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Endoscopic Cubital Tunnel Release

  • Tyson K. Cobb
  • Elizabeth R. Elander
Chapter

Abstract

Cubital tunnel syndrome is the second most common nerve entrapment disorder in the upper extremity. Most cases of idiopathic cubital tunnel syndrome will resolve without surgical intervention. Those who remain symptomatic despite conservative treatment are offered surgery. There is no consensus for the best surgical approach; however, simple release has become increasingly popular, yielding excellent surgical outcomes with fewer complications. Endoscopic release is the newest surgical option for simple release of the ulnar nerve at the elbow.

There are two types of endoscopic release performed through a single small portal: one method requires the use of specialized dissection equipment and the other using a cannula designed specifically for this purpose. This chapter will detail the indications, contraindications, surgical technique, tips and tricks, pitfalls, postoperative management, complications, and results of endoscopic release of the ulnar nerve at the elbow for cubital tunnel syndrome using a cannula method.

Keywords

Cubital tunnel Endoscopic cubital tunnel release Ulnar nerve Minimally invasive elbow Nerve compression 

Notes

Acknowledgment

Peter Schillaci for assistance with figures and videos.

Declaration of Conflict of Interest: Dr. Cobb has financial interest with Integra Life Sciences, who manufactures and sells the instrumentation for this procedure. Elizabeth Elander has no conflicts of interest to declare.

Supplementary material

Video 99.1

Complete (start to finish) clinical case of endoscopic cubital tunnel release showing both proximal and distal release with external and endoscopic views (MP4 32803 kb)

Video 99.2

An illustrated overview of the surgical anatomy identifying the layers required for release including the deep fascia, FCU muscle, and fascia deep to the FCU (MP4 30057 kb)

Video 99.3

A detailed presentation of the EndoRelease cannula and attached retractor (MP4 52386 kb)

Video 99.4

Cadaver demonstration of placement of cannula in the distal portion of release with dissected layers (MP4 75788 kb)

Video 99.5

Clinical case after distal release showing ulnar nerve decompression (MP4 27923 kb)

Video 99.6

How to manage the pulsatile bleeder (MP4 19202 kb)

Video 99.7

Case showing release on an obese patient which typically requires a larger incision and fat pad rotated anteriorly (MP4 16110 kb)

Video 99.8

Demonstration of distal release with detailed description of how to know when the release is complete (MP4 45175 kb)

Video 99.9

Case of ulnar nerve rotated into harm’s way and how to handle it (MP4 20699 kb)

References

  1. 1.
    Cobb TK. Endoscopic cubital tunnel recurrence rates. Hand (N Y). 2010;5(2):179.CrossRefGoogle Scholar
  2. 2.
    Cobb TK. Endoscopic cubital tunnel release. J Hand Surg. 2010;35A:1690–7.CrossRefGoogle Scholar
  3. 3.
    Cobb TK, Sterbank P. Five year review of endoscopic cubital tunnel release. (Abstruct Publication SP41). J Hand Surg (Br). 2008;33E(Suppl 1):49.Google Scholar
  4. 4.
    Cobb TK, Walden AL, Merrell PT, Lemke JH. Setting expectations following endoscopic cubital tunnel release. Hand (N Y). 2014;9(3):356–63.CrossRefGoogle Scholar
  5. 5.
    Watts AC, Bain CL. Patient rated outcomes of ulnar nerve decompression: a comparison of endoscopic and open in situ decompression. J Hand Surg. 2009;34A:1492–8.CrossRefGoogle Scholar

Copyright information

© ISAKOS 2020

Authors and Affiliations

  • Tyson K. Cobb
    • 1
  • Elizabeth R. Elander
    • 2
  1. 1.Orthopaedic SpecialistsDavenportUSA
  2. 2.Anchorage Fracture and Orthopedic ClinicDavenportUSA

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