scholarly journals Endoscopic cubital tunnel decompression: state of the art

2021 ◽  
pp. jisakos-2020-000506
Author(s):  
Margaret W Fok ◽  
Tyson Cobb ◽  
Gregory Ian Bain
Keyword(s):  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Randomised Study ◽  
Anterior Transposition ◽  
Compressive Neuropathy ◽  
Tunnel Syndrome ◽  
Randomised Controlled ◽  
Double Blinded

Cubital tunnel syndrome is a common compressive neuropathy of the upper limb. Surgical decompression is indicated for patients who failed conservative therapy. Decompression in situ has shown to achieve comparable outcomes as decompression with anterior transposition in idiopathic cubital tunnel syndrome. Endoscopic cubital tunnel decompression has gained popularity in recent years, as surgeons can attain decompression of the ulnar nerve along its course using a small incision. Results from randomised controlled studies and systematic reviews, comparing endoscopic with open decompression in situ, are promising. Cases in which anterior transposition of the ulnar nerve is needed, an endoscopic technique can still be used by creating an additional volar portal, for the mobilisation of ulnar nerve. Early short-term results are encouraging. Further adequately powered, prospective, preferably double-blinded, randomised study are needed.

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 Challenging the dogma: anterior transposition of the ulnar nerve is indicated in recurrent cubital tunnel syndrome

2020 ◽  
Vol 46 (1) ◽  
pp. 45-449
Author(s):  
Mike Ruettermann
Keyword(s):  
Ulnar Nerve ◽  
Meta Analysis ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Current Evidence ◽  
Anterior Transposition ◽  
Tunnel Syndrome ◽  
Robust Evidence ◽  
Nerve Transposition

The current evidence for treatment of primary idiopathic cubital tunnel syndrome favours an in situ release. However, anterior transposition of the ulnar nerve remains a popular procedure in recurrent cubital tunnel syndrome. For more than 20 years, I have performed an extended in situ release only, and achieved similar or better results than with nerve transposition. In performing a systematic review of the evidence for surgery for recurrent cubital tunnel syndrome, I could only include 16 out of 296 studies regarding treatment of recurrent cases of cubital tunnel syndrome. A meta-analysis was not possible, due to selection bias and disparity of outcome measurements of the studies. However, I could not find robust evidence that supports the need of an anterior transposition of the ulnar nerve in recurrent cubital tunnel syndrome over an in situ decompression. My own experience of an extended in situ release with complete neurolysis with reasonable outcomes, in combination with the lack of literature support of anterior transposition in recurrent cases, have led me to the consideration that this dogma should be revised.

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 Subcutaneous Versus Submuscular Anterior Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome

Medicine ◽  
2015 ◽  
Vol 94 (29) ◽  
pp. e1207 ◽  
Author(s):  
Chun-Hua Liu ◽  
Shi-Qiang Wu ◽  
Xiao-Bin Ke ◽  
Han-Long Wang ◽  
Chang-Xian Chen ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Anterior Transposition ◽  
Tunnel Syndrome

Functional Outcome of Anterior Transposition of the Vascularized Ulnar Nerve for Cubital Tunnel Syndrome

1998 ◽  
Vol 23 (5) ◽  
pp. 613-616 ◽  
Author(s):  
A. ASAMI ◽  
K. MORISAWA ◽  
T. TSURUTA
Keyword(s):  
Functional Outcome ◽  
Ulnar Nerve ◽  
Conduction Velocity ◽  
Nerve Conduction ◽  
Nerve Conduction Velocity ◽  
Clinical Results ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Anterior Transposition ◽  
Tunnel Syndrome

Anterior transposition of the ulnar nerve is a widely used treatment for cubital tunnel syndrome, but neurolysis performed at the time of surgery may impair the blood supply to the ulnar nerve. This study compared the results of intramuscular anterior transposition of the ulnar nerve with or without preserving the extrinsic vessels of the ulnar nerve in 35 patients. The postoperative nerve conduction velocity and the clinical results were better in the group in which the extrinsic vessels were presented.

scholarly journals The 7 Structures Distal to the Elbow That Are Critical to Successful Anterior Transposition of the Ulnar Nerve

Hand ◽  
2018 ◽  
Vol 14 (6) ◽  
pp. 776-781 ◽  
Author(s):  
John M. Felder ◽  
Susan E. Mackinnon ◽  
Megan M. Patterson
Keyword(s):  
Ulnar Nerve ◽  
Ulnar Artery ◽  
Cubital Tunnel Syndrome ◽  
Medial Epicondyle ◽  
Cubital Tunnel ◽  
Anterior Transposition ◽  
Straight Line ◽  
Tunnel Syndrome ◽  
Poor Outcomes ◽  
Flexor Digitorum

Background: Ulnar nerve transposition (UNT) surgery is performed for the treatment of cubital tunnel syndrome. Improperly performed UNT can create iatrogenic pain and neuropathy. The aim of this study is to identify anatomical structures distal to the medial epicondyle that should be recognized by all surgeons performing UNT to prevent postoperative neuropathy. Methods: Ten cadaveric specimens were dissected with attention to the ulnar nerve. Intramuscular UNT surgery was simulated in each. Distal to the medial epicondyle, any anatomical structure prohibiting transposition of the ulnar nerve to a straight-line course across the flexor-pronator mass was noted and its distance from the medial epicondyle was measured. Results: Seven structures were found distal to the medial epicondyle whose recognition is critical to ensuring a successful anterior transposition of the ulnar nerve: (1) Branches of the medial antebrachial cutaneous (MABC) nerve; (2) Osborne’s fascia; (3) branches from the ulnar nerve to the flexor carpi ulnaris (FCU); (4) crossing vascular branches from the ulnar artery to the FCU; (5) the distal medial intermuscular septum between the FCU and flexor digitorum superficialis (FDS); (6) the combined muscular origins of the flexor-pronator muscles; and (7) the investing fascia of the FDS. Measurements are given for each structure. Conclusions: Poor outcomes and unnecessary revision surgeries for cubital tunnel syndrome can be avoided with intraoperative attention to 7 structures distal to the medial epicondyle. Surgeons should expect to dissect up to 12 cm distal to the medial epicondyle to adequately address these and prevent kinking of the nerve in transposition.

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