Novel Technique for Single-Site, Ultrasound-Guided Release of the Cubital Tunnel: An Anatomic Feasibility Study

Abstract

Introduction: Current management via open dissection for cubital tunnel syndrome is efficacious; however, it can lead to lengthy recovery. Sonography can be utilized in open dissections for cubital tunnel syndrome to minimize incision lengths, but it has garnered interest in cadaveric studies for achieving entirely minimally invasive decompressions.

Objective: This study aimed to examine the feasibility of sonography in diagnosing cubital tunnel syndrome and propose a minimally invasive approach to decompression using a commercially available ultrasound-guided device, leveraging its success in carpal tunnel syndrome management.

Methods: Dissections were performed on three cadaveric arms. Presurgical mapping of the ulnar nerve was performed via ultrasonography, identifying the ulnar nerve traversing muscular and bony landmarks through the elbow. Operating bidirectionally via a single site at the level of the cubital tunnel, the carpal tunnel release system was utilized under ultrasound guidance, rigidly simulating surgical operation regarding time, technique, and care of dissection. Postoperative confirmation of decompression was achieved via open dissection.

Results: In all three specimens, successful fascial release was confirmed. There was no injury to the ulnar nerve itself or any motor branches, and there was no identifiable subluxation of the nerve with complete ranging of the elbow.

Conclusions: This study demonstrates the feasibility of in-office cubital tunnel decompression, addressing the growing demand for minimally invasive interventions. By adapting techniques from carpal tunnel syndrome management, this approach offers an alternative to traditional open surgery, particularly relevant amid limitations on operating theater access. Such innovative strategies hold promise for expanding surgical options and meeting the evolving needs of patients, emphasizing the importance of adapting established techniques to address emerging challenges in patient care.

Keywords: anatomic study; cubital tunnel syndrome; peripheral nerve; ulnar nerve; ultrasound-guided release.