Compressão do nervo ulnar na região do cotovelo – síndrome do túnel cubital: revisão da literatura

Resumo

A síndrome do túnel cubital é responsável pela neuropatia do nervo ulnar, sendo superada em frequência apenas pela síndrome do túnel do carpo. O nervo ulnar apresenta anatomia complexa podendo sofrer compressão em distintos pontos ao longo de seu trajeto, por isso o entendimento das nuances clínicas e da anatomia pormenorizada assim como da técnica cirúrgica meticulosa torna-se essencial no tratamento desta patologia.

Abstract

The cubital tunnel syndrome is responsible for the ulnar nerve neuropathy, this condition is surpassed in frequency only by carpal tunnel syndrome. The ulnar nerve has complex anatomy and may suffer compression at different points along its path, so understanding the clinical nuances and detailed anatomy as well as meticulous surgical technique becomes essential in the treatment of this pathology.

Palavras-Chave

síndrome do túnel cubital - neuropatia compressiva - nervo ulnar

Keywords

cubital tunnel syndrome - compressive neuropathy - ulnar nerve

• Referências

• 1 Bozentka DJ. Cubital tunnel syndrome pathophysiology. Clin Orthop Relat Res 1998; (351) 90-94
• 2 Coppieters MW, Bartholomeeusen KE, Stappaerts KH. Incorporating nerve-gliding techniques in the conservative treatment of cubital tunnel syndrome. J Manipulative Physiol Ther 2004; 27 (9) 560-568
• 3 Palmer BA, Hughes TB. Cubital tunnel syndrome. J Hand Surg Am 2010; 35 (1) 153-163
• 4 Siqueira MG, Martins RS. The controversial arcade of Struthers. Surg Neurol 2005; 64 (Suppl. 01) S1 , 17–20, discussion S1, 20–21
• 5 Siqueira MG . Martins RS Anatomia Cirúrgica das Vias de Acesso aos Nervos Periféricos, Dilivros, 2006 ISBN 85-86703-25-7
• 6 Bruno W, Tsai T. Minimally invasive release of the cubital tunnel. Oper Tech Plast Reconstr Surg 2003; 9 (4) 131-137
• 7 Ochiai N, Honmo J, Tsujino A, Nisiura Y. Electrodiagnosis in entrapment neuropathy by the arcade of Struthers. Clin Orthop Relat Res 2000; (378) 129-135
• 8 Dellon AL, MacKinnon SE. Injury to the medial antebrachial cutaneous nerve during cubital tunnel surgery. J Hand Surg [Br] 1985; 10 (1) 33-36
• 9 Lowe III JB, Maggi SP, Mackinnon SE. The position of crossing branches of the medial antebrachial cutaneous nerve during cubital tunnel surgery in humans. Plast Reconstr Surg 2004; 114 (3) 692-696
• 10 Cutts S. Cubital tunnel syndrome. Postgrad Med J 2007; 83 (975) 28-31
• 11 Novak CB, Lee GW, Mackinnon SE, Lay L. Provocative testing for cubital tunnel syndrome. J Hand Surg Am 1994; 19 (5) 817-820
• 12 Kroonen LT. Cubital tunnel syndrome. Orthop Clin North Am 2012; 43 (4) 475-486
• 13 Wiesler ER, Chloros GD, Cartwright MS, Shin HW, Walker FO. Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel. J Hand Surg Am 2006; 31 (7) 1088-1093
• 14 Svernlöv B, Larsson M, Rehn K, Adolfsson L. Conservative treatment of the cubital tunnel syndrome. J Hand Surg Eur Vol 2009; 34 (2) 201-207
• 15 MacKinnon S, Novak C. Compression neuropathies—cubital tunnel syndrome. In: Green D, Hotchkiss R, Wolfe S, Pederson W, , eds. Green's operative hand surgery. 5th ed. New York: Elsevier; 2005: 1023-1029
• 16 Gervasio O, Gambardella G, Zaccone C, Branca D. Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: a prospective randomized study. Neurosurgery 2005; 56 (1) 108-117 , discussion 117
• 17 Nabhan A, Ahlhelm F, Kelm J, Reith W, Schwerdtfeger K, Steudel WI. Simple decompression or subcutaneous anterior transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg [Br] 2005; 30 (5) 521-524
• 18 Goldfarb CA, Sutter MM, Martens EJ, Manske PR. Incidence of re-operation and subjective outcome following in situ decompression of the ulnar nerve at the cubital tunnel. J Hand Surg Eur Vol 2009; 34 (3) 379-383
• 19 Nellans K, Tang P. Evaluation and treatment of failed ulnar nerve release at the elbow. Orthop Clin North Am 2012; 43 (4) 487-494
• 20 Ogata K, Manske PR, Lesker PA. The effect of surgical dissection on regional blood flow to the ulnar nerve in the cubital tunnel. Clin Orthop Relat Res 1985; (193) 195-198
• 21 Macadam SA, Gandhi R, Bezuhly M, Lefaivre KA. Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a meta-analysis. J Hand Surg Am 2008; 33 (8) 1314.e1-1314.e12
• 22 Baek GH, Kwon BC, Chung MS. Comparative study between minimal medial epicondylectomy and anterior subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Shoulder Elbow Surg 2006; 15 (5) 609-613
• 23 Hoffmann R, Siemionow M. The endoscopic management of cubital tunnel syndrome. J Hand Surg [Br] 2006; 31 (1) 23-29
• 24 Watts AC, Bain GI. Patient-rated outcome of ulnar nerve decompression: a comparison of endoscopic and open in situ decompression. J Hand Surg Am 2009; 34 (8) 1492-1498
• 25 Damert HG, Altmann S, Infanger M, Kraus A. Operative decisions for endoscopic treatment of cubital tunnel syndrome. Orthopedics 2013; 36 (5) 354-359