• de Ruiter Godard C W GCW Department of Neurosurgery, Haags Medisch Centrum, The Hague, the Netherlands. Electronic address: g.de.ruiter@mchaaglanden.nl. and Sjoerd G van Duinen.
• Department of Neurosurgery, Haags Medisch Centrum, The Hague, the Netherlands. Electronic address: g.de.ruiter@mchaaglanden.nl.
• World Neurosurg. 2017 Aug 1; 104: 142-147.

BackgroundSometimes during surgery for cubital syndrome an anomalous muscle called the epitrochleoanconeus is encountered. Different surgical strategies on how to decompress the ulnar nerve in the presence of this muscle have been proposed, including transection of the muscle, resection, 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 the present study, we prospectively followed a small series of patients, in which the muscle was resected.MethodsFive 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, 1 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.ResultsSix of 7 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.ConclusionsThe 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.Copyright © 2017 Elsevier Inc. All rights reserved.

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