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An anatomical study of so-called fibrous bands around the ulnar nerve distal to the cubital tunnel

  • Original Article - Peripheral Nerves
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Abstract

Background

Fibrous bands (FB) are structures that cross the ulnar nerve (UN), distal to the cubital tunnel (CT). In surgical decompression of the UN in the elbow region, by endoscopy, these FB significantly impact UN visibility. The aim of the current study was to characterize the anatomical characteristics of these FB distal to the CT.

Methodology

Eighteen formalinized upper limbs were dissected, nine right and nine left, within the Department of Anatomy of the Federal University of the State of Rio de Janeiro (UNIRIO). The dissections were performed with micro techniques, under a magnifying glass and a microscope. Classical UN exposure was established in the elbow region.

Results

Of the 18 upper limbs studied, 50% lacked any FB. When present, both the number and location of the FB varied, as near to the cubital tunnel as 3 cm past the UN’s entrance into the tunnel, and as far away as almost 11 cm distal to it. Overall, there were no FB on either the left or right side in three cadavers (33.3%), FB on both the left and right side in three, and FB only on the left in three, meaning that FB were twice as common in left limbs (n = 6) as on the right (n = 3).

Conclusions

Our study identified FB in 50% of the dissected limbs, all within 3–11 cm of the CT, though their number and location varied. Further studies are necessary to describe FB variations associated with compressive neuropathies of the UN distal to the CT.

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Authors and Affiliations

  1. Division of Neurosurgery, School of Medicine, Gaffrée e Guinle University Hospital, Federal University of Rio de Janeiro State (UNIRIO), 775 Mariz e Barros Street, Rio de Janeiro, RJ, 20270-901, Brazil

    José Fernando Guedes-Correa & Rosana Siqueira Brown

Authors
  1. José Fernando Guedes-Correa
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  2. Rosana Siqueira Brown
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Corresponding author

Correspondence to Rosana Siqueira Brown.

Ethics declarations

Our study has been approved by the appropriate ethics committee.

Conflict of interest

The authors declare that they have no conflict of interest.

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Comments

An interesting cadaveric study confirming and elaborating on prior studies demonstrating the presence of fibrous bands extending as far distally as 11 cm in the forearm that may result in entrapment of the ulnar nerve. Such a possibility is why I always take a no. 4 Penfield dissector and pass it far both distally and proximally along the course of the ulnar nerve after exposing and decompressing it to assure myself of an adequate decompression. It will be interesting to correlate these findings with ultrasound imaging studies in patients and determine their clinical significance, perhaps with careful NCV incing studies, both in clinic and intraoperatively, that may demonstrate a drop in nerve conduction velocity and/or amplitude across these entrapped segments of ulnar nerve. At present, this is an interesting finding that warrants further investigation to determine its clinical significance and potential impact on clinical outcome.

Michel Kliot

CA, USA

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Guedes-Correa, J.F., Brown, R.S. An anatomical study of so-called fibrous bands around the ulnar nerve distal to the cubital tunnel. Acta Neurochir 160, 1591–1596 (2018). https://doi.org/10.1007/s00701-018-3562-4

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  • DOI: https://doi.org/10.1007/s00701-018-3562-4

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