Minimally Invasive Treatment of Elbow Neuropathies

Abstract

Neuropathies of the elbow are a common cause of pain and disability. When conservative treatment fails, surgical treatments have been designed to alleviate compression, decrease tension, or both. Traditional surgical approaches provide extensile exposure to provide access to constricting anatomy, while preventing injury to vulnerable anatomy. Minimally invasive techniques attempt to provide the same efficacy while minimizing complications, pain, and surgical trauma to the nerve and expediting recovery through smaller skin incisions [1]. The ulnar nerve is the most commonly affected nerve at the elbow; to a lesser degree the radial nerve can be impacted. For most ulnar pathology, an in situ decompression may be adequate to treat the patient’s symptoms. If there is an associated instability of the nerve, or if the decompression leads to instability, the surgeon may opt to transpose the nerve. Furthermore, in cases of capsular releases with large gains in motion, it may be beneficial to either decompress or transpose the nerve to avoid an ulnar nerve palsy. Multiple techniques have been described to treat these conditions; what is paramount is a careful understanding of the anatomy in question.