13: In Situ Cubital Tunnel Decompression

Published on 18/04/2015 by admin

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Last modified 22/04/2025

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Procedure 13 In Situ Cubital Tunnel Decompression

image See Video 11: In Situ Cubital Tunnel Decompression

Indications

image In situ decompression of the ulnar nerve is indicated for patients with symptoms that are mild or intermittent (Table 13-1). If there is subluxation or instability of the ulnar nerve and/or ulnar nerve palsy owing to an abnormal osseous architecture of the elbow, in situ decompression is not indicated. In these situations, an anterior transposition is more appropriate to correct the anatomic problem.

Examination/Imaging

Surgical Anatomy

image The ulnar nerve is the terminal branch of the medial cord of the brachial plexus. Initially, the ulnar nerve lies medial to the axillary artery. In the upper arm, the ulnar nerve lies posteromedial to the brachial artery, posterior to the intermuscular septum, and anterior to the medial head of the triceps muscle. Approximately 8 cm proximal to the medial epicondyle is the arcade of Struthers, a thin fibrous band. At the elbow, the ulnar nerve travels posterior to the medial epicondyle and medial to the olecranon at the subcutaneous level, then it enters the cubital tunnel. The cubital tunnel is covered by fibroaponeurotic bands and the Osborne fascia (a ligament over the epicondylar groove), which is the fibroaponeurotic tissue between the two heads of the FCU. After passing through the cubital tunnel, the ulnar nerve travels deep into the forearm between the humeral and ulnar heads of the FCU. Distally, the ulnar nerve follows through the FCU to the deep flexor-pronator aponeurosis (Fig. 13-1).

image The posterior branch of the medial antebrachial cutaneous nerve is at risk of injury during cubital tunnel surgery. The proximal crossing branch lies approximately 1.8 cm proximal to the medial epicondyle, whereas the distal crossing branch is about 3.1 cm distal to the medial epicondyle (Fig. 13-2).

image The ulnar nerve may be easily compressed at five sites (see Fig. 13-1).

image The most common sites of ulnar nerve compression are the epicondylar groove and the cubital tunnel.

Procedure

Evidence

Miller RG, Hummel EE. The cubital tunnel syndrome: treatment with simple decompression. Ann Neurol. 1980;7:567-569.

A retrospective review of 12 patients with progressive cubital tunnel syndrome treated with simple decompression of the ulnar nerve. Eleven of the 12 patients had clinical and electrophysiologic evidence of improvement. Patients with the best outcomes had (1) mild weakness, (2) recent onset of symptoms, and (3) a mild abnormality of the sensory action potential preoperatively. (Level IV evidence)

Nathan PA, Istvan JA, Meadows KD. Intermediate and long-term outcomes following simple decompression of the ulnar nerve at the elbow. Chir Main. 2005;24:29-34.

A retrospective review of 102 cases of cubital tunnel syndrome in 74 patients treated with simple decompression of the ulnar nerve. Overall, 82% of patients were regarded as having 75% or more improvement in range of motion at the elbow following the surgery. Most patients (61%) were found to have improved ulnar nerve conduction velocities at follow-up. In this study, simple decompression resulted in excellent intermediate and long-term relief of symptoms in a substantial majority of patients. (Level IV evidence)

Tanigughi Y, Takami M, Tamake T, et al. Simple decompression with small skin incision for cubital tunnel syndrome. J Hand Surg [Br]. 2002;27:559-562.

A retrospective review of 18 elbows in 17 patients treated by simple decompression using only a 1.5- to 2.5-cm skin incision with no endoscopic assistance. Clinical results were evaluated as “excellent” for 4 elbows, “good” for 10, and “fair” for 4. The 4 patients with a “fair” outcome had diabetes mellitus, with marked atrophy of the interosseous muscle and unmeasurable nerve conduction velocities. (Level IV evidence)