Artikel
Long-term functional results of endoscopic cubital tunnel release
Langzeitergebnis nach endoskopischer Operation des Sulcus ulnaris Syndroms
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Autoren
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R. Hoffmann
- Abteilung für Plastische Chirurgie und Handchirurgie, Evangelisches Krankenhaus Oldenburg
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M. Wrobel
- Abteilung für Plastische Chirurgie und Handchirurgie, Evangelisches Krankenhaus Oldenburg
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Compression of the ulnar nerve in the cubital tunnel is the second most frequent entrapment neuropathy of the upper extremity. New approaches to peripheral nerve surgery include the introduction of minimally invasive and endoscopic procedures. The purpose of this paper is to present the rationale, clinical and anatomical indications, and a detailed technique of our own endoscopic technique of in situ ulnar nerve decompression at the elbow, to assess the results in a series of 75 patients and to discuss clinical indications and the anatomical basis for this minimally invasive procedure.
Methods: Anatomical study: 12 fresh cadaver arms were dissected to validate the need for extensive distal release of the ulnar nerve in patients with cubital tunnel syndrome.
Clinical study: 73 patients and 75 elbows were treated with an endoscopic cubital tunnel release technique. Indications for surgical decompression of the ulnar nerve included symptomatic patients with the evidence of muscle weakness and sensory deficits confirmed by neurosensory testing. A detailed description of the surgical technique is presented.
Results: Findings of the anatomical study were consistent in all specimens and showed evidence of 3 distinct fascial bands crossing the ulnar nerve up to a distance of 9 cm measured from the retrocondylar fossa. Mean length of the skin incision was 22 mm. Mean length of the ulnar nerve decompression was 17 cm. 95% reported improvement of symptoms within 24 hours after surgery. 92% of the patients had full elbow motion within 2 days after surgery. Preoperative sensory loss improved in 96% of all patients. Highly significant gain in strength after surgery. No recurrences. In all cases (80%) in whom postoperative nerve conduction studies were carried out, the results had improved. Ninety-eight percent of the patients returned to their previous jobs or activities. According to the modified Bishop Rating System, we found excellent results in 46 patients (60.5%), good results in 25 patients (33%) and fair results in 4 patients (5%). One patient (1%) had a poor result (Table 4).
Conclusions: After performing a total of 202 cases of this procedure with the same results, we recommend our technique as a valuable alternative to the known techniques of simple decompression of the ulnar nerve at the elbow. It is a "long distance " in situ nerve decompression based on anatomical evidence which is simple and atraumatic. It also avoids the complexity and complications of transposition procedures.
