Anterior Subcutaneous Transposition With Expanded Polytetrafluoroethylene (ASTEP) for Cubital Tunnel Syndrome: Technical Note

2020 ◽  
Vol 19 (4) ◽  
pp. E337-E342
Author(s):  
Umit Eroglu ◽  
Melih Bozkurt ◽  
Samuel B Tomlinson ◽  
Gokmen Kahilogullari ◽  
Eyyub S M Al-Beyati ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Nerve Entrapment ◽  
Entrapment Neuropathy ◽  
Cubital Tunnel ◽  
Symptom Duration ◽  
Expanded Polytetrafluoroethylene ◽  
Presenting Symptoms ◽  
Ulnar Nerve Entrapment ◽  
Tunnel Syndrome ◽  
Subcutaneous Transposition

Abstract BACKGROUND Ulnar nerve entrapment neuropathy at the elbow is the most common upper-extremity entrapment neuropathy after carpal tunnel syndrome. Surgical treatment can be complicated by perineural scarring and fibrosis, which may lead to recurrent symptoms. Expanded polytetrafluoroethylene (ePTFE) is a synthetic polymer with antiadhesive properties. OBJECTIVE To introduce the operative technique and outcomes of anterior subcutaneous transposition with ePTFE (ASTEP) in primary and recurrent cubital tunnel neuropathy. METHODS We studied 14 adult patients (11 men, 3 women; mean age, 45 yr) with cubital tunnel neuropathy (10 primary, 4 revision) who underwent surgery with the ASTEP technique between January 2008 and May 2018. Pain, numbness in the fourth/fifth fingers, and weakness of the intrinsic hand muscles were the most common presenting symptoms. Surgical outcomes were assessed using the modified McGowan and Wilson-Krout criteria. RESULTS The average (± standard deviation) preoperative symptom duration was 12.1 ± 5.2 mo (McGowan Grade 1, n = 5; Grade 2, n = 6; Grade 3, n = 3). No intraoperative or postoperative complications were observed with the ASTEP technique. Postoperative follow-up ranged from 9 mo to 7 yr (mean, 4.3 yr). All 14 patients experienced improvement in or complete resolution of their symptoms after this unique intervention. CONCLUSION Our novel technique of anterior transposition of the ulnar nerve with ePTFE was safe and highly effective in treating primary and recurrent ulnar nerve entrapment neuropathy at the elbow and represents an alternative to the current techniques.

Ulnar nerve entrapment and cubital tunnel syndrome

2003 ◽  
Vol 14 (4) ◽  
pp. 296-301 ◽  
Author(s):  
Robert L. Brady ◽  
Louis W. Catalano ◽  
O. Alton Barron
Keyword(s):  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Nerve Entrapment ◽  
Cubital Tunnel ◽  
Ulnar Nerve Entrapment ◽  
Tunnel Syndrome

Ulnar Nerve Entrapment Neuropathy at the Elbow: Simple Decompression

Neurosurgery ◽  
2004 ◽  
Vol 55 (5) ◽  
pp. 1150-1153 ◽  
Author(s):  
Jason H. Huang ◽  
Uzma Samadani ◽  
Eric L. Zager
Keyword(s):  
Ulnar Nerve ◽  
Surgical Techniques ◽  
Cubital Tunnel Syndrome ◽  
Nerve Entrapment ◽  
Entrapment Neuropathy ◽  
Ulnar Nerve Entrapment ◽  
Careful Clinical Examination ◽  
Electrophysiological Studies ◽  
Tunnel Syndrome ◽  
Simple Decompression

Abstract ULNAR NERVE ENTRAPMENT neuropathy at the elbow, or the cubital tunnel syndrome, is frequently encountered in neurosurgical practice as the second most common peripheral nerve entrapment after carpal tunnel syndrome. Patients typically present with weakness or atrophy of the hand as well as paresthesias in the ulnar nerve distribution. The diagnosis can be confirmed with a careful clinical examination and electrophysiological studies. Patients who have failed conservative therapy are considered for surgery. Although a number of surgical options are available, simple decompression of the ulnar nerve can achieve satisfactory results with appropriate patient selection. We describe the relevant anatomy and surgical techniques for simple in situ decompression of the ulnar nerve at the elbow.

