1
|
Mahan MA. Endoscopic-Assisted Ulnar Nerve Anterior Transposition: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e222-e223. [PMID: 37345940 DOI: 10.1227/ons.0000000000000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 04/18/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Mark A Mahan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
2
|
A prospective randomized study comparing retractor-endoscopic vs. open release of carpal tunnel and cubital tunnel syndromes. Clin Neurol Neurosurg 2022; 222:107437. [DOI: 10.1016/j.clineuro.2022.107437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 11/18/2022]
|
3
|
Mansour J, Ghanimeh J, Ghersi A, Moutinot B, Coulomb R, Kouyoumdjian P, Mares O. Percutaneous ultrasound-guided ulnar nerve release technique compared to open technique: A cadaveric study. SICOT J 2022; 8:40. [PMID: 36155647 PMCID: PMC9511962 DOI: 10.1051/sicotj/2022041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/08/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the outcomes of a novel percutaneous ultrasound-guided technique for release of ulnar nerve entrapment at the elbow when compared to standard open release Methods: One single surgeon performed an ultrasound-guided percutaneous release of the cubital tunnel on a group of five cadaveric elbows and open release on five others. All procedures were timed, and incision lengths were recorded. Meticulous anatomic dissection was then performed to assess the complete release of the carpal tunnel and iatrogenic injuries. RESULTS No significant difference was found between the two groups in terms of complete release and iatrogenic injury, whereas Operative time was significantly shorter for the US-guided technique. Incomplete releases of the nerve were found only during the first two trials in each group, while the third, fourth, and fifth trials showed a complete ulnar nerve release in both series, highlighting a fast learning curve for both techniques. All of this through a significantly smaller incision in the US-guided technique. CONCLUSIONS This study highlights the similar effects of these two techniques in terms of complete release of the ulnar nerve, with no clear superiority of one over the other in terms of morbidity rate. Both have a fast learning curve for an ultrasound-trained surgeon, with the US-guided technique being a less traumatic and quicker alternative procedure.
Collapse
Affiliation(s)
- Jad Mansour
- Centre Hospitalier Universitaire Nîmes-Caremeau place du professeur Robert-Debré 30029 Nîmes France
| | - Joe Ghanimeh
- Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Lebanese American University, School of Medicine Beirut Lebanon
| | - Abdelhamid Ghersi
- Centre Hospitalier Universitaire Nîmes-Caremeau place du professeur Robert-Debré 30029 Nîmes France
| | - Berenice Moutinot
- Centre Hospitalier Universitaire Nîmes-Caremeau place du professeur Robert-Debré 30029 Nîmes France
| | - Remy Coulomb
- Centre Hospitalier Universitaire Nîmes-Caremeau place du professeur Robert-Debré 30029 Nîmes France
| | - Pascal Kouyoumdjian
- Centre Hospitalier Universitaire Nîmes-Caremeau place du professeur Robert-Debré 30029 Nîmes France
| | - Olivier Mares
- Centre Hospitalier Universitaire Nîmes-Caremeau place du professeur Robert-Debré 30029 Nîmes France
| |
Collapse
|
4
|
McEntee RM, Henry TW, Bhatt SD, Beredjiklian PK, Matzon JL, Lutsky K. Wound Dehiscence Following Cubital Tunnel Surgery. J Hand Surg Am 2022:S0363-5023(22)00001-6. [PMID: 35221174 DOI: 10.1016/j.jhsa.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/04/2021] [Accepted: 12/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Cubital tunnel syndrome is the second most common upper-extremity compressive neuropathy, and persistent symptoms can necessitate operative treatment. Surgical options include simple decompression and ulnar nerve transposition. The cause of wound dehiscence after surgery is not well known, and the factors leading to the development of these complications have not been previously described. METHODS Patients undergoing ulnar nerve surgery from January 1, 2016, to December 31, 2019, were retrospectively evaluated for the development of wound dehiscence within 3 months of surgery. There were 295 patients identified who underwent transposition and 1,106 patients who underwent simple decompression. Patient demographics and past medical history were collected to evaluate the risk factors for the development of wound dehiscence. RESULTS The overall rate of wound dehiscence following surgery was 2.5%. In the simple decompression group, the rate of wound dehiscence was 2.7% (30/1,106), which occurred a mean of 21 days (range, 2-57 days) following surgery. In the transposition group, the rate of wound dehiscence was 1.7% (5/295), which occurred a mean of 20 days (range, 12-32 days) following surgery. The difference in rates of dehiscence between the decompression and transposition groups was not significant. Five patients in the simple decompression group and 1 patient in the transposition group required a secondary surgery for closure of the wound. Age, body mass index, smoking status, and medical comorbidities were not found to contribute to the development of wound dehiscence. CONCLUSIONS Wound dehiscence can occur following both simple decompression and transposition, even after postoperative evaluation demonstrates a healed wound. Surgeons should be aware of this possibility and specifically counsel patients about remaining cautious with, and protective of, their wound for several weeks after surgery. Dehiscence may be related to suboptimal vascularity in the soft tissue envelope in the posteromedial elbow. When it occurs, dehiscence can generally be treated by allowing healing by secondary intention. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
| | - Tyler W Henry
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | | | | | - Jonas L Matzon
- Division of Hand Surgery, Rothman Orthopaedics, Philadelphia, PA
| | - Kevin Lutsky
- Division of Hand Surgery, Rothman Orthopaedics, Philadelphia, PA.
