Morphological Changes of Medial Epicondyle-Olecranon Ligament and Ulnar Nerve in the Cubital Tunnel Syndrome: An Ultrasonic Study

Objective Few studies have performed detailed ultrasound measurements of medial epicondyle-olecranon (MEO) ligament that cause the entrapment of ulnar nerve. This study aims to comprehensively evaluate dynamic ultrasonographic characteristics of MEO ligament and ulnar nerve for clinical diagnosis and accurate treatment of cubital tunnel syndrome (CuTS). Methods Thirty CuTS patients (CuTS group) and sixteen healthy volunteers (control group) who underwent ultrasound scanning from October 2016 to October 2020 were retrospectively collected, with 30 elbows in each group. Primary outcomes were thickness at six points, length and width of MEO ligament. Secondary outcomes were thickness of ulnar nerve under MEO ligament at seven parts and the cross-sectional area (CSA) of ulnar nerve at proximal end of MEO ligament (P-0 mm). The thickness of MEO ligament and ulnar nerve in different points of each group was compared by one-way ANOVA analysis with Bonferroni post hoc test, other outcomes were compared between two elbow positions or two groups using independent-samples t test. Results Thickness of MEO ligament in CuTS group at epicondyle end, midpoint in transverse view, olecranon end, proximal end, midpoint in axial view, and distal end was 0.67 +/- 0.31, 0.37 +/- 0.18, 0.89 +/- 0.35, 0.39 +/- 0.21, 0.51 +/- 0.38, 0.36 +/- 0.25 at elbow extension, 0.68 +/- 0.34, 0.38 +/- 0.27, 0.77 +/- 0.39, 0.32 +/- 0.20, 0.48 +/- 0.22, 0.32 +/- 0.12 (mm) at elbow flexion, respectively. Compared with control group, they were significantly thickened except for proximal end at elbow flexion. MEO ligament thickness at epicondyle end and olecranon end was significantly larger than midpoint in two groups. No significant difference was found in length and width of MEO ligament among different comparisons. Ulnar nerve thickness at 5 mm proximal to MEO ligament (P-5 mm, 3.25 +/- 0.66 mm) was significantly increased than midpoint of MEO ligament (Mid), distal end of MEO ligament (D-0 mm), 5 mm (D-5 mm), 10 mm (D-10 mm) distal to MEO ligament at extension in CuTS group. Compared with control group, ulnar nerve thickness at P-5 mm in CuTS group was significantly increased at extension position, at D-5 mm and D-10 mm was significantly decreased at flexion position. CSA of ulnar nerve at extension position (14.44 +/- 4.65 mm(2)) was significantly larger than flexion position (11.83 +/- 3.66 mm(2)) in CuTS group, and CuTS group was significantly larger than control group at two positions. Conclusions MEO ligament in CuTS patients was thickened, which compressed ulnar nerve and caused its proximal end swelling. Ultrasonic image of MEO ligament thickness was a significant indicator for CuTS and can guide surgeons in selecting the appropriate treatment.