Back to 2014 Annual Meeting Abstracts

Background: Cubital tunnel syndrome is the second most common upper extremity compression neuropathy, and multiple surgical techniques for release of the cubital tunnel have been described. These can generally be categorized as either open or endoscopic procedures with symptom relief reported to be 80 to 90%. Endoscopic release may limit postoperative pain and lead to higher patient satisfaction according to some studies, although such access has its disadvantages. Epicondylectomy and nerve transposition may be necessary in addition to nerve decompression, and endoscopic access can limit surgical exposure for these adjunct procedures. We present a short scar technique of 4 to 5 cm aided by a lighted retractor, with which most plastic surgeons are familiar, in order to take advantage of the merits of both open and endoscopic cubital tunnel release that can be desirable to both patient and surgeon.
Methods: We performed an IRB approved retrospective analysis of a single surgeon consecutive experience of ulnar nerve decompressions using a lighted retractor assisted short scar technique between 2008 and 2013. We evaluated subjective symptom relief as well as complications, which were defined as infection, hematoma, seroma, and wound dehiscence, to determine the utility of this technique.
Results: 38 patients underwent 41 consecutive ulnar nerve decompressions. Mean age was 54 (Range 30-81). Mean follow up was 6.8 months (range 0.5 to 40 months). 34% were men and 66% were women. Pre-operative diagnosis was confirmed by positive EMG/NCS in 80% of patients. The preoperative McGowan score, (1 for mild occasional paraesthesia, subjective weakness, and positive Tinel’s sign; 2 for moderate paraesthesia, objective weakness, and positive Tinel sign; 3 for severe constant paresthesia and overt muscle wasting) was utilized to rate the pre-operative severity of symptoms with a mean score of 2.3. The dominant hand was operated on in 44% of patients. Epicondylectomy with nerve transposition was performed on 21 (51%). Improvement of symptoms was achieved in 36 (88%), with 5 patients (12%) having no change in symptoms at last follow-up. There were no complications.
Conclusion: With 88% symptom relief and no complications, we present a safe technique that achieves decompression success consistent with current literature. In our experience, this minimally invasive technique with one small incision and lighted retractors, with which most plastic surgeons are familiar from breast surgery, is a feasible alternative to both open and endoscopic decompression of the ulnar nerve. Hand surgeons with and without endoscopic experience can safely take advantage of this technique in the range of patient presentations.