Ultrasound-guided percutaneous release of the ulnar nerve at the elbow.

Abstract

Introduction: Surgical treatment of ulnar tunnel syndrome is controversial, with no consensus on the ideal procedure. Nevertheless, in-situ decompression seems to provide faster recovery with less morbidity than neurolysis-transposition. The aim of this retrospective study was to validate a new percutaneous technique using ultrasonography.

Methods: A retrospective 2-center study included 40 patients with McGowan stage 1 or 2 ulnar nerve entrapment at the elbow treated by a new limited ultrasound-guided percutaneous technique. Patients with McGowan stage 3, osteoarthritis at the elbow or instability were excluded. The study endpoint was clinical success of the percutaneous technique using ultrasonography for release of ulnar nerve entrapment at the elbow. The secondary endpoint was time to recovery.

Results: All 40 patients showed clinical improvement, with the resolution of acroparesthesia symptoms. No recurrences were observed at 13 months' follow-up. There were no cases of neurological complications, ulnar nerve instability or infection. Patients were able to return to work rapidly, with an average absence of 3.5 weeks.

Discussion: Numerous studies questioned the value of ulnar nerve transposition associated with release in the early stages. No significant difference was found between in-situ decompression and transposition; however, more complications were observed in patients with transposition.

Conclusion: Overall, this new ultrasound-guided percutaneous technique for ulnar nerve entrapment was safe. It allowed rapid recovery with effective symptom relief while limiting the risk of complications and time off work.