open access

Vol 81, No 1 (2022)
Original article
Submitted: 2020-08-27
Accepted: 2020-11-01
Published online: 2020-12-30
Get Citation

The ulnar nerve in the cubital tunnel: a foetal study

D. N. Bailey1, S. Ishwarkumar2, B. Z. De Gama1, P. Pillay1
·
Pubmed: 33438188
·
Folia Morphol 2022;81(1):31-36.
Affiliations
  1. Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
  2. Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Johannesburg, Doornfontein Campus, South Africa

open access

Vol 81, No 1 (2022)
ORIGINAL ARTICLES
Submitted: 2020-08-27
Accepted: 2020-11-01
Published online: 2020-12-30

Abstract

Background: The ulnar nerve (UN), a terminal branch of the medial cord of the brachial plexus, is located posteromedial to brachial artery coursing along medially in the arm from the anterior to the posterior compartment through the arcade of Struthers. It passes posterior to medial epicondyle of humerus and enters the cubital tunnel. Then, it exits through the distal part of the cubital fossa to enter the medial side of the forearm between the two heads of the flexor carpi ulnaris muscle underneath Osborne’s ligament to enter the anterior compartment of the forearm. Entrapment of the UN at the cubital tunnel results in a pain and a tingling sensation on the medial side of the forearm and fourth and fifth digits.
Materials and methods: This foetal study documented the course of the UN within the cubital tunnel and its anatomical relations utilising bilateral microscopic dissection of 25 foetuses (gestational age: 19–36 weeks).
Results: The UN followed the standard anatomical course in 96% (48/50) of the specimens, however it was found to lie deep to the muscles of the cubital tunnel in 6% (3/50). The radial artery joined the UN distal to the cubital tunnel in 8% (4/50), while the superior ulnar collateral artery was posteriorly related to the UN in 32% (16/50) of specimens. The Osborne’s ligament (crossed between the two heads of the flexor carpi ulnaris muscle, posterior to the medial epicondyle of the humerus) was present in all specimens 100% (50/50). It had a mean length of 6.32 ± 0.97 mm and 6.30 ± 1.10 mm on the left and right sides, respectively. The current study observed that the flexor pronator aponeurosis was present in 2% (1/50) of specimens.
Conclusions: Knowledge of the normal and variable anatomical course of the UN in the cubital tunnel in this study may assist in the diagnosis and treatment of compressive neuropathy of the UN in the cubital tunnel.

Abstract

Background: The ulnar nerve (UN), a terminal branch of the medial cord of the brachial plexus, is located posteromedial to brachial artery coursing along medially in the arm from the anterior to the posterior compartment through the arcade of Struthers. It passes posterior to medial epicondyle of humerus and enters the cubital tunnel. Then, it exits through the distal part of the cubital fossa to enter the medial side of the forearm between the two heads of the flexor carpi ulnaris muscle underneath Osborne’s ligament to enter the anterior compartment of the forearm. Entrapment of the UN at the cubital tunnel results in a pain and a tingling sensation on the medial side of the forearm and fourth and fifth digits.
Materials and methods: This foetal study documented the course of the UN within the cubital tunnel and its anatomical relations utilising bilateral microscopic dissection of 25 foetuses (gestational age: 19–36 weeks).
Results: The UN followed the standard anatomical course in 96% (48/50) of the specimens, however it was found to lie deep to the muscles of the cubital tunnel in 6% (3/50). The radial artery joined the UN distal to the cubital tunnel in 8% (4/50), while the superior ulnar collateral artery was posteriorly related to the UN in 32% (16/50) of specimens. The Osborne’s ligament (crossed between the two heads of the flexor carpi ulnaris muscle, posterior to the medial epicondyle of the humerus) was present in all specimens 100% (50/50). It had a mean length of 6.32 ± 0.97 mm and 6.30 ± 1.10 mm on the left and right sides, respectively. The current study observed that the flexor pronator aponeurosis was present in 2% (1/50) of specimens.
Conclusions: Knowledge of the normal and variable anatomical course of the UN in the cubital tunnel in this study may assist in the diagnosis and treatment of compressive neuropathy of the UN in the cubital tunnel.

Get Citation

Keywords

ulnar nerve, cubital fossa, foetal study and anatomical course

About this article
Title

The ulnar nerve in the cubital tunnel: a foetal study

Journal

Folia Morphologica

Issue

Vol 81, No 1 (2022)

Article type

Original article

Pages

31-36

Published online

2020-12-30

Page views

6306

Article views/downloads

1366

DOI

10.5603/FM.a2020.0150

Pubmed

33438188

Bibliographic record

Folia Morphol 2022;81(1):31-36.