| |
Collapse
|
5
|
Fok MWM, Cobb T, Bain GI. Endoscopic cubital tunnel decompression - Review of the literature. J Orthop Surg (Hong Kong) 2021; 29:2309499020982084. [PMID: 33410383 DOI: 10.1177/2309499020982084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb. Endoscopic cubital tunnel decompression has gained popularity in recent years as this enables surgeons to achieve decompression of the ulnar nerve along its course using a small incision. This article describes the technical peals in performing endoscopic cubital tunnel decompression. In conditions which anterior transposition of the ulnar nerve is needed, subcutaneous transposition can be performed under endoscopic guidance. In addition, current literature is reviewed, and outcomes are presented. While short term results are encouraging, further prospective randomized study with longer follow-up is recommended.
Collapse
Affiliation(s)
- Margaret Woon Man Fok
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Tyson Cobb
- Shoulder, Elbow Wrist and Hand Center of Excellence, IA, USA
| | - Gregory I Bain
- Department of Orthopaedic Surgery, 1065Flinders University, Adelaide, Australia
| |
Collapse
|
6
|
Gallo L, Gallo M, Murphy J, Waltho D, Baxter C, Karpinski M, Mowakket S, Copeland A, Thoma A. Reporting Outcomes and Outcome Measures in Cubital Tunnel Syndrome: A Systematic Review. J Hand Surg Am 2020; 45:707-728.e9. [PMID: 32591175 DOI: 10.1016/j.jhsa.2020.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/29/2020] [Accepted: 04/03/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Comparison between studies assessing outcomes after surgical treatment of cubital tunnel syndrome (CuTS) has proven to be difficult owing to variations in outcome reporting. This study aimed to identify outcomes and outcome measures used to evaluate postoperative results for CuTS. METHODS We performed computerized database searches of MEDLINE and EMBASE. Studies with 20 or more patients aged 18 and older who were undergoing medial epicondylectomy, endoscopic decompression, open simple decompression, or decompression with subcutaneous, submuscular, or intramuscular transposition for ulnar neuropathy at the elbow were included. Outcomes and outcome measures were extracted and tabulated. RESULTS Of the 101 studies included, 45 unique outcomes and 31 postoperative outcome measures were identified. These included 7 condition-specific, clinician-reported instruments; 4 condition-specific, clinician-reported instruments; 8 patient-reported, generic instruments; 11 clinician-generated instruments; and one utility measure. Outcome measures were divided into 6 unique domains. Overall, 60% of studies used condition-specific outcome measures. The frequency of any condition-specific outcome measure ranged from 1% to 37% of included studies. CONCLUSIONS There is marked heterogeneity in outcomes and outcome measures used to assess CuTS. A standardized core outcome set is needed to compare results of various techniques of cubital tunnel decompression. CLINICAL RELEVANCE This study builds on the existing literature to support the notion that there is marked heterogeneity in outcomes and outcome measures used to assess CuTS. The authors believe that a future standardized set of core outcomes is needed to limit heterogeneity among studies assessing postoperative outcomes in CuTS to compare these interventions more easily and pool results in the form of systematic reviews and meta-analyses.
