This study reviews 38 patients who had a medial elbow ganglion noted at the time of a cubital tunnel decompression. These patients were identified out of 487 cubital tunnel decompressions performed between 1980 and 1999 for a prevalence of 8%. 32 patients were followed for a mean of 37 months. The mean age of the 30 patients was 60 years (range, 38-82 years). 95% of these patients were manual laborers. 66% of these patients complained of resting pain on the medial aspect of the elbow. 76% reported a sudden numbness in the ring small finger or medial elbow pain without any prior symptoms. All patients with medial ganglia had radiographic osteoarthritis, where as 64% of the entire group of 487 elbows had osteoarthritis. Range of motion was markedly restricted with a mean extension of 17 degrees and a mean flexion of 122 degrees. Only 5 patients were suspected preoperatively of having ganglia. All patients underwent anterior subcutaneous transposition of the ulnar nerve. Two patients were noted to have recurrent ganglions at 2 and 58 months post-operatively. Most patients significantly improved and there were no major complications.
This study from Japan appeared to have an older patient population with an average age of 60 years and a higher overall prevalence of osteoarthritis. Despite only 5 of the 38 patients preoperatively suspected of having medial joint ganglion, most patients presented with similar symptoms of intolerable medial elbow pain and a sudden onset of elbow pain or numbness in the ring and small finger. The authors suggest that in patients with a history of manual labor, osteoarthritis and an acute symptom onset, the physician should suspect possibly joint ganglia and ultrasound or MRI may be used to confirm the diagnosis. The authors also caution that in-situ decompression may not allow for the identification of ganglia since the cubital tunnel is not thoroughly evaluated during this procedure. Excellent results were obtained with anterior transposition of the ulnar nerve and ganglion excision.
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