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Open Versus Endoscopische Cubital Tunnel Release

  • Brigitte E. P. A. van der Heijden
  • Henk J. Coert
Chapter

Abstract

Cubital tunnel syndrome is a symptomatic ulnar nerve dysfunction at the elbow region probably caused by a combination of compression, traction and friction. Static and dynamic factors are involved, leading to ischemia or mechanical compression, secondary to repeated elbow flexion, anatomic variants of muscles and ulnar nerve subluxation. It is the second most common form of nerve entrapment after carpal tunnel syndrome [1]. Several surgical techniques exist for treatment of cubital tunnel syndrome. Endoscopic cubital tunnel release has been reported as a promising minimally invasive technique. This chapter aims to compare outcomes and complications of open cubital tunnel release (OCTR) and endoscopic tunnel release (ECTR) in the treatment of idiopathic cubital tunnel syndrome. Methods: A systematic review of the literature was performed. Studies including adults with idiopathic cubital tunnel treated exclusively by ECTR or OCTR were included. Outcomes of interest were postoperative clinical outcome, satisfaction, pain, ability to work and complications. Postoperative clinical outcomes were dichotomized into 2 categories: improved or not improved. Results: 6 studies met the inclusion criteria (1 RCT and 5 observational), representing 156 open and 247 endoscopic decompressions. In the open group, 79% experienced improvement of clinical symptoms with 16% complication rate. In the endoscopic group, 86% experienced clinical improvement with 8% complication rate. No statistical significant differences were found for satisfaction and pain scores and ability to work. Conclusions: This review demonstrates similar effectiveness between the endoscopic (ECTR) and open (OCTR) techniques for treatment of idiopathic cubital tunnel syndrome with similar clinical outcomes and complication profiles. Keywords: compression neuropathy, cubital tunnel, endoscopic, ulnar nerve.

