Background:
Medial elbow ganglia have been reported in association with cubital
tunnel syndrome. This lesion is thought to occur rarely and has
not been emphasized in the literature. The purposes of the present
study are to report our experience with this lesion in order to
elucidate its prevalence as well as its clinical and radiographic
features, to describe our operative findings, and to present the
results of surgical treatment.
Methods:
Four hundred and eighty-seven elbows in 472 patients were treated
for cubital tunnel syndrome between 1980 and 1999. We performed
a retrospective study of the thirty-eight patients who had a medial
ganglion. All of the ganglia were excised, and the ulnar nerve was
translocated subcutaneously. Thirty-two patients were followed for
a mean of thirty-seven months.
Results:
Medial elbow ganglion was the third most common causative factor
associated with cubital tunnel syndrome, with an overall prevalence
of 8%. Resting pain in the medial aspect of the elbow was reported
by twenty-five of the thirty-eight patients, and a sudden onset
of numbness in the ring and little fingers or of medial elbow pain
without prior symptoms was reported by twenty-nine patients. The
symptoms lasted two months or less in thirty-one patients. All ganglia
originated from the medial aspect of the ulnohumeral joint, and
radiographs of that joint showed degenerative changes in thirty-seven patients.
At the time of follow-up, all measurements of sensory and motor
function of the ulnar nerve had improved and no recurrence of nerve
palsy was found.
Conclusions:
Although uncommon, medial elbow ganglia have a strong association
with osteoarthritis of the elbow and can cause a relatively acute
onset of cubital tunnel syndrome. A patient with cubital tunnel
syndrome associated with elbow osteoarthritis who complains of medial
elbow pain or severe numbness within two months after the onset
of the syndrome should be strongly suspected of having a ganglion.
Most ganglia are occult, and ultrasonography and magnetic resonance imaging
can assist in the preoperative diagnosis. Careful excision of the
ganglion performed concurrently with subcutaneous anterior transposition
of the ulnar nerve can produce satisfactory results.