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Cubital Tunnel Syndrome: Managing Ulnar Nerve Subluxation with a Medial Intermuscular Septum Sling
Alexander Shikhman, D.O., Elizabeth Santucci, John Dietrich, M.D.
Summa Health Plastic Surgery Fellowship
2021-02-11
Presenter: Alexander Shikhman
Affidavit:
The work of this project is 100% original to fellow
Director Name: Ananth Murthy, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Intro
Surgical management of nerve compression syndromes continues to evolve. In cubital tunnel syndrome, there is a growing recognition of ulnar nerve subluxation pathology. In addition to open decompression, there are various techniques described to further address subluxation including nerve transposition. We sought to evaluate a novel technique to treat subluxation involving minimal dissection and creation of a stabilizing fascial sling in patients with cubital tunnel syndrome and ulnar nerve subluxation.
Methods
We performed a retrospective review examining 19 patients who underwent decompression and fascial sling. Patients were diagnosed by physical exam and electromyography. Treatment consisted of open nerve decompression and creation of a fascial sling using the distally-based medial intermuscular septum to stabilize the ulnar nerve while keeping it in its native position. We examined patient demographics, Sane scores, and patient outcomes. Chi-square and student's t-test were used for all analysis.
Results
All 19 patients were included for analysis with nerve subluxation confirmed intra-operatively. Patients had an average age of 62 and average follow up of 136 days. There was no significant differences within our group regarding handedness, affected side, or smoking status (all p>0.05). Patients were more likely to be male (15 males vs 4 females, p<0.05). Importantly, SANE scores improved significantly after surgery (62 to 83, p<0.05). One patient developed recurrent subluxation requiring reoperation with nerve transposition.
Conclusion
In patients with cubital tunnel syndrome and ulnar nerve subluxation, nerve decompression with creation of an intermuscular sling is an effective method to improve hand function and prevent subluxation.
