Cubital Tunnel Syndrome and Treatment With In Situ Release and Medial Epicondylectomy

Abstract

Cubital tunnel syndrome (CTS) is a common compressive neuropathy. Compression of the ulnar nerve at the elbow causes pain and other symptoms in the patient's hand and forearm. It is second in incidence only to carpal tunnel syndrome or compression of the median nerve at the wrist. Cubital tunnel syndrome usually develops insidiously. Historically, the condition was first treated nonsurgically. If medical management was unsuccessful, the patient underwent surgical release of the ulnar nerve at the elbow. This procedure produced varying results with regard to resolution of symptoms, and its complications included ulnar nerve paralysis, which seldom resolved. Anterior subcutaneous transposition was used to treat posttraumatic ulnar nerve compression with only nominal success. There are several newer surgical techniques that appear to provide favorable outcomes for patients with cubital tunnel syndrome when nonsurgical management fails to provide relief. Nonetheless, no single treatment appears to be superior. This topic reviews the anatomy, pathophysiology, clinical presentation, and diagnosis of cubital tunnel syndrome, and provides a focused discussion of the rationale and technique of the authors' preferred surgical treatment, in situ ulnar nerve release with medial epicondylectomy, reflecting the authors' belief that unlike carpal tunnel syndrome, cubital tunnel syndrome is primarily a strain problem on the ulnar nerve, not merely a compression problem. Video of in situ release and medial epicondylectomy is provided.

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