Christine Bultmann1, Reimer Hoffmann. 1. Klinik für Handchirurgie, Rhön-Klinikum, Bad Neustadt, Germany. ChristineBultmann@t-online.de
Abstract
OBJECTIVE: Long endoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome (sulcus ulnaris syndrome) with direct visualization and minimal incision. INDICATIONS: Every cubital tunnel syndrome including a posttraumatic or arthrotic etiology, cubitus valgus, nerve dislocation, or other causes. Revision surgery after primary endoscopic decompression. Relative: irritation of the ulnar nerve by recurrent luxation. CONTRAINDICATIONS: Relative: previous open primary surgery. SURGICAL TECHNIQUE: Minimal longitudinal incision in the retrocondylar groove. The Osborne ligament is opened and the ulnar nerve identified. Dissection of a subcutaneous tunnel in the direction of the nerve. Decompression of the ulnar nerve by opening the muscle fascia proximally and distally while preserving all sensory nerves. Afterwards, the submuscular membrane with its fibrous bands between flexor carpi ulnaris and the nerve is opened while preserving all motor branches of the ulnar nerve. POSTOPERATIVE MANAGEMENT: Bulky, slightly compressive dressing of the entire upper extremity to prevent excessive motion in 20 degrees elbow flexion for 3 days. Then, free motion is allowed during the day. At night, the arm should be kept in near extension for 14 days. Muscular atrophy prior to surgery should imply focused physiotherapy for ulnaris-innervated muscles 8 weeks postoperatively. RESULTS: 52 patients were operated using this method. 53% felt an immediate improvement right after surgery. 47 patients (90%) were available for reexamination after 8 months. Two-point discrimination, grip and pinch strength, and nerve conduction velocity had improved significantly to normal levels. Results, measured with the modified Bishop Rating System, were excellent in 66%, good in 32%, and fair in 2%. There were no poor results. Patients with advanced stages of disease also achieved good results.
OBJECTIVE: Long endoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome (sulcus ulnaris syndrome) with direct visualization and minimal incision. INDICATIONS: Every cubital tunnel syndrome including a posttraumatic or arthrotic etiology, cubitus valgus, nerve dislocation, or other causes. Revision surgery after primary endoscopic decompression. Relative: irritation of the ulnar nerve by recurrent luxation. CONTRAINDICATIONS: Relative: previous open primary surgery. SURGICAL TECHNIQUE: Minimal longitudinal incision in the retrocondylar groove. The Osborne ligament is opened and the ulnar nerve identified. Dissection of a subcutaneous tunnel in the direction of the nerve. Decompression of the ulnar nerve by opening the muscle fascia proximally and distally while preserving all sensory nerves. Afterwards, the submuscular membrane with its fibrous bands between flexor carpi ulnaris and the nerve is opened while preserving all motor branches of the ulnar nerve. POSTOPERATIVE MANAGEMENT: Bulky, slightly compressive dressing of the entire upper extremity to prevent excessive motion in 20 degrees elbow flexion for 3 days. Then, free motion is allowed during the day. At night, the arm should be kept in near extension for 14 days. Muscular atrophy prior to surgery should imply focused physiotherapy for ulnaris-innervated muscles 8 weeks postoperatively. RESULTS: 52 patients were operated using this method. 53% felt an immediate improvement right after surgery. 47 patients (90%) were available for reexamination after 8 months. Two-point discrimination, grip and pinch strength, and nerve conduction velocity had improved significantly to normal levels. Results, measured with the modified Bishop Rating System, were excellent in 66%, good in 32%, and fair in 2%. There were no poor results. Patients with advanced stages of disease also achieved good results.