Difficulties in diagnosing cubital tunnel syndrome. Case report

The diagnosis of cubital tunnel syndrome (CTS) is based on clinical presentation, electroneuromyography, and ultrasound examination. The restoration of lost hand functions due to CTS directly depends on timely surgical treatment performed at the earliest stages, before the development of severe motor, sensory, and trophic disorders in the hand. However, CTS is often undiagnosed for a long time. A case is presented of effective surgical treatment of a 63-year-old patient engaged in heavy physical labor, who developed compressive-ischemic ulnar neuropathy (CTS) against the background of an old elbow joint injury. For a long period, the patient was followed with a misdiagnosis of cervical radiculopathy associated with osteochondrosis, which led to progressive motor and sensory disorders with impaired hand function. After surgical treatment (microsurgical decompression of the left ulnar nerve at the level of the cubital tunnel, and neurotization of the motor branch of the left ulnar nerve with the anterior interosseous nerve at the level of the distal third of the forearm) and a course of postoperative rehabilitation, the CTS symptoms completely regressed and hand function was restored. One-year follow-up demonstrated a stable positive effect. Issues of delayed diagnosis, conservative, and surgical treatment of CTS are discussed.