Results of endoscopically assisted decompression of the ulnar nerve in the elbow region

Česká verzia

Authors: H. Zítek ¹; I. Humhej ^1,2; D. Kachlík ²; M. Sameš ¹
Authors place of work: Neurochirurgická klinika FZS UJEP, a KZ, a. s. – Masarykovy nemocnice, v Ústí nad Labem, o. z. ¹; Ústav anatomie 2. LF UK, Praha ²
Published in the journal: Cesk Slov Neurol N 2021; 84/117(2): 199-204
Category: Original Paper
doi: https://doi.org/10.48095/cccsnn2021199

Summary

Aim: The aim of the study was to analyse results of endoscopically assisted decompression of the ulnar nerve in the cubital tunnel in a substantial number of patients with cubital tunnel syndrome. Materials and methods: We analysed a set of 204 patients with the diagnosis of cubital tunnel syndrome, in whom we performed 213 endoscopically assisted decompressions of the ulnar nerve in the cubital tunnel from May 2007 until December 2016. Firstly, the patients were followed for 3 months after surgery (70% of the patients) and secondly, we evaluated long-term results based on our own questionnaire completed by 55% of patients. Results: Out of 149 followed cases (141 patients), improvement or significant improvement was found in 90% of them. Nine percent of the patients described stationary symptoms and 1% felt worse. Postoperative electrophysiological examination was performed in 137 patients. Results were as follows: improvement in 89%, no change in 10%, and worsening in 1% (N = 2) of the cases. Both of these worsening’s were temporary and subsequent electromyography showed improvement after 10 and 15 months, respectively, without a need for revision surgery also due to the improved clinical condition. We obtained the completed survey from 115 patients (121 surgeries) with a follow-up of 14–129 months, 60 months on average. Overall improvement of the operated hand was expressed by 92% of patients, while 89.5% of them described a satisfactory effect of the procedure and its course. We failed to prove a statistically significant relationship between the severity of preoperative symptoms (McGowan score or electromyography finding) and the patient’s postoperative satisfaction. On the contrary, we found a strong relationship between the patient’s satisfaction after surgery and subjective return of hand sensitivity or improvement of grip strength. Conclusion: Our study proves that endoscopically assisted decompression of the ulnar nerve in cubital tunnel represents a safe and reliable alternative to other surgical procedures of ulnar nerve decompression. With the correct indication provided, the procedure leads to long-term improvement of the symptoms of cubital tunnel syndrome in vast majority of patients, including patients with a severe nerve lesion.

Keywords:

cubital tunnel syndrome – ulnar nerve – surgical decompression – endoscopy – questionnaire

Zdroje

1. Mondelli M, Giannini F, Ballerini M et al. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci 2005; 234(1–2): 5–10. doi: 10.1016/ j.jns.2005.02.010

2. Ehler E, Ridzoň P, Fenclová Z et al. Kompresivní neuropatie jako nemoc z povolání. Ces Slov Neurol N 2019; 82/ 115(5): 478–489. doi: 10.14735/ amcsnn2019478.

3. Feindel W, Stratford J. The role of the cubital tunnel in tardy ulnar palsy. Can J Surg J Can Chir 1958; 1(4): 287–300.

4. Osborne G. The surgical treatment of tardy ulnar neuritis. J Bone Joint Surg 1957; 39(4): 782.

5. Bartels RH, Verhagen WI, van der Wilt GJ et al. Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: part 1. Neurosurgery 2005; 56(3): 522–530. doi: 10.1227/ 01.neu.0000154131.01167.03.

6. Biggs M, Curtis JA. Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition. Neurosurgery 2006; 58(2): 296–304. doi: 10.1227/ 01.NEU.0000194847.04143.A1.

7. Gervasio O, Gambardella G, Zaccone C et al. Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: a prospective randomized study. Neurosurgery 2005; 56(1): 108–117. doi: 10.1227/ 01.neu.0000145854.38234.81.

