Anterior transposition of the ulnar nerve with endoscopic assistance

Konishiike, T.; Nishida, Keiichiro; Ozawa, Masatsugu; Ozaki, Toshifumi

doi:10.1177/1753193410381675

Cited by 20 publications

(8 citation statements)

References 7 publications

(11 reference statements)

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“…The aim is to preserve blood supply and avoid perineural fibrosis. The size of the incision varies from 1.5 to 3 cm, both for neurolysis (Mirza et al, 2011) as well as transpositions (Konishiike et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Ulnar nerve transposition using a mini-invasive approach: case series of 30 patients

Lequint¹,

Naïto

Awada³

et al. 2012

J Hand Surg Eur Vol

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The treatment of ulnar nerve compression at the elbow remains controversial. No single technique has yet proven its superiority. We describe a technique combining the advantages of the mini-invasive approach with those of transposition. We present the results of 30 patients, of mean age 52 years, who underwent anterior subcutaneous transposition of the ulnar nerve using a mini-invasive approach with a follow-up of more than six months. The incision measures 3 cm. The results were evaluated by measuring pain intensity, quick disabilities of the arm shoulder and hand (DASH), grip strength and pinch, and McGowan score, pre- and post-operatively. All parameters were improved post-operative. The mean pain score went from 5.5 to 4, the quick DASH from 48 to 38, mean grip strength from 28 to 31 kg, and mean pinch strength from 4.7 to 6.4 kg. The McGowan score was also improved; pre-operatively, there were 16 patients at stage III, seven patients stage II, seven patients stage I, and post-operatively there was one patient stage III, three patients stage II, 16 patients stage I, and 10 patients stage 0. Analysis of our series shows that a 3 cm incision without endoscopy allows subcutanous transposition, with results at least as good as those with other techniques. The advantages of our technique are that it is easy, has a limited approach, preserves blood supply, allows placement of the nerve in a favourable environment, and decreases nerve stretching during elbow flexion.

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Section: Discussionmentioning

confidence: 99%

Ulnar nerve transposition using a mini-invasive approach: case series of 30 patients

Lequint¹,

Naïto

Awada³

et al. 2012

J Hand Surg Eur Vol

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show abstract

“…The handling of the nerve and surrounding tissue dissection is kept to a minimum (Karthik et al, 2012). Recent articles by Lequint et al (2013) and Konishiike et al (2011) describe the advantages of a minimal invasive open approach without and with endoscopic assistance, respectively. In their studies they also transpose the nerve, which we believe unnecessarily reduces blood supply to the nerve (however they claim not to) and creates a larger wound surface.…”

Section: Discussionmentioning

confidence: 99%

Cubital tunnel syndrome: a comparison of an endoscopic technique with a minimal invasive open technique

Bolster

Zöphel

Heuvel

et al. 2013

J Hand Surg Eur Vol

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Both open and endoscopic methods for ulnar nerve decompression have been described. The purpose of this study is to compare the 6-month results of a minimal invasive open technique with an endoscopic technique. We treated 60 patients with unilateral ulnar neuropathy at the elbow, employing both techniques. Six months postoperative we found no differences in treatment effect on pain and disability scores between both groups, but both techniques resulted in an early postoperative relief of symptoms and good patient satisfaction.

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“…The procedure is safe and can be performed with little risk of damaging the antebrachial cutaneous nerve. Two other groups have described similar endoscopic techniques, one using a transparent sheath to guide the endoscope 15 and the other using CO 2 insufflation to produce a subcutaneous pocket to allow fascial release. 16 The limitation of this study was that a number of surgical options are available, whereas the number of unstable nerves at presentation is low, and hence a comparison between the methods was not possible.…”

Section: Discussionmentioning

confidence: 99%

Endoscopy-assisted subfascial anterior transposition of the ulnar nerve for the treatment of cubital tunnel syndrome

Wong

Hsu

Lin

et al. 2016

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Summary Background: Many techniques have been described to relieve the compression and reduce subluxation of the ulnar nerve following surgery. The subfascial anterior transposition of the ulnar nerve (SfATUN) is one described technique, but involves a long scar, risk of injury to the medial antebrachial cutaneous nerve, and possible nerve ischemia from anterior transposition. We assessed a more refined approach of endoscopy-assisted SfATUN for the treatment of cubital tunnel syndrome. Methods: A consecutive case series of 21 patients (15 males and 6 females) with evidence of nerve subluxation after ulnar nerve decompression were operated using an endoscopyassisted SfATUN. Each patient was assessed with pre-and postoperative nerve conduction studies, McGowan grading, and recovery of grip strength. Results: The average age of patients was 54 years (range 23e74 years), and they were followed up for a mean of 9 months (range 3e22 months). Preoperative McGowan grades were eight grade II and 13 grade III. Eighteen of the 21 patients showed improvement, including improvement by two McGowen grades in 8 patients and improvement by one grade in 10 patients. Three grade III patients did not show improvement in grading after surgery. A proportion of 90% of patients showed significant improvements in motor nerve conduction velocity of the ulnar nerve across the elbow (p < 0.001), and all showed some improvement in grip strength (p < 0.001). One patient underwent redo neurolysis. Conclusion: A combination of endoscopy-assisted SfATUN allows for decompression transposition and reduced strain on the ulnar nerve through a small scar. This is now our standard approach for cubital tunnel syndrome and the "unstable" nerve.

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Anterior transposition of the ulnar nerve with endoscopic assistance

Cited by 20 publications

References 7 publications

Ulnar nerve transposition using a mini-invasive approach: case series of 30 patients

Ulnar nerve transposition using a mini-invasive approach: case series of 30 patients

Cubital tunnel syndrome: a comparison of an endoscopic technique with a minimal invasive open technique

Endoscopy-assisted subfascial anterior transposition of the ulnar nerve for the treatment of cubital tunnel syndrome

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