Novel Technique for Ulnar Nerve Transposition at the Elbow: The Neocubital Tunnel

Overview

Journal Plast Reconstr Surg Glob Open

Specialty General Surgery

Date 2024 Aug 29

PMID 39206214

Authors

Joseph Bakhach

Salim C Saba

Dimitri Bakhach

Jana Doghman

Anika G Gnaedinger

Diya S Hammoudeh

Affiliations

Soon will be listed here.

Abstract

Background: Many standard surgical procedures for cubital tunnel syndrome rely on ulnar nerve transposition at the elbow. Placing the ulnar nerve anterior to the axis of motion decreases compression during flexion. Subcutaneous, subfascial, and submuscular positioning of the ulnar nerve may predispose to nerve irritation, instability, and compression in the two first scenarios, and requires invasive dissection in the third one. With no single procedure demonstrating clear advantages and outcomes, this study reports the results of a novel technique using the epitrochleo-olecranon ligament to create a neo-tunnel, anatomically stabilizing the ulnar nerve.

Methods: Nine consecutive patients were enrolled. Patients were evaluated qualitatively for symptomatic improvements using physical examination. The Wilson and Krout, modified McGowan, and PRUNE grading scores were used for quantitative measurement.

Results: Postoperatively, all patients reported subjective improvement in symptoms and functional improvement. There were no intraoperative or postoperative complications. Baseline severity of disease was evaluated using the McGowan scale (modified by Goldberg): eight (89%) grade IIA patients and one (11%) grade III patient. Postoperatively, seven (78%) patients were reduced to grade 0, and two (22%) patients to grade 1 ( < 0.001). Using the Wilson and Krout criteria, outcomes were as follows: six (67%) excellent, two (22%) good, and one (11%) fair. The mean postoperative PRUNE survey score was 19.3 (SD ± 24.4).

Conclusions: The neocubital tunnel technique is a relatively noninvasive, safe surgical alternative that may be considered when an anterior transposition of the ulnar nerve is indicated for surgical decompression of the cubital tunnel.

References

Kang H, Koh I, Chun Y, Oh W, Chung K, Choi Y . Ulnar nerve stability-based surgery for cubital tunnel syndrome via a small incision: a comparison with classic anterior nerve transposition. J Orthop Surg Res. 2015; 10:121. PMC: 4526197. DOI: 10.1186/s13018-015-0267-8. View

Kroonen L . Cubital tunnel syndrome. Orthop Clin North Am. 2012; 43(4):475-86. DOI: 10.1016/j.ocl.2012.07.017. View

Jaddue D, Saloo S, Sayed-Noor A . Subcutaneous vs Submuscular Ulnar Nerve Transposition in Moderate Cubital Tunnel Syndrome. Open Orthop J. 2009; 3:78-82. PMC: 2738827. DOI: 10.2174/1874325000903010078. View

Chung K . Treatment of ulnar nerve compression at the elbow. J Hand Surg Am. 2008; 33(9):1625-7. PMC: 4410271. DOI: 10.1016/j.jhsa.2008.06.024. View

Glowacki K, Weiss A . Anterior intramuscular transposition of the ulnar nerve for cubital tunnel syndrome. J Shoulder Elbow Surg. 1997; 6(2):89-96. DOI: 10.1016/s1058-2746(97)90028-8. View

MacDermid J, Grewal R . Development and validation of the patient-rated ulnar nerve evaluation. BMC Musculoskelet Disord. 2013; 14:146. PMC: 3660194. DOI: 10.1186/1471-2474-14-146. View

Nakashian M, Ireland D, Kane P . Cubital Tunnel Syndrome: Current Concepts. Curr Rev Musculoskelet Med. 2020; 13(4):520-524. PMC: 7340724. DOI: 10.1007/s12178-020-09650-y. View

Zarezadeh A, Shemshaki H, Nourbakhsh M, Etemadifar M, Moeini M, Mazoochian F . Comparison of anterior subcutaneous and submuscular transposition of ulnar nerve in treatment of cubital tunnel syndrome: A prospective randomized trial. J Res Med Sci. 2013; 17(8):745-9. PMC: 3687881. View

Leone J, Bhandari M, Thoma A . Anterior intramuscular transposition with ulnar nerve decompression at the elbow. Clin Orthop Relat Res. 2001; (387):132-9. DOI: 10.1097/00003086-200106000-00018. View

10.

Craven Jr P, Green D . Cubital tunnel syndrome. Treatment by medial epicondylectomy. J Bone Joint Surg Am. 1980; 62(6):986-9. View

11.

Khalid S, Carlton A, Kelly R, Citow J . Novel minimally invasive technique in the treatment of cubital tunnel syndrome. J Spine Surg. 2019; 5(1):88-96. PMC: 6465473. DOI: 10.21037/jss.2019.03.02. View

12.

Boers N, Buijnsters Z, Boer-Vreeke K, Wever N, Coert J, de Ruiter G . Submuscular transposition of the ulnar nerve for persistent or recurrent cubital tunnel syndrome: Results of a prospective case series. J Plast Reconstr Aesthet Surg. 2022; 75(9):3260-3268. DOI: 10.1016/j.bjps.2022.04.045. View

13.

Palmer B, Hughes T . Cubital tunnel syndrome. J Hand Surg Am. 2010; 35(1):153-63. DOI: 10.1016/j.jhsa.2009.11.004. View

14.

Liu C, Wu S, Ke X, Wang H, Chen C, Lai Z . Subcutaneous Versus Submuscular Anterior Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies. Medicine (Baltimore). 2015; 94(29):e1207. PMC: 4602994. DOI: 10.1097/MD.0000000000001207. View

15.

Foran I, Vaz K, Sikora-Klak J, Ward S, Hentzen E, Shah S . Regional Ulnar Nerve Strain Following Decompression and Anterior Subcutaneous Transposition in Patients With Cubital Tunnel Syndrome. J Hand Surg Am. 2016; 41(10):e343-e350. DOI: 10.1016/j.jhsa.2016.07.095. View

16.

Choi S, Bae J, Shin Y, Moon S, Kim J . Reliability and validity of the modified McGowan grade in patients with cubital tunnel syndrome. Arch Orthop Trauma Surg. 2022; 142(7):1697-1703. DOI: 10.1007/s00402-022-04367-8. View

17.

Tang D, Barbour J, Davidge K, Yee A, Mackinnon S . Nerve entrapment: update. Plast Reconstr Surg. 2014; 135(1):199e-215e. DOI: 10.1097/PRS.0000000000000828. View

18.

Krogue J, Aleem A, Osei D, Goldfarb C, Calfee R . Predictors of surgical revision after in situ decompression of the ulnar nerve. J Shoulder Elbow Surg. 2015; 24(4):634-9. DOI: 10.1016/j.jse.2014.12.015. View

19.

Townsend C, Katt B, Tawfik A, DeMarco M, Lutsky K, Matzon J . Functional Outcomes of Cubital Tunnel Release in Patients with Negative Electrodiagnostic Studies. Plast Reconstr Surg. 2023; 152(1):110e-115e. DOI: 10.1097/PRS.0000000000010185. View

20.

Power H, Peters B, Patterson J, Padovano W, Mackinnon S . Classifying the Severity of Cubital Tunnel Syndrome: A Preoperative Grading System Incorporating Electrodiagnostic Parameters. Plast Reconstr Surg. 2022; 150(1):115e-126e. DOI: 10.1097/PRS.0000000000009255. View