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. 2025 Jan;20(1):65-70.
doi: 10.1177/15589447231174043. Epub 2023 May 29.

Managing Ulnar Nerve Subluxation With a Medial Intermuscular Septum Sling

Brandon M Larson  1 , Alex Shikhman  1 , Meghan S Brown  1 , Mike Q Tran  1 , John W Dietrich  2
Affiliations

Managing Ulnar Nerve Subluxation With a Medial Intermuscular Septum Sling

Brandon M Larson et al. Hand (N Y). 2025 Jan.

Abstract

Background: Cubital tunnel syndrome (CuTS) is a lifestyle-altering peripheral neuropathy lacking a consensus for optimal surgical management. We describe creation of a fascial "V-sling" without ulnar nerve transposition, which is associated with increased surgical morbidity compared with decompression. The purpose of this study is to evaluate a novel technique with effective ulnar nerve decompression and subluxation prevention by creating a fascial sling in patients with CuTS and ulnar nerve subluxation.

Methods: We reviewed records of 39 elbows in 35 patients who underwent in situ ulnar nerve decompression and creation of a fascial sling in a "V" configuration to stabilize the nerve in its native position. We examined patient demographics, Single Assessment Numeric Evaluation (SANE) scores, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, and patient outcomes. Chi-square and student's t test were used for all analysis.

Results: A total of 37 extremities in 33 patients undergoing nerve decompression had nerve subluxation confirmed intraoperatively. There was a statistically significant change in preoperative and postoperative SANE scores of 64.5 and 82.3, respectively. Mean QuickDASH scores decreased significantly from 49.3 preoperative to 10.8 postoperative. The long-term QuickDASH scores obtained at mean of 564 days were maintained at 10.76.

Conclusions: This study describes a novel technique for treating CuTS by achieving in situ nerve decompression and addressing ulnar nerve subluxation with creation of an intermuscular septal sling. The technique improved functional outcomes and provided symptomatic relief, while avoiding risks commonly associated with nerve transposition.

Keywords: V-sling; cubital tunnel syndrome; diagnosis; fascial sling; nerve; nerve compression; ulnar subluxation.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(a) Compression areas released at the arcade of Struthers, the medial intermuscular septum, the arcuate ligament of Osborne, and the deep fascia of the flexor carpi ulnaris. (b) Transposition orientation of the distally based intermuscular septum toward anchoring points at the olecranon process and medial epicondyle. (c) Final location of the ulnar nerve beneath the V-sling in its native position.
Figure 2.
Figure 2.
(a) Harvesting of approximately 6 cm of medial intermuscular septum. (b) Anchoring of medial intermuscular septum to medial epicondyle forming a “V” configuration to the sling.
Figure 3.
Figure 3.
Mean Single Assessment Numeric Evaluation score before and after surgery (P < .05).
Figure 4.
Figure 4.
Mean Quick Disabilities of the Arm, Shoulder and Hand score before surgery, after surgery, and long-term (P < .05).
See this image and copyright information in PMC

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