주관 증후군

국문 초록 (Abstract)

주관 증후군은 주관절 내상과 주위에서 척골 신경이 눌려 발생하는 압박성 신경병증(compressive neuropathy)으로 수근관 증후군(carpal tunnel syndrome) 다음으로 상지에서 흔하게 발생한다. 척골 신경의 압박으로 인하여 초기에는 제4 수지의 척측 절반과 제5 수지의 감각저하 혹은 이상감각으로 증상이 나타나지만 병이 진행될 경우 비가역적 내재근의 근력저하 및 근위축, 제4, 5 수지의 갈퀴손 변형이 나타날 수도 있다. 치료법으로는 고전적인 척골 신경 감압술과 전방 이전술이 표준적 치료이나 최근 이전술 없이 감압술만으로도 좋은 결과를 보고하기에 수술 치료의 다양한 선택이 가능하다. 이에 저자는 주관 증후군의 원인과 임상 양상, 최근 수술적 치료에 대해 기술하고자 한다.

다국어 초록 (Multilingual Abstract)

Cubital tunnel syndrome is compressive neuropathy, entrapment of the ulnar nerve around the medial epicondyle of the elbow joint, and the second most common neuropathy after carpal tunnel syndrome. Patients complain of hypoesthesia or paresthesia in the ulnar half of the ring and small fingers early in the disease. Advanced disease is complicated by irreversible muscle weakness or atrophy and claw hand deformity of the ring and small fingers. Although traditional decompression and anterior transposition of the ulnar nerve is known as standard treatment, according to recent reports only simple decompression has a good outcome. So, variety of surgical treatment options are available. In this paper, we purpose to describe the causes, clinical features and recent surgical treatments of cubital tunnel syndrome.

목차 (Table of Contents)

• 서론
• 해부학
• 원인
• 진단
• 비수술적 치료
• 수술적 치료
• 수술 후 합병증(complications)
• 결론
• REFERENCES

참고문헌 (Reference)

1 Spinner RJ, "Unrecognized dislocation of the medial portion of the triceps : another cause of failed ulnar nerve transposition" 92 : 52-57, 2000

2 Chan RC, "Ulnar neuropathy at the elbow : comparison of simple decompression and anterior transposition" 7 : 545-550, 1980

3 Osborne G, "Ulnar neuritis" 35 : 392-396, 1959

4 Huang JH, "Ulnar nerve entrapment neuropathy at the elbow : simple decompression" 55 : 1150-1153, 2004

5 Lowe JB 3rd, "The position of crossing branches of the medial antebrachial cutaneous nerve during cubital tunnel surgery in humans" 114 : 692-696, 2004

6 Rogers MR, "The failed ulnar nerve transposition. Etiology and treatment" 269 : 193-200, 1991

7 Ogata K, "The effect of surgical dissection on regional blood flow to the ulnar nerve in the cubital tunnel" 193 : 195-198, 1985

8 Broudy AS, "Technical problems with ulnar nerve transposition at the elbow : findings and results of reoperation" 3 : 85-89, 1978

9 Magee RB, "Tardy ulnar palsy" 78 : 470-474, 1949

10 Lundborg G, "Surgical treatment for ulnar nerve entrapment at the elbow" 17 : 245-247, 1992

11 Bartels RH, "Surgical management of ulnar nerve compression at the elbow : an analysis of the literature" 89 : 722-727, 1998

12 Caputo AE, "Subcutaneous anterior transposition of the ulnar nerve for failed decompression of cubital tunnel syndrome" 25 : 544-551, 2000

13 Aoki M, "Strain on the ulnar nerve at the elbow and wrist during throwing motion" 87 : 2508-2514, 2005

14 Black BT, "Stabilized subcutaneous ulnar nerve transposition with immediate range of motion. Long-term follow-up" 82 : 1544-1551, 2000

15 Gervasio O, "Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome : a prospective randomized study" 56 : 108-117, 2005

16 Nabhan A, "Simple decompression or subcutaneous anterior transposition of the ulnar nerve for cubital tunnel syndrome" 30 : 521-524, 2005

