cubital tunnel syndrome

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CUBITAL TUNNEL SYNDROME GERALD J. E TURU’PADANG C 111 11 324

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Page 1: Cubital Tunnel Syndrome

CUBITAL TUNNEL SYNDROMEGERALD J. E TURU’PADANG

C 111 11 324

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Sejarah

• Feindel dan Stratford pertama kali menggunakan terowongan kubiti istilah pada tahun 1958. Mereka menekankan bahwa saraf ulnaris dikompresi pada siku karena kekhasan anatomi ke wilayah itu.

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Apa itu Cubital Tunnel Syndrome?

1. Cubital Tunnel Syndrome• Atau disebut juga dengan Jepitan saraf ulnaris pada

bagian Siku. Cubital tunnel syndrome adalah kondisi yang menyebabkan saraf ulnaris yang berada di siku terjepit.

Nervus ulnaris masuk ke dalam kompartemen ekstensor dari lengan atau melalui septum intermuskularis ulnaris pada insersi muskulus deltoideus. Selanjutnya saraf ini berada di belakang epikondilus medialis humerus dan mencapai kompartemen fleksor pada lengan bawah dan berjalan di antara olekranon dan kaput epikondilus dari fleksor karpi ulnaris.

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ELBOW ANATOMY

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Patofisiologi Sebagai siku bergerak dari ekstensi untuk fleksi, jarak antara epikondilus medial dan olecranon meningkatkan 5 mm untuk setiap 45 ° fleksi siku. Fleksi siku mengakibatkan tekanan pada ligamen kolateral medial (MCL) dan retinakulum diatasnya. Perubahan bentuk terowongan kubiti dari putaran ke sebuah terowongan oval, dengan penurunan tinggi 2,5-mm, alur siku retrocondylar pada aspek inferior epikondilus medialis tidak sedalam alur pada posterior. Terowongan kubiti yang kehilangan tinggi akibat fleksi mengakibatkan penurunan volume kurang lebih 55% pada kanal, sehingga tekanan intraneural ulnaris meningkat dari 7 mm Hg sampai 14 mm Hg. Kombinasi abduksi bahu, Hasil ekstensi siku, fleksi pergelangan tangan dan peningkatan tekanan yang besar dalam terowongan kubiti, mengakibatkan tekanan intraneural ulnaris meningkat menjadi sekitar 6 kali normal.

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CUBITAL TUNNEL SYNDROME

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CauseIt is not known exactly what causes compression of the ulnar nerve at the elbow. Some factors can make it more likely that the nerve will be compressed. These include:

Prior fractures of the elbow

Bone spurs

Swelling of the elbow joint

Cubital tunnel syndrome may be a result of direct or indirect trauma and is vulnerable to traction, friction, and compression. Traction injuries may be the result of longstanding valgus deformity and flexion contractures, but are most common in throwers due to extreme valgus stress placed on the arm. [2] Compression of the nerve at the cubital tunnel may occur due to reactive changes at the MCL, adhesions within the tunnel, hypertrophy of the surrounding musculature, or joint changes.[3]

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OSBORNE’S LIGAMENT

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CLINICAL SIGN

• Sensory changes in ulnar nerve distribution (little + ½ ring finger)

• Intrinsic weakness (not always!)• Tinel’s sign at medial elbow• Elbow flexion test (3 min @ 120°

flexion reproduces symptoms)

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TREATMENT

Nonsteroidal-Anti-Inflammatory MedicationAnti-inflammatory medicine such as ibuprofen or Motrin may help reduce swelling around the nerve and alleviate pain. Steroid (cortisone) injections around the ulnar nerve are not generally used because there is a risk of damage to the nerve.

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SUBMUSCULAR / INTRAMUSCULAR TRANSPOSITION

TECHNIQUE

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REFERENSI• Michael Zlowodzki MD, University of Minnesota,Department of Orthopaedic Surgery:

CUBITAL TUNNEL SYNDROME : Diagnosis and Management .

• American Society for Surgey of Hand. 2006. Cubital Tunnel Syndrome. http://www.assh.org/AM/Template.cfm?Section=Hand_Conditions&Template=/CustomSource/HandMap.cfm. Accesed on 28th May, 2008.

• American Academic of Orthopaedic Surgeons (AAOS) . 2000. Ulnar Nerve Entrapment. http://www.hss.edu/index.htm. Accesed 0n 28th May 2008.

• Michael Bermant, MD. 1996-2008. Cubital Tunnel Syndrome . http://www.plasticsurgery4u.com/index.html. Accesed on 28th May, 2008.

• http://www.handsurgeonlondon.co.uk/conditions/cubital-tunnel-syndrome.aspx

• Author: James R Verheyden, MD; Pemimpin Redaksi: Harris Gellman, MD, http://emedicine.medscape.com/article/1231663-overview

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