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Endoscopic Ulnar Nerve Release and Transposition

Morse, Levi P. BMBS (Hons), BPhty*; McGuire, Duncan T. MBCHB, FC Ortho, MMed; Bain, Gregory I. MBBS, FRACS, FA (Ortho) A, PhD

Techniques in Hand & Upper Extremity Surgery: March 2014 - Volume 18 - Issue 1 - p 10–14
doi: 10.1097/BTH.0000000000000030
Techniques

The most common site of ulnar nerve compression is within the cubital tunnel. Surgery has historically involved an open cubital tunnel release with or without transposition of the nerve. A comparative study has demonstrated that endoscopic decompression is as effective as open decompression and has the advantages of being less invasive, utilizing a smaller incision, producing less local symptoms, causing less vascular insult to the nerve, and resulting in faster recovery for the patient. Ulnar nerve transposition is indicated with symptomatic ulnar nerve instability or if the ulnar nerve is located in a “hostile bed” (eg, osteophytes, scarring, ganglions, etc.). Transposition has previously been performed as an open procedure. The authors describe a technique of endoscopic ulnar nerve release and transposition. Extra portals are used to allow retractors to be inserted, the medial intermuscular septum to be excised, cautery to be used, and a tape to control the position of the nerve. In our experience this minimally invasive technique provides good early outcomes. This report details the indications, contraindications, surgical technique, and rehabilitation of the endoscopic ulnar nerve release and transposition.

*Department of Orthopaedics and Trauma, Modbury Hospital

Department of Orthopaedics and Trauma, Modbury Hospital, Royal Adelaide Hospital

Department of Orthopaedics and Trauma, Discipline of Anatomy and Pathology, Modbury Hospital, Royal Adelaide Hospital, University of Adelaide, North Adelaide, SA

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Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Gregory I. Bain, MBBS, FRACS, FA (Ortho) A, PhD, Department of Orthopaedics and Trauma, Discipline of Anatomy and Pathology, Modbury Hospital, Royal Adelaide Hospital, University of Adelaide, 196 Melbourne Street, North Adelaide, SA 5006. E-mail: greg@gregbain.com.au.

© 2014 by Lippincott Williams & Wilkins