Collapse
Affiliation(s)
- Lucas Gallo
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matteo Gallo
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Murphy
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Waltho
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Charmaine Baxter
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marta Karpinski
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sadek Mowakket
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Copeland
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Achilleas Thoma
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
7
|
Senger S, Keiner D, Schwerdtfeger K, Oertel J. Imaging of Microhemodynamics in Peripheral Nerves by Contact Endoscope. World Neurosurg 2019; 126:e1302-e1308. [PMID: 30898754 DOI: 10.1016/j.wneu.2019.03.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Entrapment neuropathies include a wide field of locations. In most cases, the microsurgical decompression is still the therapy of choice. However, the role of venous stasis and ischemia is still discussed controversially. Here the authors evaluated the visualization of microvessels and the microperfusion at peripheral nerves with a contact endoscope during the surgical decompression for the first time. METHODS Eight patients were subjected to endoscopic or endoscopically assisted peripheral nerve decompression. In 3 patients with nerve tumors, the tumor carrying nerve was inspected endoscopically proximal and distal to the tumor site before and after resection. Microcirculation was assessed by a contact endoscope, allowing a 150-fold magnification, at superficial areas proximal and distal to the compression site. The electronically stored records were analyzed retrospectively using image processing software. Vessel diameter, red blood cell velocity, and blood flow, before and after decompression, were extracted. RESULTS The contact endoscope was easy to handle intraoperatively without problems. All minimally invasive procedures were performed without complications. In the offline computer-assisted analysis, single arterioles and veins were visualized showing decreased red blood cell velocity prior to decompression. After surgical treatment, a statistically significant increase of blood flow was observed. CONCLUSIONS Basically, the application of a contact endoscope for visualization of peripheral nerves' microcirculation is feasible. The observed effect of increased blood flow after decompression should be compared with the clinical outcome in a further prospective randomized study.
Collapse
Affiliation(s)
- Sebastian Senger
- Department of Neurosurgery, Medical School of the Saarland University, Homburg, Saar, Germany
| | - Dörthe Keiner
- Department of Neurosurgery, Medical School of the Saarland University, Homburg, Saar, Germany
| | - Karsten Schwerdtfeger
- Department of Neurosurgery, Medical School of the Saarland University, Homburg, Saar, Germany
| | - Joachim Oertel
- Department of Neurosurgery, Medical School of the Saarland University, Homburg, Saar, Germany.
| |
Collapse
|
8
|
Buchanan PJ, Chieng LO, Hubbard ZS, Law TY, Chim H. Endoscopic versus Open In Situ Cubital Tunnel Release: A Systematic Review of the Literature and Meta-Analysis of 655 Patients. Plast Reconstr Surg 2018; 141:679-684. [PMID: 29481399 DOI: 10.1097/prs.0000000000004112] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cubital tunnel syndrome is the second most common peripheral entrapment syndrome. To date, there is no true consensus on the ideal surgical management. A minimally invasive, endoscopic approach has gained popularity but has not been adequately compared to the more traditional, open approach. METHODS With compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was performed to identify studies published between 1990 and 2016 that compared the efficacy of endoscopic cubital tunnel release to open cubital tunnel release. A meta-analysis was then performed through a random-effects model with inverse variance weighting to calculate I values for heterogeneity analysis. Forest plots were constructed for each analysis group. RESULTS Five studies involving 655 patients (endoscopic cubital tunnel release, n = 226; open cubital tunnel release, n = 429) were included. Meta-analysis revealed no significant superiority of open release in achieving an "excellent" or "good" Bishop score (OR, 1.27; 95 percent CI, 0.59 to 2.75; p = 0.54) and reduction in visual analogue scale score (mean difference, -0.41; 95 percent CI, -1.49 to 0.67; p = 0.46). However, in the endoscopic release cohort, lower rates of new-onset scar tenderness/elbow pain were found (OR, 0.19; 95 percent CI, 0.07 to 0.53; p = 0.002), but there was a higher incidence of postoperative hematomas (OR, 5.70; 95 percent CI, 1.20 to 27.03; p = 0.03). The reoperation rate in the endoscopic and open release groups was 4.9 and 4.1 percent, respectively (p = 0.90). CONCLUSIONS The authors demonstrated equivalent overall clinical improvement between endoscopic and open cubital tunnel release in terms of Bishop score and visual analogue scale score reduction. Because of the low power of most studies, further investigations with a larger patient population and longer follow-up are needed to better characterize the role of endoscopic cubital tunnel release.
