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

2019 ◽  
Vol 44 (1) ◽  
pp. 35-38 ◽  
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

scholarly journals Predicting Revision Following In Situ Ulnar Nerve Decompression for Patients With Idiopathic Cubital Tunnel Syndrome

2016 ◽  
Vol 41 (3) ◽  
pp. 427-435 ◽  
Author(s):  
Michael P. Gaspar ◽  
Patrick M. Kane ◽  
Dechporn Putthiwara ◽  
Sidney M. Jacoby ◽  
A. Lee Osterman
Keyword(s):  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Nerve Decompression ◽  
Tunnel Syndrome

scholarly journals Anconeus Epitrochlearis Muscle Associated With Cubital Tunnel Syndrome: A Case Series

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 477-482
Author(s):  
Nicholas Kim ◽  
Ryan Stehr ◽  
Hani S. Matloub ◽  
James R. Sanger
Keyword(s):  
Ulnar Nerve ◽  
Nerve Conduction ◽  
Case Series ◽  
Cubital Tunnel Syndrome ◽  
Nerve Conduction Studies ◽  
Cubital Tunnel ◽  
Persistent Symptoms ◽  
Compressive Neuropathy ◽  
Tunnel Syndrome

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.

scholarly journals Predictors of surgical outcomes after in situ ulnar nerve decompression for cubital tunnel syndrome

2018 ◽  
Vol Volume 14 ◽  
pp. 69-74 ◽  
Author(s):  
Lingde Kong ◽  
Jiangbo Bai ◽  
Kunlun Yu ◽  
Bing Zhang ◽  
Jichun Zhang ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Surgical Outcomes ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Nerve Decompression ◽  
Tunnel Syndrome

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

Neurosurgery ◽  
2012 ◽  
Vol 72 (4) ◽  
pp. 605-616 ◽  
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.

Long-term Reoperation Rate for Cubital Tunnel Syndrome: Subcutaneous Transposition Versus In Situ Decompression

Hand ◽  
2019 ◽  
pp. 155894471987315
Author(s):  
Douglas T. Hutchinson ◽  
Ryan Sullivan ◽  
Micah K. Sinclair
Keyword(s):  
Ulnar Nerve ◽  
Reoperation Rate ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Multicenter Cohort Study ◽  
Tunnel Syndrome ◽  
Subcutaneous Transposition

Background: The purpose of this study was to compare the long-term revision rate of in situ ulnar nerve decompression with anterior subcutaneous transposition surgery for idiopathic cubital tunnel syndrome. Methods: This retrospective, multicenter, cohort study compared patients who underwent ulnar nerve surgery with a minimum 5 years of follow-up. The primary outcome studied was the need for revision cubital tunnel surgery. In total, there were 132 cases corresponding to 119 patients. The cohorts were matched for age and comorbidity. Results: The long-term reoperation rate for in situ decompression was 25% compared with 12% for anterior subcutaneous transposition. Seventy-eight percent of revisions of in situ decompression were performed within the first 3 years. Younger age and female sex were identified as independent predictors of need for revision. Conclusions: In the long-term follow-up, in situ decompression is seen to have a statistically significant higher reoperation rate compared with subcutaneous transposition.

scholarly journals Ultrasound diagnosis of ulnar nerve dislocation and snapping triceps syndrome

2012 ◽  
Vol 16 (2) ◽  
pp. 65-67
Author(s):  
Vivek Bhagwat Gupta ◽  
Kiran B Patankar ◽  
Farheen Paranjpe ◽  
Jeetendra Patil
Keyword(s):  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Ultrasound Diagnosis ◽  
Cubital Tunnel ◽  
Pictorial Essay ◽  
Dynamic Ultrasound ◽  
Tunnel Syndrome

Dislocation of the ulnar nerve with snapping triceps syndrome has been implicated as a cause of cubital tunnel syndrome. Patients with this condition may clinically present with a snapping sensation at the elbow upon flexion along with ulnar neuropathic symptoms. Though demonstration of this condition is possible by static MRI images, ultrasound can be used as a more accessible and inexpensive modality for attaining diagnosis. This pictorial essay emphasises the technique, findings and role of dynamic ultrasound in the diagnosis of this entity.

MINIMALIST CUBITAL TUNNEL TREATMENT

Neurosurgery ◽  
2009 ◽  
Vol 65 (suppl_4) ◽  
pp. A145-A149 ◽  
Author(s):  
Tarek Abuelem ◽  
Bruce Loyal Ehni
Keyword(s):  
Nerve Injury ◽  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Senior Author ◽  
Cutaneous Nerve ◽  
Ulnar Neuropathy ◽  
Cubital Tunnel ◽  
Success Rates ◽  
Tunnel Syndrome

