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Endoscopic Ulnar Nerve Decompression and Transposition

  • Gregory BainEmail author
  • Margaret Woon Man Fok
Chapter

Abstract

Cubital tunnel syndrome is the second most common compressive neuropathy in the upper extremity. Decompression of the ulnar nerve at the elbow is indicated when conservative therapies failed. However, in the situation where the affected ulnar nerve is subluxatable, anterior transposition is warranted in order to achieve a sustainable good outcome. Traditionally surgical decompression and anterior transposition are performed in an open method. As the endoscopic techniques have evolved (Hoffmann and Siemionow, JHSB. 31:23–29, 2006), the nerve can now be decompressed and transpose, with minimally invasive techniques (Watts and Bain, JHSA. 34:1492–1498, 2009).

Keywords

Ulnar nerve Cubital tunnel syndrome Endoscopic release Anterior transposition Peripheral neuropathy 

Notes

Acknowledgment

Conflict of Interest: All authors declare no conflict of interest.

Supplementary material

Video 100.1a

Endoscopic view of the deep fasciae, with the hooded scope creating a space between the subcutaneous fat and deep fascia. Release of the deep fascia using Metzenbaum scissor (MOV 19229 kb)

Video 100.1b

The distal release of the ulnar nerve within the FCU muscle. Be cautious not to damage the muscular branches of the ulnar nerve (MOV 13303 kb)

Video 100.1c

Release of flexor pronator aponeurosis (MOV 6464 kb)

Video 100.2a

Proximal release of ulnar nerve (MOV 7540 kb)

Video 100.2b

Cautery is used with caution but is valuable to prevent unnecessary bleeding during dissection (MOV 4102 kb)

Video 100.2c

Continuation of the release of the deep fasciae after cautery (MOV 10287 kb)

Video 100.3

A nylon tape, which is introduced in the anterior portal, is used to retract the nerve. The ulnar nerve is mobilized from the loose areolar tissue under endoscopic guidance (MOV 21054 kb)

Video 100.4a

The stability of the ulnar nerve is checked during entire arc of elbow motion, via direct (MOV 4282 kb)

Video 100.4b

Endoscopic vision (MOV 4013 kb)

References

  1. 1.
    Hoffmann R, Siemionow M. The endoscopic management of cubital tunnel syndrome. JHSB. 2006;31:23–9.CrossRefGoogle Scholar
  2. 2.
    Watts AC, Bain GI. Patient-rated outcomes of ulnar nerve decompression: a comparison of endoscopic and open in situ decompression. JHSA. 2009;34:1492–8.Google Scholar
  3. 3.
    Morse LP, McGuire DT, Bain GI. Endoscopic ulnar nerve release and transposition. Tech Hand Surg. 2014;18:10–4.CrossRefGoogle Scholar
  4. 4.
    Bain G, Phadnis J, Saeed H. Soft tissue endoscopy in elbow pathologies. In: Pederzini LA, et al., editors. Elbow and sports. Berlin: Springer.  https://doi.org/10.1007/978-3-662-48742-6_18.CrossRefGoogle Scholar

Copyright information

© ISAKOS 2020

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryFlinders University, and Flinders Medical CentreAdelaideAustralia
  2. 2.Department of Orthopaedics and TraumatologyQueen Mary Hospital, The University of Hong KongHong KongChina

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