Sindrom ng Radial Tunnel Impormasyon

Ang nararamdaman mo

Maaaring mapansin mo ang malalim at nakakairita na sakit sa panlabas na bahagi ng iyong siko. Karaniwang umaabot ang hindi komportableng pakiramdam na ito pababa sa itaas na bahagi ng iyong forearms patungo sa pulso at kamay. Hindi tulad ng iba pang isyu sa nerbiyos, karaniwang hindi mo nararamdaman ang kahinaan sa iyong kamay sa yugtong ito. Sa halip, ang pangunahing sintomas ay patuloy na sakit na mahirap ituring sa isang tiyak na punto.

Karaniwang lumalala ang sakit kapag inuunat mo ang iyong pulso o mga daliri laban sa resistensya. Maaari mong maranasan ang pagtaas nito kapag humahawak sa mga bagay, pag-ikot ng hawakan ng pinto, o pag-angat ng mga bagay na may palad na nakaharap pababa. Ang mga gawain na nangangailangan ng paulit-ulit na paggalaw ng braso, tulad ng pag-type o pag-aalaga sa hardin, ay maaaring magdulot ng mga paglala. Maaari ring mas malinaw na maranasan ang sakit sa gabi, na nagiging sanhi ng hirap sa paghanap ng komportableng posisyon sa pagtulog.

Maaaring maging hamon ang mga pang-araw-araw na gawain habang lumalala ang hindi komportableng pakiramdam. Ang mga simpleng kilos tulad ng pag-abot sa likod ng iyong likod upang isara ang bra o pagtupi ng isang kamiseta ay maaaring magdulot ng matalim na pananakit o mahinang sakit. Maaari mong mapansin na iwasan mo ang mga partikular na galaw upang protektahan ang iyong braso, na maaaring magdulot ng pagkatigas sa loob ng panahon. Habang ang pahinga ay madalas na nagbibigay ng ilang ginhawa, maaaring manatili ang sakit at makagambala sa iyong pang-araw-araw na gawain.

Kung ang mga konserbatibong hakbang ay hindi makapagpapagaan ng iyong mga sintomas, maaari naming talakayin ang karagdagang mga pagpipilian. Ang aming pamamaraan ay nakatuon sa pagtukoy sa pinagmulan ng iritasyon upang gabayan ang iyong paggaling. Layunin naming tulungan kang mabawi ang ginhawa at kakayahan sa pamamagitan ng isang plano na inangkop sa iyong mga partikular na pangangailangan.

Ano ang nangyayari talaga

Ang Radial Tunnel Syndrome ay nangyayari kapag ang radial nerve ay napipigilan habang dumadaan ito sa iyong braso. Ang nerbiyong ito ay dumadaan sa isang makitid na daanan sa iyong forearms, na kilala bilang radial tunnel. Isipin mo ang tunnel na ito na parang isang mahigpit na manggas. Kapag ang mga tissue sa paligid nito ay namamaga o nagiging mahigpit, ito ay pumipiga sa nerbiyong iyon. Ang presyur na ito ay humahadlang sa pagpapadala ng malinaw na mga signal ng nerbiyong iyon sa iyong mga kalamnan.

Ang radial nerve ang kontrolado ang mga kalamnan na nagpapataas ng iyong pulso at mga daliri. Nagbibigay din ito ng pakiramdam sa likod ng iyong kamay. Kapag ang nerbiyong iyon ay napipiga, maaaring maranasan mo ang malalim na sakit sa panlabas na bahagi ng iyong siko at forearm. Karaniwang lumalala ang sakit na ito kapag sinusubukan mong tuusin ang iyong pulso laban sa resistensya. Maaari mo ring mapansin ang kahinaan sa iyong hawak o hirap sa pagtaas ng mga bagay. Ang mga sintomas na ito ay nangyayari dahil ang nerbiyong iyon ay nahihirapan makipag-ugnayan sa iyong mga kalamnan sa ilalim ng presyur.

