Minimally Invasive Ulnar Nerve Decompression for Cubital Tunnel Syndrome

Yong-Jun Cho; Sung-Min Cho; Seung-Hoon Sheen; Dong-Hwa Heo; Jun-Hyung Cho; Sae-Moon Oh

doi:10.13004/jknts.2009.5.1.16

Journal List > J Korean Neurotraumatol Soc > v.5(1) > 1084043

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Cho, Cho, Sheen, Heo, Cho, and Oh: Minimally Invasive Ulnar Nerve Decompression for Cubital Tunnel Syndrome

Clinical Article

Journal of Korean Neurotraumatology Society 2009; 5(1): 16-21.

Published online: 30 June 2009

DOI: https://doi.org/10.13004/jknts.2009.5.1.16

Minimally Invasive Ulnar Nerve Decompression for Cubital Tunnel Syndrome

Yong-Jun Cho, MD, Sung-Min Cho, MD, Seung-Hoon Sheen, MD, Dong-Hwa Heo, MD, Jun-Hyung Cho, MD, Sae-Moon Oh, MD

Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chucheon, Korea.

Address for correspondence: Yong-Jun Cho, MD. Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, 153 Gyo-dong, Chucheon 200-704, Korea. Tel: +82-33-240-5173, Fax: +82-33-242-9970, nssur771@hanmail.net

Received 26 September 2008 Revised 31 December 2008 Accepted 31 December 2008

Abstract

Objective

The purpose of this study is to present the efficacy of the surgical technique using a minimal skin incision for the treatment of cubital tunnel syndrome. Ulnar nerve entrapment at the elbow is the second most common compression neuropathy of the upper extremity. Surgical treatment of conventional simple decompression of ulnar nerve is considered to be relatively safe and reliable. However, this surgical technique is needed a relatively long incision and often can result in significant postoperative scarring and delay in return to work.

Methods

Ten patients with cubital tunnel syndrome underwent simple decompression using a 2 cm or less skin incision. According to Dellon's criteria, one elbow was classified as grade 1, four as grade 2, and five as grade 3. Preoperative electrodiagnostic studies were performed on all patients and 6 of them were rechecked postoperatively.

Results

Preoperative motor conduction velocity (MCV) within the segment was 35.5±16.2 m/s and decreased than the result of MCV in the below the elbow-wrist segment (59.3±5.9 m/s, p<0.05). Postoperative results of MCV were improved in all patients from 37.1±13.2 m/s to 51.9±8.9 m/s (p<0.05). After an average follow-up of 5.9±5.0 months, all patients were reported to be in good or excellent condition.

Conclusion

We could observe an enough distance of the ulnar nerve from proximal to distal area without difficulty using manual retraction. Simple decompression through a small skin incision can be recommended for the treatment of cubital tunnel syndrome, if the indication is appropriate.

Keywords: Cubital tunnel syndrome, Ulnar nerve, Minimally invasive

Figures and Tables

FIGURE 1

Skin marking at left elbow for simple decompression of ulnar nerve using a small incision. A 2 cm skin incision made between the medial epicondyle (E) and olecranon (O). Left side of photo is proximal.

FIGURE 2

Intraoperative photo shows the ulnar nerve (asterisk) and Osborne's ligament (black arrow).

FIGURE 3

The skin is retracted to distal side with a retractor. The released ulnar nerve (asterisk) and a head of flexor carpi ulnaris muscle (black arrow) are seen.

FIGURE 4

The skin is retracted to proximal side with a retractor. The ulnar nerve (asterisk) is released.

TABLE 1

Dellon's classification of cubital tunnel syndrome (n=10)

TABLE 2

Modified Bishop's scoring system

^*medical council grading

TABLE 3

Surgical results

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