Ulnar nerve compression at the elbow is the most common neuropathy of the upper extremity. Surgical options include in situ decompression, decompression with anterior transposition of the ulnar nerve, and medial epicondylectomy with or without decompression. With the advancement of endoscopic surgery, techniques of endoscopic in situ decompression of the ulnar nerve and endoscopic anterior transposition of ulnar nerve have been reported. This article describes a technique of endoscopically assisted anterior subcutaneous transposition of ulnar nerve that is composed of an open release and mobilization of the ulnar nerve at and distal to the cubital tunnel and endoscopic release and mobilization of the ulnar nerve proximal to the cubital tunnel.

https://www.arthroscopytechniques.org/article/S2212-6287(16)00047-5/pdf

Endoscopically Assisted Anterior Subcutaneous Transposition of Ulnar Nerve

Cubital tunnel syndrome refers to ulnar nerve compressive neuropathy and most commonly occurs at the level of the elbow. Surgical options include in situ decompression, decompression with anterior transposition of the ulnar nerve, and medial epicondylectomy with or without decompression. With the advancement of endoscopic surgery, techniques of endoscopic in situ decompression of the ulnar nerve, endoscopy-assisted anterior transposition, and endoscopic anterior transposition of the ulnar nerve have been reported with the advantage of minimally invasive surgery. We describe a 2-portal technique of endoscopy-assisted anterior subcutaneous transposition of the ulnar nerve.

Endoscopic Anterior Subcutaneous Transposition of the Ulnar Nerve

OBJECTIVE To evaluate the surgical method and the results of endoscopic decompression and anterior transposition of the ulnar nerve for treatment of cubital tunnel syndrome. METHODS Between May 2008 and August 2009, 13 cases of cubital tunnel syndrome were treated with endoscopic decompression and anterior transposition of the ulnar nerve. There were 4 males and 9 females with an average age of 47.5 years (range, 32-60 years). The injury was caused by fractures of the humeral medial condyle in 1 case, by long working in elbow flexion position with no obvious injury in 10 cases, and subluxation of ulnar nerve in 2 cases. The locations were the left side in 6 cases and the right side in 7 cases. The disease duration was 4-30 months. The time from onset to operation was 3-20 months (mean, 8.5 months). Ten patients complicated by intrinsic muscle atrophy. RESULTS The operation was successfully performed in 13 cases, and the operation time was 45-60 minutes. All the wounds gained primary healing. All patients were followed up 12-18 months (mean, 14 months). The numbness of ring finger, little finger, and the ulnar side of hand were decreased obviously on the first day after operation. The examination of electromyogram showed that the ulnar nerve conduction increased at 2 weeks, the amplitude was improved, and recruitment of the intrinsic muscles of hand enhanced. In 10 cases complicated by intrinsic muscle atrophy, myodynamia was recovered to the normal in 7 cases and was mostly recovered in 3 cases at 3 months after operation. The symptom of cubital tunnel syndrome disappeared and gained a normal function at 12 months after operation. According to the assessment of Chinese Medical Association and Lascar et al. grading criteria, the clinical results were excellent in 10 cases and good in 3; the excellent and good rate was 100%. Patients recovered to work 12-16 days (mean, 14 days) after operation. No recurrence occurred during follow-up. CONCLUSION The surgical method of endoscope and microscope assisted three small incisions for treatment cubital tunnel syndrome has less invasion with small incision and complete decompression. Patients can recover to work early. It is a convenient and efficient procedure for treating cubital tunnel syndrome.

Endoscope and microscope assisted three small incisions for treatment of cubital tunnel syndrome

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Endoscope and microscope assisted three small incisions for treatment of cubital tunnel syndrome