A novel endoscopic technique in treating single nerve entrapment syndromes with special attention to ulnar nerve transposition and tarsal tunnel release: clinical application.

Abstract

OBJECTIVE:

To describe a simple retractor integrated endoscopic technique for treating idiopathic solitary compression neuropathies with special attention to the anterior transposition of the ulnar nerve and tarsal tunnel release, and to present the clinical results.

METHODS:

Eleven patients with ulnar sulcus syndrome, eight with tarsal tunnel syndrome, and one with meralgia paraesthetica (seven females and 13 males; age range, 12-64 yr) were treated with endoscopic anterior ulnar nerve transposition and in situ decompression of the tibial (eight patients) and lateral femoral cutaneous nerves (one patient), respectively. The selection criteria were: classical nerve compression symptoms, failed conservative treatment, abnormal electrophysiology, and a nonviolated anatomic region. The degree of nerve compression (after Dellon) was rated as moderate in five out of 20 patients and as severe in 15 out of 20 patients. Electrophysiological studies were conducted independently by physicians specializing in these techniques. Postoperative recovery was evaluated according to the nine-point Bishop rating system.

RESULTS:

Of the 11 patients with anterior ulnar nerve transposition, seven scored excellent, three scored good, and one scored fair (mean follow-up, 15.5 mo; range, 6-27 mo). Five patients with tarsal tunnel release scored excellent and three scored good (mean follow-up, 10.1 mo; range, 3-24 mo). The patient with meralgia paraesthetica showed an excellent score at 28 months after surgery. There were no technical or postoperative complications. None of the operations had to be converted to open surgery.

CONCLUSION:

We describe a new endoscopic technique for transposing the ulnar nerve and decompressing the tibial nerve. This technique could be extrapolated to release other single nerve entrapments. The simplicity of the technique, and our preliminary clinical results, may encourage other groups to adapt this method.

• Authors: Kartik G Krishnan, Thomas Pinzer, Gabriele Schackert
• Journal: Neurosurgery (Neurosurgery) Vol. 59 Issue 1 Suppl 1 Pg. ONS89-100; discussion ONS89-100 (Jul 2006) ISSN: 1524-4040 [Electronic] United States
• PMID: 16888558 (Publication Type: Clinical Trial, Journal Article)

Topics

• Adolescent
• Adult
• Ankle (anatomy & histology, physiopathology, surgery)
• Child
• Decompression, Surgical (instrumentation, methods)
• Elbow (anatomy & histology, physiopathology, surgery)
• Endoscopy (methods)
• Female
• Humans
• Male
• Medical Illustration
• Middle Aged
• Neuralgia (etiology, physiopathology, surgery)
• Neurosurgical Procedures (instrumentation, methods)
• Occupational Diseases (etiology, physiopathology, surgery)
• Peripheral Nervous System Diseases (etiology, physiopathology, surgery)
• Postoperative Complications
• Tarsal Tunnel Syndrome (physiopathology, surgery)
• Tibial Nerve (pathology, physiopathology, surgery)
• Treatment Outcome
• Ulnar Nerve (pathology, physiopathology, surgery)
• Ulnar Nerve Compression Syndromes (physiopathology, surgery)