gms | German Medical Science

Objectives/Interrogation: A number of endoscopic techniques have been described utilising a traditional mini-open incision with a steep learning curve. We describe our experience of a suprafascial technique to decompress the ulnar nerve at the elbow using a custom-made Tulip® Endoscope System, and present the results from this novel technique. The Tulip ® Endoscope allows both blunt and sharp dissection, as well as excellent visualisation and access to all structures essential for nerve decompression.

Methods: The majority of patients had regional block anaesthesia with less than 10 opting for WALANT. The patient is positioned laterally, with the shoulder abducted and elbow flexed over a support. A 2 cm endoscopic portal in the proximal forearm allows identification of the flexor carpi ulnaris (FCU) fascia. The Tulip ® instrument is introduced and a channel over the fascia, identifying Osborne's fascia and medial epicondyle. A small constant perforating vessel helps identify the site of incision of Osborne's fascia. The remainder of the fascia and more proximal structures are divided with scissors under direct visualisation. Reversing the direction of the scope allows proximal to distal dissection deep to FCU, allowing for the division of all fascial bands down to distal third of the forearm.

Subsequently a retrospective single surgeon series involving 255 consecutive patients undergoing endoscopic cubital tunnel decompression (ECuTD) over a 9 year period (2008 to 2017) was conducted. The demographics, reoccurrence, and complications were recorded.

Results: From our cohort, there were 57 percent males (N=146) and 43 percent females (n=109). The mean age of our patients were 55 years (range 13 - 90).

2 cases (0.78 Percent) were converted to open procedures, one due to significant scar tissue, and the other for excessive patient movement. One patient (0.39 percent) had a post-operative haematoma. There were no instances of reoccurrence - defined as return of symptoms after a 3 months being symptom-free, However 4 (1.56 percent) patients underwent further open exploration for failure of relief of symptoms. 1 patient (0.39 Percent) was found to have a subluxating nerve and underwent anterior transposition. No injury to the medial cutaneous nerve of the forearm was observed.

Conclusions: Our results demonstrates that the Tulip ® Endoscope provides a safe and reproducible means to decompress the ulnar nerve at the elbow with very low complication, recurrence and re-operation rates.