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Endoscopic Cubital Tunnel Decompression - A modified technique
Chris Bainbridge, MBChB, FRCS; Nakul Kain, MBBS, MRCS; The Pulvertaft Hand Unit
The Pulvertaft Hand Unit, Derby, United Kingdom

Introduction

Over the last 10yrs, Endoscopic Cubital Tunnel Decompression (ECuTR) has grown in popularity with the minimally invasive technique achieving better symptom relief and less scarring compared to open techniques.1 We present a new suprafascial technique which not only allows more extensive ulnar nerve decompression as with current techniques, but also protects against injury to the medial cutaneous nerve.

Technique

A 3cm transverse incision is made just distal to the elbow using the medial epicondyle and olecranon as landmarks. Unique to this technique is the suprafascial plane and custom instrumentation (Tulip) used to approach the ulnar nerve. This allows direct visualisation and release of constricting structures, thus facilitating an extensile approach to the decompression.

Methods

A retrospective analysis of case notes was carried out on all patients who underwent endoscopic cubital tunnel decompression over a 4yr period (2008 -2011). Data regarding the preoperative nerve conduction studies, surgical technique and complications were extracted.

Results

121 patients underwent endoscopic cubital tunnel decompression over the 4yr period. Over 90% of patients had ulnar nerve compression confirmed on nerve conduction studies. Patients were discharged at 6 week follow up if symptoms had improved. Improvement/resolution of symptoms was present in 90% of cases. Complication rate is comparable to current literature.

Conclusion

The senior author's endoscopic technique for cubital tunnel decompression is successful and satisfactory, allowing direct visualisation of the ulnar nerve throughout the procedure.

References

1. R. HOFFMANN and M. SIEMIONOW. The Endoscopic Management of Cubital Tunnel Syndrome. J Hand Surg [Br] 2006 31: 23


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