ULNAR NERVE ENTRAPMENT BY ANCONEUS EPITROCHLEARIS LIGAMENT

Hand Surgery ◽  
2012 ◽  
Vol 17 (01) ◽  
pp. 83-84 ◽  
Author(s):  
William H. C. Tiong ◽  
Jason Kelly
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Ulnar Nerve ◽  
Upper Limb ◽  
Carpal Tunnel ◽  
Nerve Entrapment ◽  
Entrapment Neuropathy ◽  
Review Of The Literature ◽  
Inflammatory Conditions ◽  
Ulnar Nerve Entrapment ◽  
Tunnel Syndrome

Ulnar nerve entrapment at the elbow is the second most common upper limb entrapment neuropathy other than carpal tunnel syndrome. There have been many causes identified ranging from chronic aging joint changes to inflammatory conditions or systemic disorders. Among them, uncommon anatomical variants accounts for a small number of cases. Here, we report our experience in managing ulnar nerve entrapment caused by a rare vestigial structure, anconeus epitrochlearis ligament, and provide a brief review of the literature of its management.

scholarly journals Management of cubital tunnel syndrome by anterior trans-muscular transposition of the ulnar nerve

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
Ahmed Shawky Ammar ◽  
Mohamed Ahmed El Tabl ◽  
Dalia Salah Saif
Keyword(s):  
Clinical Outcome ◽  
Ulnar Nerve ◽  
Visual Analog Scale ◽  
Electrophysiological Study ◽  
Cubital Tunnel Syndrome ◽  
Nerve Entrapment ◽  
Cubital Tunnel ◽  
Analog Scale ◽  
Tunnel Syndrome ◽  
Dash Questionnaire

Abstract Background Various surgical options are used for the treatment of ulnar nerve entrapment at the elbow. In this study, anterior trans-muscular transposition of the ulnar nerve was used for the treatment of cubital tunnel syndrome. Objectives To evaluate the surgical results of anterior trans-muscular transposition technique for the treatment of cubital tunnel syndrome with particular emphasis on clinical outcome. Methods Forty patients with cubital tunnel syndrome were operated using anterior trans-muscular transposition technique. Patients were classified into post-operative clinical outcome grades according to the Wilson & Krout criteria, and they were followed up by visual analog scale (VAS), the Disability of Arm Shoulder and Hand (DASH) questionnaire, electrophysiological study, and post-operative clinical evaluation. Results Forty patients with cubital tunnel syndrome who underwent anterior trans-muscular transposition of the ulnar nerve show a significant clinical improvement at 24 months post-surgery regarding visual analog scale (VAS), the Disability of Arm Shoulder and Hand (DASH) questionnaire, electrophysiological study, and the Wilson & Krout grading as 87.5% of the patients recorded excellent and good outcome. Conclusion Anterior transmuscular transposition of the ulnar nerve is a safe and effective treatment for ulnar nerve entrapment at the elbow.

scholarly journals Ulnar Nerve Neuropathy Secondary to “Snapping Triceps Syndrome”

2017 ◽  
Vol 3 ◽  
pp. 2513826X1771645
Author(s):  
Stahs Pripotnev ◽  
Colin White
Keyword(s):  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Dominant Male ◽  
Ulnar Nerve Compression ◽  
Compression Neuropathy ◽  
History Of ◽  
Tunnel Syndrome ◽  
Subcutaneous Transposition ◽  
Abnormal Anatomy

Cubital tunnel syndrome is the second most common compression neuropathy of the upper extremity and the most common point of compression for the ulnar nerve. We present a case of ulnar nerve compression neuropathy at the elbow secondary to an abnormal subluxating medial head of triceps. A 37-year-old right hand dominant male presented with a history of bilateral medial elbow pain and ulnar distribution hand numbness. During his left cubital tunnel release surgery, the abnormal anatomy was noted. Initial subfascial anterior transposition was insufficient and had to be revised to a subcutaneous transposition intraoperatively. Failure to recognize the contribution of triceps abnormalities can lead to incomplete resolution following surgery. Surgeons should be wary of uncommon findings and adjust their approach appropriately.

scholarly journals Clinical Experience of Ulnar Nerve Entrapment Neuropathy from 32 Surgical Procedures

2003 ◽  
Vol 17 (3) ◽  
pp. 233-238
Author(s):  
Masahiro Kawanishi ◽  
Iwao Nishiura ◽  
Akira Morimoto ◽  
Hajime Handa
Keyword(s):  
Ulnar Nerve ◽  
Clinical Experience ◽  
Surgical Procedures ◽  
Nerve Entrapment ◽  
Entrapment Neuropathy ◽  
Ulnar Nerve Entrapment

scholarly journals Anconeus Epitrochlearis Muscle as a Cause of Ulnar Nerve Compression at the Elbow

