Endoscopic cubital release Financial interest G Inventor G Stock holder.

Endoscopic cubital releaseEndoscopic cubital releaseFinancial interestFinancial interest

Endoscopic cubital releaseEndoscopic cubital releaseFinancial interestFinancial interest

InventorInventorStock holderStock holder

InventorInventorStock holderStock holder

Endoscopic cubital tunnel Endoscopic cubital tunnel releaserelease


Treatment of cubital tunnel Treatment of cubital tunnel syndromesyndromeConservative treatmentConservative treatmentSurgical optionsSurgical options

Open cubital tunnel releaseOpen cubital tunnel releaseAnterior transposition of ulna nerveAnterior transposition of ulna nerve

SubmuscularSubmuscularSubcutanoeousSubcutanoeous

Medial epicondylectomyMedial epicondylectomy

Treatment of cubital tunnel Treatment of cubital tunnel syndromesyndromeConservative treatmentConservative treatmentSurgical optionsSurgical options

Open cubital tunnel releaseOpen cubital tunnel releaseAnterior transposition of ulna nerveAnterior transposition of ulna nerve

SubmuscularSubmuscularSubcutanoeousSubcutanoeous

Medial epicondylectomyMedial epicondylectomy



Platt in Br J Surg, 1926Platt in Br J Surg, 1926Anterior transposition of ulna nerveAnterior transposition of ulna nerve

Widely practiced todayWidely practiced todayProblemsProblems

Dissections and mobilization of the Dissections and mobilization of the ulna Nulna N

Platt in Br J Surg, 1926Platt in Br J Surg, 1926Anterior transposition of ulna nerveAnterior transposition of ulna nerve

Widely practiced todayWidely practiced todayProblemsProblems

Dissections and mobilization of the Dissections and mobilization of the ulna Nulna N



Problems with dissection and Problems with dissection and mobilizationmobilizationInterfering with the blood supplyInterfering with the blood supplyCompromising articular branchesCompromising articular branchesCompromising muscular branchesCompromising muscular branchesJeopardizing antebrachial cutaneous Jeopardizing antebrachial cutaneous

nervesnervesCreates large area of scar bedCreates large area of scar bed

Problems with dissection and Problems with dissection and mobilizationmobilizationInterfering with the blood supplyInterfering with the blood supplyCompromising articular branchesCompromising articular branchesCompromising muscular branchesCompromising muscular branchesJeopardizing antebrachial cutaneous Jeopardizing antebrachial cutaneous

nervesnervesCreates large area of scar bedCreates large area of scar bed



Regional blood flow to the UNRegional blood flow to the UNSmith 1966, Arch. Surg. Smith 1966, Arch. Surg.

5-8cm detachment of mesoneurium5-8cm detachment of mesoneuriumImpaired segmental circulationImpaired segmental circulationNot maintained anastomotic channelsNot maintained anastomotic channels

Regional blood flow to the UNRegional blood flow to the UNSmith 1966, Arch. Surg. Smith 1966, Arch. Surg.

5-8cm detachment of mesoneurium5-8cm detachment of mesoneuriumImpaired segmental circulationImpaired segmental circulationNot maintained anastomotic channelsNot maintained anastomotic channels



Regional blood flow to the UNRegional blood flow to the UNK Ogata and Manske 1984, Cl Orth R K Ogata and Manske 1984, Cl Orth R

ResearchResearchVascular injection studiesVascular injection studiesAnterior transposition associated with Anterior transposition associated with

significant decrease in blood flowsignificant decrease in blood flow

Regional blood flow to the UNRegional blood flow to the UNK Ogata and Manske 1984, Cl Orth R K Ogata and Manske 1984, Cl Orth R

