Endoscopic detection of compressing fascial bands around the ulnar nerve within the FCU

The aim of this study is to endoscopically evaluate the ulnar nerve proximal and distal to the cubital tunnel after in situ decompression to identify and eventually release fascial bands capable of compressing the ulnar nerve.

We performed a retrospective review of 16 ulnar nerve compression cases in 12 patients. Eight men and four women with a mean age of 52 years (range, 23-77 years) were clinically diagnosed and confirmed with neurophysiologic studies. A 4-6-cm curvilinear incision was made at the medial elbow, and the ulnar nerve was identified and decompressed at the cubital tunnel. Then, a 2.7-mm endoscope was passed 8 to 10 cm proximal and distal to the medial epicondyle allowing for visualization of the ulnar nerve and its surrounding soft tissues.

The endoscopic evaluation of the 16 ulnar nerves demonstrated no compressive bands outside of the cubital tunnel. All patients had satisfactory outcomes.

The good results reported after in situ ulnar nerve decompression have questioned the need for endoscopically assisted decompression of the ulnar nerve proximal and distal to the cubital tunnel. Some authors suggest the existence of fascial bands within the flexor carpi ulnaris (FCU) capable of compressing the ulnar nerve. This study would suggest that fibrous bands deep in the FCU capable of compressing the ulnar nerve do not exist. Our satisfactory outcomes would support the perception that extensive decompression of the ulnar nerve beyond the cubital tunnel is not routinely needed.