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Treatment
Surgical treatment of Cubital Tunnel Syndrome is indicated, if padding and splinting do not improve the condition
The endoscopic (arthroscopic) treatment
Dr. Reimer Hoffmann from Oldenburg, Germany, has introduced an endoscopic (arthroscopic)surgical method of treatment, requiring a very small incision and yet allowing a very long decompression of the nerve with very good results.
Traditional treatments
Traditional methods require long incisions, invasive tissue dissection, often the nerve is transposed from its normal anatomical position, some surgeons even remove a part of the inner elbow bone. This maximally invasive procedure leades to scarring, weeks and months of impaired arm function.
Click to enlarge the images.
The endoscopic treatment
The endoscopic operation requires only an incision of about 20 mm and allows a nerve release over a distance of upt to 30 cm. Functional impairment is minimal and the resting period of the operated arm is only a few days (see illustrations). Professionals (doctors, dentists, journalists, engineers and other white collar workers) can in most cases be resumed the day following surgery.
Frequently asked questions
The endoscopic release of the ulnar nerve only requires a vers small skin incision. Does that not mean, the nerve is released insufficiently?
On the contrary. With the endoscopic technique an adaeqate release and decompression of the nerve is achieved much better than with the conventional open technique.
How can that be explained?
During the open method the structures that compress the nerve are released ove a distance between 8 and 12 cm. With the endoscopic method the release of the nerve is much longer and therefore more effective. The distance of decompression is between 18 and 30 cm! Moreover, this release with the endoscope is very delicate, the surroungding tissue is separated without as much as touching the nerve
What exactly does “endoscopic” mean?
The operation requires special instruments similar to those used in abdominal and gynaecological laparoscopic (“keyhole”)surgery for decades already. The most important of those instruments are a speculum and the endoscope, manufactured by KARL STORZ Endoscopes, Tuttlingen, Germany). Speculum and endoscope enable the surgeon to look deep inside the arm and have a perfect (HD) view of the anatomy. In combination with special scissors the precise dissection and nerve release are possible.
Are the results of open and endoscopic surgery similar?
Published studies have shown that the endoscopic method is superior. The nerve recovers quicker. The reasons are many, one of them is the preservation of blood supply. In the open technique, especially when the nerve is transposed, fine vessels, that nourish the nerve, are destroyed. Another reason is, that sometimes the nerve compression is multifocal (more than one tight spots). With the endoscopic technique the release is long and more complete.
What is the main advantage of the endoscopic procedure?
The most important advantage, apart from the quicker recovery, is the fact, that no immobilisation is necessary and following the operation the patients are able to regain full movement of the arm within days.