Ulnar Nerve Decompression in Cubital Tunnel Syndrome – Open In Situ Decompression Versus Endoscopic Decompression

Background: Cubital tunnel syndrome is a common compressive neuropathy of the upper extremity. The anconeus epitrochlearis muscle is an unusual but occasional contributor. We review our experience with this anomalous muscle in elbows with cubital tunnel syndrome. Methods: We retrospectively reviewed charts of 13 patients noted to have an anconeus epitrochlearis muscle associated with cubital tunnel syndrome. Results: Ten patients had unilateral ulnar neuropathy supported by nerve conduction studies. Three had bilateral cubital tunnel syndrome symptoms with 1 of those having normal nerve conduction studies for both elbows. Eight elbows were treated with myotomy of the anconeus epitrochlearis muscle and submuscular transposition of the ulnar nerve. The other 8 elbows were treated with myotomy of the anconeus epitrochlearis muscle and in situ decompression of the ulnar nerve only. All but 1 patient had either clinical resolution or improvement of symptoms at follow-up ranging from 2 weeks to 1 year after surgery. The 1 patient who had persistent symptoms had received myotomy and in situ decompression of the ulnar nerve only. Conclusions: An anomalous anconeus epitrochlearis occasionally results in compression of the ulnar nerve but is usually an incidental finding. Its contribution to compression neuropathy can be tested intraoperatively by passively ranging the elbow while observing the change in vector and tension of its muscle fibers over the ulnar nerve. Regardless of findings, we recommend myotomy of the muscle and in situ decompression of the ulnar nerve. Submuscular transposition of the ulnar nerve may be necessary if there is subluxation.

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Minimally Invasive Ulnar Nerve Decompression for Cubital Tunnel Syndrome

Journal of Korean Neurotraumatology Society ◽

10.13004/jknts.2009.5.1.16 ◽

2009 ◽

Vol 5 (1) ◽

pp. 16 ◽

Cited By ~ 2

Author(s):

Yong-Jun Cho ◽

Sung-Min Cho ◽

Seung-Hoon Sheen ◽

Dong-Hwa Heo ◽

Jun-Hyung Cho ◽

...

Keyword(s):

Minimally Invasive ◽

Ulnar Nerve ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Nerve Decompression ◽

Tunnel Syndrome

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The Use of Preoperative Dynamic Ultrasound to Predict Ulnar Nerve Stability Following In Situ Decompression for Cubital Tunnel Syndrome

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2018.10.013 ◽

2019 ◽

Vol 44 (1) ◽

pp. 35-38 ◽

Cited By ~ 6

Author(s):

Michael Rutter ◽

Louis C. Grandizio ◽

W. James Malone ◽

Joel C. Klena

Keyword(s):

Ulnar Nerve ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Dynamic Ultrasound ◽

Tunnel Syndrome

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P.086 Endoscopic assisted ulnar nerve decompression: a technical note

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.170 ◽

2017 ◽

Vol 44 (S2) ◽

pp. S35-S35

Author(s):

MB Alotaibi ◽

B Yarascavitch ◽

K Reddy

Keyword(s):

Ulnar Nerve ◽

Early Identification ◽

Skin Incision ◽

Cubital Tunnel Syndrome ◽

Technical Note ◽

Surgical Approaches ◽

Nerve Decompression ◽

Endoscopic View ◽

Tunnel Syndrome

Background: Cubital tunnel syndrome is the second most frequent upper extremity entrapment neuropathy. Various surgical approaches have been described in the literature for Ulnar nerve decompression, ranging from open In-situ decompression to endoscopic Ulnar nerve release. In this technical note we describe a new endoscopic approach for Ulnar nerve decompression. Methods: Four cadavers, a total of eight fresh arms were dissected using our new endoscopic technique. The technique involves a 2.5cm skin incision placed 2.5cm distal to the medial epicondyle, and perpendicular to the long nerve axis. Early identification of motor branches was achieved using this skin incision. Under endoscopic view using 30 degree rigid scope Ulnar nerves were decompressed Results: Early identification of motor branches was achieved using distally placed skin incision in all eight arms. Conclusions: The safety of identifying Ulnar nerve motor branches in the early steps of the procedure, and the avoidance of scar formation over the elbow joint are the proposed advantages of this approach. More clinical studies needed to validate this outcome.

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Endoscopic vs Open Decompression of the Ulnar Nerve in Cubital Tunnel Syndrome

Neurosurgery ◽

10.1227/neu.0000000000000981 ◽

2015 ◽

Vol 77 (6) ◽

pp. 960-971 ◽

Cited By ~ 24

Author(s):

Sarah Schmidt ◽

Waltraud Kleist Welch-Guerra ◽

Marc Matthes ◽

Jörg Baldauf ◽

Ulf Schminke ◽

...

