Sindrom kubitalnog kanala

Igor Knežević, Katarina Barbarić Starčević, Damir Starčević, Ivan Bojanić

Sindrom kubitalnog kanala susrećemo relativno često te on predstavlja značajan javnozdravstveni problem. Specifičnost tijeka ulnarnog živca niz ruku, a napose anatomski međuodnosi s koštanim i mekotkivnim strukturama u području lakta čine ga vrlo podložnim vanjskim utjecajima, ponajviše silama kompresije. Progresija parestezija na ulnarnoj strani četvrtog prsta i na čitavom petom prstu zahvaćene šake uz pojavu motoričke slabosti i atrofije mišića šake uvelike ograničava bolesnike, najčešće one koji se bave aktivnostima koje zahtijevaju da im je lakat duže vremena u fleksiji, da neometano obavljaju svakodnevne aktivnosti. Stoga je iznimno važno pravovremeno dijagnosticiranje sindroma koje se zasniva na iscrpnoj anamnezi i detaljnom kliničkom pregledu uz pomoć niza specifičnih testova koji su detaljno opisani u radu. Elektromioneurografijom možemo utvrditi stupanj kompresije ulnarnog živca te pratiti uspješnost daljnjeg liječenja. Blaži oblici sindroma kubitalnog kanala uspješno se liječe konzervativnim načinom, dok teže oblike sindroma te one koji su neosjetljivi na provedeno konzervativno liječenje treba liječiti kirurški. Metode kirurškog liječenja sindroma možemo podijeliti na one koje ostavljaju živac u ležištu u kubitalnom kanalu poput in situ dekompresije i medijalne epikondilektomije te na one tijekom kojih se živac premješta u novo ležište ispred i iznad medijalnog epikondila, što nazivamo antepozicijom ulnarnog živca. Sve opisane metode pokazale su se gotovo jednako uspješnima, no usprkos tomu istraživanja pokazuju da se u današnje vrijeme kao metoda izbora kirurškog liječenja sindroma kubitalnog kanala najčešće koristi in situ dekompresija.

Cubital tunnel syndrome is relatively common; therefore, it represents a significant public health problem. Unique course of the ulnar nerve along the arm, in respect to bone and soft tissue structures of the elbow, is what makes it very susceptible to external forces, especially compression. Worsening paraesthesia on the ulnar side of the fourth finger and the whole fifth finger including muscle weakness and muscle atrophy is causing disability, particularly in patients spending longperiods with a flexed elbow, limiting them in continuing their everyday activities. Therefore, early diagnosis, based on comprehensive anamnesis and detailed physical examination
in addition to the use of specific tests elaborated in this article, is crucial. Electromyoneurography helps grade the level of ulnar nerve compression and monitor the treatment progress. Mild grade cubital tunnel syndrome has been successfully treated non-operatively. However, moderate and severe cases, as well as those cases which did not respond with improvement to non-operative treatment, should be treated surgically. Surgical techniques available for treating cubital tunnel syndrome are divided into ones that leave the ulnar nerve at its original site, like in situ decompression or medial epicondylectomy, and those who displace the ulnar nerve in front of the medial epicondyle, as during nerve transposition. This article depicts the critical stages of every technique, including comparing their advantages and disadvantages. Even though they all proved to be safe and effective, research has shown that in situ decompression is most widely and commonly used surgical technique for treating cubital tunnel syndrome.