Collapse
Affiliation(s)
- Patrick J Buchanan
- Gainesville and Miami, Fla.,From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine
| | - Lee O Chieng
- Gainesville and Miami, Fla.,From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine
| | - Zachary S Hubbard
- Gainesville and Miami, Fla.,From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine
| | - Tsun Y Law
- Gainesville and Miami, Fla.,From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine
| | - Harvey Chim
- Gainesville and Miami, Fla.,From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine
| |
Collapse
|
9
|
Law TY, Hubbard ZS, Chieng LO, Chim HW. Trends in Open and Endoscopic Cubital Tunnel Release in the Medicare Patient Population. Hand (N Y) 2017. [PMID: 28644930 PMCID: PMC5484454 DOI: 10.1177/1558944716679610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cubital tunnel syndrome (CUT) is the second most common peripheral neuropathy with an annual incidence of 24.7 per 100 000, affecting nearly twice as many men as women. With increasing focus on cost-effectiveness and cost-containment in medicine, a critical understanding of utilization of health care resources for open and endoscopic approaches for cubital tunnel release is of value. The purpose of this study was to evaluate the costs and utilization trends of open and endoscopic cubital tunnel release. METHODS We performed a retrospective review of a Medicare database within the PearlDiver Supercomputer (Warsaw, Indiana) for procedures performed from 2005 to 2012. Annual utilization, charges, reimbursement, demographic data, and compound annual growth rate were evaluated. RESULTS Our query returned 262 104 patients with CUT, of which 69 378 (26.5%) and 4636 (1.8%) were surgically managed with open and endoscopic release respectively. Average charges were higher in endoscopic release ($3798) than open release ($3197) while reimbursements were higher in open releases ($1041) than endoscopic release, ($866). Both were performed most commonly in the <65 years age range. CONCLUSIONS Despite the unexpectedly lower reimbursement rate with endoscopic release, endoscopy utilization is growing faster than open releases in the Medicare population. Lower reimbursement is likely related to lack of a dedicated current procedural terminology code for endoscopic cubital tunnel release.
Collapse
Affiliation(s)
- Tsun Yee Law
- University of Miami Miller School of Medicine, FL, USA
| | | | | | - Harvey W. Chim
- University of Miami Miller School of Medicine, FL, USA,Harvey W. Chim, Division of Plastic Surgery, University of Miami Miller School of Medicine, Clinical Research Building, 1120 N.W. 14th Street, 4th Floor, Miami, FL 33136, USA.
| |
Collapse
|
10
|
Ren YM, Zhou XH, Qiao HY, Wei ZJ, Fan BY, Lin W, Feng SQ. Open versus endoscopic in situ decompression in cubital tunnel syndrome: A systematic review and meta-analysis. Int J Surg 2016; 35:104-110. [PMID: 27633448 DOI: 10.1016/j.ijsu.2016.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 07/29/2016] [Accepted: 09/10/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We conducted this systematic review and meta-analysis to compare the clinical efficacy and safety between open and endoscopic in situ decompression surgery methods for cubital tunnel syndrome (CuTS). METHODS PubMed, Medline, Embase, Cochrane Library and CNKI were searched for eligible studies. The data were extracted by two of the coauthors (WL, BYF) independently and were analyzed using RevMan statistical software, version 5.1. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool and the Newcastle-Ottawa Scale were used to assess the risk of bias. RESULTS Seven studies were included for systematic review, and six studies were included for meta-analysis. The CuTS patients received open in situ decompression (OISD) or endoscopic in situ decompression (EISD). A pooled analysis of postoperative Bishop score showed that the difference was not statistically significant between the EISD group and the OISD group (RR = 0.99, 95% CI = 0.88-1.12, P = 0.88). The overall estimate of postoperative satisfaction between the EISD group and the OISD group was not found to be significant (RR = 0.98, 95% CI = 0.89-1.08, P = 0.70). The overall estimate of complications (RR = 0.88, 95% CI = 0.24-3.29, P = 0.85) suggested that the difference was not statistically significant. CONCLUSIONS EISD and OISD for treating CuTS have equivalent efficacy for postoperative clinical improvement, whereas the incidences of complications of endoscopic surgical procedure were also same as those with the open surgical procedure. In situ decompression (especially EISD, with minor intraoperative trauma) could be treated as a valuable alternative to treat CuTS.