Titingnan ng iyong doktor ang tiyak na punto kung saan nangyayari ang pagpigil na ito. Walang iisang paraan sa operasyon na makakapagpakita at magpapalaya sa lahat ng posibleng punto ng pagpigil sa radial tunnel. Dahil dito, mahalaga ang maingat na pagsusuri. Kung hindi tumutulong ang mga konservatibong paggamot, maaaring irekomenda ang operasyon upang palayain ang nerbiyong iyon. Ang layunin ay lumikha ng mas maraming espasyo upang muling malayang makagalaw ang nerbiyong iyon.

Sa ilang kaso, ang isyu ay may kaugnayan sa ibang mga problema sa siko. Halimbawa, ang katigasan ng siko ay minsan ay may ugat sa iritasyon ng nerbiyong iyon. Kung ikaw ay gagawa ng operasyon para sa katigasan ng siko, titingnan ng iyong doktor ang anumang involvement ng nerbiyong iyon. Maaaring isaalang-alang ang preventive nerve release kahit normal ang iyong nerbiyong function bago ang operasyon. Tumatulong ito upang maiwasan ang mga kinabukasang komplikasyon at siguraduhin ang pinakamainam na paggaling para sa galaw at lakas ng iyong braso.

Mga maitutulong namin dito

Ang ginagamit na pamamaraan ni Dr. Kieran Hirpara, isang surgeon sa upper limb sa Mater Private Hospital Rockhampton, ay sumasalamin sa paraan ng paggamot sa kondisyong ito sa aming klinika. Karaniwan, nagsisimula kami sa hindi operatibong paggamot. Ang unang hakbang na ito ay nakatuon sa pahinga at pagbabago ng mga gawain upang bawasan ang stress sa forearms. Layunin ng physiotherapy na palakasin at paluwagin ang lakas at flexibility ng braso at pulso. Karaniwan kaming nagre-rekomenda na subukan nang maayos ang konservatibong paggamot bago isaalang-alang ang ibang mga opsyon.

Ang medikal na pamamahala ay tumutulong sa pagkontrol ng sakit at pamamaga habang nagpapagaling ka. Maaaring imungkahi ng iyong surgeon ang mga anti-inflammatory na gamot upang bawasan ang pamamaga sa paligid ng nerve. Sa ilang kaso, pinag-uusapan namin ang mga injection. Ang mga injection ng cortisone ay maaaring pampahina ng pamamaga, bagaman pansamantala ang epekto. Ang mga injection ng hyaluronic acid o platelet-rich plasma (PRP) ay iba pang mga opsyon na maaaring pag-usapan ng iyong surgeon upang suportahan ang kalusugan ng tissue. Layunin ng mga tratamientong ito na bawasan ang mga sintomas at mapabuti ang function nang hindi nangangailangan ng operasyon.

Isinasaalang-alang ang operasyon kapag hindi sapat ang pag-unlad mula sa hindi operatibong paggamot. Inirerekomenda rin namin ang operasyon agad para sa mga structural o acute na problema, tulad ng pinsala sa nerve dahil sa fracture, nang walang nakaraang hindi operatibong subok. Ang surgical decompression ay kinabibilangan ng pagpapalaya ng pressure sa radial nerve. Ito ay isang viable na opsyon para sa mga kaso na hindi tumutugon sa konservatibong paggamot. Sa mga partikular na sitwasyon, tulad ng pinsala sa nerve dahil sa cement sa panahon ng elbow replacement, ang agad na pag-alis ng cement at pagpapalaya ng nerve ay maaaring makatulong sa pagpapagaling. Para sa matagal nang pinsala sa nerve kung saan hindi na maiaayos ang nerve, maaaring gamitin ang tendon transfers upang ibalik ang function ng kamay. Pinag-uusapan namin ang mga opsyong ito sa iyo upang matiyak na ang plano ay angkop sa iyong mga pangangailangan.

Ano ang inaasahan

Para sa karamihan, ang radial tunnel syndrome ay gumagaling nang walang kailangang operasyon. Ang spontaneous recovery ay nangyayari sa 70%–88% ng mga pinsala sa radial nerve. Ibig sabihin, malamang na mag-aayos ang iyong mga sintomas nang sarili sa paglipas ng panahon. Ang unang hakbang ay ang pamamahala nang hindi kailangan ng operasyon (nonsurgical management). Gabay ng iyong surgeon ang iyong mga conservative treatments upang matulungan ang iyong nerve na gumaling.

