Case Series: A Minimally Invasive Tunneling Approach for Cubital Tunnel Syndrome

Abstract

Background Cubital tunnel syndrome (CuTS) is the second most common peripheral neuropathy in the United States. All three current surgical treatment approaches, consisting of in situ decompression, medial epicondylectomy, and transposition, require large curvilinear incisions and dissections that cross the medial epicondyle. However, the use of a large curvilinear incision may not be necessary for in situ decompression and may be achieved with small incisions proximal and distal to the medial epicondyle. This may limit the risk of peri-incisional pain and numbness, similar to the benefits provided by endoscopy. Objective The aim of this study is to evaluate a minimally invasive tunneling approach for in situ ulnar nerve decompression utilizing 2 cm incisions proximal and distal to the medial epicondyle. Methods A retrospective chart review was performed for patients at Emory University Hospital with CuTS who underwent minimally invasive tunneling for in situ decompression. Seven cases were identified. Patient demographics and data on post-operative complications were collected. Pre-operative severity was graded as a Modified McGowan severity. The primary outcome was evaluated using the post-surgical Messina Criterion. Secondary outcomes were reports of peri-incisional pain or numbness evaluated at follow-up. Descriptive statistics are presented. Results Pre-operatively, one of the seven cases was Grade I McGowan and the remaining six were Grade 2a or 2b. Post-operatively, on the Messina Criterion, four of seven patients were rated as having “Good” outcomes, two of seven had “Fair”, while one of seven had “Poor.” There was one post-operative surgical site infection. Among the other six cases, there were no reports of peri-incisional pain or numbness. Conclusions The use of less-invasive tunneling approach to in situ decompression yielded positive outcomes in this case series with no reports of peri-incisional pain or numbness. A prospective trial may be useful to explore the theoretical benefits of this novel tunneling approach.

Cost-saving Minimal Incision Endoscopic-assisted Cubital Tunnel Release Using Simple Surgical Instruments: Case Series

“…There were many common complications, such as peri-incisional pain or numbness, wound dehiscence, hematomas, or iatrogenic nerve injury, reported. These complications could be related to the large incision required [6]. Recently, minimally invasive procedures, such as the minimal incision and endoscopic techniques, have become more favorable, with the theoretical benefits of a smaller incision, reduced pain and time of return to work, and iatrogenic injury to nerve branches, vessels, and surrounding tissue [12].…”

“…Recently, minimally invasive procedures, such as the minimal incision and endoscopic techniques, have become more favorable, with the theoretical benefits of a smaller incision, reduced pain and time of return to work, and iatrogenic injury to nerve branches, vessels, and surrounding tissue [12]. With the technique that this study proposed, the incision needed was 7-9 mm, which is considered almost half that in the minimal incisional technique [6,13]. But it still has the benefit of the endoscope maintaining clear visualization along the decompression side.…”

“…The classical incision normally uses an 8-10 cm length of incision, which allows wide exposure but endangers the median antebrachial cutaneous nerve (MABC) as well as causes postoperative pain and increases healing time [2,5]. Various minimal incision techniques were proposed using the mobility of the soft tissue around the elbow to shorten the recovery time and reduce scar tenderness and iatrogenic injury to MABC [6]. The cadaveric studies show that the compressive structures spanning from an average of 8.2 cm.…”