Endoscopic cubital release Financial interest

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Endoscopic cubital releaseFinancial interest

• Inventor
• Stock holder

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Endoscopic 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

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Endoscopic 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

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Endoscopic 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

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Endoscopic 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

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Endoscopic 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

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Endoscopic cubital tunnel release

• Goals
• Minimize extensive soft tissue dissections
• Minimize manipulation of the nerve
• Minimize mobilization of the nerve
• Preserve the mesoneurium

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Endoscopic cubital tunnel release

• ECUTR may be the answer

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Endoscopic cubital tunnel release

• instrumentation

Compliments of AMS
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Clear cannula

• 360 degree visualization

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Endoscopic cubital tunnel release

• Standard
• 4mm scope
• Locking device
• Sleeve knife

Compliments of AMS
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Land Marks

• Landmarks
• Med. Epicondyle
• Olecrenon
• 3-5 cm incision

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Surgical technique

• Incision
• Landmarks
• Med. Epicondyle
• Olecrenon
• 3-5 cm incision

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Surgical technique

• Division Osborns ligament
• Identification of Ant. Br. Cut. Nerve
• Identification of unla nerve

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Surgical technique

• Distal dissection
• Clamp or scissor dissection

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Surgical technique

• Distal dissection
• Dissector

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Surgical technique

• Follow the pathway
• Created by dissector
• Obturator cannula assembly
• Remove the obturator

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Endoscopic VisualizationDivision
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Surgical technique

• Arthroscope 4mm 30 degree
• Visualize
• Knife sleeve assembly
• Division

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Surgical technique Endoscopic visualization
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Surgical Technique

• Fix Knife to Endoscope
• Slide knife over scope
• Lock Knife in place

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Surgical technique Endoscopic visualization
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Surgical Technique

• Proximal Dissection

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Surgical Technique

• Proximal insertion of obturator cannula

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Endoscopic visualization
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Surgical Technique

• Endoscopic Visualization
• Arcade of Struthers

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Surgical technique

• If nerve subluxes on flexion
• Medial epicondyletomy
• Anterior transposition

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Results

• 17 patients
• 6 Females
• 11 Males

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Results

• 2 pt. underwent Med. Epicondylectomy
• 1 pt. had anterior transposition

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Results

• Complications
• 2 haematomas
• No ulna nerve injury
• No injury to M A B cutaneous nerve
• No recurrence
• 1 hypertrophic scar

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Results

• 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.
•  

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Results

• 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.

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Conclusions

• Minimally invasive
• No manipulation of the nerve
• No interruption of blood supply
• Avoids sacrifice of the articular/muscular Br.

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New 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
•  

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Thank you