Kung hindi magpapabuti ang iyong mga sintomas sa pamamagitan ng conservative care, maaaring maging opsyon ang operasyon. Ang surgical decompression ay naglalayong bawasan ang pressure sa radial nerve. Karaniwang ginagamit lamang ito sa mga kaso na patuloy na masakit kahit na may ibang treatments. Ang prognosis pagkatapos ng operasyon ay nakadepende sa ilang mga salik, kabilang ang tagal ng iyong mga sintomas at ang tiyak na dahilan ng compression sa nerve.

Ang recovery ay isang unti-unting proseso. Kung kailangan ng operasyon, layunin ng iyong surgeon na bawasan ang pressure sa nerve. Maaaring mapansin mo ang mga pagbabago sa sensation o lakas sa loob ng ilang linggo hanggang buwan. Sa ilang mga kaso, tulad ng mga pinsala na may kinalaman sa fractures, ang maagang surgical exploration sa loob ng 3 linggo mula sa pinsala ay maaaring mapabuti ang pagkakataon na mabawi ang function ng nerve. Gayunpaman, kahit na may intervention, hindi garantisadong makakabangon nang buo ang lahat.

Mahalagang magkaroon ng realistic na mga inaasahan. Habang ang maraming pasyente ay nakakaranas ng malaking pagpapabuti, may ilang mga taong patuloy na may mga residual na sintomas. Ang layunin ng treatment ay bawasan ang sakit at ibalik ang function sa pinakamataas na antas na posible. Tatalakayin ng iyong surgeon ang iyong tiyak na prognosis batay sa iyong indibidwal na kondisyon at tugon sa mga unang treatments.

Kung ang pinsala sa nerve ay malala o matagal nang nangyayari, maaaring isaalang-alang ang karagdagang mga procedures tulad ng tendon transfers. Ang mga operasyong ito ay tumutulong na ibalik ang function sa pamamagitan ng pagrereroute ng mga tendon. Ito ay karaniwang huling resort para sa mga irreparable na nerve lesions. Gayunpaman, ang karamihan sa mga pasyente ay nakakahanap ng ginhawa sa pamamagitan ng mga non-surgical na paraan o standard na decompression.

Narito kami upang suportahan ka sa bawat yugto ng paglalakbay na ito. Masusubaybayan namin nang mahigpit ang iyong progreso at ia-adjust ang iyong care plan kung kinakailangan. Ang aming layunin ay tulungan kang bumalik sa iyong mga pang-araw-araw na gawain na may minimong discomfort. Huwag mag-atubiling magtanong kung hindi ka sigurado kung ano ang inaasahan sa susunod.

Kailan pumunta sa doktor

Pumunta sa iyong GP (General Practitioner) kung mayroon kang patuloy na sakit sa labas na bahagi ng siko o sa forearms na hindi gumagaling kahit magpahinga. Humingi ng pagsusuri ng espesyalista kung mapansin mo ang kahinaan sa iyong pulso o mga daliri, o kung nakakaapekto ang mga sintomas sa iyong pagtulog o trabaho. Bigyang-pansin agad ang biglaang paglala ng sakit o pamamanhid. Bagama’t maraming sugat sa radial nerve ang gumagaling nang spontaneous sa loob ng 3 hanggang 5 buwan, mahalaga ang maagang pagsusuri. Ang surgical exploration sa loob ng 3 linggo pagkatapos ng sugat ay may kaakibat na mas mataas na pagkakataon ng pagbawi ng function ng radial nerve kumpara sa paghihintay. Ang nonsurgical na pamamahala ang unang hakbang na paggamot para sa radial tunnel syndrome, ngunit ang tamang pagtatasa ay tinitiyak na makakakuha ka ng angkop na alaga.

Evidence & references

Overview

Radial tunnel syndrome is a compression neuropathy of the radial nerve [2].
Most publications regarding uncommon upper extremity compression neuropathies, including radial tunnel syndrome, are small retrospective series or case reports [2].
Treatment decisions for uncommon upper extremity compression neuropathies are not typically based on high levels of evidence [2].
Nonsurgical management is the first-line treatment for radial tunnel syndrome [1].
Surgical decompression is a viable option for refractory cases of radial tunnel syndrome [1].
There is ongoing controversy regarding the diagnosis and outcomes of radial tunnel syndrome [1].
Surgery is advocated for high radial nerve entrapment neuropathy cases resistant to conservative treatment [14].
Dissection of the entire length of the fibrous tunnel is important in the surgical management of high radial nerve entrapment neuropathy [14].

