Cubital tunnel syndrome does not require transposition of the ulnar nerve

A simple, safe and reliable surgical landmark for medial epicondylectomy

“…The rationale for ISD is that, on flexion, the shape of the cubital tunnel changes and this leads to neurological compression. Because of its high success rate and simplicity, ISD is usually the procedure of choice [14]. It is not generally recommended to perform ISD if the floor of the cubital tunnel is abnormal or if the ulnar nerve is unstable or in the presence of significant cubitus valgus and, in these situations, ME or anterior transposition is favoured.…”

“…In an anatomical study, O'Driscoll et al estimated that only 20% of the width of the ME could be resected without violating the ligament [12]. The risk of clinical valgus instability after ME is low, although the radiological incidence is higher [1,8,14]. This may be a result of the inherent stability of the elbow and also because, even when the aim of surgery is a complete medial epicondylectomy, this is often not actually performed [8,14].…”

“…If <20% was excised, it was termed a minimal epicondylectomy. Other studies have dissected the anterior band of the UCL and performed the osteotomy at its medial margin [14,21,24]. An alternative description is to excise a fragment of a particular size; this is variable, ranging from 2 mm to 8 mm [7][8][9][10][11]13].…”

Submuscular Versus Subcutaneous Anterior Ulnar Nerve Transposition: A Rat Histologic Study

“…23 Conversely, anterior transposition has notable disadvantages, including the complexity of the procedure, possible devascularization of the nerve, intraneural injury, perineural fibrosis, and injury to the motor branches of the flexor carpi ulnaris. 24 Recent evidence in the literature suggests that in situ decompression offers results similar to anterior transposition, without these complications. [25][26][27][28] Thus, clinicians disagree as to whether anterior transposition is necessary in addition to in situ decompression.…”

Scope-Assisted Release of the Cubital Tunnel

“…5,18,[22][23][24][25] A medial epicondylectomy adds more risk because it requires removal of osseous tissue, which can lead to bone pain, heterotopic ossification, or ulnar nerve vulnerability. 25,26 Instability to the medial elbow, although rare, may also result, 26 but this is typically from an unsatisfactory medial epicondylectomy. 25 Anterior transposition of the nerve adds considerably more risk because it requires removal of the nerve from its natural bed in the retrocondylar groove.…”