Keyword(s):

Ulnar Nerve ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Double Blind Study ◽

Double Blind ◽

Endoscopic Decompression ◽

Neurophysiological Data ◽

Tunnel Syndrome ◽

Tunnel Syndromes

Abstract BACKGROUND: Prospective randomized data for comparison of endoscopic and open decompression methods are lacking. OBJECTIVE: To compare the long- and short-term results of endoscopic and open decompression in cubital tunnel syndrome. METHODS: In a prospective randomized double-blind study, 54 patients underwent ulnar nerve decompression for 56 cubital tunnel syndromes from October 2008 to April 2011. All patients presented with typical clinical and neurophysiological findings and underwent preoperative nerve ultrasonography. They were randomized for either endoscopic (n = 29) or open (n = 27) surgery. Both patients and the physician performing the follow-up examinations were blinded. The follow-up took place 3, 6, 12, and 24 months postoperatively. The severity of symptoms was measured by McGowan and Dellon Score, and the clinical outcome by modified Bishop Score. Additionally, the neurophysiological data were evaluated. RESULTS: No differences were found regarding clinical or neurophysiological outcome in both early and late follow-up between both groups. Hematomas were more frequent after endoscopic decompression (P = .05). The most frequent constrictions were found at the flexor carpi ulnaris (FCU) arch and the retrocondylar retinaculum. We found no compressing structures more than 4 cm distal from the sulcus in the endoscopic group. The outcome was classified as “good” or “excellent” in 46 out of 56 patients (82.1%). Eight patients did not improve sufficiently or had a relapse and underwent a second surgery. CONCLUSION: The endoscopic technique showed no additional benefits to open surgery. We could not detect relevant compressions distal to the FCU arch. Therefore, an extensive far distal endoscopic decompression is not routinely required. The open decompression remains the procedure of choice at our institution.

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Open vs Retractor-Endoscopic In Situ Decompression of the Ulnar Nerve in Cubital Tunnel Syndrome

Neurosurgery ◽

10.1227/neu.0b013e3182846dbd ◽

2012 ◽

Vol 72 (4) ◽

pp. 605-616 ◽

Cited By ~ 38

Author(s):

Stephan Dützmann ◽

K. Daniel Martin ◽

Stephan Sobottka ◽

Gerhard Marquardt ◽

Gabriele Schackert ◽

...

Keyword(s):

Postoperative Pain ◽

Ulnar Nerve ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Matched Pairs ◽

Short Term ◽

Tunnel Syndrome ◽

Endoscopic In Situ Decompression

Abstract BACKGROUND: Both open ulnar nerve decompression and retractor-endoscopic ulnar nerve decompression have been shown to yield good results. However, a comparative evaluation of the techniques is lacking. OBJECTIVE: To compare the results of open and endoscopic surgery in cubital tunnel syndrome. METHODS: One hundred fourteen patients undergoing open (n = 59) or endoscopic (n = 55) decompression of the ulnar nerve for cubital tunnel syndrome were retrospectively compared. The long- and short-term outcomes were compared with respect to the time until return to full activity and the duration of postoperative pain. Additionally, matched pairs between the 2 groups were chosen for analysis (n = 34). RESULTS: Long-term results in the open vs endoscopic groups were as follows: excellent results, 54.2% vs 56.4%; good results, 23.8% vs 32.7%; fair results, 20.3% vs 9.1%; and poor results, 1.7% vs 1.8%, respectively. For the matched pairs, the results had similar significance levels (P = .84). The times until return to full activity in the open vs the endoscopic groups were as follows: 2 to 7 days, 18.6% vs 76.4%; 7 to 14 days, 55.9% vs 10.9%; and > 14 days, 25.4% vs 12.7% (P < .001 between nonmatched and matched pairs). The durations of postoperative pain in the open vs the endoscopic groups were as follows: 1 to 3 days, 45.8% vs 67.3%; 3 to 10 days, 42.5% vs 25.4%; and > 10 days, 11.7% vs 7.3% (P =.04 for nonmatched and P = .05 for matched pairs). CONCLUSION: There are no significant differences in long-term outcomes after open and retractor-endoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome. The short-term results are significantly better in endoscopic surgery.

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Relationship between Smoking and Outcomes after Cubital Tunnel Release

Journal of Hand and Microsurgery ◽

10.1055/s-0037-1618329 ◽

2018 ◽

Vol 10 (01) ◽

pp. 012-015

Author(s):

Nicholas Crosby ◽

Naveed Nosrati ◽

Greg Merrell ◽

Hill Hasting

Keyword(s):

Ulnar Nerve ◽

Cubital Tunnel Syndrome ◽

Smoking History ◽

Cubital Tunnel ◽

Nerve Decompression ◽

Pain Scores ◽

Significant Difference ◽

Tunnel Syndrome ◽

Simple Decompression ◽

Postoperative Improvement

Abstract Purpose Several studies have drawn a connection between cigarette smoking and cubital tunnel syndrome. One comparison article demonstrated worse outcomes in smokers treated with transmuscular transposition of the ulnar nerve. However, very little is known about the effect that smoking might have on patients who undergo ulnar nerve decompression at the elbow. The purpose of this study is to evaluate the effect of smoking preoperatively on outcomes in patients treated with ulnar nerve decompression. Materials and Methods This study used a survey developed from the comparison article with additional questions based on outcome measures from supportive literature. Postoperative improvement was probed, including sensation, strength, and pain scores. A thorough smoking history was obtained. The study spanned a 10-year period. Results A total of 1,366 surveys were mailed to former patients, and 247 surveys with adequate information were returned. No significant difference was seen in demographics or comorbidities. Patients who smoked preoperatively were found to more likely relate symptoms of pain. Postoperatively, nonsmoking patients generally reported more favorable improvement, though these findings were not statistically significant. Conclusion This study finds no statistically significant effect of smoking on outcomes after ulnar nerve decompression. Finally, among smokers, there were no differences in outcomes between simple decompression and transposition.

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