Anatomy & Pathophysiology

The humeral trochlea protrudes into the cubital tunnel during elbow flexion, causing dynamic morphologic changes in the ulnar nerve [38].
Shoulder position increases ulnar nerve strain at the elbow of patients with cubital tunnel syndrome [47].
Increased elbow flexion in patients with cubital tunnel syndrome influences the intraneural blood flow of the ulnar nerve [49].
The mechanism of symptom provocation in cubital tunnel syndrome by the elbow flexion test is not explained simply by dynamic pressure in the cubital tunnel, suggesting other pathophysiological factors contribute [54].
Ulnar nerve gliding is most severe during passive wrist movement in elbow flexion and forearm supination [55].
Dynamic ulnar nerve compression at the elbow due to the anconeus epitrochlearis muscle is an uncommon disorder with unknown incidence and pathophysiologic mechanisms [66].
The throwing elbow is a common source of nerve injuries due to the unique combination of anatomy, high forces, and sheer repetition associated with throwing sports [60].
The study documents the incidence and distribution pattern of motor damage in patients with radiohumeral epicondylopathy and illustrates variations in topographical and functional neuroanatomy to describe a pathoanatomic substrate for this clinical picture [61].
A cadaveric study could not detect a definitive effect of elbow deformity (cubitus valgus/varus) on ulnar nerve strain or demonstrate the extent of acceptable clinical elbow deformity [59].
No significant relationships were found between chronic structural adaptations of the shoulder (strength or ROM) and chronic structural adaptations of the elbow in professional baseball pitchers [34].

Classification

Radial tunnel syndrome is defined as a pain syndrome caused by compression of the posterior interosseous nerve at the proximal forearm [10].
Radial tunnel syndrome is considered an illness construct based on speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [5].
Radial tunnel syndrome and posterior interosseous nerve syndrome are viewed as a single condition presenting along a spectrum of nerve entrapment [37].
Radial tunnel syndrome is distinguished from posterior interosseous nerve syndrome and superficial radial nerve compression (Wartenberg's syndrome) within the context of unusual compression neuropathies of the forearm [11].
Radial neuropathies are rare compared to other entrapment neuropathies [3].
Radial tunnel syndrome is classified as an uncommon compression syndrome of the upper extremity [2].

Clinical Presentation

Radial tunnel syndrome is characterized as a pain syndrome caused by compression of the posterior interosseous nerve at the proximal forearm [10].
Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [5].
Radial neuropathies are rare [3].
Radial tunnel syndrome and posterior interosseous nerve syndrome are distinct clinical entities that share overlapping clinical presentations [6].

Investigations

Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [5].
Radial tunnel syndrome is a pain syndrome caused by compression of the posterior interosseous nerve at the proximal forearm [10].
Dynamic ultrasonographic assessment of changes in the anteroposterior (AP) diameter and cross-sectional area (CSA) is an effective diagnostic tool for identifying radial tunnel syndrome [68].
Magnetic Resonance Imaging (MRI) may depict coexistent or alternative conditions such as lateral epicondylitis, which may explain the patient's symptoms or may identify compressive lesions that may be amenable to surgical resection or decompression [45].
MRI has emerged as the imaging modality of choice for the evaluation of elbow pain in the athlete due to its high spatial resolution, excellent soft tissue contrast, and multiplanar imaging capabilities [70].
Most clinicians order preoperative tests before offering surgery for cubital tunnel syndrome, but only 6% order both electrodiagnostic (EDX) testing and ultrasound as per expert consensus [7].
Clinical evaluation is paramount in the diagnosis of cubital tunnel syndrome because electrodiagnostic testing often is not sufficiently sensitive to detect changes associated with the syndrome [9].
Ultrasound may be able to better identify patients with early stages of ulnar neuropathy with negative electrodiagnostic findings [72].
MRI is an effective diagnostic modality, and clinicians should be aware of primary synovial chondromatosis as a causative factor of cubital tunnel syndrome [20].
Only a small number of individuals with MRI evidence of an anconeus epitrochlearis muscle (AEM) had clinical evidence of ulnar neuropathy [48].

