肘管综合征资料

您的感受

您可能会感到环指和小指出现刺痛或麻木。这通常是尺神经受压的第一个迹象。该神经穿过肘部内侧突起后方的一个狭窄通道，称为肘管。当您弯曲肘部时，这个空间会缩小，神经会被拉伸。这种压迫和张力的组合会刺激神经，导致症状加重。

疼痛并不总是主要问题。然而，有些人会感到肘部或前臂上部的酸痛。当您长时间保持肘部弯曲时，不适感往往会加重。如果您睡觉时手臂蜷曲，可能会发现症状在夜间加重。在需要长时间弯曲肘部的活动后，例如将电话贴在耳边或躺在床上看书，也可能出现这种情况。

随着病情进展，您可能会感到手部无力。这会使日常任务变得困难。您可能难以牢固地抓握物体，或者发现扣衬衫纽扣很困难。简单的动作，如伸手到背后扣文胸或塞衬衫下摆，可能会变得具有挑战性。在更严重的情况下，手部的小肌肉可能会萎缩，导致手掌形状出现可见变化。

患有此病的男性比女性更容易出现肌肉萎缩。如果您过去患有腕管综合征，则发展为肘管综合征的风险更高。相反，如果您患有肘管综合征，以后也可能发展为腕管综合征。您的外科医生将检查您的手和肘部，以评估感觉和力量。他们将寻找神经受刺激的迹象，并确定您护理的最佳方案。

实际发生了什么

肘管综合征是由于尺神经在穿过肘部时受到挤压或牵拉所致。该神经负责提供环指和小指的触觉，并控制手部的小肌肉。由于其解剖位置，这条神经非常表浅。它紧贴肘内侧皮肤走行，因此极易受到刺激。

可以将神经想象成一根花园水管。当你弯曲肘部时，神经所在的间隙会变小。肘部的骨骼也会向该间隙内突出。这会挤压神经并使其处于紧张状态。如果长时间保持肘部弯曲，这种压力会不断累积，导致神经血流受阻。这就是为什么症状在夜间或手持电话贴在耳边时往往加重。

神经也可能发生移位。在屈肘过程中，神经可能会向前滑过骨骼表面。这称为半脱位。它会导致额外的摩擦和刺激。久而久之，这种持续的摩擦和挤压会损伤神经的保护性鞘膜。你可能会感到手部麻木或刺痛。手部肌肉可能变得无力。在某些情况下，手指可能出现爪形畸形。

疼痛并不总是主要问题。你可能会感到肘部或前臂酸痛。麻木感通常在出现无力之前加重。外科医生会根据这些体征来确诊。他们会检查手背是否有感觉减退，这有助于精确定位神经受压的位置。

我们提供多种治疗方法。大多数人通过改变日常习惯即可获得缓解。我们可能会建议避免长时间屈肘。如果症状持续存在，我们将讨论手术方案。这些手术旨在解除神经压迫。可以通过小切口或内镜（摄像头）进行。目标是停止神经受压，促进神经愈合。

我们能做什么

Mater Private Hospital Rockhampton 的上肢外科医生 Kieran Hirpara 博士在我们的诊所采用清晰、循序渐进的方案来处理这一疾病。患者通过全科医生或物理治疗师转诊至我们的诊所。诊所评估（病史、体格检查及必要的影像学检查）确立诊断。对于退行性或长期存在的问题，我们通常先尝试非手术治疗——包括调整活动方式、物理治疗或手部治疗、夹板固定和注射治疗——并在非手术治疗未能带来足够改善时考虑手术。对于结构性或急性问题，我们可能会直接建议手术，而无需先进行非手术治疗的尝试。

您可以从改变肘部的使用方式开始。避免倚靠肘部或长时间保持肘部弯曲。物理治疗旨在保持神经顺畅滑动并增强关节周围的肌肉力量。我们通常建议先充分尝试这种方法，然后再转向更强的治疗手段。

