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Wide Decompression May Render the Ulnar Nerve Unstable: A Cadaveric Study.

Andrew P Hurvitz1, Brian T Fitzgerald, Leo T Kroonen

  • 1Department of Orthopaedics, U.S. Naval Hospital, Okinawa, Japan. ahurv@hotmail.com.

Journal of Surgical Orthopaedic Advances
|October 30, 2016
PubMed
Summary
This summary is machine-generated.

Ulnar nerve instability, or subluxation, occurred in 50% of cadaveric elbows after in situ decompression. Increasing proximal release beyond 4 cm significantly raised the rate of ulnar nerve subluxation.

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Area of Science:

  • Orthopedic Surgery
  • Neuroscience
  • Anatomy

Background:

  • Cubital tunnel syndrome is a common entrapment neuropathy.
  • In situ decompression is a surgical technique to relieve pressure on the ulnar nerve.
  • Ulnar nerve instability can be a complication of surgical decompression.

Purpose of the Study:

  • To assess the incidence of ulnar nerve instability after incrementally widened in situ decompression.
  • To determine the relationship between the extent of proximal decompression and ulnar nerve subluxation.

Main Methods:

  • Sixteen cadaveric elbows underwent in situ decompression of the ulnar nerve.
  • The release extended proximally in 2-cm increments up to 10 cm.
  • Ulnar nerve subluxation was evaluated after complete decompression.

Main Results:

  • Fifty percent (8 of 16) of elbows exhibited ulnar nerve subluxation post-decompression.
  • The rate of subluxation increased with greater proximal release length.
  • Subluxation rates significantly increased beyond 4 cm of proximal decompression.

Conclusions:

  • Extensive proximal decompression during cubital tunnel release may lead to ulnar nerve instability.
  • Surgical decompression should be limited to the cubital tunnel if it is the sole site of compression.
  • Careful consideration of decompression extent is crucial to avoid iatrogenic ulnar nerve subluxation.