In Situ Decompression in the Treatment of Cubital Tunnel Syndrome

Year 2018, Volume: 25 Issue: 2, 132 - 138, 06.06.2018

Güray Altun Tuhan Kurtulmuş İsmail Oltulu Necdet Sağlam

https://doi.org/10.17343/sdutfd.334447

Abstract

Objective: We have evaluated the functional scores of in situ ulnar nerve decompressed cubital tunnel sendrome patients. Materials and Methods: Between january 2006 and december 2010, 32
cubital tunnel syndrome patients operated in our clinic with ulnar neuropathy were evaluated retrospectively from 43 patients. All patients were diagnosed with clinically and electromyography, follow up period was at least 3 years. And also any patient have surgical history about cubital tunnnel syndrome before. McGowan’s classification was used for preoperative scoring and the Wilson Krout classification for postoperative clinical evaluation.
Results: Preoperatively 24 patient were degree 2, 8 patients were degree 3. There were excellent results in 22 patients (%), good in 7 (%), fair in 2 (%), and poor in one (%). Any of patients re-opereted cause of complaints.
Conclusion: In situ decompression is an effective, simple and safe methode for cubital tunnel syndrome without ulnar nerve subluxation and with nöral continuity is intact.

Keywords

ulnar nerve, in situ decompression, neuropathy, cubital tunnel syndrome

Kubital Tünel Sendromu Tedavisinde in Situ Dekompresyon

Abstract

Giriş:
Bu
çalışmamızda, kübital tünel sendromu (KTS) tanısı ile in situ ulnar sinir
dekompresyonu yapılan hastaların fonksiyonel sonuçlarını değerlendirdik.

Gereç
ve Yöntem: Ocak 2006 ile Aralık 2010 tarihleri
arasında 43 hastadan yeterli takibi yapılan ve çağrıya cevap veren 32 hasta
geriye dönük olarak değerlendirildi. Hastaların ameliyat öncesi klinik durumları McGowan
derecelendirme sistemine göre ve ameliyat sonrası durumları ise Wilson&Krout
derecelendirme sistemine göre belirlendi. Çalışmaya muayene ve
elektromiyelografiyle (EMG) kübital tünel sendromu tanısı konulan, en az 6 ay
konservatif olarak tedaviye cevap vermeyen, in situ dekompresyon prosedürü
uygulanan, daha önce kübital tünel sendromu nedeniyle ameliyat edilmeyen
hastalar dahil edildi.

Bulgular:
Ameliyat
öncesi 24 hastada evre 2, 8 hastada evre 3 nöropati mevcuttu. Ameliyat sonrası
22 hastada mükemmel, 7 hastada iyi, 2 hastada makul, 1 hastada kötü sonuç elde
edildi. Kötü sonuç elde edilen tek hastanın ameliyat öncesi evre 3 nöropatisi mevcuttu.
Şikayetlerinin tekrarlaması sebebiyle hiçbir hastaya tekrar cerrahi tedavi
uygulanmadı.

Tartışma
Sonuçlar: Kübital tünel sendromunda in situ dekompresyon ulnar
sinir bütünlüğü korunmuş ve ulnar sinir subluksasyonu görülmeyen olgularda düşük
komplikasyon oranlarıyla etkili, basit, güvenilir bir yöntemdir. 

Keywords

ulnar sinir, in situ dekompresyon, nöropati, kubital tünel sendromu, kübital tünel sendromu

