Cubital tunnel decompression with medial epicondylectomy
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Cubital tunnel syndrome is the second commonest upper limb peripheral nerve entrapment. The syndrome is a complex pathophysiological spectrum with nerve compression and nerve tension both playing important roles. Decompression of the nerve may create scar tether points, reduce neural glide and increase tension during normal functional elbow range of motion. Creation of instability renders the nerve vulnerable to further irritation and compression against the posterior and medial aspect of the medial epicondyle during movement. Transposition of the nerve has been proposed as a solution to both compression and tension by decompressing the nerve and then rerouting it in a more anterior plan such that the course is shorter and there is no tension during elbow flexion.
I use this procedure in approximately 1:5 of my primary surgery cases and in all my revision cases. Frequently when a nerve has been transposed and has secondary compression points I will relocate the nerve after performing a neurolysis and medial epicondylectomy. These are specific steps to the procedure that cannot be omitted or the results will not be predictable.
Author: Mr Dominic Power FRCS (TR & Orth)
Institution: The Queen Elizabeth Hospital ,Birmingham ,UK.