如果疼痛持续存在，我们可能会讨论药物治疗。这包括使用抗炎药物以减少神经周围的肿胀。在某些情况下，我们会提供注射治疗。皮质类固醇注射可以减轻炎症，并提供数周至数月的缓解。透明质酸或富血小板血浆（PRP）注射也是支持组织健康的选项。这些治疗有助于管理症状，但不能解决神经受压的根本原因。

当保守治疗已达到极限且您的症状继续影响日常生活时，我们会考虑手术。手术涉及松解压迫尺神经的紧张组织。这一简单的步骤为神经自由滑动创造了更多空间。我们会与您讨论所有选项，以确保选择符合您的具体需求和生活习惯。

预期情况

您的预后主要取决于治疗前症状的严重程度。如果是轻中度神经压迫，手术通常能带来手部症状的临床显著缓解。许多患者发现，不仅肘部，而且在尺神经分布区以外的区域，疼痛和功能也得到了改善。这意味着您的手部整体使用可能会感觉更轻松、疼痛更少。

如果是重度或长期存在的神经压迫，伴有肌肉萎缩或严重麻木，手术很可能会阻止病情进一步恶化。虽然可以改善症状，但力量和感觉可能无法完全恢复正常。在这些情况下，治疗目标是阻止病情进展并提供有用的缓解，而非彻底治愈。

对于接受初次手术的大多数患者，效果良好。然而，如果因症状复发或持续存在而需要翻修手术，预后则较难预测。虽然许多患者仍能获得改善，但完全恢复的几率低于初次治疗。翻修减压术后，约 23% 的患者实现症状完全缓解，77% 的患者出现部分运动或感觉改善。

并发症通常不常见。标准原位松解术的短期并发症发生率为 3.6%，而尺神经前移术为 9.6%。感染发生率约为 2.17%。总体而言，约 5.7% 的患者需要二次手术，既往有肘部创伤或接受过神经前移术的患者发生率更高。

如果不进行治疗，症状通常会持续或加重。早期干预通常能带来更好的功能预后。运动员，特别是过头投掷运动员，术后重返赛场率很高，85% 的患者恢复活动，72% 的患者恢复到之前的表现水平。您的外科医生将讨论哪种方案能为您的具体情况提供缓解与风险的最佳平衡。

何时就诊

如果您注意到手部或手指麻木加重，尤其是无名指和小指，请寻求专科医生评估。如果肘部或前臂疼痛经休息后无改善，请就诊于全科医生。如果出现握力减弱或手部肌肉萎缩，请及时就医。影响睡眠或日常工作的症状也需要进行评估。早期评估有助于预防永久性神经损伤。您的外科医生可以判断是需要保守治疗还是手术以减轻尺神经受压。

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Cubital tunnel syndrome involves related anatomy, clinical presentation, and current management options [1].
A subset of patients with cubital tunnel syndrome may benefit from earlier referral for hand surgery evaluation and earlier surgery [2].
Patient-reported outcomes of surgical treatment for cubital tunnel syndrome are good but are affected by preoperative symptom severity [4].
Surgery is effective in treating cubital tunnel syndrome, with more than 90% of patients cured or showing improvement [5].
More rigorous scientific studies are needed to determine the most effective surgical approaches for cubital tunnel syndrome [6].
A treatment algorithm has been proposed to provide clarity about the challenges of treating the complex patient population with cubital tunnel syndrome [7].
There is currently no consensus on the best surgical treatment of cubital tunnel syndrome [8].
Carpal tunnel and cubital tunnel syndrome requiring surgery is more common in deprived patients and occurs at an earlier age [12].
Endoscopic cubital tunnel decompression has gained popularity, with early short-term results showing satisfactory outcomes and minimal complications [14].
The selection of operative procedures for cubital tunnel syndrome is influenced by patient factors and surgeon preference, with most surgeons using more than one operative procedure [29].

