Subscribe to RSS
Surgical Treatment of Cubital Tunnel in Pediatric AthletesFunding None.
Received: 28 August 2017
Accepted: 04 January 2018
20 March 2018 (online)
Background Cubital tunnel syndrome is the second most common upper extremity peripheral nerve entrapment syndrome. In particular, cubital tunnel has been documented occasionally in young, throwing athletes.
Materials and Methods Billing databases were searched for patients undergoing surgical decompression of the ulnar nerve at the elbow, who were age 18 or younger at the time of surgery. Charts were reviewed and patients were included if they had an isolated mononeuropathy consistent with cubital tunnel syndrome and were symptomatic. Data on age of onset, duration of symptoms, Dellon classification, nerve subluxation, provocative testing results, nerve conductions, and exacerbating activities were abstracted. Patients were contacted for a postsurgical follow-up questionnaire.
Results Seven patients were identified. The average age was 16, and duration of symptoms was 7 months. All seven patients had normal electrodiagnostic studies and had failed a course of conservative treatment. All were satisfied with surgery and felt improvement. One stopped playing their sport, and three had mild symptoms with varied activities.
Conclusion Although uncommon, pediatric cubital tunnel syndrome does occur. Surgical release improves symptoms and return to activities. Nevertheless, some degree of symptoms often persists. Electrodiagnostic studies may be negative in many patients with an otherwise consistent history and examination.
Level of Evidence This is a level IV therapeutic study.
- 1 Fernandez E, Pallini R, Lauretti L, Scogna A, La Marca F. Neurosurgery of the peripheral nervous system: cubital tunnel syndrome. Surg Neurol 1998; 50 (01) 83-85
- 2 Gugenheim Jr JJ, Stanley RF, Woods GW, Tullos HS. Little League survey: the Houston study. Am J Sports Med 1976; 4 (05) 189-200
- 3 Lyman S, Fleisig GS, Waterbor JW. et al. Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc 2001; 33 (11) 1803-1810
- 4 Godshall RW, Hansen CA. Traumatic ulnar neuropathy in adolescent baseball pitchers. J Bone Joint Surg Am 1971; 53 (02) 359-361
- 5 Aoki M, Kanaya K, Aiki H, Wada T, Yamashita T, Ogiwara N. Cubital tunnel syndrome in adolescent baseball players: a report of six cases with 3- to 5-year follow-up. Arthroscopy 2005; 21 (06) 758-758
- 6 Torg JS, Pollack H, Sweterlitsch P. The effect of competitive pitching on the shoulders and elbows of preadolescent baseball players. Pediatrics 1972; 49 (02) 267-272
- 7 Calfee RP, Manske PR, Gelberman RH, Van Steyn MO, Steffen J, Goldfarb CA. Clinical assessment of the ulnar nerve at the elbow: reliability of instability testing and the association of hypermobility with clinical symptoms. J Bone Joint Surg Am 2010; 92 (17) 2801-2808
- 8 Stewart JD, Eisen A. Tinel's sign and the carpal tunnel syndrome. BMJ 1978; 2 6145 1125-1126
- 9 Buehler MJ, Thayer DT. The elbow flexion test. A clinical test for the cubital tunnel syndrome. Clin Orthop Relat Res 1988; (233) 213-216
- 10 Dellon AL. Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg Am 1989; 14 (04) 688-700
- 11 Burns PB, Kim HM, Gaston RG. et al. Predictors of functional outcomes after simple decompression for ulnar neuropathy at the elbow: a multicenter study by the SUN study group. Arch Phys Med Rehabil 2014; 95 (04) 680-685
- 12 Felice KJ, Royden Jr JonesH. Pediatric ulnar mononeuropathy: report of 21 electromyography-documented cases and review of the literature. J Child Neurol 1996; 11 (02) 116-120
- 13 Stutz CM, Calfee RP, Steffen JA, Goldfarb CA. Surgical and nonsurgical treatment of cubital tunnel syndrome in pediatric and adolescent patients. J Hand Surg Am 2012; 37 (04) 657-662
- 14 Raynor EM, Shefner JM, Preston DC, Logigian EL. Sensory and mixed nerve conduction studies in the evaluation of ulnar neuropathy at the elbow. Muscle Nerve 1994; 17 (07) 785-792