8. Nabhan A, Ahlhelm F, Kelm J et al. Simple decompression or subcutaneous anterior transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg 2005; 30(5): 521–524. doi: 10.1016/ j.jhsb.2005.05.011.

9. Krejčí T, Večeřa Z, Krejčí O et al. Comparing endoscopic and open decompression of the ulnar nerve in cubital tunnel syndrome: a prospective randomized study. Acta Neurochir (Wien) 2018; 160(10): 2011–2017. doi: 10.1007/ s00701-018-3647-0.

10. Schmidt S, Kleist Welch-Guerra W, Matthes M et al. Endoscopic vs open decompression of the ulnar nerve in cubital tunnel syndrome: a prospective randomized double-blind study. Neurosurgery 2015; 77(6): 960–971. doi: 10.1227/ NEU.0000000000000981.

11. Bolster MJ, Zöphel OT, van den Heuvel ER et al. Cubital tunnel syndrome: a comparison of an endoscopic technique with a minimal invasive open technique. J Hand Surg Eur Vol 2014; 39(6): 621–625. doi: 10.1177/ 1753193413498547.

12. Humhej I, Sames M. Syndrom útlaku ulnárního nervu v oblasti lokte – přehled operačních technik a srovnání jejich výsledků. Cesk Slov Neurol Neurochir 2010; 73(5): 510–516.

13. Tsai TM, Bonczar M, Tsuruta T et al. A new operative technique: cubital tunnel decompression with endoscopic assistance. Hand Clin 1995; 11(1): 71–80.

14. Mirza A, Reinhart MK, Bove J et al. Scope-assisted release of the cubital tunnel. J Hand Surg 2011; 36(1): 147–151. doi: 10.1016/ j.jhsa.2010.10.016.

15. Hoffmann R, Siemionow M. The endoscopic management of cubital tunnel syndrome. J Hand Surg Edinb Scotl 2006; 31(1): 23–29. doi: 10.1016/ j.jhsb.2005.08.008.

16. Krishnan KG, Pinzer T, Schackert G. A novel endoscopic technique in treating single nerve entrapment syndromes with special attention to ulnar nerve transposition and tarsal tunnel release: clinical application. Neurosurgery 2006; 59 (Suppl 1): ONS89-100. doi: 10.1227/ 01.NEU.0000219979.23067.5C.

17. Mc Gowan AJ. The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg Br 1950; 32-B(3): 293–301. doi: 10.1302/ 0301-620X.32B3.293.

18. Dellon AL. Techniques for successful management of ulnar nerve entrapment at the elbow. Neurosurg Clin N Am 1991; 2(1): 57–73.

19. Felder JM, Mackinnon SE, Patterson MM. The 7 structures distal to the elbow that are critical to successful anterior transposition of the ulnar nerve. Hand (N Y) 2019; 14(6): 776–781. doi: 10.1177/ 1558944718771390.

20. Pavelka M, Rhomberg M, Estermann D et al. Decompression without anterior transposition: an effective minimally invasive technique for cubital tunnel syndrome. Minim Invasive Neurosurg 2004; 47(2): 119–123. doi: 10.1055/ s-2004-818453.

21. Tsai TM, Chen IC, Majd ME et al. Cubital tunnel release with endoscopic assistance: results of a new technique. J Hand Surg 1999; 24(1): 21–29. doi: 10.1053/ jhsu.1999.jhsu25a0021.

22. Ahcan U, Zorman P. Endoscopic decompression of the ulnar nerve at the elbow. J Hand Surg 2007; 32(8): 1171–1176. doi: 10.1016/ j.jhsa.2007.07.004.

23. Dützmann S, Martin KD, Sobottka S et al. Open vs retractor-endoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome: a retrospective cohort study. Neurosurgery 2013; 72(4): 605–616. doi: 10.1227/ NEU.0b013e3182846dbd.

24. Watts AC, Bain GI. Patient-rated outcome of ulnar nerve decompression: a comparison of endoscopic and open in situ decompression. J Hand Surg 2009; 34(8): 1492–1498. doi: 10.1016/ j.jhsa.2009.05.014.