Endoscopic Anatomical Nerve Observation and Minimally Invasive Management of Cubital Tunnel Syndrome

2008 ◽  
Vol 34 (1) ◽  
pp. 115-120 ◽  
Author(s):  
A. YOSHIDA ◽  
I. OKUTSU ◽  
I. HAMANAKA
Keyword(s):  
Minimally Invasive ◽  
Ulnar Nerve ◽  
Motor Nerve ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Invasive Treatment ◽  
Pneumatic Tourniquet ◽  
Abductor Digiti Minimi ◽  
Tunnel Syndrome

Experience with the use of the Universal Subcutaneous Endoscope (USE) system in surgical treatment of cubital tunnel syndrome in 35 patients is reported. Patients included in the study had pre- and postoperative clinical and electrophysiological data, and had undergone a minimum follow-up period of 13 months. Mean patient age was 59.5 years and the mean follow-up period was 25.9 months. The operation was performed under local anaesthesia without pneumatic tourniquet and on an out-patient basis. A 1.5 cm portal is made at the cubital tunnel and the USE system is inserted next to the ulnar nerve, first distally and then proximally. The nerve is endoscopically assessed and only the tissue that compresses the nerve is released, in keeping with the principles of minimally invasive treatment. Preoperative tingling sensations disappeared postoperatively in 63% of cases. Pain and sensory disturbance recovered to normal in 92% and 89% of cases, respectively. Abnormal motor nerve conduction velocities improved in 77%. Abductor digiti minimi weakness MMT 0, 1, 2 in 16 hands recovered to MMT 4 or 5 in eight. First-dorsal interosseous weakness in 18 hands recovered to MMT 4 or 5 in seven. There were no complications in this series. The endoscopic approach facilitates inspection of the ulnar nerve so that selective release of the tissue that compresses the nerve can readily be performed. The technique has proven effective in the treatment of cubital tunnel syndrome.

Simultaneous Compression of the Median and Ulnar Nerve at the Elbow: A Retrospective Study

2018 ◽  
Vol 23 (02) ◽  
pp. 198-204 ◽  
Author(s):  
Dimitrios Skouteris ◽  
Sofia Thoma ◽  
Georgios Andritsos ◽  
Nikolaos Tasios ◽  
Praxitelis Praxitelous ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Ulnar Nerve ◽  
Correct Diagnosis ◽  
Sudden Onset ◽  
Cubital Tunnel Syndrome ◽  
Surgical Decompression ◽  
Cubital Tunnel ◽  
Tunnel Syndrome ◽  
Proximal Forearm

Background: Simultaneous compression of the median and ulnar nerve at the elbow region has not been sufficiently highlighted in the literature. The purposes of the present study are to report our experience regarding this entity, to elucidate the clinical features, and to describe the operative technique and findings as well as the results of simultaneous decompression performed through the same medial incision. Methods: We performed a retrospective study of thirteen elbows in thirteen patients -nine men and four women- with simultaneous compression of the median and ulnar nerve at the elbow region between 2000 and 2011. All were manual workers. Diagnosis was largely based on symptoms, patterns of paresthesia, and specific tests. Surgical decompression of both nerves at the same time was performed through a single anteromedial incision creating large flaps. Results: Patients were followed for a mean of thirty-eight months (range seven to ninety six). Resting pain in the proximal forearm as well as sudden onset of numbness in the ring and little fingers were reported by all patients. Nerve conduction studies were positive only for cubital tunnel syndrome. In all patients symptoms subsided following surgical decompression. At the time of final follow up there is no evidence of recurrence. Conclusions: Proximal median nerve compression can be seen in association with cubital tunnel syndrome. Careful evaluation of the reported symptoms as well as thorough clinical examination are the keystone of the correct diagnosis. Also, on the basis of this study, we believe that concurrent decompression can be performed through a single medial incision, though extensive dissection may be required.

scholarly journals Ulnar Nerve Enlargement at the Medial Epicondyle Negatively Correlates With Nerve Conduction Velocity in Cubital Tunnel Syndrome

Hand ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 165-169
Author(s):  
T. David Luo ◽  
Amy P. Trammell ◽  
Luke P. Hedrick ◽  
Ethan R. Wiesler ◽  
Francis O. Walker ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Nerve Conduction ◽  
Nerve Conduction Velocity ◽  
Motor Nerve ◽  
Cubital Tunnel Syndrome ◽  
Medial Epicondyle ◽  
Cubital Tunnel ◽  
Motor Nerve Conduction ◽  
Nerve Enlargement ◽  
Tunnel Syndrome

Background: In cubital tunnel syndrome (CuTS), chronic compression often occurs at the origin of the flexor carpi ulnaris at the medial epicondyle. Motor nerve conduction velocity (NCV) across the elbow is assessed preoperatively to corroborate the clinical impression of CuTS. The purpose of this study was to correlate preoperative NCV to the direct measurements of ulnar nerve size about the elbow at the time of surgery in patients with clinical and/or electrodiagnostic evidence of CuTS. Methods: Data from 51 consecutive patients who underwent cubital tunnel release over a 2-year period were reviewed. Intraoperative measurements of the decompressed nerve were taken at 3 locations: at 4 cm proximal to the medial epicondyle, at the medial epicondyle, and at the distal aspect of Osborne fascia at the flexor aponeurotic origin. Correlation analysis was performed comparing nerve size measurements to slowing of ulnar motor nerve conduction velocities (NCV) below the normal threshold of 49 m/s across the elbow. Results: Enlargement of the ulnar nerve at the medial epicondyle and nerve compression at the flexor aponeurotic origin was a consistent finding. The mean calculated cross-sectional area of the ulnar nerve was 0.21 cm2 above the medial epicondyle, 0.30 cm2 at the medial epicondyle, and 0.20 cm2 at the flexor aponeurotic origin ( P < .001). There was an inverse correlation between change in nerve diameter and NCV slowing ( r = −0.529, P < .001). Conclusions: For patients with significantly reduced preoperative NCV and clinical findings of advanced ulnar neuropathy, surgeons can expect nerve enlargement, all of which may affect their surgical decision-making.