Treatment

Non-Operative Management

Nonsurgical management is the first-line treatment for radial tunnel syndrome [1].
Initial treatment of most compressive neuropathies at the elbow is nonoperative, consisting of rest and avoidance of elbow flexion [35].
Most cases of ulnar nerve compression improve with nonsurgical treatment [43].
A prolonged nonsurgical approach is warranted in most cases for median nerve or anterior interosseous nerve (AIN) compression [46].

Operative Management: Indications and Outcomes

Surgical decompression remains a viable option for radial tunnel syndrome cases refractory to nonsurgical management [1].
Surgery is advocated for high radial nerve entrapment neuropathy cases resistant to conservative treatment [14].
Reoperation after primary surgery of cubital tunnel syndrome gives satisfactory results for patients who fail conservative treatment [28].
The majority of ulnar nerve compression cases get better with surgical decompression [43].
Surgery is effective in treating cubital tunnel syndrome, with more than 90% of patients cured or showing improvement [19].
Patient-reported outcomes of surgical treatment for cubital tunnel syndrome are good but are affected by preoperative symptom severity [13].
In situ decompression of the ulnar nerve is a reliable treatment for cubital tunnel syndrome with a low failure rate [39].

Operative Techniques: Decompression vs. Transposition

Current evidence suggests that different surgical methods to treat ulnar neuropathy at the elbow do not differ in their clinical outcomes [15].
Simple decompression and anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome have been compared in a meta-analysis [18].
Both minimal medial epicondylectomy and anterior subcutaneous transposition of the ulnar nerve can be used for the treatment of cubital tunnel syndrome with a high rate of satisfaction [36].
In situ decompression and partial epicondylectomy both represent efficient and safe methods for cubital tunnel syndrome management [56].
Medial epicondylectomy is recommended for patients with cubital tunnel syndrome associated with abnormal nerve-conduction velocity [25].

Operative Techniques: Endoscopic vs. Open

Endoscopic and open cubital tunnel release techniques demonstrate similar effectiveness, outcomes, complication profiles, and reoperation rates for idiopathic cubital tunnel syndrome [40].
An open randomized controlled trial (EVOCU) aims to provide evidence-based recommendations on the efficacy, patient treatment experience, and safety profile of endoscopic versus open release for cubital tunnel syndrome [24].
The endoscopic technique has proven effective in the treatment of cubital tunnel syndrome [42].

Operative Technical Considerations

Clinical evaluation is paramount in the diagnosis of cubital tunnel syndrome because electrodiagnostic testing often is not sufficiently sensitive to detect changes associated with the syndrome [9].
For high radial nerve entrapment neuropathy, it is important to dissect the entire length of the fibrous tunnel during surgery [14].

Complications

Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [5].
Most publications regarding uncommon compression syndromes of the radial, ulnar, and median nerves are small retrospective series or case reports [2].
Treatment decisions for uncommon compression syndromes are not typically based on high levels of evidence [2].
Radial neuropathies are rare [3].
The short-term complication rates of cubital tunnel surgery are low (3.2%) [27].
Short-term complication rates for cubital tunnel surgery are higher for patients with chronic kidney disease [27].
Results of revision surgery for recurrent or persistent cubital tunnel syndrome are less predictable and satisfying than primary surgery [29].
The risk of revision surgery following in situ ulnar nerve decompression for idiopathic cubital tunnel syndrome is low [69].
The risk of revision surgery following in situ ulnar nerve decompression for idiopathic cubital tunnel syndrome is increased in patients younger than 50 years [69].

Recovery

Surgical decompression is a viable option for refractory cases of radial tunnel syndrome, despite ongoing controversy regarding diagnosis and outcomes [1].
Most publications on uncommon compression syndromes of the radial nerve are small retrospective series or case reports, and treatment decisions are not typically based on high levels of evidence [2].
Radial neuropathies are rare [3].

