Endoscopic decompression of the ulnar nerve at the elbow

The ideal operative treatment for cubital tunnel syndrome, the second most common form of peripheral compression neuropathy, remains controversial. We therefore reviewed our series of endoscopically assisted ulnar nerve decompression at the elbow to determine the effectiveness of the procedure, which was intended to minimize perioperative morbidity and scar discomfort.

In 36 patients (ages 22-76 years) with clinical McGowan grade I (4 patients), II (21 patients), and III (11 patients) and electrophysiologic signs of cubital tunnel syndrome (35 primary, 1 recurrent), 20 cm of the ulnar nerve was released through a 3.5-cm-long skin incision above the medial epicondyle. A 4-mm, 30 degrees standard endoscope and custom-made guiding-dissecting tool were utilized during the procedure, and the mean postoperative follow-up examination was 14 months (range 6-19).

No macroscopically visible nerves and vessels were injured during the procedure. The only postoperative complication was hematoma in one patient that resolved after conservative management. One case was converted from endoscopic to open because of a ganglion that surrounded the nerve in the forearm. There was no scar discomfort (ie, painful neuroma, impaired sensibility, or burning sensation) or elbow extension deficit after surgery, and surgical wounds all healed within a week. Outcomes were excellent in 21 of 36 cases and good in 12 of 36 cases. All patients improved electrophysiologically after surgery, were satisfied with the procedure, returned to full activities within 3 weeks, and would have the procedure again.

By using a safe and reliable endoscopic technique characterized by a short incision, minimum soft tissue dissection, and early postoperative mobilization, we were able to preserve the benefits of conventional approaches (namely, complete release and good visualization), while avoiding problems such as painful scarring and elbow contracture.