Cubital Tunnel Syndrome

During a 15-year period, 145 patients presenting with cubital tunnel syndrome were operated upon. They are divided into two groups: (1) Primary tunnel syndrome — 27 cases (18.6%), with a "pure" past history, and (2) secondary — 118 cases (81.4%) with the lesion occurring after a known causative event. Investigation of 100 healthy persons, 50 men and 50 women (200 extremities) show, when elbow flexes, the ulnar nerve moves around the epicondyle in 50% of men, whereas in the remainder nerve subluxation or dislocation anteriorly to the epicondyle occurs. In women, the figures are 72% and 28%, respectively. Apparently in men, the nerve being more mobile is more sensitive to gliding impairment in the tunnel compared to women. In the series of 145 patients, there is a 4.5 : 1 men-to-women ratio, the men being affected much more often. The role of traction in the pathomechanic is further suggested by two facts: the presence of elbow flexion contracture (52%) of the patients and firm ulnar nerve adhesions to the tunnel wall (73%). Skin electroresistance assessment using a high-sensitivity microamperimeter was conducted in 100 patients. Skin electroresistance may remain within normal limits even in cases of expressed sensory and motor impairment. This points to the great resistance of sympathetic fibres against the compression and traction within the canal. Concerning the type of anterior transfer, a combined procedure was used by placing the nerve subcutaneously for the proximal part, and intramuscularly for the distal one. Nerve recovery may proceed even ten years after anterior transfer.