scholarly journals Cubital tunnel syndrome

2021 ◽  
Vol 6 (9) ◽  
pp. 743-750
Author(s):  
Abdus S. Burahee ◽  
Andrew D. Sanders ◽  
Colin Shirley ◽  
Dominic M. Power
Keyword(s):  
Ulnar Nerve ◽  
Motor Nerve ◽  
Nerve Transfer ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Common Procedure ◽  
Tunnel Syndrome ◽  
Distal Nerve ◽  
Denervated Muscles ◽  
Simple Decompression

Cubital tunnel syndrome (CuTS) is the second most common compression neuropathy of the upper limb, presenting with disturbance of ulnar nerve sensory and motor function. The ulnar nerve may be dynamically compressed during movement, statically compressed due to reduction in tunnel volume or compliance, and tension forces may cause ischaemia or render the nerve susceptible to subluxation, further causing local swelling, compression inflammation and fibrosis. Superiority of one surgical technique for the management of CuTS has not been demonstrated. Different techniques are selected for different clinical situations with simple decompression being the most common procedure due to its efficacy and low complication rate. Adjunctive distal nerve transfer for denervated muscles using an expendable motor nerve to restore the axon population in the distal nerve is in its infancy but may provide a solution for severe intrinsic weakness or paralysis. Cite this article: EFORT Open Rev 2021;6:743-750. DOI: 10.1302/2058-5241.6.200129

Minimally Invasive Ulnar Nerve Decompression for Cubital Tunnel Syndrome

2009 ◽  
Vol 5 (1) ◽  
pp. 16 ◽  
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

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

Neurosurgery ◽  
2015 ◽  
Vol 77 (6) ◽  
pp. 960-971 ◽  
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.

scholarly journals The utility of ultrasound examination in cubital tunnel syndrome caused by heterotopic ossification

2020 ◽  
Vol 1 (1) ◽  
pp. 117
Author(s):  
Jakub Jačisko ◽  
Karolína Sobotová ◽  
Kamal Mezian
Keyword(s):  
Heterotopic Ossification ◽  
Ulnar Nerve ◽  
Ultrasound Examination ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Entrapment Syndrome ◽  
Heterotopic Ossifications ◽  
Tunnel Syndrome

This case presents the utility of ultrasound examination in diagnostics, providing accurate therapy and follow-up of entrapment syndrome of the ulnar nerve, caused by heterotopic ossification. The heterotopic ossifications were in this case presumably linked to a long-term working with a vibration sander.

Anterior Submuscular Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome

1995 ◽  
Vol 20 (4) ◽  
pp. 447-453 ◽  
Author(s):  
C. B. PASQUE ◽  
G. M. RAYAN
Keyword(s):  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Subjective Outcome ◽  
Postoperative Patient ◽  
Factors Influencing ◽  
Tunnel Syndrome ◽  
Compensation Status ◽  
Adequate Decompression

48 patients with 50 involved limbs were retrospectively analyzed to determine factors influencing the outcome of surgical treatment for cubital tunnel syndrome. All patients were treated by anterior submuscular transposition of the ulnar nerve with Z-lengthening of the flexor-pronator origin. There were 24 men and 24 women with an average age of 42 years± 16.4 years (range, 5–75 years). The average follow-up time was 58 months (range, 12–156 months). A grading system was used pre- and post-operatively based on the severity of subjective complaints and objective findings. 92% of the patients were satisfied, or satisfied with some reservations, and only 8% were dissatisfied. All patients had either fair or poor pre-operative grades. 84% had excellent or good post-operative grades and only 16% had fair grades. There were no recurrences or poor post-operative grades in our series. Workers’ compensation status had no statistically significant adverse effect on postoperative patient satisfaction or post-operative grade. Anterior submuscular transposition of the ulnar nerve in this series provided satisfactory subjective outcome, relief of symptoms and adequate decompression of the ulnar nerve at the elbow.

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.

Simple Decompression or Subcutaneous Anterior Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome

2005 ◽  
Vol 30 (5) ◽  
pp. 521-524 ◽  
Author(s):  
A. NABHAN ◽  
F. AHLHELM ◽  
J. KELM ◽  
W. REITH ◽  
K. SCHWERDTFEGER ◽  
...  
Keyword(s):  
Motor Nerve ◽  
Operative Procedure ◽  
Cubital Tunnel Syndrome ◽  
Neurological Deficits ◽  
Cubital Tunnel ◽  
Nerve Decompression ◽  
Anterior Transposition ◽  
Tunnel Syndrome ◽  
Simple Decompression

The purpose of this prospective randomised study was to evaluate which operative technique for treatment of cubital tunnel syndrome is preferable: subcutaneous anterior transposition or nerve decompression without transposition. This study included 66 patients suffering from pain and/or neurological deficits with clinically and electromyographically proven cubital tunnel syndrome. Thirty-two patients underwent nerve decompression without transposition and 34 underwent subcutaneous transposition of the nerve. Follow-up examinations evaluating pain, motor and sensory deficits as well as motor nerve conduction velocities, were performed 3 and 9 months postoperatively. There were no significant differences between the outcomes of the two groups at either postoperative follow-up examination. We recommend simple decompression of the nerve in cases without deformity of the elbow, as this is the less invasive operative procedure.

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