gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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The key clinical symptoms that differentiates cervical radiculopathy from cubital tunnel syndrome

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  • presenting/speaker Takashi Ogawa - Hamamatsu University School of Medicine, Hamamatsu, Japan
  • Takao Omura - Hamamatsu University School of Medicine, Hamamatsu, Japan
  • Tomohiko Hasegawa - Hamamatsu University School of Medicine, Hamamatsu, Japan
  • Yukihiro Matsuyama - Hamamatsu University School of Medicine, Hamamatsu, Japan

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-528

doi: 10.3205/19ifssh0793, urn:nbn:de:0183-19ifssh07932

Published: February 6, 2020

© 2020 Ogawa et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

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Objectives/Interrogation: Ulnar nerve is supplied by fibers originating from C8, T1 roots and it is sometimes difficult to differentiate cubital tunnel syndrome (CuTS) from C8 radiculopathy. The purpose of this study was to retrospectively review cases of C8 radiculopathy that were referred to our hospital that were diagnosed as CuTS at the previous hospital.

Methods: 238 cases who were referred to our department suspected for CuTS were included in this study. All the patients were examined for their neurological symptoms and underwent electrophysiological study. Among the patients with normal conduction velocity (NCV), 22 cases were diagnosed as C8 radiculopathy by MRI.

We investigated the clinical symptoms of elbow and cervical spine, radiographic findings, distribution of the paralyzed muscles and the electrophysiological testing results.

Results and Conclusions: The numbness at the ulnar half of the ring and little finger was observed in 18 cases (88%), and in 14 cases (64%) the area of numbness was observed in the forearm, extending proximally to the wrist crease.

Positive Tinel's like sign was observed in 5cases (23%) and positive Froment sign also in 5 cases (23%). However, spurling or Jackson sign of the cervical spine was positive in only 1 case (5%). In radiographic evaluation, 8 cases had osteoarthritis of the elbow (36%), 13 cases had spondylosis change of the cervical spine (59%) and only 1 case had C7/Th1 intervertebral foramen disorder (5%). On manual muscle testing, 17 cases had paralysis of the first dorsal interosseous muscles (IOD (1)) or the abductor digiti minimi muscle of little finger (ADQ) (77%), but a part of these muscles innervated by the ulnar nerve, some cases had paralysis of the extensor digitorum or the abductor pollicis brevis muscle. In all cases, conduction velocity of the ulnar nerve was normal, but the amplitude was decreased to 80% in comparison with the healthy side. After the diagnosis of C8 radiculopathy, 3 cases (14%) received surgical treatment and the rest were treated conservatively.

The most common difference between a typical CuTS and C8 radiculopathy was sensory disturbance extending to the ulnar side of forearm. Also, paralysis was present in the muscles innervated by the radius and the median nerve, so a detailed evaluation of the muscle strength is required. The electrophysiological testing shows normal conduction velocity of the ulnar nerve but reduced amplitude in C8 radiculopathy.