Medial epicondylectomy for the treatment of ulnar nerve compression at the elbow

doi:10.1016/S0363-5023(09)91100-5

The Journal of Hand Surgery

Volume 15, Issue 1, January 1990, Pages 22-29

https://doi.org/10.1016/S0363-5023(09)91100-5 Get rights and content

Decompression of the ulnar nerve at the elbow with medial epicondylectomy was done in 43 patients and reviewed with an average follow-up of 2.3 years. Eight were graded as excellent, 23 as good, 9 as fair, and 3 as poor results. A special emphasis was placed on analysis of the potential disadvantages of medial epicondylectomy including bone tenderness at the osteotomy site, vulnerability of the ulnar nerve, ulnar collateral ligament instability, and weakness from disruption of the flexor pronator origin. Clinical assessment of strength including quantitative measurement of pinch strength, grip strength and endurance, and testing of forearm muscles did not show these potential disadvantages to be significant problems.

References (33)

G Osborne
Compression neuritis of the ulnar nerve at the elbow
The Hand
(1970)
D Gore et al.
Medial epicondylectomy for subluxing ulnar nerve
Am J Surg
(1966)
AI Froimson et al.
Treatment of compression neuropathy of the ulnar nerve at the elbow by epicondylectomy and neurolysis
J Hand Surg
(1980)
RJ Foster et al.
Factors related to the outcome of surgically managed compression ulnar neuropathy at the elbow level
J Hand Surg
(1981)
RD Leffert
Anterior submuscular transpositon of the ulnar nerves by the Learmonth technique
J Hand Surg
(1982)
AS Broudy et al.
Technical problems with ulnar nerve transposition at the elbow: findings and results of reoperation
J Hand Surg
(1978)
RS Adelaar et al.
McDowell The treatment of cubital tunnel syndrome
J Hand Surg
(1984)
DM Dawson et al.
Entrapment neuropathies
(1983)
W Feindel et al.
Cubital tunnel compression in tardy ulnar palsy
Can Med Assoc J
(1958)
W Feindel et al.
The role of the cubital tunnel in tardy ulnar palsy
Can J Surg
(1958)

DH Wilson et al.

Surgery of ulnar neuropathy at the elbow; 16 cases treated by decompression without transposition

J Neurosurg

(1973)

PB Thomsen

Compression neuritis of the ulnar nerve treated with simple decompression

Acta Orthop Scand

(1977)

GV Osborne

The surgical treatment of tardy ulnar neuritis In: Proceedings and reports of councils and associations

J Bone Joint Surg

(1975)

DW Vanderpool et al.

Peripheral compression lesions of the ulnar nerve

J Bone Joint Surg

(1968)

E Jenson

Ulnar perineuritis

Acta Psychiat Scand

(1958)

L Zacharia

Anteposito n ulnaris

Ugeskr Laeger

(1967)

Cited by (87)