Key Evidence

[L4] The article reviews the anatomy, diagnosis, and treatment of radial tunnel syndrome, noting that while nonsurgical management is first-line, surgical decompression remains a viable option for refractory cases despite ongoing controversy regarding diagnosis and outcomes. [1] (10.5435/jaaos-d-23-00314)
[L4] This article reviews uncommon compression syndromes of the radial, ulnar, and median nerves, noting that most publications are small retrospective series or case reports and treatment decisions are not typically based on high levels of evidence. [2] (10.1016/j.hcl.2013.04.014)
[L3] Ulnar and radial neuropathies were less common, with ulnar neuropathies more frequent in men and radial neuropathies being rare. [3] (10.1177/1753193419886741)
[L5] Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis. [5] (10.1016/j.jhsa.2010.03.020)
[Paper] This article is a review of the history, anatomy, and clinical presentation of radial tunnel syndrome (RTS) and posterior interosseous nerve syndrome (PINS). [6] (10.1016/s0749-0712(21)00357-7)
[L4] Most clinicians order preoperative tests before offering surgery for cubital tunnel syndrome, but only 6% order both EDX and ultrasound as per expert consensus. [7] (10.1177/17531934261434155)
[L4] Clinical evaluation is paramount in the diagnosis of cubital tunnel syndrome because electrodiagnostic testing often is not sufficiently sensitive to detect changes associated with the syndrome. [9] (10.1016/j.hcl.2013.08.019)
[L5] Radial tunnel syndrome is a pain syndrome caused by compression of the posterior interosseous nerve at the proximal forearm. [10] (10.1016/j.ocl.2012.07.022)
[L5] This article is a review examining unusual compression neuropathies of the forearm, specifically focusing on the radial nerve, including posterior interosseous nerve syndrome, radial tunnel syndrome, and superficial radial nerve compression (Wartenberg's syndrome). [11] (10.1016/j.jhsa.2009.10.016)
[L3] The patient-reported outcome of surgical treatment of cubital tunnel syndrome is good but is affected by preoperative symptom severity. [13] (10.1016/j.jhsa.2009.05.014)
[Case_report] The authors advocate for surgery in high radial nerve entrapment neuropathy cases resistant to conservative treatment, emphasizing the importance of dissecting the entire length of the fibrous tunnel. [14] (10.1016/j.jse.2025.02.060)
[L4] Current evidence suggests that different surgical methods to treat ulnar neuropathy at the elbow do not differ in their clinical outcomes. [15] (10.1016/j.hcl.2013.04.013)
[L1] This report represents the best cumulative evidence to date examining the surgical management of cubital tunnel syndrome. [18] (10.1016/j.jhsa.2008.03.006)
[L4] Surgery was effective in treating cubital tunnel syndrome with more than 90% of patients cured or showing improvement. [19] (10.1016/j.otsr.2014.03.009)
[Case_report] MRI is an effective diagnostic modality, and clinicians should be aware of primary synovial chondromatosis as a causative factor of cubital tunnel syndrome. [20] (10.1177/1758573216683396)
[L2] This study aims to provide an evidence-based recommendation on which method has the best efficacy, patient treatment experience, and safety profile for cubital tunnel syndrome by comparing open and endoscopic release. [24] (10.1186/s12891-023-06234-y)
[L4] The procedure is recommended for patients with cubital tunnel syndrome associated with abnormal nerve-conduction velocity. [25] (10.2106/00004623-198062060-00016)
[L4] The short-term complication rates of cubital tunnel surgery are low (3.2%), but higher for patients with chronic kidney disease. [27] (10.1016/j.jhsa.2017.01.020)
[L4] Results of revision surgery for recurrent or persistent cubital tunnel syndrome are less predictable and satisfying than primary surgery. [29] (10.1016/j.jhsa.2011.11.024)
[L3] However, no significant relationships between adaptations in shoulder strength or ROM were related to chronic structural adaptations of the elbow. [34] (10.1177/03635465251317509)
[L5] Initial treatment of most compressive neuropathies at the elbow is nonoperative, consisting of rest and avoidance of elbow flexion. [35] (10.5435/00124635-199809000-00004)
