Novel Technique for Ulnar Nerve Transposition at the Elbow: The Neocubital Tunnel.

Abstract

Many standard surgical procedures for cubital tunnel syndrome rely on ulnar nerve transposition at the elbow. Placing the ulnar nerve anterior to the axis of motion decreases compression during flexion. Subcutaneous, subfascial, and submuscular positioning of the ulnar nerve may predispose to nerve irritation, instability, and compression in the two first scenarios, and requires invasive dissection in the third one. With no single procedure demonstrating clear advantages and outcomes, this study reports the results of a novel technique using the epitrochleo-olecranon ligament to create a neo-tunnel, anatomically stabilizing the ulnar nerve. Nine consecutive patients were enrolled. Patients were evaluated qualitatively for symptomatic improvements using physical examination. The Wilson and Krout, modified McGowan, and PRUNE grading scores were used for quantitative measurement. Postoperatively, all patients reported subjective improvement in symptoms and functional improvement. There were no intraoperative or postoperative complications. Baseline severity of disease was evaluated using the McGowan scale (modified by Goldberg): eight (89%) grade IIA patients and one (11%) grade III patient. Postoperatively, seven (78%) patients were reduced to grade 0, and two (22%) patients to grade 1 (P < 0.001). Using the Wilson and Krout criteria, outcomes were as follows: six (67%) excellent, two (22%) good, and one (11%) fair. The mean postoperative PRUNE survey score was 19.3 (SD ± 24.4). The neocubital tunnel technique is a relatively noninvasive, safe surgical alternative that may be considered when an anterior transposition of the ulnar nerve is indicated for surgical decompression of the cubital tunnel.