Complete Removal Of The Epitrochleoanconeus Muscles In Patients With Cubital Tunnel Syndrome: Results From A Small Prospective Case Series
Godard C.W. de Ruiter, MD, PhD1; Sjoerd G van Duinen, MD, PhD2
1Haaglanden Medisch Centrum, The Hague, Netherlands; 2Leiden University Medical Center, Leiden, Netherlands
Background
Sometimes during surgery for cubital syndrome an anomalous muscle called the anconeus epitrochlearis or epitrochleoanconeus is encountered. Different surgical strategies how to decompress the ulnar nerve in the presence of this muscle have been proposed, including transection of the muscle (myotomy), resection (myectomy), or subcutaneous transposition of the ulnar nerve. Because of the low incidence, there is no consensus on what type of surgical treatment can best be performed. In this study, we prospectively followed a small series of patients, in which the muscle was resected.
Material and methods
Five patients who presented to our clinic with cubital tunnel syndrome in the presence of an epitrochleoanconeus muscle were followed prospectively. Two patients had bilateral epitrochleoanconeus muscles, one patient had recurrent symptoms after previous myotomy. Clinical outcome after resection of the muscle was graded using the Likert scale. In addition, histopathologic analysis was performed on the resected muscles, including ATPase histochemistry.
Results
Six out of seven cases had complete relief of symptoms (Likert 1) 6 weeks after excision of the epitrochleoanconeus muscle, including the case with recurrent symptoms after previous myotomy. Histopathologic analysis of the muscles showed grouped muscle fiber atrophy and type grouping in all cases, both signs of denervation that confirm the compressive pathophysiology of cubital tunnel syndrome in these patients.
Discussion
The results of this small prospective case series show that excision of the epitrochleoanconeus muscle in patients with cubital tunnel syndrome frequently leads to complete recovery. Further support for this surgical strategy was found from histopathologic analysis of the resected muscles and the complete recovery in the case that previously underwent a myotomy procedure.
The consequence of applying the surgical strategy of complete resection of the epitrochleoanconeus muscle is that the procedure becomes more complex than in case of simple transection requiring careful preoperative work-up (with ultrasound and/or MRI) and performance of the surgery under general anesthesia.
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