Endoscopic Release of the Ulnar Nerve at the Elbow: Technique Description and Case Series

Oliveira, Ricardo Kaempf de; Brunelli, João Pedro Farina; Araújo, Matheus Baldasso; Aita, Márcio; Carratalá, Vicente; Delgado, Pedro J.

doi:10.1055/s-0042-1751023

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Original Article • Rev Bras Ortop 58 (3) • May-Jun 2023 • https://doi.org/10.1055/s-0042-1751023 copy

Endoscopic Release of the Ulnar Nerve at the Elbow: Technique Description and Case Series

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The endoscopic release of the ulnar nerve reproduces a simple (in situ) procedure with smaller incisions, less soft tissue damage, and higher preservation of nerve vascularization. Endoscopy allows the clear visualization of the entire path of the nerve and surrounding noble structures. Moreover, it reveals any signs of compression and allows a safe release of 10cm distally or proximally to the medial epicondyle.

Methods

A retrospective survey revealed that 15 subjects (1 with a bilateral injury) underwent an ulnar nerve compression release at the elbow using the endoscopic technique with Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA) equipment from January 2016 to January 2020.

Results

Symptoms of ulnar nerve compression improved in all patients; on average, they resumed their work activities in 26.5 days. There was no recurrence or need for another procedure. In addition, there were no severe procedure-related complications, such as infection and nerve or vascular injury. One patient had transient paresthesia of the sensory branches to the forearm, with complete functional recovery in 8 weeks.

Conclusion

Our study shows that the endoscopic release of the ulnar nerve at the elbow with the Agee equipment is a safe, reliable technique with good outcomes.

ulnar nerve; cubital tunnel syndrome; nerve compression syndromes; elbow; paresthesia; minimally invasive surgical procedures

Grade 0	No symptoms
Grade 1	Minimal symptoms with paresthesia and dysesthesia. No weakness or atrophy of the intrinsic musculature supplied by the ulnar nerve.
Grade 2	Moderate symptoms with weakness and atrophy of the intrinsic musculature supplied by the ulnar nerve. Preservation of some motor function.
Grade 3	Severe symptoms with paralysis of the intrinsic musculature supplied by the ulnar nerve. Marked hand weakness.

Outcome	Description
Excellent	No pain on the incision site, with minimal sensitive or motor abnormalities.
Good	Improvement of compressive symptoms but with occasional sensitive abnormalities.
Regular	Improvement but with persistent sensitive or motor abnormalities, which are minor compared with the preoperative period.
Poor	No improvement or worsening of symptoms.

Evaluation	Score
Patient satisfaction
Satisfied	2
Satisfied with restrictions	1
Not satisfied	0
Improvement
Improvement	2
No alteration	1
Worsening	0
Intensity of residual symptoms (pain, paresthesia, weakness)
Asymptomatic	3
Occasional	2
Moderate	1
Intense	0
Professional activity
Working or able to resume work	1
Not working	0
Intensity of labor
Limited	0
Unlimited	1
Grip and pinch strength
> 80% on both sides	2
> 80% on one side	1
< 80% on both sides	0
Static sensitivity and two-point discrimination
Normal (> 5mm)	1
Abnormal (< 5mm)	0
	Total 12
Score
Excellent	10-12
Good	7-9
Regular	4-6
Poor	1-3

Elbows	Gender	Age (years old)	Side	Onset (months)	ENMG	McGowan	Wilson & Krout	Resume working ^(days)	Follow-up (months)	Bishop
1	Male	34	Left	8	Moderate	2	Excellent	30	12	Excellent
2	Female	49	Left	12	Moderate	2	Excellent	15	24	Excellent
3	Male	39	Right	18	Severe	2	Good	60	18	Good
4	Male	33	Left	6	Moderate	2	Excellent	15	12	Excellent
5	Male	66	Left	24	Severe	3	Good	30	12	Regular
6	Male	26	Right	12	Severe	2	Excellent	20	18	Excellent
7	Female	52	Left	8	Moderate	3	Excellent	15	24	Excellent
8	Male	44	Left	9	Moderate	2	Excellent	30	18	Excellent
9	Female	52	Right	9	Moderate	2	Excellent	45	24	Excellent
10	Female	53	Left	15	Moderate	2	Excellent	30	36	Excellent
11	Male	38	Right	18	Severe	3	Good	15	9	Excellent
12	Male	47	Left	12	Moderate	3	Excellent	10	12	Excellent
13	Female	60	Left	12	Severe	2	Regular	30	18	Regular
14	Male	41	Right	12	Moderate	3	Good	45	18	Good
15	Female	51	Right	6	Severe	2	Excellent	20	12	Excellent
16	Female	48	Right	9	Severe	2	Excellent	15	9	Excellent

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence João Pedro Farina Brunelli, Rua Leopoldo Bier, 825 Conjunto 301, Porto Alegre, RS, Brazil CEP: 90620-100 (e-mail: brunelli.joao@gmail.com).