Endoscopic Ulnar Nerve Decompression and Transposition

Endoscopic cubital tunnel decompression – Review of the literature

“…the presence of hostile bed, ulnar nerve hypermobility (refer to the above on discussion), cubital valgus and previous incomplete ulnar nerve decompression, the procedure can still be done under endoscopic guidance by creating an additional volar portal. 21,35,45…”

“…Conventionally, in the presence of ulnar nerve subluxation, concomitant ulnar nerve transposition at the time of surgical decompression is recommended. 9,10,[20][21][22][23][24] Interestingly Bartels et al 4 who randomized 152 patients suffering from cubital tunnel syndrome into either simple decompression and anterior subcutaneous transposition, irrespective of the mobility of their ulnar nerve, demonstrated that there was no significant difference in clinical outcomes between two groups at 1 year follow-up. There was no significant increase in persistent symptoms and recurrence.…”

“…If the nerve is found to be subluxatable or dislocatable during elbow flexion, anterior transposition is recommended by GB and MWM. [21][22][23][24] Prior to wound closure, hemostasis is obtained with long bipolar forceps. This is especially important in the presence of tourniquet use 13,19,[27][28][29] (Tables 1 and 2).…”

“…the presence of hostile bed, ulnar nerve hypermobility (refer to the above on discussion), cubital valgus and previous incomplete ulnar nerve decompression, the procedure can still be done under endoscopic guidance by creating an additional volar portal. 21,35,45 Contraindications Similar to endoscopic cubital tunnel release in situ. In addition, as this is a subcutaneous anterior transposition, in conditions like severe elbow contracture, previous trauma or surgery causing abundant scar around the elbow and in thin patients who predispose to ulnar nerve irritation, necessitating submuscular transposition, this technique is contraindicated.…”