Collapse
Affiliation(s)
- Yi-Ming Ren
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Xian-Hu Zhou
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Hu-Yun Qiao
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, PR China
| | - Zhi-Jian Wei
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Bao-You Fan
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Wei Lin
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Shi-Qing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, PR China.
| |
Collapse
|
11
|
Aldekhayel S, Govshievich A, Lee J, Tahiri Y, Luc M. Endoscopic Versus Open Cubital Tunnel Release: A Systematic Review and Meta-Analysis. Hand (N Y) 2016; 11:36-44. [PMID: 27418887 PMCID: PMC4920515 DOI: 10.1177/1558944715616097] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several surgical techniques exist for treatment of cubital tunnel syndrome. Endoscopic cubital tunnel release (ECTuR) has been recently reported as a promising minimally invasive technique. This study aims to compare outcomes and complications of open cubital tunnel release (OCTuR) and ECTuR in the treatment of idiopathic cubital tunnel syndrome. METHODS A systematic review of the literature (1980-2014) identified 118 citations. Studies including adults with idiopathic cubital tunnel treated exclusively by ECTuR or OCTuR were included. Outcomes of interest were postoperative grading, complications, number of reoperations, and the need for intraoperative conversion to another technique. Postoperative outcomes were combined into a uniform scale with 4 categories: "excellent," "good," "fair," and "poor." RESULTS Twenty studies met the inclusion criteria (17 observational and 3 comparative), representing 425 open and 556 endoscopic decompressions. In the open group, 79.8% experienced "good" or "excellent" results with 12% complication rate and 2.8% reoperation rate. In the endoscopic group, 81.8% experienced "good" or "excellent" results with 9% complication rate and 1.6% reoperation rate. Meta-analysis of 3 comparative studies demonstrated a significantly lower overall complication rate with ECTuR. Subgroup analysis of complications revealed a significantly higher incidence of scar tenderness and elbow pain with OCTuR. CONCLUSIONS The current study demonstrates similar effectiveness between the endoscopic (ECTuR) and open (OCTuR) techniques for treatment of idiopathic cubital tunnel syndrome with similar outcomes, complication profiles, and reoperation rates.
Collapse
Affiliation(s)
| | | | - James Lee
- McGill University Health Centre, Montreal, Québec, Canada
| | - Youssef Tahiri
- McGill University Health Centre, Montreal, Québec, Canada
| | - Mario Luc
- McGill University Health Centre, Montreal, Québec, Canada,Mario Luc, Assistant Professor, Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal General Hospital, 1650 Cedar Avenue, Room L9-317, Montreal, Québec, Canada H3G 1A4.
| |
Collapse
|
12
|
Smeraglia F, Del Buono A, Maffulli N. Endoscopic cubital tunnel release: a systematic review. Br Med Bull 2015; 116:155-63. [PMID: 26608457 DOI: 10.1093/bmb/ldv049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Theoretical advantages of endoscopic cubital tunnel release are the short incision, lower risk of nerve damage, reduced manipulation of the nerve and possible faster recovery. SOURCES OF DATA We systematically searched Medline (PubMed), Web of Science and Scopus databases using the following keywords: 'endoscopic ulnar nerve', 'endoscopic cubital nerve', 'endoscopic ulnar compression' and 'endoscopic ulnar neuropathy'. Twenty-one studies were included in this review. The quality of the studies was assessed using the Coleman Methodological Score. AREAS OF AGREEMENT Endoscopic release is effective for cubital tunnel entrapment and allows adequate visualization of the site of entrapment. There is a negative association between the severity of the compression and reported outcomes. Injury to the medial branch of the antebrachial cutaneous nerve is less frequent thanks to the limited dissection. The most frequent complication is the development of a hematoma. AREAS OF CONTROVERSY It is unclear whether ulnar nerve instability is a contraindication to simple decompression. GROWING POINTS The shorter time to return to work and the cosmetic appearance of the scar can be considered advantages of the endoscopic technique. AREAS TIMELY FOR DEVELOPING RESEARCH There is a need to perform randomized clinical trials with common and validated scoring system with a longer duration of follow-up. The literature pertinent to endoscopic cubital tunnel release is lacking in the evaluation of the learning curve. Further investigations are necessary to assess the role of ulnar nerve instability.
