nerve entrapment at the cubital tunnel near the elbow, which is known as cubital tunnel syndrome.

Ulnar nerve entrapment

Ulnar nerve entrapment is a condition where the ulnar nerve becomes physically trapped or pinched, resulting in pain, numbness, or weakness, primarily affecting the little finger and ring finger of the hand. Entrapment may occur at any point from the spine at cervical vertebra C7 to the wrist; the most common point of entrapment is in the elbow. Prevention is mostly through correct posture and avoiding repetitive or constant strain. Treatment is usually conservative, including medication, activity modification and exercise, but may sometimes include surgery. Prognosis is generally good, with mild to moderate symptoms often resolving spontaneously.

Ulnar neuropathy

Ulnar neuropathy is a disorder involving the ulnar nerve. Ulnar neuropathy may be caused by entrapment of the ulnar nerve with resultant numbness and tingling. Motor function can be assessed by testing for a positive Froment's sign, or making an OK sign, little finger abduction can be tested as well.

Elbow Joint between the upper and lower parts of the arm

The elbow is the visible joint between the upper and lower parts of the arm. It includes prominent landmarks such as the olecranon, the elbow pit, the lateral and medial epicondyles, and the elbow joint. The elbow joint is the synovial hinge joint between the humerus in the upper arm and the radius and ulna in the forearm which allows the forearm and hand to be moved towards and away from the body.

Struthers ligament

Struthers' ligament is a feature of human anatomy consisting of a band of connective tissue at the medial aspect of the distal humerus. It courses from the supracondylar process of the humerus to the medial humeral epicondyle. It is not a constant ligament, and can be acquired or congenital. The structure was highlighted by John Struthers, who discussed the feature's evolutionary significance with Charles Darwin. Struthers originally reported that the ligament usually arose at a position 3.2 to 6.4 cm from the medial condyle, being 1.2 to 1.9 cm in length, and nearer to the anterior than the medial border of the humerus.

Median nerve palsy

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

Palmaris profundus muscle

Palmaris profundus is a rare anatomical variant in the anterior compartment of forearm. It was first described in 1908. It is usually found incidentally in cadaveric dissection or surgery.

Epitrochleoanconeus muscle

The epitrochleoanconeus muscle is a small accessory muscle of the arm which runs from the back of the inner condyle of the humerus over the ulnar nerve to the olecranon.

Osbornes ligament Connective tissue in the body

Osborne's ligament, also Osborne's band, Osborne's fascia, Osborne's arcade, arcuate ligament of Osborne, or the cubital tunnel retinaculum, refers to either the connective tissue which spans the humeral and ulnar heads of the flexor carpi ulnaris (FCU) or another distinct tissue located between the olecranon process of the ulna and the medial epicondyle of the humerus. It is named after Geoffrey Vaughan Osborne, a British orthopedic surgeon, who described the eponymous tissue in 1957.

References

  1. Moore, Keith L. (2010). Clinically Oriented Anatomy 6th Ed. Baltimore, MD: Lippincott, Williams and Wilkins. p. 770. ISBN   978-07817-7525-0.
  2. Macchi, Veronica; Tiengo, Cesare; Porzionato, Andrea; Stecco, Carla; Sarasin, Gloria; Tubbs, Shane; Maffulli, Nicola; De Caro, Raffaele (2014-08-01). "The cubital tunnel: a radiologic and histotopographic study". Journal of Anatomy. 225 (2): 262–269. doi:10.1111/joa.12206. ISSN   1469-7580. PMC   4111932 . PMID   24917209.
  3. Szabo RM; et al. (2007). "Natural History and Conservative Management of Cubital Tunnel Syndrome". Hand Clinics. 23 (3): 311–318. doi:10.1016/j.hcl.2007.05.002. PMID   17765583.
  4. "Cubital Tunnel Syndrome: Cell Phone Elbow | Health News and Tips For Computer Users and Abusers". Archived from the original on 2007-07-14. Retrieved 2007-08-31.
  5. Kao, Stephanie Y. (1 November 2003). "Carpal Tunnel Syndrome As an Occupational Disease". The Journal of the American Board of Family Practice. 16 (6): 533–542. doi: 10.3122/jabfm.16.6.533 . PMID   14963080 . Retrieved 2008-06-15.
  6. Werner, Robert A. (June 2006). "Evaluation of Work-Related Carpal Tunnel Syndrome". Journal of Occupational Rehabilitation. 16 (2): 201–216. doi:10.1007/s10926-006-9026-3. PMID   16705490.