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Title: Minimally invasive decompression as treatment for the cubital tunnel syndrome: anatomical guidelines and surgical outcome evaluation
Authors: Claeskens, Jorien
Advisors: WEYNS, Frank
Issue Date: 2012
Publisher: tUL Diepenbeek
Abstract: Introduction: The cubital tunnel syndrome (CubTS) is the most common ulnar nerve compression neuropathy at the elbow and is a major disability in daily life. The simple decompression (SD) procedure has become more popular as surgical treatment because of its effectiveness and low invasive character. In order to increase the wellbeing of the patients, minimally invasive SD approach and insufficient attention is being directed to the anatomy. Yet it is important to avoid injury to the posterior branch(es) of the medical antibrachial cutaneous nerve (MACN) and the crossing branch of the basilic vein during surgery in order to avoid the postoperative complications. Goal: This study aimed to increase the insights into a minimally invasive SD approach to treat the CubTS. Therefore anatomical guidelines were offered, which included the description of the position of the posterior branch(es) of the MACN and the crossing branch of the basilic vein, as well as the discussion of the required SD incision length and location in order to achieve a minimally invasive and effective SD procedure, based on the relevant anatomy. In addition, the surgical outcome of the minimally invasive decompression (MID) procedure was evaluated in CubTS patients. The MID procedure is based on the SD using a smaller incision of 3.5 cm. The evaluation of the surgical outcome included the investigation of the effectiveness, minimal invasiveness and remaining aspects of the MID procedure in order to examine the use of a smaller SD incision. Materials and methods: Three upper limbs of three formalin fixed cadavers were dissected. In two of these specimens the course of the posterior branch(es) of the MACN in relation to the medial epicondyle was preserved and documented. In all the three specimens the course of the crossing branch of the basilic vein in relation to the medial epicondyle was investigated and documented. The MID procedure is being performed in our hospital for several years as treatment of the CubTS. A retrospective patient study was performed in 31 CubTS patients by means of postoperative questionnaire and subsequent consultation or telephone interview. The clinical outcome parameters to investigate the effectiveness and minimal invasiveness were the CubTS symptoms and the postoperative complications associated with injury to the MACN and basilic vein branches respectively. Results: In the two specimens the following results were obtained regarding the course of the posterior branch(es) of the MACN in relation to the medial epicondyle: a distal crossing branch was present in the two specimens, a branch crossing at the medial epicondyle was present in one specimen and a proximal crossing branch was present in none of the specimens. The crossing branch of the basilic vein was identified in the three specimens and located a position of 2 to 3 cm proximal to the medial epicondyle. The MID surgery significantly reduced all the CubTS symptoms, i.e. an average reduction for pain of 44.51%, for paraesthesia of 66.04%, for hypaesthesia of 65.05% and for muscle weakness of 51.65% per patient. In the majority of patients the symptoms did improve. In most patients none of the postoperative complications were present near the wound, i.e. in 74.19% of the patients. Most patients were (very) satisfied regarding their MID surgery and returned to work between 1 to 4 weeks after surgery. Conclusion: From the anatomical guidelines and the MID surgical outcome evaluation, it was clear that when the MACN and basilic vein branches were taken into account during surgery and a smaller and a smaller SD incision was applied based on the position of the MACN branches, the risk of injury to these branches was minimized and consequently the postoperative complications were avoided, implying that a minimally invasive SD procedure can be achieved in this manner. Altogether, these findings suggest that the use of a smaller SD incision of 3 to 3.5cm in length, located exactly between the medial epicondyle and olecranon, could result in a minimally invasive SD procedure, without altering its effectiveness. These results of the study contribute to the wellbeing of CubTS patients.
Notes: master in de biomedische wetenschappen-klinische moleculaire wetenschappen
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Category: T2
Type: Theses and Dissertations
Appears in Collections:Master theses

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