Collapse
Affiliation(s)
| | - Angelo Del Buono
- Department of Orthopaedic and Trauma Surgery, Ospedale Vaio Fidenza (PR), Fidenza, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi, Salerno 84081, Italy Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4 DG, UK
| |
Collapse
|
13
|
Abstract
It is safe to say that in situ decompression of the ulnar nerve in cubital tunnel syndrome has been demonstrated to achieve equivalent functional results when compared with more elaborate techniques, such as decompression with nerve transposition. The evolution toward procedures associated with less patient morbidity is reflected by the introduction of endoscopic techniques for the treatment of cubital tunnel syndrome. The authors have incorporated the endoscopic approach as proposed by Hoffmann and Siemionow into their practice and have obtained favorable results. Although the skin incision can frequently be kept to a minimum (<2 cm), superior visualization associated with this approach allows for in situ decompression of the ulnar nerve along a distance of up to 30 cm. Despite the extent of decompression performed, operative morbidity is minimal, with return to full duty being the rule even in manual laborers within 10 to 14 days postoperatively.
Collapse
Affiliation(s)
- Horst Zajonc
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | | |
Collapse
|
14
|
Martin KD, Dützmann S, Sobottka SB, Rambow S, Mellerowicz HA, Pinzer T, Schackert G, Krishnan KG. Retractor-endoscopic nerve decompression in carpal and cubital tunnel syndromes: outcomes in a small series. World Neurosurg 2013; 82:e361-70. [PMID: 24056216 DOI: 10.1016/j.wneu.2013.09.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 06/18/2013] [Accepted: 09/13/2013] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To present midterm to long-term results obtained in carpal tunnel release, in situ decompression, and anterior transposition of the ulnar nerve using the retractor integrated endoscope. METHODS During the period 2000-2010, 145 patients underwent endoscopic carpal tunnel releases (n = 47), endoscopic in situ decompression of the ulnar nerve (n = 55), and endoscopic anterior transposition of the ulnar nerve (n = 52). Bilateral surgery was performed in 9 patients. Independent examinations at 24 months after surgery were used for objective results (Bishop score). Subjective results were procured using a questionnaire. RESULTS After endoscopic carpal tunnel release, 59.6% of patients showed excellent results, 21.2% showed good results, 12.8% showed fair results, and 6.4% showed poor results according to objective scoring. In 85% of patients, subjective improvement was noted after surgery; symptoms were the same as before surgery in 12.8% of patients and were worse in 2.1% of patients after surgery. After endoscopic in situ decompression, 56.4% of patients showed excellent results on objective scoring, 32.7% showed good results, 9.1% showed fair results, and 1.8% showed poor results. On subjective questioning, 72.7% of patients reported improvement, 20% reported no change in symptoms, and 7.3% reported worse symptoms. After endoscopic anterior transposition of the ulnar nerve, 48.1% of patients showed excellent results on objective scoring, 26.9% showed good results, 23.1% showed fair results, and 1.9% showed poor results. Subjectively, 65.4% of patients reported improvement, 26.9% reported no change in symptoms, and 7.7% reported worse symptoms. Patients with symptom duration of <9 months before surgery showed better results than patients with symptom duration of >9 months. CONCLUSIONS The retractor-endoscopic technique provides good long-term results after carpal tunnel release, in situ decompression, and anterior subcutaneous transposition of the ulnar nerve. Outcomes showed some correlation to the duration of preoperative symptoms.
Collapse
Affiliation(s)
- K-Daniel Martin
- Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Stephan Dützmann
- Department of Neurological Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Stephan B Sobottka
- Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Stefanie Rambow
- Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Helene A Mellerowicz
- Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Thomas Pinzer
- Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Gabriele Schackert
- Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Kartik G Krishnan
- Department of Neurological Surgery, Justus Liebig University, Giessen, Germany.
| |
Collapse
|
15
|
Dützmann S, Martin KD, Sobottka S, Marquardt G, Schackert G, Seifert V, Krishnan KG. Open vs Retractor-Endoscopic In Situ Decompression of the Ulnar Nerve in Cubital Tunnel Syndrome. Neurosurgery 2012; 72:605-16; discussion 614-6. [DOI: 10.1227/neu.0b013e3182846dbd] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Both open ulnar nerve decompression and retractor-endoscopic ulnar nerve decompression have been shown to yield good results. However, a comparative evaluation of the techniques is lacking.
