title: Cubital tunnel syndrome associated with medial elbow Ganglia and osteoarthritis of the elbow.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan. hirokato@med.hokudai.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kato
authors.forename: Takuya
authors.initials: T
authors.lastname: Hirayama
authors.forename: Akio
authors.initials: A
authors.lastname: Minami
authors.forename: Norimasa
authors.initials: N
authors.lastname: Iwasaki
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Hirachi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020430:Cubital Tunnel Syndrome / Q000150:complications* / Q000601:surgery; D004551:Elbow Joint / Q000503:physiopathology; D005260:Female; D005724:Ganglia / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications*; D016059:Range of Motion, Articular; D012189:Retrospective Studies