gms | German Medical Science

Objective: Recently, several publications suggested that there might be an advantage of endoscopic ulnar nerve decompression compared to open decompression in cubital tunnel syndrome. Fibrous bands distally to the “FCU arch” are suspected to be commonly responsible for compression and are accessible only by the endoscopic technique. The aim of the study was to compare the long- and short-term results of both techniques.

Method: From 10/08 to 04/11 54 patients underwent ulnar nerve decompression for 56 cubital tunnel syndromes. All patients presented with typical clinical signs and neurophysiology. The patients received preoperative ulnar nerve ultrasound. They were randomized for either endoscopic or open operation. There were no significant differences between the groups in term of age, severeness of pain and symptoms, or duration of complaints. Under general anaesthesia 29 nerves were decompressed endoscopically and 27 nerves open. The patients as well as the physician performing the postop follow-up examination were blinded and the follow-up took place 3, 6, 12 and 24 months postoperatively.

Results: Intraoperatively we found the well-described compressing structures, mostly the FCU arch and the fascia on the roof of the bony ulnar sulcus. Endoscopically, in none oft the cases we could see distal, nerve-compressing fibrous bands within the Flexor carpi ulnaris. The outcome was classified as “good” or “excellent” (modified Bishop Score) in 46 of 56 cases (82,1%). There were 9 patients who did not improve sufficiently or had a later relapse and underwent a second surgery. Significantly more hematomas occurred after endoscopic decompression (n=0,05). Otherwise we neither found differences in the early follow-up nor in the last follow-up concerning the clinical outcome and neurophysiology.

Conclusions: There are no benefits for the endoscopic technique. Furthermore we could not detect fibrous bands compressing the nerve more than 4cm distally to the bony sulcus. Therefore in our opinion an extensive endoscopic decompression far distal to the FCU is not routinely needed to achieve good results.