Ultrasound-guided Percutaneous Ulnar Nerve Release at the Elbow: A Stepwise Approach

Cubital tunnel syndrome is the second most common compressive neuropathy in the upper limb. A wide range of surgical techniques have been described, from simple in situ decompression to anterior transposition, both through open and endoscopic approaches. Recent advances in ultrasonography and the development of dedicated instrumentation have enabled the emergence of ultrasound-guided cubital tunnel release as a feasible, effective, minimally invasive alternative. However, concerns regarding potential complications and inconsistent outcomes have limited widespread adoption. The aim of this study is to define appropriate indications for ultrasound-guided cubital tunnel release and to present a reproducible, stepwise description of the technique. Twenty-two patients who met the inclusion criteria were treated with this method. Clinical improvement was achieved in 95% of cases, with a mean postoperative modified Bishop score of 8.75. One patient experienced persistent paresthesia with no improvement after surgery. Symptom recurrence was observed in 2 patients, at 2 and 12 months postoperatively. No major complications such as nerve injury, skin necrosis, complex regional pain syndrome, elbow stiffness, or surgical site infection were reported. One case of ulnar nerve instability developed 1 year after surgery. Based on our findings, we propose key technical pearls and patient selection guidelines that may enhance surgical outcomes. A step-by-step surgical video is provided as Supplemental Digital Content, http://links.lww.com/BTH/A237 to facilitate learning and dissemination of the technique.