OBJECTIVE:
To compare the results of open and endoscopic surgery in cubital tunnel syndrome.
METHODS:
One hundred fourteen patients undergoing open (n = 59) or endoscopic (n = 55) decompression of the ulnar nerve for cubital tunnel syndrome were retrospectively compared. The long- and short-term outcomes were compared with respect to the time until return to full activity and the duration of postoperative pain. Additionally, matched pairs between the 2 groups were chosen for analysis (n = 34).
RESULTS:
Long-term results in the open vs endoscopic groups were as follows: excellent results, 54.2% vs 56.4%; good results, 23.8% vs 32.7%; fair results, 20.3% vs 9.1%; and poor results, 1.7% vs 1.8%, respectively. For the matched pairs, the results had similar significance levels (P = .84). The times until return to full activity in the open vs the endoscopic groups were as follows: 2 to 7 days, 18.6% vs 76.4%; 7 to 14 days, 55.9% vs 10.9%; and > 14 days, 25.4% vs 12.7% (P < .001 between nonmatched and matched pairs). The durations of postoperative pain in the open vs the endoscopic groups were as follows: 1 to 3 days, 45.8% vs 67.3%; 3 to 10 days, 42.5% vs 25.4%; and > 10 days, 11.7% vs 7.3% (P =.04 for nonmatched and P = .05 for matched pairs).
CONCLUSION:
There are no significant differences in long-term outcomes after open and retractor-endoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome. The short-term results are significantly better in endoscopic surgery.
Collapse
Affiliation(s)
- Stephan Dützmann
- Department of Neurological Surgery, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany
| | - K. Daniel Martin
- Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Stephan Sobottka
- Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Gerhard Marquardt
- Department of Neurological Surgery, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany
| | - Gabriele Schackert
- Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Volker Seifert
- Department of Neurological Surgery, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany
| | - Kartik G. Krishnan
- Department of Neurological Surgery, Justus Liebig University, Giessen, Germany
| |
Collapse
|
16
|
Alblas CL, van Kasteel V, Jellema K. Injection with corticosteroids (ultrasound guided) in patients with an ulnar neuropathy at the elbow, feasibility study. Eur J Neurol 2012; 19:1582-4. [PMID: 22339768 DOI: 10.1111/j.1468-1331.2012.03676.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND PURPOSE Unlike carpal tunnel syndrome, little is known about injection with corticosteroids in patients with an ulnar neuropathy at the elbow (UNE). The purpose of this feasibility study is to see whether injection with corticosteroids is safe in patients with UNE and whether there are grounds to launch a prospective placebo-controlled study on the effects of corticosteroids. METHODS Patients with clinical symptoms of UNE and a nerve conduction study compatible with UNE or thickened ulnar nerve at the elbow (> 10 mm(2)) by ultrasonography were included. All included patients received an ultrasound-guided injection of 1 ml containing 40 mg methylprednisoloneacetate and 10 mg lidocainhydrochloride (Depo-Medrol(®)). Complications of the injection were monitored. After 3 months, nerve conduction studies and ultrasonography were repeated and a clinical outcome determined. RESULTS Eight patients with nine UNE were included. None of the patients mentioned increase in the symptoms directly after the injection nor had an infection on the injection site or haematoma. After 3 months, there was improvement of the symptoms in five patients. One patient deteriorated and three had no change of the symptoms at all. Overall, there was no significant change of the thickness of the ulnar nerve with mean difference -0.056 mm(2) (95% CI -2.56 to 2.45 mm(2)). CONCLUSION We showed that injection with corticosteroids in patients with UNE is easy and safe, and based on this result, we found enough arguments to launch a prospective, placebo-controlled trial to explore the effectiveness of corticosteroids in patients with UNE.
