Simple Decompression of the Ulnar Nerve: An Alternative to Anterior Transposition

Abstract

Anterior transposition and/or medial epicondylectomy are often considered procedures of choice for ulnar neuropathy at the elbow. Much experience suggests simple decompression to be a comparably effective alternative which involves less trauma, morbidity, and rehabilitation time. The post-operative clinical and electrophysiological results of 52 cases of simple decompression (41 patients) are summarized. Excellent or good clinical results were found in 75% of the nerves. Mean ulnar motor conduction velocities were significantly improved post-operatively, although nerve conduction parameters did not consistently correlate with clinical outcome. The average return-to-work time was 5.1 weeks. The advantages of simple decompression make it the procedure of choice for most cases of ulnar neuropathy.

Recovery of ulnar innervated intrinsic muscles following anterior transposition of the ulnar nerve

“…The analysis by Bartels et al (20) Two studies by Nathan et al (9,10) reported results for simple decompression, assessing outcome by patients reporting decreased symptoms of numbness or tingling. A satisfactory result indicated a greater than 50% reduction in symptoms.…”

Minimal Epicondylectomy Improves Neurologic Deficits in Moderate to Severe Cubital Tunnel Syndrome

“…Simple decompression of the ulnar nerve around the elbow [1,10,25,32], medial epicondylectomy [6,11,17,19], or anterior transposition [15,23] have advantages and disadvantages. Thus the choice generally is based on the surgeon's preference and experience [24,30,36].…”

Selection of Operative Procedures for Cubital Tunnel Syndrome

“…Much of the controversy of the operative procedure for carpal tunnel syndrome is the method by which to release the ligament but most surgeons would agree that successful management of patients with carpal tunnel syndrome depends on complete release of the flexor retinaculum [1,3,6,17,22]. In contrast for cubital tunnel syndrome, there are numerous operative procedures that have been described for the treatment of cubital tunnel syndrome ranging from simple decompression, medial epicondylectomy to transposition of the ulnar nerve [2,4,7,9,12,13,14,15,16,19,21,23,24,25,26,27,29,30,31]. These procedures vary not only in surgical technique but also in the correction of the etiologic factors.…”

“…There are numerous operative procedures described for the treatment of cubital tunnel syndrome ranging from simple decompression, medial epicondylectomy to transposition of the ulnar nerve [2,4,7,9,12,13,14,15,16,19,21,23,24,25,26,27,29,30,31]. With each operative procedure, there have been reports of excellent patient outcome as well as postoperative complications [10,11,18,28].…”