References

• 1. Bartels RH, Menovsky T, Van Overbeeke JJ, Verhagen WI. Surgical management of ulnar nerve compression at the elbow: an analysis of the literature. J Neurosurg 1998;89(5):722-7.
• 2. Folberg CR, Weiss AP, Akelman E. Cubital tunnel syndrome. Part I: presentation and diagnosis. Orthop Rev 1994;23(2):136-44.
• 3. Dellon AL. Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg 1989;14(4):688–700.
• 4. Dellon AL, Coert JH. Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow. J Bone Joint Surg 2004;86A(Suppl 1, Pt 2):169 –79.
• 5. Kleinman WB, Bishop AT. Anterior intramuscular transposition of the ulnar nerve. J Hand Surg 1989;14(6):972–9.
• 6. Neblett C, Ehni G. Medial epicondylectomy for ulnar nerve palsy. J Neurosurg 1970;32(1):55– 62.
• 7. Hoffmann R, Siemionow M. The endoscopic management of cubital tunnel syndrome. J Hand Surg 2006;31(1):23–9.
• 8- McGowan AJ: The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg Br 1950 Aug;32-B(3):293-301.
• 9- Wilson DH, Krout R: Surgery of ulnar neuropathy at the elbow: 16 cases treated by decompression without transposition. Technical note. J Neurosurg. 1973 Jun;38(6):780-5
• 10. Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manupulative Physiol Ther 2005;28(5):345
• 11. Apfelberg DB, Larson SJ. Dynamic anatomy of the ulnar nerve at the elbow. Plast Reconstr Surg 1973;51(1):76-81.
• 12. Macnicol MF. Extraneural pressures affecting the ulnar nerve at the elbow. Hand 1982;14(1):5-11.
• 13. Pechan J, Julius I. The pressure measurement in the ulnar nerve. A contribution to the pathophysiology of cubital tunnel syndrome. J Biomech 1975;8(1):75-9.
• 14. Werner CO, Ohlin P, Elmqvist D. Pressure recorded in ulnar neuropathy. Acta Orthop Scand 1985;56(5):404-6.
• 15. Vanderpool DW, Chalmers J, Lamb DW, Whiston TB. Peripheral compression lesions of the ulnar nerve. J Bone Joint Surg Br 1968;50(4):792-803.
• 16. Lundborg G. Structure and function of the intraneural microvessels as related to trauma, edema formation and nerve function. J Hand Surg [Am] 1975;57(7):938-48.
• 17. Gelberman RH, Yamaguchi K, Hollstien SB, Winn SS, Heidenreich FP, Bindra RR, et al. Changes in interstitial pressure and cross sectional area of the cubital tunnel and of the ulnar nevre with flexion of the elbow. J Bone Joint Surg Am 1998;80(4):492-501.
• 18. Lascar T, Laulan J. Cubital tunnel syndrome: a retrospective review of 53 anterior subcutaneous transpositions. J Hand Surg [Br] 2000;25(5);453-6.
• 19. Asamoto S, Böker D.K, Jödicke A. Surgical treatment of ulnar nerve entrapment at the elbow. Neurol Med Chir (Tokyo) 2005:45(5);240-245
• 20. Kuschner SH. Cubital tunnel syndrome. Treatment by medial epicondylectomy. Hand Clin 1996;12(2):411-9.
• 21. Bednar SB, Blair SJ, Light TR. Complications of the treatment of cubital tunnel syndrome. Hand Clin 1994;10(1):83-92.
• 22. Cole RJ, Jemison DM, Hayes CW. Anterior elbow dislocation following medial epicondylectomy: a case report. J Hand Surg [Am]1994;19:614-6.
• 23. Schnabl SM, Kisslinger F, Schramm A, Dragu A, Kneser U, Unglaub F ve ark. Objective outcome of partial medial epicondylectomy in cubital tunnel syndrome. Arch Orthop Trauma Surg 2010;130(12):1549-56
• 24. Kleinman WB. Cubital tunnel syndrome: anterior transposition as a logical approach to complete nerve decompression. J Hand Surg [Am] 1999;24:886-97.
• 25. Posner MA. Compressive ulnar neuropathies at the elbow: I. Etiology and diagnosis. J Am Acad Orthop Surg 1998;6(5):282-8.
• 26. Oertel J, Keiner D, R. Gaab M. Endoscopic decompression of the ulnar nerve at the elbow. Neurosurgery 2010; 66(4): 817-24.
• 27. Huang JH, Samadani U, Zager EL. Ulnar nerve entrapment neuropathy at the elbow: simple decompression. Neurosurgery 2004; 55(5):1150-3.
• 28. Sarris I, Gobel F, Gainer M, Vardakas DG, Vogt MT, Sotereanos DG. Medial brachial and antebrachial cutaneous nerve injuries: effect on outcome in revision cubital tunnel surgery. J Reconstr Microsurg 2002;18:665–70.
• 29. Foster RJ, Edshage S. Factors related to the outcome of surgically managed compressive ulnar neuropathy at the elbow level. J Hand Surg 1981;6(2):181–92.