Collapse
Affiliation(s)
- C L Alblas
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.
| | | | | |
Collapse
|
17
|
Keiner D, Tschabitscher M, Welschehold S, Oertel J. Anterior interosseous nerve compression syndrome: is there a role for endoscopy? Acta Neurochir (Wien) 2011; 153:2225-9. [PMID: 21786008 DOI: 10.1007/s00701-011-1091-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 07/14/2011] [Indexed: 12/27/2022]
Abstract
BACKGROUND Anterior interosseous nerve syndrome is characterized by paralysis of the flexor digitorum profundus, the flexor pollicis longus and the pronator quadratus muscles without sensory loss. Extended exploration of the anterior interosseous nerve is the surgical treatment of choice. The present study evaluates the feasibility of an endoscopic approach for nerve decompression. METHODS Preparation of the anterior interosseous nerve was performed in ten human cadaver arms. Subsequently, one female patient suffering from anterior interosseous nerve syndrome was endoscopically operated on. FINDINGS A skin incision of 3-4 cm in the proximal direction was made at the forearm, and the median nerve was visualized between the pronator teres muscle and the flexor digitorum superficialis. Subsequently, the anterior interosseus nerve branch was identified, followed distally and decompressed under endoscopic view. The procedure could be accomplished in all cases under endoscopic view. Due to the very steep surgical angle, a branch of the anterior interosseus nerve was injured in one cadaver case. In all other cases, no adverse effects were observed. In the clinical case, the anterior interosseus nerve was endoscopically identified and decompressed, but a skin incision of 5 cm was required. CONCLUSIONS The results demonstrate that an endoscopic decompression of the anterior interosseus nerve is possible. Several difficulties occurred: Due to the depth of the surgical approach, especially in case of bulky muscles and very small skin incisions, the view is limited, harboring a higher risk of nerve injury. With more experience and specially designed endoscopes, application of this technique in anterior interosseus nerve compression syndrome might become more feasible.
Collapse
Affiliation(s)
- Doerthe Keiner
- Neurochirurgische Klinik, Universitaetsklinikum des Saarlandes, Homburg Saar, Germany
| | | | | | | |
Collapse
|
18
|
Stadie AT, Keiner D, Fischer G, Conrad J, Welschehold S, Oertel J. Simple Endoscopic Decompression of Cubital Tunnel Syndrome With the Agee System. Oper Neurosurg (Hagerstown) 2010; 66:325-31; discussion 331-2. [DOI: 10.1227/01.neu.0000369949.97016.b1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Abstract
BACKGROUND
Simple decompression in ulnar nerve compression syndromes offers options for endoscopic applications.
OBJECTIVE
The authors present their initial experience with the Agee device.
PATIENTS AND METHODS
The monoportal endoscopic technique (Agee system) was evaluated on 10 cadaveric arms. Subsequently, 32 arms of 29 patients were operated on between January 2006 and March 2009. All patients presented with typical clinical signs and neurophysiologic studies. Long-term follow-up examinations were obtained in 27 of 32 arms.
RESULTS
In the cadaver study, the ulnar nerve was always correctly identified. No nerve damage occurred, and sufficient decompression of the ulnar nerve was always achieved. In the clinical series, no intraoperative complications were observed. A change to open technique was not required, and no worsening of the cubital tunnel syndrome occurred. Two wound infections required surgical wound cleaning. Wound hematomas treated conservatively were found in 5 cases. On long-term follow-up, an improvement in the McGowan-Classification was achieved in 22 of 27 cases. One patient was operated on by open surgery after endoscopic surgery.
CONCLUSION
The endoscopic technique for ulnar nerve entrapment syndrome using an Agee device appears to be safe and efficient. The results are comparable to those achieved with simple open decompression. A randomized prospective study should be performed to further evaluate the value of new technique in ulnar nerve entrapment syndrome.
Collapse
Affiliation(s)
- Axel Thomas Stadie
- Neurochirurgische Klinik und Poliklinik, Universitaetsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstrasse 1, D-55101 Mainz, Germany
| | - Doerthe Keiner
- Neurochirurgische Klinik und Poliklinik, Universitaetsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstrasse 1, D-55101 Mainz, Germany
| | - Gerrit Fischer
- Neurochirurgische Klinik und Poliklinik, Universitaetsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstrasse 1, D-55101 Mainz, Germany
| | - Jens Conrad
- Neurochirurgische Klinik und Poliklinik, Universitaetsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstrasse 1, D-55101 Mainz, Germany
| | - Stefan Welschehold
- Neurochirurgische Klinik und Poliklinik, Universitaetsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstrasse 1, D-55101 Mainz, Germany
| | - Joachim Oertel
- Neurochirurgische Klinik und Poliklinik, Universitaetsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstrasse 1, D-55101 Mainz, Germany
| |
Collapse
|