Abstract
Cubital tunnel syndrome is the second most common nerve entrapment disorder in the upper extremity. Most cases of idiopathic cubital tunnel syndrome will resolve without surgical intervention. Those who remain symptomatic despite conservative treatment are offered surgery. There is no consensus for the best surgical approach; however, simple release has become increasingly popular, yielding excellent surgical outcomes with fewer complications. Endoscopic release is the newest surgical option for simple release of the ulnar nerve at the elbow.
There are two types of endoscopic release performed through a single small portal: one method requires the use of specialized dissection equipment and the other using a cannula designed specifically for this purpose. This chapter will detail the indications, contraindications, surgical technique, tips and tricks, pitfalls, postoperative management, complications, and results of endoscopic release of the ulnar nerve at the elbow for cubital tunnel syndrome using a cannula method.
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Notes
- 1.
Some surgeons may find it to be a relative contradiction to be unable to achieve the optimal elbow exposure due to limited shoulder range of motion; however this should become less of a problem once the surgeon is more comfortable performing the procedure.
References
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Cobb TK, Sterbank P. Five year review of endoscopic cubital tunnel release. (Abstruct Publication SP41). J Hand Surg (Br). 2008;33E(Suppl 1):49.
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Acknowledgment
Peter Schillaci for assistance with figures and videos.
Declaration of Conflict of Interest: Dr. Cobb has financial interest with Integra Life Sciences, who manufactures and sells the instrumentation for this procedure. Elizabeth Elander has no conflicts of interest to declare.
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1 Electronic Supplementary Material
Complete (start to finish) clinical case of endoscopic cubital tunnel release showing both proximal and distal release with external and endoscopic views (MP4 32803Â kb)
An illustrated overview of the surgical anatomy identifying the layers required for release including the deep fascia, FCU muscle, and fascia deep to the FCU (MP4 30057Â kb)
A detailed presentation of the EndoReleaseâ„¢ cannula and attached retractor (MP4 52386Â kb)
Cadaver demonstration of placement of cannula in the distal portion of release with dissected layers (MP4 75788Â kb)
Clinical case after distal release showing ulnar nerve decompression (MP4 27923Â kb)
How to manage the pulsatile bleeder (MP4 19202Â kb)
Case showing release on an obese patient which typically requires a larger incision and fat pad rotated anteriorly (MP4 16110Â kb)
Demonstration of distal release with detailed description of how to know when the release is complete (MP4 45175Â kb)
Case of ulnar nerve rotated into harm’s way and how to handle it (MP4 20699 kb)
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Cobb, T.K., Elander, E.R. (2020). Endoscopic Cubital Tunnel Release. In: Bain, G., Eygendaal, D., van Riet, R. (eds) Surgical Techniques for Trauma and Sports Related Injuries of the Elbow. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58931-1_99
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DOI: https://doi.org/10.1007/978-3-662-58931-1_99
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