Ultrasound-guided surgical treatment for ulnar nerve entrapment: A cadaver study |
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| Institution: | 1. Comete Inserm U1075 - UCBN EA 3917, département de chirurgie orthopédique et traumatologique, hôpital Côte-de-Nacre, CHU de Caen, BP 95182, 14033 Caen cedex 9, France;2. Service de rhumatologie, hôpital Côte-de-Nacre, CHU de Caen, BP 95182, 14033 Caen cedex 9, France;1. Clinique La Montagne, 10, rue de la Montagne, 92400 Courbevoie, France;2. Institut français de chirurgie de la main, 5, rue du Dôme, 75116 Paris, France;1. Service de traumatologie-orthopédie, Pavillon 32, Centre hospitalier universitaire Ibn Rochd, 1, rue des Hôpitaux, Quartier des hôpitaux, 20360 Casablanca, Morocco;2. Service de médecine physique et de réadaptation, Centre hospitalier universitaire Ibn Rochd, 1, rue des Hôpitaux, Quartier des hôpitaux, 20360 Casablanca, Morocco;1. Division of Plastic Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL;2. Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI;1. Clinical Medical College, Jilin University, Changchun, China;2. Ultrasound Department, Jilin University, Changchun, China;1. Division of Plastic Surgery, Department of Surgery, Lehigh Valley Health Network, Cedar Crest & I-78, P.O. Box 689, Allentown, PA 18103-4689, USA;2. Section of Plastic Surgery, University of Michigan Medical School, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA |
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| Abstract: | Several open and endoscopic techniques for the surgical treatment of ulnar nerve entrapment at the elbow (cubital tunnel syndrome) have been described that provide decompression with or without anterior transposition. Based on our experience with US-guided decompression for carpal tunnel syndrome in our department, we developed a similar surgical technique for the decompression of the ulnar nerve at the elbow. Using sixteen cadaver upper limbs, we performed decompression of all the structures possibly responsible for ulnar nerve compression at the elbow. The structures involved were Struthers’ arcade, the cubital tunnel retinaculum, Osborne's fascia and Amadio-Beckenbaugh's arcade. The procedure was followed by anatomical dissection to confirm complete sectioning of the compressive structures, absence of iatrogenic vascular or nervous injuries and absence of nerve dislocation or instability. There were no remaining compressive structures after the release procedure. There was no iatrogenic damage to the nerves and no nerve dislocation was observed during elbow flexion or extension. In 3.4% cases, a thin superficial layer of one or more of the identified structures remained but these did not appear to compress the nerve based on US imaging. Using ultrasonographic visualization of the nerve and compressive structures is easy. Each procedure can be tailored according to the nerve compression sites. Our cadaveric study shows the feasibility of an US-guided percutaneous surgical release for ulnar nerve entrapment. |
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| Keywords: | Ulnar nerve Surgical decompression Percutaneous technique Sonography Nerf ulnaire Décompression chirurgicale Technique percutanée Échographie |
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