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• W4243495661 abstract "To the Editor: We appreciate the helpful comments.1 In our study, we report surgical treatment of 9 cases of ulnar nerve intraneural ganglion (IG) cyst at the elbow.2 Cystic articular branch (CAB) between the IG cyst of ulnar nerve and the adjacent elbow joint is found in each patient intraoperatively, which supports the unifying articular theory proposed by Dr Spinner.3 At last, 7 patients out of 9 (77%) have a good motor recovery outcome, and no symptomatic recurrence of IG cysts is seen after disconnection of the CAB. We conclude that surgical treatment of IG of ulnar nerve at the elbow is good, and CAB neurectomy is important and necessary.2 Ulnar nerve entrapment at the elbow, or cubital tunnel syndrome (CUTS), is the second most common compressive neuropathy of the upper extremity after carpal tunnel syndrome. Ulnar nerve entrapment could be caused by the arcade of struthers, the medial intermuscular septum, the medial epicondyle, the cubital tunnel, and the deep flexor pronator aponeurosis. It could also be caused by occupying masses along the course of ulnar nerve at the elbow such as intraneural or extraneural ganglion cysts.4,5 CUTS and IG cysts of the ulnar nerve at the elbow have very similar symptoms and electromyogram (EMG) testing results, so it is very difficult to distinguish them by clinical symptoms and EMG. CUTS patients have hypoesthesias in the area innervated by ulnar nerve and related muscle atrophy. Except above similar symptoms of CUTS, IG has additional local elbow pain and touchable masses in the elbow. B ultrasound and magnetic resonance imaging are helpful to distinguish CUTS and IG, just as shown in our study.2 Osei et al6 used a very large database to investigate the incidence of CUTS in United States. They found an incidence of about 30 persons per 100 000 per year, and a surgical treatment rate of about 41.3%. Debate on how to choose conservative or surgical treatment for CUTS and IG patients still have no consensus so far. Clinical symptom and EMG largely contribute to the therapy decision. We suggest conservative treatment for mild to moderate CUTS and surgery for severe CUTS. Conservative treatment with elbow splinting may be considered in the early stages of CUTS (mild to moderate). When conservative treatment fails, clinical symptom persists or advances, such as motor weakness or muscle atrophy, surgical treatment should be suggested.7 In primary CUTS, open or endoscopically assisted in Situ decompression is currently suggested, while anterior transposition of the ulnar nerve is recommended for revision. While for IG, we suggest surgical decompression as soon as possible after diagnosis, including decompression and anterior subcutaneous transposition of the ulnar nerve, evacuation of the cyst contents, and CAB neurectomy. Just as shown in our study, delayed surgery could result in poor outcomes.2 Disclosures The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article." @default.
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• W4243495661 date "2019-11-01" @default.
• W4243495661 modified "2023-10-13" @default.
• W4243495661 title "In Reply: Surgical Treatment of Intraneural Ganglion Cysts of the Ulnar Nerve at the Elbow: Long-Term Follow-up of 9 Cases" @default.
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• W4243495661 doi "https://doi.org/10.1093/neuros/nyz476" @default.
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