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Background:

Ulnar nerve entrapment is the second most common compression neuropathy. Despite many studies evaluating outcomes of various techniques for decompression, there lacks agreement on one gold standard. It is generally accepted that an intra-operative finding of dynamic subluxation of the ulnar nerve over the medial epicondyle should be corrected by fixation or transposition of the ulnar nerve. We present here a novel technique using a slip of medial head of triceps to secure the ulnar nerve in situ following cubital tunnel release.

Method:

An intra-operative finding of dynamic ulnar nerve subluxation during cubital tunnel release was treated by harvesting a slip of medial head of triceps and securing it to joint capsule over the medial epicondyle. A retrospective chart review of patients undergoing this procedure was performed to evaluate post-operative outcomes.

Results:

Seventy-five patients underwent this procedure between 2005-2016 by two surgeons. Intra-operatively, in situ stimulation shows that the triceps sling does not contract over the ulnar nerve. Ten patients had pre-existing chronic ulnar nerve subluxation, 2 patients had recurrent ulnar nerve compression despite anterior transposition, and 63 patients had findings of dynamic ulnar nerve subluxation following standard in-situ cubital tunnel release. Mean follow-up with 3 months to 1 year. All patients had clinical resolution or improvement of the ulnar nerve compression neuropathy. There was no recurrence of ulnar nerve subluxation, no exacerbation of ulnar neuropathy, and no triceps weakness or pain with elbow extension at last follow-up appointment.

Conclusions:

Fixation of the ulnar nerve in situ with a slip of the medial head of triceps is a safe and effective procedure for eliminating ulnar nerve subluxation over the medial epicondyle. A short surgical video illustrating this procedure will be included in the presentation.