Intraoperative Subluxation of the Ulnar Nerve: Use of a Triceps Sling Reconstruction Technique
2020, Journal of Hand Surgery
To determine whether the triceps sling reconstruction technique is a safe and effective treatment of intraoperative ulnar nerve subluxation after in situ decompression.
Twelve patients who underwent a triceps sling reconstruction for intraoperative ulnar nerve subluxation after in situ release were retrospectively reviewed. The triceps sling technique consists of harvesting a small, distally based strip of triceps tendon and suturing the proximal end of the strip to the posterior aspect of the released Osborne ligament. Thus, a sling is created between the medial epicondyle and the olecranon, preventing the nerve from subluxating. Patients were clinically evaluated before and after surgery. Visual analog scale pain scores, static 2-point discrimination, strength, and Disabilities of the Arm, Shoulder, and Hand score were assessed.
At a mean follow-up of 31 months (range, 24–38 months), there was a significant improvement in mean visual analog pain scores from 8.6 to 0.2. Static 2-point discrimination was improved from a mean of 9.1 mm before surgery to 5.7 mm afterward. Strength improved by a mean of 33% and 30% with grip and pinch, respectively. Mean Disabilities of the Arm, Shoulder, and Hand score improved from 45.9 to 3.7. No subluxation of the ulnar nerve was noted after surgery. No other complications were noted. No reoperations were required during the follow-up period.
Triceps sling reconstruction is a safe treatment in patients with intraoperative ulnar nerve subluxation after in situ decompression.
Therapeutic IV.
Clinical features affecting the patient-based outcome after minimal medial epicondylectomy for cubital tunnel syndrome
2018, Journal of Plastic, Reconstructive and Aesthetic Surgery
Little information is currently available to analyze unsatisfactory surgical outcomes for cubital tunnel syndrome (CuTS). The aim of this study was to analyze the clinical features influencing patient-reported outcomes of minimal medial epicondylectomy for CuTS.
We evaluated 91 patients who underwent minimal medial epicondylectomy for CuTS using the grip strength; two-point discrimination; Disability of the Arm, Shoulder and Hand (DASH) questionnaire; and a satisfaction with treatment questionnaire for one year, postoperatively. The clinical features evaluated as prognostic indicators included age, gender, body mass index (BMI), smoking, alcohol consumption, comorbidities, hand dominance, work level, history of elbow trauma, elbow arthritis, elbow flexion contracture, duration of symptoms, and severity of disease.
Grip strength, two-point discrimination, and DASH scores exhibited significant clinical improvements, with 77% (70/91) of patients satisfied with treatment. In terms of patient-reported disability, heavy smoking, elbow flexion contracture, and preoperative disease severity increased DASH scores at 1-year follow-up. However, only heavy smoking and elbow flexion contracture were associated with a higher likelihood of dissatisfaction with treatment.
Heavy smoking, elbow flexion contracture, and preoperative disease severity are associated with persistently increased disability after minimal medial epicondylectomy for CuTS. However, only heavy smoking and elbow flexion contracture were associated with a higher likelihood of dissatisfaction with the treatment.
Surgical management of the elderly elbow
2016, Maturitas
The elbow has a major role in helping with the positioning of the hand in space. Any pathology of the joint can result in pain, loss of function and difficulties with activities of daily living. With an increasingly elderly population the degenerative conditions affecting the elbow are becoming more prevalent. Besides traumatic injury, the more commonly encountered problems are osteoarthritis, inflammatory arthritis, nerve compression and stiffness. An awareness of these conditions is important for those who provide care to this patient group. Whilst many of these conditions can be managed conservatively in primary care, some patients are referred to secondary care and elect for surgical treatments. This review considers the surgical treatments for the common elbow pathologies in the elderly population, including the potential complications associated with such treatments.
Risk factors predicting revision surgery after medial epicondylectomy for primary cubital tunnel syndrome
2016, Journal of Shoulder and Elbow Surgery
Citation Excerpt :
Although HO has been reported in previous studies after ME, the degree of ectopic bone formation and overall incidence after ME remain unclear. In addition, there are no mentions of any patients who actually required revision surgery for removal of HO after ME.15,18 By contrast, HO formation was the most commonly occurring complication aside from general perineural scarring and adhesions in our series, with 5 patients found to have ectopic bone formation at the time of revision.
Medial epicondylectomy (ME) is one of several accepted surgical options for the treatment of cubital tunnel syndrome (CuTS). Although reported outcomes after ME are generally favorable, few data exist regarding which patients are prone to poorer outcomes requiring revision surgery. The goal of this study was to identify risk factors predicting the need for revision surgery after ME for the treatment of CuTS.
We conducted a retrospective chart review of all patients treated at our institution with ME for CuTS from 2006 through 2011. We identified patients who underwent additional operations for recurrent or persistent ulnar nerve symptoms as the revision cohort. We performed bivariate analysis to determine which variables had a significant influence on the need for revision surgery. We examined qualitative factors associated with revision, including the degree of bony resection performed during the index ME, and intraoperative findings at the time of revision surgery.
Revision surgery was required in 13.3% of cases (11 of 83). On bivariate analysis, younger age, associated workers' compensation claims, lesser disease severity, and preoperative opioid use were all significant predictors of the need for revision surgery. Perineural scarring and heterotopic bone formation about the elbow were the 2 most common findings at the time of revision.
For patients with CuTS, the risk of revision surgery after ME is higher in younger patients, patients with less severe disease, patients taking opioid medications preoperatively, and patients with associated workers' compensation claims.
Level IV; Case Series; Treatment Study
Ulnar Nerve Compression
2016, Hand and Upper Extremity Rehabilitation: A Practical Guide
The effect of vascular pedicle preservation on blood flow and clinical outcome following ulnar nerve transposition
2014, Journal of Hand Surgery
To evaluate the efficacy of a technique to preserve the extrinsic vascular supply to the ulnar nerve after transposition and its effect on blood flow and clinical outcome.
We included 36 patients with cubital tunnel syndrome. The patients were randomly selected to undergo vascular pedicles–sparing surgery for anterior ulnar nerve transposition (VP group) or nerve transposition and artery ligation (non-VP group). Blood flow to the ulnar nerve was estimated intraoperatively at 3 locations in the cubital tunnel before and after transposition using a laser Doppler flowmeter. Clinical results at 3, 6, and 12 months after surgery were also compared between the 2 groups.
The blood flow before ulnar nerve transposition was not significantly different between the groups. Blood flow at all 3 locations after the ulnar nerve transposition was significantly higher in the VP group than in the non-VP group. Blood flow in the non-VP group reduced to values between 28% and 52% from the pre-transposition baseline values. After surgery, no significant differences were observed in the clinical results between the groups, except for the Disabilities of the Arm, Shoulder and Hand scores at 12 months after surgery, which was greater in the non-VP group.
The procedure of preserving the extrinsic vascular pedicles can prevent compromise of blood flow to the ulnar nerve immediately after nerve transposition. However, this procedure had no correlation to improved recovery of ulnar nerve function after surgery.
Therapeutic II.

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¹: From the Department of Orthopedic Surgery, Tufts Medical School; Hand Surgery Service, Department of Orthopedics, New England Baptist Hospital, Boston, Mass.

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Medial epicondylectomy for the treatment of ulnar nerve compression at the elbow

The Hand

Am J Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

Entrapment neuropathies

Cubital tunnel compression in tardy ulnar palsy

Can Med Assoc J

The role of the cubital tunnel in tardy ulnar palsy

Can J Surg

Surgery of ulnar neuropathy at the elbow; 16 cases treated by decompression without transposition

J Neurosurg

Compression neuritis of the ulnar nerve treated with simple decompression

Acta Orthop Scand

The surgical treatment of tardy ulnar neuritis In: Proceedings and reports of councils and associations

J Bone Joint Surg

Peripheral compression lesions of the ulnar nerve

J Bone Joint Surg

Ulnar perineuritis

Acta Psychiat Scand

Anteposito n ulnaris

Ugeskr Laeger