Anatomy & Pathophysiology

Definitions for the degree of ulnar nerve instability at the elbow are not uniformly agreed upon [28].
With elbow flexion, the ulnar nerve did not move appreciably in the distal–proximal direction directly at the cubital tunnel [49].
Maximal ulnar nerve excursion during elbow flexion occurs in the fatty region proximal to the elbow [49].
The humeral trochlea protrudes into the cubital tunnel during elbow flexion, causing dynamic morphologic changes in the ulnar nerve [50].
Tearing of the ulnar collateral ligament significantly increases elbow valgus laxity, which elongates the ulnar nerve during simulated throwing motion [51].
Increased elbow flexion influences the intraneural blood flow of the ulnar nerve in patients with cubital tunnel syndrome [57].
Exposure to lesser extraneural pressure by repetitive non-maximum elbow flexion might be more deleterious than maximum flexion pressure in cubital tunnel syndrome [55].
Shoulder position changes the ulnar nerve strain around the elbow in living patients with cubital tunnel syndrome [56].
The mechanism of symptom provocation by the elbow flexion test cannot be explained simply by dynamic pressure in the cubital tunnel, suggesting other pathophysiological factors contribute [58].
Ulnar nerve gliding is most severe during passive wrist movement in elbow flexion and forearm supination [59].
The 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 [61].
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 [62].
Dynamic ulnar nerve compression at the elbow due to the anconeus epitrochlearis muscle is an uncommon disorder with much remaining to be elucidated about its incidence and pathophysiologic mechanisms [64].

Classification

Cubital tunnel syndrome is the most common form of entrapment of the ulnar nerve [18].
Cubital tunnel syndrome is the second most common nerve compression syndrome of the upper extremity [18].
Further development of a classification system for ulnar nerve instability may be warranted to standardize treatment [28].
High-resolution ultrasound (HRU) shows good correspondence to clinical and ENMG classifications in cubital tunnel syndrome [35].
An intraoperative ulnar nerve subluxation classification system has promise in preventing adverse complications of ulnar nerve hypermobility after endoscopic cubital tunnel release [43].

Clinical Presentation

Patients with cubital tunnel syndrome present earlier in the course of their disease than patients with carpal tunnel syndrome [3].
Men with cubital tunnel syndrome are more likely to present with muscle atrophy than women [10].
The majority of patients suffering from cubital tunnel syndrome with mild or moderate symptoms benefit from conservative treatment [20].
Cubital tunnel syndrome in pediatric or adolescent patients is rare [19].
Non-operative treatment of cubital tunnel syndrome in pediatric and adolescent patients is unlikely to resolve symptoms [22].
There is no consensus reference standard for the diagnosis of Cubital Tunnel Syndrome [11].
Provocative tests for Cubital Tunnel Syndrome have inadequate or inconsistent sensitivity and specificity [11].
Diagnosis of Cubital Tunnel Syndrome should be discussed in terms of probabilities rather than certainties [11].
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 [17].
Nearly forty percent of patients with a provisional diagnosis of Cubital Tunnel Syndrome had either another nerve pathology or a normal nerve conduction study [21].

Investigations

Electrodiagnostic testing is often not sufficiently sensitive to detect changes associated with cubital tunnel syndrome [17].
Clinical evaluation is paramount in the diagnosis of cubital tunnel syndrome [17].
Ulnar nerve cross-sectional area (CSA) measured by ultrasound is useful for the diagnosis of cubital tunnel syndrome [47].
Ulnar nerve CSA measured by ultrasound is most significantly different between patients and controls at the medial epicondyle [47].
Power Doppler ultrasound has high predictive value for severe cubital tunnel syndrome defined by axonal loss [54].
MRI is an effective diagnostic modality for identifying primary synovial chondromatosis as a causative factor of cubital tunnel syndrome [38].
Only a small number of individuals with MRI evidence of an anconeus epitrochlearis muscle (AEM) had clinical evidence of ulnar neuropathy [48].
Cubital tunnel decompression is associated with prior trauma to the anatomic site [53].

Treatment

Non-Operative Management

The majority of patients with mild or moderate cubital tunnel syndrome symptoms benefit from conservative treatment [20].
Non-operative treatment is unlikely to resolve symptoms in pediatric and adolescent patients [22].

