Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
HAND
Published in: HAND 4/2015

01-12-2015

The effect of operative technique on ulnar nerve strain following surgery for cubital tunnel syndrome

Authors: Justin Mitchell, John C. Dunn, Nicholas Kusnezov, Julia Bader, Derek F. Ipsen, Christopher L. Forthman, Aaron Dykstra

Published in: HAND | Issue 4/2015

Login to get access

Abstract

Background

The aim of this study is to compare the amount of strain on the ulnar nerve based on elbow position after in situ release, subcutaneous transposition, submuscular transposition, and medial epicondylectomy.

Methods

Six matched cadaver upper extremity pairs underwent ulnar nerve decompression, transposition in a sequential fashion, while five elbows underwent medial epicondylectomy. A differential variable reluctance transducer (DVRT) was placed in the ulnar nerve. An in situ release, a subcutaneous transposition, and a submuscular transposition were performed sequentially with the strain being measured after each procedure in neutral, full elbow flexion, and extension positions. The strain was then averaged and compared for each procedure. Five cadavers underwent medial epicondylectomy and were similarly tested.

Results

After the in situ release, there was no statistically significant change in strain in either flexion or extension. After a subcutaneous transposition, there was a statistically significant decrease in strain in full elbow flexion but not in extension. Similarly after a submuscular transposition, there was a statistically significant decrease in strain in full flexion but not in extension. There was not a statistically significant change in strain with medial epicondylectomy.