Abstract OBJECTIVE The surgical treatment of cubital tunnel syndrome by various techniques is often met with disappointing results. An optimal treatment is not agreed upon. The authors propose a collection of techniques which they believe optimizes outcome and minimizes iatrogenic injuries. METHODS A combination of a novel skin incision which minimizes scar and iatrogenic cutaneous nerve injury, a technique of in situ decompression, and an atraumatic technique of ensuring complete nerve exploration proximal and distal to the incision is presented; these methods have been in use by the senior author for a number of years. RESULTS Numerous reports have demonstrated that the success of in situ ulnar nerve release by division of Osborne's fascia is equivalent to the success rates of more invasive operations for the condition of ulnar neuropathy. The authors share this view in the majority of cases of ulnar neuropathy, and they present a technique that can be expanded, if necessary, on the basis of surgical findings, with only a few indications for the greater epicondylectomy or transposition procedures. CONCLUSION The authors present a means of treating cubital tunnel syndrome. Failure of in situ cubital tunnel release, as with failure of any ulnar procedure, can be attributed to intraoperative ulnar nerve injury, injury to the medial antebrachial cutaneous nerve, inadequate longitudinal exploration and release, scar formation with recurrent compression and/or traction, and the possibility that decompression could lead to iatrogenic symptomatic nerve subluxation. The authors discuss the rationale for a minimalist open surgical approach for the treatment of cubital tunnel syndrome, and each of these concerns is addressed.

Sonographic Follow-Up of Patients With Cubital Tunnel Syndrome Undergoing in Situ Open Neurolysis or Endoscopic Release: The SPECTRE Study

Hand ◽  
2019 ◽  
pp. 155894471985781
Author(s):  
Stefano Lucchina ◽  
Cesare Fusetti ◽  
Marco Guidi
Keyword(s):  
Clinical Outcome ◽  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Sonographic Examination ◽  
Cross Sectional ◽  
Endoscopic Release ◽  
Significant Difference ◽  
Tunnel Syndrome

Background:The measurement of cross-sectional area (CSA) is a diagnostic tool to detect entrapments syndrome. The aim of this study was to compare the clinical outcome in elbows undergoing endoscopic and “in situ” open cubital tunnel release for cubital tunnel syndrome (CuTS) using ultrasound-related changes in the largest CSA of the ulnar nerve. The purpose is to determine the association between clinical outcome and CSA. Methods: From May 2011 to April 2016, 60 patients with CuTS were prospectively followed and not randomly divided in two groups: 30 patients undergoing an endoscopic release (ER) and 30 patients with “in situ” open neurolysis (OR). A sonographic examination was performed by the senior authors at baseline and 3, 6, and 12 months after surgical decompression. Results: CSA values were statistically significantly lower in the ER. Hand grip strength difference with Jamar test was not statistically significant a 12 months (39 kg vs 27 kg). Static-2 point discrimination test difference was only statistically significant lower in the endoscopic group at 3, 6 and 12 months but not clinically relevant (5 mm vs 6 mm). The American Shoulder and Elbow Surgeons—Elbow questionnaire (ASES-e) function score, ASES-e Pain score, and ASES-e Satisfaction score were not statistically significant different between the two groups at 3, 6, and 12 months post operatively. Conclusions: The study confirms that in spite of lower values of CSA in the ER, there is not a statistically significant difference between the two techniques in terms of subjective outcomes. Ultrasound (US) measurements seem to have a limited value in clinical results of patients treated for entrapment neuropathy of the ulnar nerve. Type of study/LOE: Prognostic Level III

scholarly journals Ulnar Nerve In Situ Decompression versus Transposition for Idiopathic Cubital Tunnel Syndrome: An Updated Meta-Analysis

2018 ◽  
Vol 11 (01) ◽  
pp. 018-027 ◽  
Author(s):  
Joseph Said ◽  
Duncan Van Nest ◽  
Carol Foltz ◽  
Asif Ilyas
Keyword(s):  
Clinical Improvement ◽  
Ulnar Nerve ◽  
Revision Surgery ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Odds Ratios ◽  
Tunnel Syndrome

Abstract Purpose Evidence for the superiority of in situ simple decompression (SD) versus ulnar nerve transposition (UNT) for cubital tunnel syndrome remains controversial. The purpose of this study was to compare the clinical improvement, complication rate, and revision rate of SD versus UNT using the available evidence. Materials and Methods We performed a literature search of relevant publications using PubMed, SCOPUS, Cochrane Library, and Springer Link. Inclusion criteria included (1) adult patients >18 years of age, (2) idiopathic cubital tunnel syndrome, (3) primary comparison studies including both SD versus UNT with discrete data for each procedure, (4) average follow-up of at least 2 months, and (5) a full English language manuscript available. Odds ratios of improvement, complications, and revision surgery after SD compared with UNT were calculated. Data were analyzed using both fixed and random effects models, and studies were assessed for publication bias and heterogeneity. Results A total of 1,511 articles from 1970 to 2017 were identified before inclusion, and exclusion criteria were applied. Ultimately 17 studies met the inclusion criteria and included 2,154 procedures. Of these, 1,040 were SD, and 1,114 were UNT procedures. Study heterogeneity was low. Odds ratios of clinical improvement and revision surgery with SD versus UNT were not significantly different. The odds ratio of complications with SD versus UNT was 0.449 (95% confidence interval [CI] of 0.290–0.695) and 0.469 (95% CI of 0.297–0.738) for fixed and random effect models, respectively. The difference in complications between SD versus UNT was significant (P < 0.001). Conclusion There is no statistically significant difference in clinical outcomes or rate of revision surgery between SD versus UNT. However, there were significantly more complications with UNT. The current body of evidence regarding cubital tunnel syndrome lacks prospective, randomized, controlled trials, uniform reporting of indications, and standardized outcome scoring.

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