2017 ◽  
Vol 36 (03) ◽  
pp. 190-193
Author(s):  
Luiz Cannoni ◽  
Luciano Haddad
Keyword(s):  
Surgical Treatment ◽  
Ulnar Nerve ◽  
Complete Recovery ◽  
Nerve Entrapment ◽  
Ulnar Nerve Compression ◽  
Left Hand ◽  
Ulnar Nerve Entrapment ◽  
Compressive Neuropathy ◽  
Tunnel Syndrome ◽  
Magnetic Resonance Imaging Mri

AbstractUlnar nerve entrapment is the second most common compressive neuropathy in the upper limb, after carpal tunnel syndrome (Dellon, 1986). One of the causes that must be considered is the accessory anconeus epitrochlearis muscle, which is present in 4% to 34% of the general population (Husarik et al, 2010; Vanderpool et al, 1968; Nellans et al, 2014).We describe a patient with symptoms of compression of the left ulnar nerve at the elbow and the result of the surgical treatment.The patient presented with hypoesthesia in the fourth and fifth fingers of the left hand, and reduction of strength in the fifth finger abduction. No alterations were found in the thumb adduction.Initially, the treatment was conservative (splint, physiotherapy, analgesics); surgical treatment was indicated due to the continuity of the symptoms.The ulnar nerve was surgically released and transposed, with complete recovery after 6 months of follow-up.Ulnar nerve entrapment at the elbow by the anconeus epitrochlearis muscle is not common, but it must not be ignored (Chalmers, 1978). Ultrasonography (Jung et al, 2013; Bargalló et al, 2010), elbow magnetic resonance imaging (MRI) (Jeon, 2005), and electromyography (Byun, 2011) can help establish the proper diagnosis.

scholarly journals Anterior subcutaneous transposition for persistent ulnar neuropathy after neurolysis

2017 ◽  
Vol 42 (3) ◽  
pp. E8 ◽  
Author(s):  
Jort A. N. van Gent ◽  
Mirjam Datema ◽  
Justus L. Groen ◽  
Willem Pondaag ◽  
Job L. A. Eekhof ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Clinical Problem ◽  
Nerve Entrapment ◽  
Consecutive Series ◽  
Satisfaction Scale ◽  
Definitive Answer ◽  
Excellent Outcome ◽  
Poor Outcome ◽  
Ulnar Nerve Entrapment ◽  
Subcutaneous Transposition

OBJECTIVE Little is known about optimal treatment if neurolysis for ulnar nerve entrapment at the elbow fails. The authors evaluated the clinical outcome of patients who underwent anterior subcutaneous transposition after failure of neurolysis of ulnar nerve entrapment (ASTAFNUE). METHODS A consecutive series of patients who underwent ASTAFNUE performed by a single surgeon between 2009 and 2014 was analyzed retrospectively. Preoperative and postoperative complaints in the following 3 clinical modalities were compared: pain and/or tingling, weakness, and numbness. Six-point satisfaction scores were determined on the basis of data from systematic telephonic surveys. RESULTS Twenty-six patients were included. The median age was 56 years (range 22–79 years). The median duration of complaints before ASTAFNUE was 23 months (range 8–78 months). The median interval between neurolysis and ASTAFNUE was 11 months (range 5–34 months). At presentation, 88% of the patients were experiencing pain and/or tingling, 46% had weakness, and 50% had numbness of the fourth and fifth fingers. Pain and/or tingling improved in 35%, motor function in 23%, and sensory disturbances in 19% of all the patients. Improvement in at least 1 of the 3 clinical modalities was found in 58%. However, a deterioration in 1 of the 3 modalities was noted in 46% of the patients. On the patient-satisfaction scale, 62% reported a good or excellent outcome. Patients with a good/excellent outcome were a median of 11 years younger than patients with a fair/poor outcome. No other factor was significantly related to satisfaction score. CONCLUSIONS A majority of the patients were satisfied after ASTAFNUE, even though their symptoms only partly resolved or even deteriorated. Older age is a risk factor for a poor outcome. Other factors that affect outcome might play a role, but they remain unidentified. One of these factors might be earlier surgical intervention. The modest results of ASTAFNUE should be mentioned when counseling patients after failure of neurolysis of ulnar nerve entrapment to manage their expectations. Patients, especially those who are elderly, might even consider not undergoing a secondary procedure. A randomized trial that includes a conservative treatment group and groups undergoing one of the several possible surgical procedures is needed to find the definitive answer for this clinical problem.

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