Operative Management: General Principles and Selection

There is currently no consensus on the best surgical treatment for cubital tunnel syndrome [8].
Most surgeons use more than one operative procedure for cubital tunnel syndrome, with selection influenced by patient factors and surgeon preference [29].
None of the surgical techniques has demonstrated universal superiority above all others, but all appear to be effective [41].
A subset of patients may benefit from earlier referral for hand surgery evaluation and earlier surgery [2].
Reoperation after primary surgery provides satisfactory results for patients who fail conservative treatment [15].
In situ decompression of the ulnar nerve is a reliable treatment with a low failure rate [40].

Operative Techniques: Decompression

Simple decompression with a small skin incision yielded satisfactory results in 14 of 18 elbows with no postoperative dislocation of the ulnar nerve [32].
Endoscopic and open in situ decompression techniques demonstrate similar effectiveness, outcomes, complication profiles, and reoperation rates for idiopathic cubital tunnel syndrome [39].
The patient-reported outcome of surgical treatment is good but is affected by preoperative symptom severity [4].

Operative Techniques: Transposition and Other Procedures

Both minimal medial epicondylectomy and anterior subcutaneous transposition can be used for cubital tunnel syndrome with a high rate of satisfaction [37].
Medial epicondylectomy is recommended for patients with cubital tunnel syndrome associated with abnormal nerve-conduction velocity [33].
The procedure offers complete release of constricting structures while preserving blood supply to the nerve and allowing early postoperative elbow mobilization [25].

Operative Techniques: Specialized and Combined Procedures

Bony encasement of the ulnar nerve secondary to heterotopic ossification of the elbow is treated with an approach that leads to superior range of motion, improved or resolved ulnar neuropathy, and good to excellent long-term functional outcomes [26].
Dual endoscopic carpal and cubital tunnel release is a safe and effective treatment option for patients with concurrent syndromes recalcitrant to nonsurgical management [36].

Complications

Surgery was effective in treating cubital tunnel syndrome with more than 90% of patients cured or showing improvement [5].
The short-term complication rates of cubital tunnel surgery are low (3.2%) [24].
Short-term complication rates for cubital tunnel surgery are higher for patients with chronic kidney disease [24].
Endoscopic cubital tunnel decompression shows satisfactory outcomes and minimal complications [14].
Reoperation after primary surgery of cubital tunnel syndrome gave satisfactory results for patients who fail conservative treatment [15].
Results of revision surgery for recurrent or persistent cubital tunnel syndrome are less predictable and satisfying than primary surgery [31].
Poor outcomes and unnecessary revision surgeries for cubital tunnel syndrome can be avoided with intraoperative attention to 7 structures distal to the medial epicondyle [44].

Recovery

Patients with carpal tunnel syndrome present earlier in the course of their disease than patients with cubital tunnel syndrome [3].
The patient-reported outcome of surgical treatment of cubital tunnel syndrome is good but is affected by preoperative symptom severity [4].
Symptoms in an extra-ulnar distribution can resolve following cubital tunnel release [9].
Reliable, reproducible, and valid outcomes measures are lacking from the surgical literature for cubital tunnel syndrome [13].
Endoscopic cubital tunnel decompression shows satisfactory outcomes and minimal complications in early short-term results [14].
The short-term complication rates of cubital tunnel surgery are low (3.2%), but higher for patients with chronic kidney disease [24].
Treatment of bony encasement of the ulnar nerve secondary to heterotopic ossification leads to superior range of motion, improved or resolved ulnar neuropathy, and good to excellent long-term functional outcomes [26].
There are no significant differences in long-term outcomes after open and retractor-endoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome [30].
Patients with an anomalous muscle (AE) experience quicker symptom improvement after cubital tunnel release than those without the anomalous muscle [34].

