| Abstract [eng] |
Summary. Relevance of the problem: Ulnar tunnel syndrome, also known as cubital tunnel syndrome or elbow tunnel syndrome, is statistically the second most common compression neuropathy of the upper limb[1] after carpal tunnel syndrome. It is estimated that between 2% and 6% of the general population have had symptoms of this syndrome[2]. Characteristic sensory and motor symptoms include paresthesia of the ulnar nerve innervation area (78%), weakness of the ulnar nerve innervated muscles (59%) and pain in the elbow and medial forearm (46%)[3]. The longer the duration of the nerve compression, the poorer the treatment outcome. In clinical practice ulnar neuropathy is diagnosed on the basis of clinical and instrumental examination. The main diagnostic modalities are radiological, electroneuroradiography[1], ultrasound, and magnetic resonance imaging[4]. Once ulnar tunnel syndrome is diagnosed it is classified according to McGowan's methodology. Treatment is then tailored according to the severity of the lesion and the nature of the complaints. If sensory and motor disturbances are not present, conservative treatment is applied. Pharmaceutical and rehabilitative measures are prescribed during this phase of the treatment. Non-steroidal anti-inflammatory drugs are the most commonly prescribed. Arm splints are also suggested to reduce elbow movement and workload.[5]. In the case of prolonged ulnar tunnel syndrome or failure of conservative treatment surgical treatment is recommended. As there are still no generally accepted treatment guidelines[6] each surgeon performing such operations can choose their own surgical technique. The surgical technique can be open or endoscopic. The most common surgical techniques are in situ decompression and anterior transposition surgery. Small incision surgery (one or two) and epicondylectomy are less common[5]. Mainly two types of endoscopic surgeries are performed: endoscopic decompression and endoscopic transposition (very rare). The aim: The aim of this analysis was to review publicly available scientific articles and summarize the data on the different surgical methods utilized for treating ulnar tunnel syndrome, assessing their effectiveness and criteria for their application. Additionally, to investigate the aetiopathogenesis, it’s clinical manifestations, conservative treatment options and their efficacy. Material and methods: Articles describing different surgical approaches to the treatment of ulnar tunnel syndrome, their selection strategies, outcomes and effectiveness were included and analyzed. Results: 52 articles published in the "PubMed/Medline" database were analyzed. The findings show that there is still no consensus on the classification of this pathology and the optimal surgical approach. Conclusions: In most cases the authors agreed that anterior transposition is the surgical approach of choice in the presence of ulnar nerve submergence. However, when the nerve is not submerged, surgeons has the freedom to select their preferred surgical method. Many authors recommend the first operation being a small incision or endoscopic surgery. |
