The role of in situ decompression in patients with severe ulnar nerve compression is still controversial. Thirty patients with severe ulnar nerve compression confirmed clinically and electrophysiologically underwent simple decompression. The mean age of the patients was 58 (range 26–87) years. Through incisions ≤4 cm the nerves were fully visualized and decompressed. Outcome was measured prospectively using Modified Bishop’s score (BS), grip and pinch strengths and two-point discrimination (2PD). Significant improvement in power (p = 0.01) and pinch grip (p = 0.001) was noted at 1 year. The grip strength continued to improve up to 1 year. According to the BS, 24 patients (80%) had good to excellent results at 1 year. Minimally invasive in situ decompression is technically simple, safe and gives good results in patients with severe nerve compression. The BS and 2PD were more reliable than grip strength in assessing these patients at follow-up.
Bartels RHMA,Menovsky T,Van-Overbeeke JJ,Verhagen WIM.Surgical management of ulnar nerve compression at the elbow: An analysis of the literature.J Neurosurg.. 1998;89:722-7
4.
Bartels RH,Termeer EH,Van-Der-Wilt GJ, et al.Simple decompression or anterior subcutaneous transposition for ulnar neuropathy at the elbow: A cost-minimization analysis.Neurosurgery. 2005;56:531-6
5.
Biggs M,Curtis JA.Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition.Neurosurgery. 2006;58:296-304
6.
Brauer CA,Graham B.The surgical treatment of cubital tunnel syndrome: A decision analysis.J Hand Surg Eur.. 2007;32:654-62
7.
Campbell JB,Post KD,Mobantz RA.A technique for relief of motor and sensory deficits occurring after anterior ulnar transposition – Technical note.J Neurosurg.. 1974;40:405-9
8.
Childress HM.Recurrent ulnar-nerve dislocation at the elbow.Clin Orthop Relat Res.. 1975;108:168-73
9.
Chung KC.Treatment of ulnar nerve compression at the elbow.J Hand Surg Am.. 2008;33:1625-7
10.
Dellon AL.Review of treatment results for ulnar nerve entrapment at the elbow.J Hand Surg Am.. 1989;14:688-700
11.
Dellon AL,Chang E,Coert JH,Campbell KR.Intraneural ulnar nerve pressure changes related to operative techniques for cubital tunnel decompression.J Hand Surg Am.. 1994;19:923-30
12.
Gelberman RH,Yamaguchi K,Hollstien SB, et al.Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow. An experimental study in human cadavera.J Bone Joint Surg Am.. 1998;80:492-501
13.
Gervasio O,Gambardella G,Zaccone C,Branca D.Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: A prospective randomized study.Neurosurgery. 2005;56:108-17
14.
Goldfarb CA,Sutter MM,Martens EJ,Manske PR.Incidence of reoperation and subjective outcome following in situ decompression of the ulnar nerve at the cubital tunnel.J Hand Surg Br.. 2009;34:379-83
15.
Hoffmann R,Siemionow M.The endoscopic management of cubital tunnel syndrome.J Hand Surg Eur.. 2006;31:23-9
16.
Kleinman WB,Bishop AT.Anterior intramuscular transposition of the ulnar nerve.J Hand Surg Am.. 1989;14:972-9
17.
Lim BH,Toh CL,Wong HP,Pho RW.Cadaveric study on the vascular anatomy of the ulnar nerve at the elbow – a basis for anterior transposition?.Ann Acad Med Singapore. 1992;21:689-93
18.
Lundborg G,Rosen B.The two point discrimination test – Time for reappraisal?.J Hand Surg Br.. 2004;29:418-22
19.
Macadam SA,Bezuhly M,Lefaivre KA.Outcomes measures used to assess results after surgery for cubital tunnel syndrome: A systematic review of the literature.J Hand Surg Am.. 2009;34:1482-91
20.
Macadam SA,Gandhi R,Bezuhly M,Lefaivre KA.Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: A meta-analysis.J Hand Surg Am.. 2008;33:1314
21.
Mowlavi A,Andrews K,Lille S,Verhulst S,Zook EG,Milner S.The management of cubital tunnel syndrome: A meta-analysis of clinical studies.Plast Reconstr Surg.. 2000;106:327-34
22.
Nouhan R,Kleinert JM.Ulnar nerve decompression by transposing the nerve and Z-lengthening the flexor–pronator mass: Clinical outcome.J Hand Surg Am.. 1997;22:127-31
23.
Ogino T,Minami A,Fukuda K.Tardy ulnar nerve palsy caused by cubitus varus deformity.J Hand Surg Br.. 1986;11:352-6
24.
Pasque CB,Rayan GM.Anterior submuscular transposition of ulnar nerve at the elbow for cubital tunnel syndrome.J Hand Surg Br.. 1995;20:447-53
Posner MA.Compressive ulnar neuropathies at the elbow: I. Etiology and diagnosis.J Am Acad Orthop Surg.. 1998;6:282-8
27.
Shooter D.Use of two-point discrimination as a nerve repair assessment tool: Preliminary report.ANZ J Surg.. 2005;10:866-8
28.
Siemionow M,Agaoglu G,Hoffmann R.Anatomic characteristics of a fascia and its bands overlying the ulnar nerve in the proximal forearm: A cadaver study.J Hand Surg Eur.. 2007;32:302-7
29.
Szabo RM,Kwak C.Natural history and conservative management of cubital tunnel syndrome.Hand Clin.. 2007;23:311-18
30.
Waugh RP,Zlotolow DA.In situ decompression of the ulnar nerve at the cubital tunnel.Hand Clin.. 2007;23:319-27
31.
Yoshida A,Okutsu I,Hamanaka I.Endoscopic anatomical nerve observation and minimally invasive management of cubital tunnel syndrome.J Hand Surg Eur.. 2009;34:115-20
32.
Zlowodzki M,Chan S,Bhandari M,Kalliainen L,Schubert W.Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome – A meta-analysis of randomized, controlled trials.J Bone Joint Surg Am.. 2007;89:2591-8
