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2010.09.20
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Ulnar nerve compression at elbow (Cubital tunnel syndrome)/ 手術予習

Indication
-sensory loss in the ulnar nerve distribution with nerve studies
-clinical evidence of intrinsic muscle denervation

Operative procedure
-A 5cm postero-medial incision over the medial epicondyle
-Branches of the medial antebrachial cutaneous nerve are identified and protected
-The fascia over the nerve is released sequentially,
(1) in the upper arm
(2) fibroaponeurotic covering of the epicondylar groove
(3) Osborne's ligament
(4) fascia where the nerve passes between the 2 heads of the FCU
-Anterior transposition of the ulnar nerve
-A 1cm wide medially based flap of fascia can be turned down to the proximal skin edge to prevent posterior subluxation of the nerve.

Outcome
-In one study, 92% of patients recovered grade 3 motor strength or better (Ref. 1).

Complication
-ulnar nerve injury
-medial antebrachial cutaneous nerve injury
-hematoma

References
1. Kim DH, Han K, Tiel RL, Murovic JA, Kline DG. Surgical outcomes of 654 ulnar nerve lesions. J Neurosurg. 2003 May;98(5):993-1004.

RIMG0079_5.jpg
A. fibroaponeurotic covering of the epicondylar groove
B. FUC筋膜(Osborne's ligament?)
C. FUC筋膜
D. 筋膜中隔
E. Struthers arcade(内上顆より8cm近位)
F. Triceps上の筋膜
G. FCU2頭間の膜(Osborne's ligament?)
※絞扼部=ABGのいずれか






Last updated  2010.09.20 13:09:42
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