Conclusion

An in situ release of the ulnar nerve at the elbow may relieve pressure on the nerve but does not address the problem of strain which may be the underlying pathology in many cases of ulnar neuropathy at the elbow (UNE). Transposition of the ulnar nerve anterior to the medial epicondyle addresses the problem of strain on the ulnar nerve. In addition, it does not create an increased strain on the ulnar nerve with elbow extension.
Literature
1.
Baek GH, Kwon BC, Chung MS. Comparative study between minimal medial epicondylectomy and anterior subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Shoulder Elbow Surg. 2006;15:609–13.CrossRefPubMed
2.
Bartels RHMA, Verhagen WLM, van der Wilt GJ, Meulstee J, van Rossum LGM, Grotenhis JA. Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: part 1. Neurosurgery. 2005;56:522–30.CrossRefPubMed
3.
Bimmler D, Meyer VE. Surgical treatment of the ulnar nerve entrapment neuropathy: submuscular anterior transposition or simple decompression of the ulnar nerve? Long-term results in 79 cases. Ann Chir Main Memb Super. 1996;15:148–57.CrossRefPubMed
4.
Byl C, Puttiltz C, Byl N, Lotz J, Topp K. Strain in the median and ulnar nerves during upper-extremity positioning. J Hand Surg. 2002;27A:1032–40.CrossRef
5.
Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2012;7:CD006839.PubMed
6.
Capo JT, Jacob G, Maurer RJ, Nourbakhish A, Preston JS. Subcutaneous anterior transposition versus decompression and medial epicondylectomy for the treatment of cubital tunnel syndrome. Orthopaedics. 2011;34:e713–7. doi:10.​3928/​01477447-20110922-18.
7.
Charles YP, Coulet B, Rouzaud JC, Daures JP, Chammas M. Comparative clinic outcomes of submuscular and subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg. 2009;34A:866–74.CrossRef
8.
Chimenti PC, Hammert WC. Ulnar neuropathy at the elbow an evidence-based algorithm. Hand Clin. 2013;29:435–42.CrossRefPubMed
9.
Cirpar M, Turker M, Yalcinozan M, Eke M, Sahin F. Effect of partial, distal epicondylectomy on reduction of ulnar nerve strain: a cadaver study. J Hand Surg [Am]. 2013;28(3):666–71.CrossRef
10.
Dellon AL. Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg. 1989;14:688–700.CrossRef
11.
Dellon AL. Techniques for successful management of ulnar nerve entrapment at the elbow. Neurosurg Clin N Am. 1991;2:57–73.PubMed
12.
Denny-Brown D, Doherty MM. Effects of transient nerve stretching of peripheral nerve. Arch Neural Psychiat. 1945;54:116–29.CrossRef
13.
Doi M. An experimental study on elongation of peripheral nerve: electrophysiological and morphological changes. J Jpn Soc Surg Hand. 1990;6:1041–52.
14.
Driscoll PJ, Glasby MA, Lawson GM. An in vivo study of peripheral nerves in continuity: biomechanical and physiological responses to elongation. J Orthop Res. 2002;20:370–5.CrossRefPubMed
15.
Eaton RG, Crowe JF, Parkes JC. Anterior transposition of the ulnar nerve using a non-compressing fasciodermal sling. J Bone Joint Surg Am. 1980;62:820–5.PubMed
16.
Elhassan B, Steinmann SP. Entrapment neuropathy of the ulnar nerve. J Am Acad Orthop Surg. 2007;15:672–81.PubMed
17.
Gelberman RH, Yamaguchi K, Hollstein SB, Winn SS, Heidenreich FP, Bindra RR, et al. Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow. J Bone Joint Surg Am. 1998;80:492–501.PubMed
18.
Gervasio O, Gambardella G, Zarcone C, Branca D. Simple decompression versus anterior submuscular transposition of the ulnar nerve in sever cubital tunnel syndrome: a prospective randomized study. Neurosurgery. 2005;56:108–17.PubMed
19.
Grewal R, Varitimidis SE, Vardakas DG, Fu FH, Sotereanos DG. Ulnar nerve elongation and excursion in the cubital tunnel after decompression and anterior transposition. J Hand Surg (Br). 2000;25B:457–60.CrossRef
20.
Haftek J. Stretch injury of peripheral nerve. J Bone Joint Surg (Br). 1970;52B:354–65.
21.
Hong CZ, Long HA, Kanakamedala RV, Chang YM, Yates L. Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation. Arch Phys Med Rehabil. 1996;77:573–7.CrossRefPubMed
22.
Hasegawa T. An experimental study on elongation injury of peripheral nerve. Nihon Seikeigeka Gakkai Zasshi. 1992;66:1184–93.PubMed
23.
Hicks D, Toby EB. Ulnar strains at the elbow: the effect of in situ decompression and medial epicondylectomy. J Hand Surg [Am]. 2002;27(6):1026–31.CrossRef
24.
Heithoff SJ, Millender LH, Nalebuff EA, Petruska AJ. Medial epicondylectomy for the treatment of ulnar nerve compression at the elbow. J Hand Surg. 1990;15(1):22–9.CrossRef
25.
26.
Keiner D, Gaab MR, Schroeder HWS, Oertel J. Comparison of the long-term results of anterior transposition of the ulnar nerve or simple decompression in the treatment of subital tunnel syndrome—a prospective study. Acta Neurochir. 2009;151:311–6.CrossRefPubMed
