Morphology of the Cubital Tunnel: An Anatomical and Biomechanical Study With Implications for Treatment of Ulnar Nerve Compression

Purpose The purpose of this study is to provide a thorough understanding of the anatomy of the cubital tunnel and to outline specific anatomical parameters of the cubital tunnel retinaculum (CuTR) that might aid in the management of ulnar nerve problems. The hypotheses of this study are (1) that the nerve elongates with elbow flexion and (2) that the cross-sectional area of the cubital tunnel is inversely proportional to the degree of elbow flexion. Methods Eleven fresh-frozen cadaver arms were dissected at the medial elbow. The CuTR was identified, and its thickness was measured. After excising the CuTR, we measured the elongation of the anterior and posterior aspects of the ulnar nerve, as well as the length of the CuTR origin/insertion, at increasing intervals of elbow flexion (15 degrees, 30 degrees, 45 degrees, 90 degrees, 120 degrees, and 135 degrees). Using 3-dimensional digitization technology, the surface of the cubital tunnel was recorded at 4 positions of elbow flexion (15 degrees, 45 degrees, 90 degrees, and 135 degrees) and analyzed to define the tunnel geometry. Results The CuTR origin-to-insertion length and the ulnar nerve length both increased significantly with increasing flexion angle. Both lengths at 90 degrees, 120 degrees, and 135 degrees of elbow flexion were greater than at 15 degrees or 30 degrees. The cubital tunnel area was significantly less at 135 degrees compared to either 45 degrees or 90 degrees of flexion. There was a linear relationship between the cubital tunnel area of the different arms with the corresponding nerve cross-sectional area when measured at the level of the epicondyle and when the arm was at 90 degrees of elbow flexion. Conclusions The CuTR begins to stretch at 60 degrees of flexion and continues to stretch with increasing flexion. Similarly, the ulnar nerve is more taut in flexion. The area within the cubital tunnel decreases beyond 90 degrees of elbow flexion. Clinical relevance Understanding the dynamic anatomical relationships of the cubital tunnel might help in the safe treatment of cubital tunnel syndrome when using minimally invasive techniques and instrumentation. (J Hand Surg 2011;36A:1988-1995. Copyright (C) 2011 by the American Society for Surgery of the Hand. All rights reserved.)