Key Evidence

[L5] This article reviews related anatomy, clinical presentation, and current management options for cubital tunnel syndrome with an emphasis on contemporary outcomes research. [1] (10.1016/j.jhsa.2015.03.011)
[L3] A subset of patients with cubital tunnel syndrome may benefit from earlier referral for hand surgery evaluation and earlier surgery. [2] (10.1177/15589447211058821)
[L4] Patients with carpal tunnel syndrome present earlier in the course of their disease than patients with cubital tunnel syndrome. [3] (10.1016/j.jhsa.2007.03.009)
[L3] The patient-reported outcome of surgical treatment of cubital tunnel syndrome is good but is affected by preoperative symptom severity. [4] (10.1016/j.jhsa.2009.05.014)
[L4] Surgery was effective in treating cubital tunnel syndrome with more than 90% of patients cured or showing improvement. [5] (10.1016/j.otsr.2014.03.009)
[L4] More rigorous scientific studies are needed to determine the most effective surgical approaches for cubital tunnel syndrome. [6] (10.1007/s12178-020-09650-y)
[L4] The purpose of this review is to summarize the most up-to-date literature regarding cubital tunnel syndrome and propose a treatment algorithm to provide clarity about the challenges of treating this complex patient population. [7] (10.1016/j.jhsg.2022.07.008)
[L5] There is currently no consensus on the best surgical treatment of cubital tunnel syndrome. [8] (10.1016/j.ocl.2012.07.017)
[L3] This study documents resolution of symptoms in an extra-ulnar distribution after cubital tunnel release. [9] (10.1007/s11552-014-9688-9)
[L4] Men with cubital tunnel syndrome are more likely to present with muscle atrophy than women. [10] (10.1177/1558944716643096)
[L4] There is no consensus reference standard for the diagnosis of Cubital Tunnel Syndrome, and provocative tests have inadequate or inconsistent sensitivity and specificity; diagnosis should be discussed in terms of probabilities rather than certainties. [11] (10.1016/j.jhsa.2011.03.021)
[L4] Carpal tunnel and cubital tunnel syndrome requiring surgery is more common in deprived patients and occurs at an earlier age. [12] (10.1177/1753193420939384)
[L3] Reliable, reproducible, and valid outcomes measures are lacking from the surgical literature for cubital tunnel syndrome. [13] (10.1016/j.jhsa.2009.05.010)
[L5] Endoscopic cubital tunnel decompression has gained popularity with early short-term results being encouraging, showing satisfactory outcomes and minimal complications. [14] (10.1136/jisakos-2020-000506)
[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. [17] (10.1016/j.hcl.2013.08.019)
[L5] Cubital tunnel syndrome is the most common form of entrapment of the ulnar nerve and the second most common nerve compression syndrome of the upper extremity. [18] (10.1016/s0749-0712(21)00356-5)
[L3] Cubital tunnel syndrome in pediatric or adolescent patients is rare and can be treated successfully with surgical intervention. [19] (10.1016/j.jhsa.2012.01.016)
[L2] The majority of patients suffering from cubital tunnel syndrome with mild or moderate symptoms benefit from conservative treatment. [20] (10.1177/1753193408098480)
[L4] Nearly forty percent of patients with a provisional diagnosis of CubTS had either another nerve pathology or a normal test. [21] (10.1016/j.jse.2020.01.064)
[L4] Non-operative treatment of cubital tunnel syndrome in pediatric and adolescent patients is unlikely to resolve symptoms. [22] (10.1016/s0363-5023(11)60063-4)
[L4] The short-term complication rates of cubital tunnel surgery are low (3.2%), but higher for patients with chronic kidney disease. [24] (10.1016/j.jhsa.2017.01.020)
[L5] The procedure offers complete release of constricting structures while preserving blood supply to the nerve and allowing early postoperative elbow mobilization. [25] (10.1016/s0749-0712(21)00325-5)
[L4] This treatment approach leads to superior range of motion, improved or resolved ulnar neuropathy, and good to excellent long-term functional outcomes. [26] (10.1016/j.jse.2023.12.003)
[L4] Most surgeons use more than one operative procedure in their treatment of patients with cubital tunnel syndrome and the selection of the operative procedure is influenced by patient factors and surgeon preference. [29] (10.1007/s11552-008-9133-z)
[L3] There are no significant differences in long-term outcomes after open and retractor-endoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome. [30] (10.1227/neu.0b013e3182846dbd)