[L3] Both methods can be used for the treatment of cubital tunnel syndrome with a high rate of satisfaction. [36] (10.1016/j.jse.2005.10.007)
[L5] The authors advocate for consistent use of the terminology distinguishing the deep branch of the radial nerve (DBRN) and the posterior interosseous nerve (PIN), and recommend viewing radial tunnel syndrome and posterior interosseous nerve syndrome as a single condition presenting along a spectrum of nerve entrapment. [37] (10.1177/17531934241254706)
[L5] The humeral trochlea protrudes into the cubital tunnel during elbow flexion, causing dynamic morphologic changes in the ulnar nerve. [38] (10.1016/j.jse.2022.05.026)
[L4] In situ decompression of the ulnar nerve is a reliable treatment for cubital tunnel syndrome with a low failure rate. [39] (10.1177/1753193408101467)
[L1] The current study demonstrates similar effectiveness between the endoscopic (ECTuR) and open (OCTuR) techniques for treatment of idiopathic cubital tunnel syndrome with similar outcomes, complication profiles, and reoperation rates. [40] (10.1177/1558944715616097)
[L4] The technique has proven effective in the treatment of cubital tunnel syndrome. [42] (10.1177/1753193408094443)
[L4] MR imaging may depict coexistent or alternative conditions such as lateral epicondylitis, which may explain the patient's symptoms or may identify compressive lesions that may be amenable to surgical resection or decompression. [45] (10.1148/radiol.2401050028)
[L5] Surgical decompression of the median nerve or the AIN in the forearm is rarely indicated; a prolonged nonsurgical approach is warranted in most cases. [46] (10.5435/jaaos-d-16-00010)
[L4] To the best of our knowledge, this is the first study showing that shoulder position changes the ulnar nerve strain around the elbow in living patients with CubTS. [47] (10.1016/j.jse.2015.01.014)
[L4] Only a small number of individuals with MRI evidence of an AEM had clinical evidence of ulnar neuropathy. [48] (10.1016/j.jse.2018.03.021)
[L3] Increased elbow flexion in patients with CuTS influences the intraneural blood flow of the ulnar nerve. [49] (10.1016/j.jhsa.2021.06.024)
[L3] The mechanism of provocation of symptoms of cubital tunnel syndrome by the elbow flexion test could not be explained simply by dynamic pressure in the cubital tunnel, and other pathophysiological factors could also be contributing. [54] (10.1016/j.jhsa.2010.11.013)
[L4] Ulnar nerve gliding was most severe during passive wrist movement in elbow flexion and forearm supination. [55] (10.5397/cise.2024.00934)
[L3] In situ decompression and partial epicondylectomy both represent efficient and safe methods for cubital tunnel syndrome management. [56] (10.1016/j.jse.2009.10.014)
[L5] The study could not detect a definitive effect of elbow deformity on ulnar nerve strain or demonstrate the extent of acceptable clinical elbow deformity. [59] (10.1186/s12891-022-05786-9)
[L5] The throwing elbow is a common source of nerve injuries due to the unique combination of anatomy, high forces, and sheer repetition associated with throwing sports. [60] (10.1016/j.csm.2004.04.012)
[L4] Dynamic ulnar nerve compression at the elbow due to the anconeus epitrochlearis muscle is an uncommon, little-known disorder with much remaining to be elucidated about its incidence and pathophysiologic mechanisms. [66] (10.1016/j.jhsg.2022.11.002)
[L4] Dynamic ultrasonographic assessment of changes in the AP diameter and CSA is an effective diagnostic tool for identifying radial tunnel syndrome. [68] (10.1177/17531934261443138)
[L3] For patients with idiopathic cubital tunnel syndrome, the risk of revision surgery following in situ ulnar nerve decompression is low, but increased in patients younger than 50 years. [69] (10.1016/j.jhsa.2015.12.012)
[L5] MRI has emerged as the imaging modality of choice for the evaluation of elbow pain in the athlete due to its high spatial resolution, excellent soft tissue contrast, and multiplanar imaging capabilities. [70] (10.1016/j.csm.2010.06.004)
[L4] Ultrasound may be able to better identify patients with early stages of ulnar neuropathy with negative electrodiagnostic findings. [72] (10.1016/j.jhsa.2023.08.014)

References

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