Keywords

Ulnar nerve Neuropathy Endoscopy Open surgery 

References

  1. 1.
    Mondelli M, Giannini F, Ballerini M, Ginanneschi F, Martorelli E. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci. 2005;234:5–10.CrossRefGoogle Scholar
  2. 2.
    Boone S, Gelberman RH, Calfee RP. The management of cubital tunnel syndrome. J Hand Surg Am. 2015;40:1897–1904; quiz 1904.CrossRefGoogle Scholar
  3. 3.
    Mondelli M, Giannini F, Morana P, Rossi S. Ulnar neuropathy at the elbow: predictive value of clinical and electrophysiological measurements for surgical outcomes. Electromyogr Clin Neurphysiol. 2004;44:349–56.Google Scholar
  4. 4.
    Dellon L, Chang E, Coert JH, Campbell KR. Intraneural ulnar nerve pressure changes related to operative techniques for cubital tunnel decompression. J Hand Surg Am. 1994;19(6):923–30.CrossRefGoogle Scholar
  5. 5.
    Dellon L. Review of treatment results of for ulnar nerve entrapment at the elbow. J Hand Surg Am. 1989;14A:688–700.CrossRefGoogle Scholar
  6. 6.
    McGowan A. The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg. 1950;32B(3):293–9.CrossRefGoogle Scholar
  7. 7.
    Dellon L. Diagnosis and treatment of ulnar nerve compression at the elbow. Tech Hand Up Extrem Surg. 2000;4(2):127–36.CrossRefGoogle Scholar
  8. 8.
    Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2012;(7):CD006839.Google Scholar
  9. 9.
    Dutch Guideline for treatment of cubital tunnel syndrome: richtlijn neuropathie van de nervus ulnaris bij de elleboog, 2011 door Nederlandse Vereniging van Neurologie in samenwerking met de Nederlandse Vereniging voor plastiche Chirurgie en Nederlandse Vereniging voor Neurochirurgie (pp. 0–88).Google Scholar
  10. 10.
    Tsai T, Chen I, Majd M, Lim B. Cubital tunnel release with endoscopic assistance: results of a new technique. J Hand Surg Am. 1999;24:21–9.CrossRefGoogle Scholar
  11. 11.
    Hoffmann R, Siemionow M. The endoscopic management of cubital tunnel syndrome. J Hand Surg Br. 2006;31:23–9.CrossRefGoogle Scholar
  12. 12.
    Dellon L, MacKinnon S. Injury to the medial antebrachial cutaneous nerve during cubital tunnel surgery. J Hand Surg Br. 1985;10:33–6.CrossRefGoogle Scholar
  13. 13.
    Ren Y, Zhou X, Qiao H, Wei Z, Fan B, Lin W, et al. Open versus endoscopic in situ decompression in cubital tunnel syndrome: a systematic review and meta-analysis. Int J Surg. 2016;35:104–10.CrossRefGoogle Scholar
  14. 14.
    Buchanan P, Chieng L, Hubbard Z, Law T, Chim H. Endoscopic versus open in situ cubital tunnel release: a systematic review of the literature and meta-analysis of 655 patients. Plast Reconstr Surg. 2018;141(3):679–84.CrossRefGoogle Scholar
  15. 15.
    Furlan A, Malmivaara A, Chou R, Maher C, Deyo R, Schoene M, et al. 2015 updated method guideline for systematic reviews in the cochrane back and neck group. Spine. 2015;40(21):1660–73.CrossRefGoogle Scholar
  16. 16.
    Neumann I, Santesso N, Akl E, Rind D, Vandvik P, Alonso-Coello P, et al. A guide for health professionals to interpretet and use recommendations in guidelines developed with the GRADE approach. J Clin Epidemiol. 2016;72:45–55.CrossRefGoogle Scholar
  17. 17.
    Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. Ottawa: Ottawa Hospital Research Institute; 2000.Google Scholar
  18. 18.
    Watts A, Bain G. Patient-rated outcome of ulnar nerve decompression: a comparison of endoscopic and open in situ decompression. J Hand Surg Am. 2009;34:1492–8.CrossRefGoogle Scholar
  19. 19.
    Saint-Cyr M, Lakhiany C, Tsai T. Surgical management of cubital tunnel syndrome: a comparative analysis of outcome using four different techniques. Eur J Plast Surg. 2013;36:693–700.CrossRefGoogle Scholar
  20. 20.
    Dützmann S, Martin K, Sobottka S, et al. Open vs retractor-endoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome: a retrospective cohort study. Neurosurgery. 2013;72:605–16; discussion 614–616CrossRefGoogle Scholar
  21. 21.
    Bolster M, Zöphel O, van den Heuvel E, Ruettermann M. Cubital tunnel syndrome: a comparison of an endoscopic technique with a minimal invasive open technique. J Hand Surg Eur Vol. 2014;39:621–5.CrossRefGoogle Scholar
  22. 22.
    Bacle G, Marteau E, Freslon M, et al. Cubital tunnel syndrome: comparative results of a multicenter study of 4 surgical techniques with a mean follow-up of 92 months. Orthop Traumatol Surg Res. 2014;100(Suppl):S205–8.CrossRefGoogle Scholar
  23. 23.
    Schmidt S, Kleist Welch-Guerra W, Matthes M, Baldauf J, Schminke U, Schroeder H. Endoscopic vs open decompression of the ulnar nerve in cubital tunnel syndrome: a prospective randomized double-blind study. Neurosurgery. 2015;77:960–70; discussion 970–1.CrossRefGoogle Scholar
  24. 24.
    Race C, Saldana M. Anatomic course of the medial antebrachial cutaneous nerve during cubital tunnel surgery. J Hand Surg. 1991;16:48–52.CrossRefGoogle Scholar
  25. 25.
    Lowe J, Maggi S, Mackinnon S. The position of crossing branches of the medial antebrachial cutaneous nerve during cubital tunnel surgery in humans. Plast Reconstr Surg. 2004;114:692–6.CrossRefGoogle Scholar
  26. 26.
    Mirza A, Mirza J, Lee B, et al. An anatomical basis for endoscopic cubital tunnel release and associated clinical outcome. J Hand Surg Am. 2014;39:1363–9.CrossRefGoogle Scholar
  27. 27.
    Oertel J, Keiner D, Gaab M. Endoscopic decompression of the ulnar nerve at the elbow. Neurosurgery. 2010;66:817–24; discussion 824.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Brigitte E. P. A. van der Heijden
    • 1
  • Henk J. Coert
    • 2
  1. 1.Department of Plastic SurgeryJeroen Bosch HospitalDen BoschThe Netherlands
  2. 2.Department of Plastic SurgeryUtrecht University Medical CenterUtrechtsThe Netherlands

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