Title: Endoscopic cubital release Financial interest
1Endoscopic cubital releaseFinancial interest
2Endoscopic cubital tunnel release
- Treatment of cubital tunnel syndrome
- Conservative treatment
- Surgical options
- Open cubital tunnel release
- Anterior transposition of ulna nerve
- Submuscular
- Subcutanoeous
- Medial epicondylectomy
3Endoscopic cubital tunnel release
- Platt in Br J Surg, 1926
- Anterior transposition of ulna nerve
- Widely practiced today
- Problems
- Dissections and mobilization of the ulna N
4Endoscopic cubital tunnel release
- Problems with dissection and mobilization
- Interfering with the blood supply
- Compromising articular branches
- Compromising muscular branches
- Jeopardizing antebrachial cutaneous nerves
- Creates large area of scar bed
5Endoscopic cubital tunnel release
- Regional blood flow to the UN
- Smith 1966, Arch. Surg.
- 5-8cm detachment of mesoneurium
- Impaired segmental circulation
- Not maintained anastomotic channels
6Endoscopic cubital tunnel release
- Regional blood flow to the UN
- K Ogata and Manske 1984, Cl Orth R Research
- Vascular injection studies
- Anterior transposition associated with
significant decrease in blood flow
7Endoscopic cubital tunnel release
- Goals
- Minimize extensive soft tissue dissections
- Minimize manipulation of the nerve
- Minimize mobilization of the nerve
- Preserve the mesoneurium
8Endoscopic cubital tunnel release
9Endoscopic cubital tunnel release
Compliments of AMS
10Clear cannula
11Endoscopic cubital tunnel release
- Standard
- 4mm scope
- Locking device
- Sleeve knife
Compliments of AMS
12Land Marks
- Landmarks
- Med. Epicondyle
- Olecrenon
- 3-5 cm incision
13Surgical technique
- Incision
- Landmarks
- Med. Epicondyle
- Olecrenon
- 3-5 cm incision
14Surgical technique
- Division Osborns ligament
- Identification of Ant. Br. Cut. Nerve
- Identification of unla nerve
15Surgical technique
- Distal dissection
- Clamp or scissor dissection
16Surgical technique
- Distal dissection
- Dissector
17Surgical technique
- Follow the pathway
- Created by dissector
- Obturator cannula assembly
- Remove the obturator
18Endoscopic VisualizationDivision
19Surgical technique
- Arthroscope 4mm 30 degree
- Visualize
- Knife sleeve assembly
- Division
20Surgical technique Endoscopic visualization
21Surgical Technique
- Fix Knife to Endoscope
- Slide knife over scope
- Lock Knife in place
22Surgical technique Endoscopic visualization
23Surgical Technique
24Surgical Technique
- Proximal insertion of obturator cannula
25Endoscopic visualization
26Surgical Technique
- Endoscopic Visualization
- Arcade of Struthers
27(No Transcript)
28Surgical technique
- If nerve subluxes on flexion
- Medial epicondyletomy
- Anterior transposition
29Results
- 17 patients
- 6 Females
- 11 Males
30Results
- 2 pt. underwent Med. Epicondylectomy
- 1 pt. had anterior transposition
31Results
- Complications
- 2 haematomas
- No ulna nerve injury
- No injury to M A B cutaneous nerve
- No recurrence
- 1 hypertrophic scar
32Results
- Tsai et al
- endoscopic cubital tunnel
- 85 elbows in 76 patients
- 32 months follow up
- 42 had excellent results, 45 had good results,
11 had fair results, and 2 had poor results. - Conclusion
- These results are comparable to the other
decompressive techniques, which overall result in
85-90 good-to-excellent results. -
33Results
- Hoffmann et al
- 75 patients (76 cases).
- Release the U nerve release 17 cm
- Incision averaging 2.8 cm in length.
- The mean follow-up 11 months
- Good to excellent results in 94 of patients.
34Conclusions
- Minimally invasive
- No manipulation of the nerve
- No interruption of blood supply
- Avoids sacrifice of the articular/muscular Br.
35New Design
- Winged Design
- Will open and close the slot at any time and then
lock into place - Protect the nerve and gently move it from the
cutting blade - Will be out in Four Weeks
-
36Thank you