27.
Kwan MK, Wall EJ, Massie J, Garfin SR. Strain, stress, an stretch of peripheral nerve. Rabbit experiments in vitro and in vivo. Acta Orthop Scand. 1992;63:267–72.CrossRefPubMed
28.
Lundborg G, Bradley KC. Effects of stretching the tibial nerve of the rabbit: a preliminary study of the intraneural circulation and the barrier function of the perineurium. J Bone Joint Surg. 1973;55B:390–401.
29.
Macadam SA, Dandhi R, Bezuhly M, Lefaivre KA. Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a meta-analysis. J Hand Surg. 2008;33A:1314–24.
30.
Mackinnon SE, Novak CB. Compressive neuropathies. In: Green DP, editor. Green’s operative hand surgery, ed 5. Philadelphia: Churchill Livingstone; 2005. p. 1024–33.
31.
32.
McPherson SA, Meals RA. Cubital tunnel syndrome. Orthop Clin North Am. 1992;23:111–23.PubMed
33.
Nabhan A, Ahlhelm F, Kelm J, Reith W, Schwedtfeger K, Steudel WI. Simple decompression or subcutaneous anterior transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg (Br). 2005;30:521–4.CrossRef
34.
Norkus SA, Myers LD, Keniston RC, Meadows KD. Simple decompression of the ulnar nerve: an alternative to anterior transposition. J Hand Surg (Br). 1992;17:251–4.CrossRef
35.
Ochi K, Horiuchi Y, Nakamura T, Sato K, Arino H, Koyanagi T. Ulnar nerve strain at the elbow in patients with cubital tunnel syndrome: effect of simple decompression. J Hand Surg Euro. 2013;38(5):474–80.CrossRef
36.
Ogata K, Naito M. Blood flow of peripheral nerve effects of dissection, stretching and compression. J Hand Surg (Br). 1986;11:10–4.CrossRef
37.
Osei DA, Padegimas EM, Calfee RP, Gelbermann RH. Outcomes following modified oblique medial epicondylectomy for treatment of cubital tunnel syndrome. J Hand Surg. 2013;38A:336–43.CrossRef
38.
Palmer BA, Hughes TB. Cubital tunnel syndrome. J Hand Surg. 2010;35A:153–63.CrossRef
39.
Rinkel WD, Schreuders TAR, Koes BW, Huisstede BMA. Current evidence for effectiveness of interventions for cubital tunnel syndrome, radial tunnel syndrome, instability, or bursitis of the elbow: a systematic review. Clin J Pain. 2013;29:1087–96.CrossRefPubMed
40.
Sunderland S. Nerves and nerve injuries. 1968. Edinburgh and London: E&@ Livingstone Ltd
41.
Svernlov B, Larsson M, Rehn K, Adolfsson L. Conservative treatment of the cubital tunnel syndrome. J Hand Surg Eur Vol. 2009;34:201–7.CrossRefPubMed
42.
Takai S, Dohno H, Watanabe Y, Yoshino N, Ogura T, Hirasawa Y. In situ strain and stress of nerve conduction blocking in the brachial plexus. J Ortho Res. 2002;20:1311–4.CrossRef
43.
Turner RS. The rate of conduction in stretched and unstretched nerves. Physiol Zool. 1951;24:323–9.
44.
Wall EJ, Massie JB, Kwan MK, Rydevik BL, Myers RR, Garfin SR. Experimental stretch neuropathy. Changes in nerve conduction under tension. J Bone Joint Surg. 1992;74B:126–9.
45.
Warwick D. Ulnar nerve compression at the elbow. In: Warwick D, editor. Hand surgery, ed 1. New York: Oxford University Press Inc; 2009. p. 314–23.CrossRef
46.
Williams CS, Abrahamsson SO, Shea M, Seiler JG, Hayes WC, Gelberman RH. Biomechanical effects o operative mobilization and transposition in a canine ulnar nerve model. J Hand Surg. 1997;22A:193–9.CrossRef
47.
Yamada H. Studies of electrophysiological and morphological changes in sciatic nerve of rabbit under various types of stretch and relaxation. J Jpn Orthop Assoc. 1987;61:217–31.
48.
49.
Zlodowski M, Chan S, Bhandari M, Kalliainen L, Schubert W. Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome. J Bone Joint Surg Am. 2007;89:2591–8.CrossRef
Metadata
Title
The effect of operative technique on ulnar nerve strain following surgery for cubital tunnel syndrome
Authors
Justin Mitchell
John C. Dunn
Nicholas Kusnezov
Julia Bader
Derek F. Ipsen
Christopher L. Forthman
Aaron Dykstra
Publication date
01-12-2015
Publisher
Springer US
Published in
HAND / Issue 4/2015
Print ISSN: 1558-9447
Electronic ISSN: 1558-9455
DOI
https://doi.org/10.1007/s11552-015-9770-y

Other articles of this Issue 4/2015

HAND 4/2015 Go to the issue

Surgery Articles

The influence of subluxation on the severity of symptoms, disability, and the results of operative treatment in TMC osteoarthritis with total joint arthroplasty

Therapy Articles

Surgeon personality is associated with recommendation for operative treatment

Review

Extraskeletal osteosarcoma of the hand: the role of marginal excision and adjuvant radiation therapy

Multimedia Articles

Surgical correction of distal radius malunions using an anatomic radial locking plate

OriginalPaper

Achieving the optimal epinephrine effect in wide awake hand surgery using local anesthesia without a tourniquet

OriginalPaper

The utility of ultrasound for diagnosing purulent infections of the upper extremity