17 Cheng CJ, "Scratch collapse test for evaluation of carpal and cubital tunnel syndrome" 33 : 1518-1524, 2008

18 Vogel RB, "Revision anterior submuscular transposition of the ulnar nerve for failed subcutaneous transposition" 57 : 311-316, 2004

19 Gabel GT, "Reoperation for failed decompression of the ulnar nerve in the region of the elbow" 72 : 213-219, 1990

20 Biggs M, "Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition" 58 : 296-304, 2006

21 Novak CB, "Provocative testing for cubital tunnel syndrome" 19 : 817-820, 1994

22 Bartels RH, "Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow : part 1" 56 : 522-530, 2005

23 Vanderpool DW, "Peripheral compression lesions of the ulnar nerve" 50 : 792-803, 1968

24 Watts AC, "Patient-rated outcome of ulnar nerve decompression : a comparison of endoscopic and open in situ decompression" 34 : 1492-1498, 2009

25 Efstathopoulos DG, "Outcome of partial medial epicondylectomy for cubital tunnel syndrome" 444 : 134-139, 2006

26 Charness M, "Occupational disorders of the upper extremity" Churchill Livingstone 227-252, 1992

27 Szabo RM, "Natural history and conservative management of cubital tunnel syndrome" 23 : 311-318, 2007

28 Mallette P, "Muscle atrophy at diagnosis of carpal and cubital tunnel syndrome" 32 : 855-858, 2007

29 Sarris I, "Medial brachial and antebrachial cutaneous nerve injuries : effect on outcome in revision cubital tunnel surgery" 18 : 665-670, 2002

30 King T, "Late results of removing the medial humeral epicondyle for traumatic ulnar neuritis" 41 : 51-55, 1959

31 Iba K, "Intraoperative measurement of pressure adjacent to the ulnar nerve in patients with cubital tunnel syndrome" 31 : 553-558, 2006

32 Mackinnon S, "Green’s operative hand surgery" Elsevier 1023-1029, 2005

33 Fitzgerald BT, "Functional outcomes in young, active duty, military personnel after submuscular ulnar nerve transposition" 29 : 619-624, 2004

34 Ochiai N, "Electrodiagnosis in entrapment neuropathy by the arcade of Struthers" 378 : 129-135, 2000

35 Apfelberg DB, "Dynamic anatomy of the ulnar nerve at the elbow" 51 : 79-81, 1973

36 Spinner RJ, "Cubitus varus associated with dislocation of both the medial portion of the triceps and the ulnar nerve" 24 : 718-726, 1999

37 Heithoff SJ, "Cubital tunnel syndrome does not require transposition of the ulnar nerve" 24 : 898-905, 1999

38 Kato H, "Cubital tunnel syndrome associated with medial elbow Ganglia and osteoarthritis of the elbow" 84 : 1413-1419, 2002

39 Kleinman WB, "Cubital tunnel syndrome : anterior transposition as a logical approach to complete nerve decompression" 24 : 886-897, 1999

40 Palmer BA, "Cubital tunnel syndrome" 35 : 153-163, 2010

41 Svernlöv B, "Conservative treatment of the cubital tunnel syndrome" 34 : 201-207, 2009

42 Posner MA, "Compressive ulnar neuropathies at the elbow: ii. treatment" 6 : 289-297, 1998

43 Gellman H, "Compression of the ulnar nerve at the elbow : cubital tunnel syndrome" 57 : 187-197, 2008

44 Gelberman RH, "Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow. An experimental study in human cadavera" 80 : 492-501, 1998

45 Lim BH, "Cadaveric study on the vascular anatomy of the ulnar nerve at the elbow--a basis for anterior transposition?" 21 : 689-693, 1992

46 Leffert RD, "Anterior submuscular transposition of the ulnar nerves by the Learmonth technique" 7 : 147-155, 1982

47 Kleinman WB, "Anterior intramuscular transposition of the ulnar nerve" 14 : 972-979, 1989

48 Learmonth JR, "A technique for transplanting the ulnar nerve" 75 : 792-793, 1942

49 Tsai TM, "A new operative technique : cubital tunnel decompression with endoscopic assistance" 11 : 71-80, 1995