Symptomatic epineural ganglion cyst of the ulnar nerve in the cubital tunnel: a case report and brief review of the literature

doi:10.1054/jocn.2000.0676

Journal of Clinical Neuroscience

Volume 7, Issue 6, November 2000, Pages 542-543

https://doi.org/10.1054/jocn.2000.0676 Get rights and content

Abstract

An unusual case of pain and weakness in the hand and forearm due to a ganglion cyst of the ulnar nerve at the elbow is presented. The patient was managed initially as a case of cervical disc disease and cervical spondylosis and later as a case of carpal tunnel syndrome at an another institution. Cervical radiography and cervical magnetic resonance imaging scans were inconclusive. Neurosurgical referral revealed tenderness at the right cubital tunnel, weakness of the right hand and forearm muscles, and sensory deficit along the medial border of the forearm and the hand. The diagnosis of ulnar nerve compression at the elbow was made. Nerve conduction studies of the ulnar nerve at the elbow confirmed the diagnosis. A ganglion cyst of the ulnar nerve was excised microsurgically with a complete postoperative sensory motor recovery.

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Cited by (23)

The cubital tunnel syndrome caused by the intraneural or extraneural ganglion cysts: Case report and review of the literature
2017, Journal of Plastic, Reconstructive and Aesthetic Surgery
Cubital tunnel syndrome is the second most common nerve compression syndrome in peripheral nerve compression disease. Although potential ulnar nerve entrapment can occur at multiple points along its course, such as the arcade of struthers, the medial intermuscular septum, the medial epicondyle, the cubital tunnel, and the deep flexor pronator aponeurosis, the most common site of entrapment is the cubital tunnel. However, cubital tunnel syndrome could also be caused by the occupying masses along the course of ulnar nerve, such as intraneural or extraneural ganglia. The cubital tunnel syndrome caused by intraneural or extraneural ganglion cysts has been rarely reported. In our hospital, there were 184 patients with cubital tunnel syndrome who underwent surgical treatment from January 2010 to January 2014. Of these patients, 16 had extraneural cysts and 3 had intraneural ganglion cysts. The incidence rate of cysts in the cubital tunnel was 10.33%. Electromyography was used as routine examination. Ultrasound was used only in some patients in whom elbow mass was suspected. In the surgery of the cubital tunnel syndrome combined with cyst, if any other cysts were found, we should be remove completely the cyts and decompress the ulnar nerve thoroughly with the ulnar nerve being anterior transposition. These cysts were confirmed by histopathological examination. Finally, we compared the clinical features of patients who had a medial elbow ganglion with those of patients who had only cubital tunnel syndrome. B ultrasound can significantly improve the diagnosis. All patients were followed up for 4 months to 2 years, and the curative effect was good.
Compression and entrapment neuropathies
2013, Handbook of Clinical Neurology
Citation Excerpt :
The ulnar nerve may be compressed by a prominent medial head of the triceps and an anconeus epitrochlearis muscle (O’Hara and Stone, 1996). Ganglion cysts may also compress the ulnar nerve in the cubital tunnel (Sharma et al., 2000). Perineurioma may also cause an ulnar neuropathy (Beekman et al., 2004b).
Peripheral nerve entrapments are frequent. They usually appear in anatomical tunnels such as the carpal tunnel. Nerve compressions may be due to external pressure such as the fibular nerve at the fibular head. Malignant or benign tumors may also damage the nerve. For each nerve from the upper and lower limbs, detailed clinical, electrophysiological, imaging, and therapeutic aspects are described. In the upper limbs, carpal tunnel syndrome and ulnar neuropathy at the elbow are the most frequent manifestations; the radial nerve is less frequently involved. Other nerves may occasionally be damaged and these are described also. In the lower limbs, the fibular nerve is most frequently involved, usually at the fibular head by external compression. Other nerves may also be involved and are therefore described. The clinical and electrophysiological examination are very important for the diagnosis, but imaging is also of great use. Treatments available for each nerve disease are discussed.
The largest reported epineural ganglion of the ulnar nerve causing cubital tunnel syndrome: Case report and review of the literature
2013, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
Allieu suggested that such ganglia are more likely to occur in middle aged men with a previous history of elbow trauma and this is the most likely causative factor in this case.2 Previous reported ulnar nerve ganglions in the cubital tunnel, as summarized in Table 1,5–8 have been significantly smaller compared to the 11 × 3 cm cyst in this case. Surgical excision is the mainstay of treatment and it is usually possible to perform a complete excision of epineural ganglions.4
Intraneural ganglion of the ulnar nerve
2012, Formosan Journal of Musculoskeletal Disorders
Citation Excerpt :
The symptoms involve pain, numbness, sensory impairment in the medial border of the forearm and hand, reduced grip strength, and wasting of the intrinsic hand muscles.23 Total excision of the epineural ganglion may not always be possible without damaging the nerve, especially if the ganglion is intraneural.23 In summary, we presented the case of a patient with intraneural ganglion cyst in the ulnar nerve at the level of the forearm with a significant delay in the diagnosis.
We report the case of a 76-year-old right-hand dominant man with hypertension and type 2 diabetes mellitus who presented with numbness of the right ring and little fingers for 8 months and a palpable mass lesion in the right forearm for 3 months before his hospital visit. The patient exhibited grip power weakness and atrophy of intrinsic muscles. Magnetic resonance imaging confirmed a well-defined oval mass of 1.5 × 0.6 × 0.6 cm³ between the ulnar bone and nerve. This lesion was hyperintense on T2-weighted images and isointense on T1-weighted images. A zigzag incision was made for ulnar nerve exposure, and the tumor lesion was identified and carefully excised with minimal damage of ulnar nerve. A cystic mass invaded ulnar nerve extending approximately 1.5 cm was resected and reconstructed by sural nerve grafting. The patient was examined 6 months after surgery. His grip power and muscle strength increased, and no numbness or pain was detected. The outcome of this case suggests a potential surgical benefit exists even in cases of apparent chronic or severe denervation atrophy and that ganglion excision and nerve grafting should be considered.
Ulnar nerve compression in the cubital tunnel by a nodular fasciitis
2011, Clinical Neurology and Neurosurgery
Citation Excerpt :
Potential ulnar nerve entrapment can occur at 5 common sites across the elbow: the arcade of Struthers, the medial intermuscular septum, the medial epicondyle, the cubital tunnel, and the deep flexor pronator aponeurosis. Cubital tunnel syndrome is usually caused by compression of a cubital tunnel component such as an aponeurosis of the flexor carpi ulnaris and a medial epicondyle, but several authors have reported that cubital tunnel syndrome may also be caused by a mass compressing the ulnar nerve, for example a ganglion, synovial chondromatosis, uremic tumoral calcinosis or a giant cell tumor of the tendon sheaths [3–7]. Our intraoperative pathological report suggested fibromatoses.
Cubital tunnel syndrome caused by uremic tumoral calcinosis
2006, Journal of Shoulder and Elbow Surgery

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Case reportsSymptomatic epineural ganglion cyst of the ulnar nerve in the cubital tunnel: a case report and brief review of the literature

Abstract

J Hand Surg (Am)

Ganglion cysts of peripheral nerves

Ganglion cyst involvement of peripheral nerves

J Neurosurg

Case reports
Symptomatic epineural ganglion cyst of the ulnar nerve in the cubital tunnel: a case report and brief review of the literature