Endoscopic decompression of the ulnar nerve at the elbow

Recently, several studies suggested that simple decompression is as effective as anterior transposition in ulnar nerve entrapment syndrome. Simple decompression might be performed with minimally invasive techniques. The authors present their technique and results with endoscopic decompression in ulnar nerve entrapment syndrome.

Between January 2005 and March 2008, 24 patients (mean age, 45.5 years; range, 26-67 years) underwent surgery for 26 ulnar nerve entrapment syndromes (2 bilateral). All patients presented with typical clinical signs and neurophysiologic studies.

Intraoperatively, the ulnar nerve was localized directly at the sulcus, and subsequently under endoscopic view, the decompression was completed approximately 10 cm proximal as well as distal. In 26 cases, a significant compression of the nerve was found directly at and distal to the sulcus. In 1 case, a subluxation of the nerve was observed, the endoscopic technique was abandoned, and open anterior submuscular transposition followed. The procedure was successful in 19 of 22 cases (86%). Neither intraoperative nor postoperative complications were observed. Nevertheless, the identification of the nerve directly at the sulcus, where severe nerve compression was often found, seemed to be difficult and potentially risky, particularly in obese patients.

The endoscopic technique for ulnar nerve entrapment syndrome seems to be safe and effective. However, particularly in patients with a thick subcutaneous fat layer, identification of the nerve at the sulcus is difficult and possible more risky than in open simple decompression. A randomized prospective study should be performed to further evaluate the value of this new technique in the treatment of ulnar nerve entrapment syndrome.