Keywords

ulnar nerve
cubital fossa
foetal study and anatomical course

Authors

D. N. Bailey
S. Ishwarkumar
B. Z. De Gama
P. Pillay

References (23)
  1. Amadio P, Beckenbaugh R. Entrapment of the ulnar nerve by the deep flexorpronator aponeurosis. J Hand Surg. 1986; 11(1): 83–87.
  2. Assmus H, Antoniadis G, Bischoff C. Carpal and cubital tunnel and other, rarer nerve compression syndromes. Dtsch Arztebl Int. 2015; 112(1-2): 14–25; quiz 26.
  3. Bartels RH, Grotenhuis JA, Kauer JMG. The arcade of Struthers: an anatomical study. Acta Neurochir (Wien). 2003; 145(4): 295–300; discussion 300.
  4. Becker R, Manna B. Anatomy, upper limb, elbow, nerves, ulnar. StatPearls Publishing, Treasure Island (FL) 2018.
  5. Caetano EB, Sabongi Neto JJ, Vieira LA, et al. The arcade of Struthers: an anatomical study and clinical implications. Rev Bras Ortop. 2017; 52(3): 331–336.
  6. Cutts S. Cubital tunnel syndrome. Postgrad Med J. 2007; 83(975): 28–31.
  7. Degeorges R, Masquelet AC. The cubital tunnel: anatomical study of its distal part. Surg Radiol Anat. 2002; 24(3-4): 169–176.
  8. Depukat P, Mizia E, Zwinczewska H, et al. Topography of ulnar nerve and its variations with special respect to carpal region. Folia Med Cracov. 2014; 54(4): 45–58.
  9. Gonzalez MH, Lotfi P, Bendre A, et al. The ulnar nerve at the elbow and its local branching: an anatomic study. J Hand Surg Br. 2001; 26(2): 142–144.
  10. Granger A, Sardi JP, Iwanaga J, et al. Osborne's ligament: a review of its history, anatomy, and surgical importance. Cureus. 2017; 9(3): e1080.
  11. Green JR, Rayan GM. The cubital tunnel: anatomic, histologic, and biomechanical study. J Shoulder Elbow Surg. 1999; 8(5): 466–470.
  12. Heithoff SJ. Cubital tunnel syndrome: ulnar nerve subluxation. J Hand Surg Am. 2010; 35(9): 1556; author reply 1556–7.
  13. Inserra S, Spinner M. An anatomic factor significant in transposition of the ulnar nerve. J Hand Surg. 1986; 11(1): 80–82.
  14. Joshi SD, Joshi SS. Study of cubital tunnel. J Anat Soc India. 2002; 51(2): 173–175.
  15. Macchi V, Tiengo C, Porzionato A, et al. The cubital tunnel: a radiologic and histotopographic study. J Anat. 2014; 225(2): 262–269.
  16. Mizia E, Zarzecki MP, Pekala JR, et al. An anatomical investigation of rare upper limb neuropathies due to the Struthers' ligament or arcade: a meta-analysis. Folia Morphol. 2021; 80(2): 255–266.
  17. Moore KL. Clinically Oriented Anatomy 6th Ed. Lippincott, Williams and Wilkins, Baltimore, MD 2010: 770.
  18. Moore KL, Dalley AF, Agur AMR. Clinically orientated anatomy. Lippincott, Williams and Wilkins 2014: 514–516.
  19. Sawardeker P, Kindt KE, Baratz NE. Nerve Compression: Ulnar Nerve of the Elbow. 2015.
  20. Siemionow M, Agaoglu G, Hoffmann R. Anatomic characteristics of a fascia and its bands overlying the ulnar nerve in the proximal forearm: a cadaver study. J Hand Surg Eur Vol. 2007; 32(3): 302–307.
  21. Standring S. Gray's Anatomy E-Book: The Anatomical Basis of Clinical Practice. Elsevier Health Sciences 2015.
  22. Xarchas KC, Psillakis I, Koukou O, et al. Ulnar nerve dislocation at the elbow: review of the literature and report of three cases. Open Orthop J. 2007; 1: 1–3.
  23. Yamada K, Nagaoka M, Nagao S, et al. Anatomical study of osborne ligament elongation in relation to elbow flexion. J Nihon University Med Ass. 2013; 72(3): 154–158.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.: +48 58 320 94 94, faks: +48 58 320 94 60, e-mail: viamedica@viamedica.pl