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.

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 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.

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.

scholarly journals Endoscopic cubital tunnel decompression – Review of the literature

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902098208
Author(s):  
Margaret Woon Man Fok ◽  
Tyson Cobb ◽  
Gregory I Bain
Keyword(s):  
Ulnar Nerve ◽  
Randomized Study ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Short Term ◽  
Compressive Neuropathy ◽  
Endoscopic Guidance ◽  
Tunnel Syndrome ◽  
Subcutaneous Transposition

Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb. Endoscopic cubital tunnel decompression has gained popularity in recent years as this enables surgeons to achieve decompression of the ulnar nerve along its course using a small incision. This article describes the technical peals in performing endoscopic cubital tunnel decompression. In conditions which anterior transposition of the ulnar nerve is needed, subcutaneous transposition can be performed under endoscopic guidance. In addition, current literature is reviewed, and outcomes are presented. While short term results are encouraging, further prospective randomized study with longer follow-up is recommended.

Simple Endoscopic Decompression of Cubital Tunnel Syndrome With the Agee System

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons325-ons332 ◽  
Author(s):  
Axel Thomas Stadie ◽  
Doerthe Keiner ◽  
Gerrit Fischer ◽  
Jens Conrad ◽  
Stefan Welschehold ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Nerve Entrapment ◽  
Endoscopic Technique ◽  
Cubital Tunnel ◽  
Long Term Follow Up ◽  
Tunnel Syndrome ◽  
Nerve Entrapment Syndrome

Abstract BACKGROUND Simple decompression in ulnar nerve compression syndromes offers options for endoscopic applications. OBJECTIVE The authors present their initial experience with the Agee device. PATIENTS AND METHODS The monoportal endoscopic technique (Agee system) was evaluated on 10 cadaveric arms. Subsequently, 32 arms of 29 patients were operated on between January 2006 and March 2009. All patients presented with typical clinical signs and neurophysiologic studies. Long-term follow-up examinations were obtained in 27 of 32 arms. RESULTS In the cadaver study, the ulnar nerve was always correctly identified. No nerve damage occurred, and sufficient decompression of the ulnar nerve was always achieved. In the clinical series, no intraoperative complications were observed. A change to open technique was not required, and no worsening of the cubital tunnel syndrome occurred. Two wound infections required surgical wound cleaning. Wound hematomas treated conservatively were found in 5 cases. On long-term follow-up, an improvement in the McGowan-Classification was achieved in 22 of 27 cases. One patient was operated on by open surgery after endoscopic surgery. CONCLUSION The endoscopic technique for ulnar nerve entrapment syndrome using an Agee device appears to be safe and efficient. The results are comparable to those achieved with simple open decompression. A randomized prospective study should be performed to further evaluate the value of new technique in ulnar nerve entrapment syndrome.

scholarly journals Incidence of Re-Operation and Subjective Outcome Following in Situ Decompression of the Ulnar Nerve at the Cubital Tunnel

2009 ◽  
Vol 34 (3) ◽  
pp. 379-383 ◽  
Author(s):  
C. A. GOLDFARB ◽  
M. M. SUTTER ◽  
E. J. MARTENS ◽  
P. R. MANSKE
Keyword(s):  
Ulnar Nerve ◽  
Failure Rate ◽  
Chart Review ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Persistent Symptoms ◽  
Additional Surgery ◽  
Tunnel Syndrome

The purpose of this investigation was to determine the failure rate of in situ decompression for cubital tunnel syndrome as determined by the need for additional surgery. We performed a comprehensive chart review of 56 adult patients who had undergone in situ decompression for cubital tunnel syndrome in 69 extremities with more than 1 year follow-up. The patients completed a comprehensive questionnaire concerning preoperative and postoperative pain, numbness, and weakness. After decompression, symptoms were improved substantially or resolved. Five limbs (7%) with persistent symptoms postoperatively were treated successfully with anterior submuscular transposition. These data suggest that in situ decompression of the ulnar nerve is a reliable treatment for cubital tunnel syndrome and has a low failure rate. The uncommon patient with continued symptoms after decompression can be treated effectively with transposition of the ulnar nerve.

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