Cubital tunnel syndrome: Anterior transposition as a logical approach to complete nerve decompression

• Published in: The Journal of hand surgery (American ed.) Vol. 24; no. 5; pp. 886 - 897
• Main Author: Kleinman, William B.
• Format: Journal Article
• Language: English
• Published: New york, NY Elsevier Inc 01-09-1999; Elsevier
• Subjects: Biological and medical sciences; Cubital tunnel syndrome; Cubital Tunnel Syndrome - physiopathology; Cubital Tunnel Syndrome - surgery; Decompression, Surgical - methods; Elasticity; Humans; Medical sciences; Microcirculation; Orthopedic surgery; surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Ulnar Nerve - surgery; ulnar nerve compression syndrome; ulnar nerve compression syndrome; Cubital tunnel syndrome; surgery; Human; Nervous system diseases; Compression; Pathophysiology; Cubital nerve; Surgical transfer; Diseases of the osteoarticular system; Biomechanics; Treatment; Surgery; Upper limb; Peripheral nerve disease; Technique; Elbow
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1053/jhsu.1999.0886

In it's native position, deep to Osborne's ligament, within the retrocondylar groove of the elbow, the ulnar nerve courses with a significant lever distance posterior to the elbow axis of rotation. In this position, flexion of the elbow places longitudinal traction and local compression forces on the nerve. This biomechanical consideration, as well as variations in anatomy, may potentially contribute to a decrease in the nerve's microcirculation and partial pressure of oxygen, leading to cubital tunnel syndrome. Anterior transposition of the ulnar nerve at the elbow for cubital tunnel syndrome will eliminate natural as well as pathological traction and compression forces; the procedure relieves the nerve of potential microcirculation compromise. Risks of mobilizing the nerve for transposition, however, include iatrogenic ischemia from segmental separation of the nerve from its mesentery-like extrinisic blood supply. Intrinsic interstitial “step-ladder” vessels within the substance of the ulnar nerve allow it to be separated from its extrinsic circulation safely, making anterior transposition a logical and reasonable choice for cubital tunnel syndrome requiring operative intervention. (J Hand Surg 1999;24A:886–897. Copyright © by the American Society for Surgery of the Hand.)