[L4] Results of revision surgery for recurrent or persistent cubital tunnel syndrome are less predictable and satisfying than primary surgery. [31] (10.1016/j.jhsa.2011.11.024)
[L4] The technique yielded satisfactory results in 14 of 18 elbows with no postoperative dislocation of the ulnar nerve. [32] (10.1054/jhsb.2002.0821)
[L4] The procedure is recommended for patients with cubital tunnel syndrome associated with abnormal nerve-conduction velocity. [33] (10.2106/00004623-198062060-00016)
[L3] Patients with an AE experience quicker symptom improvement after cubital tunnel release than those without the anomalous muscle. [34] (10.1016/j.jhsa.2017.06.033)
[L4] HRU proved to be an effective diagnostic tool for cubital tunnel syndrome and its etiologies, showing good correspondence to clinical and ENMG classifications. [35] (10.1016/j.otsr.2014.03.008)
[L4] Preliminary data demonstrate that dual endoscopic carpal and cubital tunnel release is a safe and effective treatment option for patients who present with concurrent cubital and carpal tunnel syndromes recalcitrant to nonsurgical management. [36] (10.1007/s11552-013-9552-3)
[L3] Both methods can be used for the treatment of cubital tunnel syndrome with a high rate of satisfaction. [37] (10.1016/j.jse.2005.10.007)
[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. [38] (10.1177/1758573216683396)
[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. [39] (10.1177/1558944715616097)
[L4] In situ decompression of the ulnar nerve is a reliable treatment for cubital tunnel syndrome with a low failure rate. [40] (10.1177/1753193408101467)
[L4] None of the techniques in this review has demonstrated universal superiority above all others, but all appear to be effective in the treatment of cubital tunnel syndrome. [41] (10.3389/fsurg.2018.00048)
[L4] Our preliminary report of patients shows satisfactory outcomes, which suggests that our intraoperative ulnar nerve subluxation classification system has promise in preventing adverse complications of ulnar nerve hypermobility after endoscopic cubital tunnel release. [43] (10.1016/j.jhsg.2020.05.001)
[L5] Poor outcomes and unnecessary revision surgeries for cubital tunnel syndrome can be avoided with intraoperative attention to 7 structures distal to the medial epicondyle. [44] (10.1177/1558944718771390)
[L1] The ulnar nerve CSA measured by US imaging is useful for the diagnosis of cubital tunnel syndrome (CuTS), and is most significantly different between patients and controls at the medial epicondyle. [47] (10.1016/j.apmr.2017.08.467)
[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)
[L5] With elbow flexion, the ulnar nerve did not move appreciably in the distal–proximal direction directly at the cubital tunnel, but maximal excursion was in the fatty region proximal to the elbow. [49] (10.1016/j.jhsa.2012.03.016)
[L5] The humeral trochlea protrudes into the cubital tunnel during elbow flexion, causing dynamic morphologic changes in the ulnar nerve. [50] (10.1016/j.jse.2022.05.026)
[L5] Tearing of the UCL significantly increased elbow valgus laxity, which in turn elongated the ulnar nerve during simulated throwing motion. [51] (10.1016/j.jse.2019.02.009)
[L4] Cubital tunnel decompression is associated with prior trauma to the anatomic site. [53] (10.1016/j.jhsa.2017.07.009)
[L3] Power Doppler ultrasound demonstrated high predictive value for severe cubital tunnel syndrome defined by axonal loss. [54] (10.1177/15589447221127334)
[L4] The increased pressure in the cubital tunnel could still be important, as exposure to a lesser extraneural pressure by repetitive non-maximum elbow flexion might be more deleterious. [55] (10.3109/2000656x.2012.747962)
[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. [56] (10.1016/j.jse.2015.01.014)
[L3] Increased elbow flexion in patients with CuTS influences the intraneural blood flow of the ulnar nerve. [57] (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. [58] (10.1016/j.jhsa.2010.11.013)
[L4] Ulnar nerve gliding was most severe during passive wrist movement in elbow flexion and forearm supination. [59] (10.5397/cise.2024.00934)
[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. [61] (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. [62] (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. [64] (10.1016/j.jhsg.2022.11.002)

References

[1] The Management of Cubital Tunnel Syndrome. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.03.011

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