ResearchResearchVascular injection studiesVascular injection studiesAnterior transposition associated with Anterior transposition associated with

significant decrease in blood flowsignificant decrease in blood flow



GoalsGoalsMinimize extensive soft tissue Minimize extensive soft tissue

dissectionsdissectionsMinimize manipulation of the nerveMinimize manipulation of the nerveMinimize mobilization of the nerveMinimize mobilization of the nervePreserve the mesoneuriumPreserve the mesoneurium

GoalsGoalsMinimize extensive soft tissue Minimize extensive soft tissue

dissectionsdissectionsMinimize manipulation of the nerveMinimize manipulation of the nerveMinimize mobilization of the nerveMinimize mobilization of the nervePreserve the mesoneuriumPreserve the mesoneurium



ECUTR may be the answerECUTR may be the answerECUTR may be the answerECUTR may be the answer

QuickTime™ and a decompressor

are needed to see this picture.



instrumentationinstrumentationinstrumentationinstrumentation

Compliments of AMS

Clear cannulaClear cannulaClear cannulaClear cannula

360 degree visualization360 degree visualization360 degree visualization360 degree visualization



StandardStandard4mm scope4mm scopeLocking deviceLocking deviceSleeve knifeSleeve knife

StandardStandard4mm scope4mm scopeLocking deviceLocking deviceSleeve knifeSleeve knife

Compliments of AMS

Land MarksLand MarksLand MarksLand Marks LandmarksLandmarks

Med. EpicondyleMed. Epicondyle OlecrenonOlecrenon 3-5 cm incision3-5 cm incision

LandmarksLandmarks Med. EpicondyleMed. Epicondyle OlecrenonOlecrenon 3-5 cm incision3-5 cm incision

Surgical techniqueSurgical techniqueSurgical techniqueSurgical technique IncisionIncision LandmarksLandmarks


IncisionIncision LandmarksLandmarks


Surgical techniqueSurgical techniqueSurgical techniqueSurgical technique

Division Osborns ligamentDivision Osborns ligament Identification of Ant. Br. Cut. NerveIdentification of Ant. Br. Cut. Nerve Identification of unla nerveIdentification of unla nerve

Division Osborns ligamentDivision Osborns ligament Identification of Ant. Br. Cut. NerveIdentification of Ant. Br. Cut. Nerve Identification of unla nerveIdentification of unla nerve


Distal dissectionDistal dissectionClamp or scissor dissectionClamp or scissor dissection

Distal dissectionDistal dissectionClamp or scissor dissectionClamp or scissor dissection


Distal dissectionDistal dissectionDissectorDissector

Distal dissectionDistal dissectionDissectorDissector

Surgical techniqueSurgical techniqueSurgical techniqueSurgical technique Follow the pathwayFollow the pathway Created by dissectorCreated by dissector Obturator cannula assemblyObturator cannula assembly Remove the obturatorRemove the obturator

Follow the pathwayFollow the pathway Created by dissectorCreated by dissector Obturator cannula assemblyObturator cannula assembly Remove the obturatorRemove the obturator

Endoscopic VisualizationEndoscopic Visualization&&

DivisionDivision

Endoscopic VisualizationEndoscopic Visualization&&

DivisionDivision

Surgical techniqueSurgical techniqueSurgical techniqueSurgical technique Arthroscope 4mm 30 degreeArthroscope 4mm 30 degree Visualize Visualize Knife sleeve assemblyKnife sleeve assembly DivisionDivision

Arthroscope 4mm 30 degreeArthroscope 4mm 30 degree Visualize Visualize Knife sleeve assemblyKnife sleeve assembly DivisionDivision

Surgical techniqueSurgical technique Endoscopic visualizationEndoscopic visualizationSurgical techniqueSurgical technique Endoscopic visualizationEndoscopic visualization

Surgical TechniqueSurgical TechniqueSurgical TechniqueSurgical Technique

Fix Knife to EndoscopeFix Knife to Endoscope Slide knife over Slide knife over

scopescope Lock Knife in placeLock Knife in place

Fix Knife to EndoscopeFix Knife to Endoscope Slide knife over Slide knife over

scopescope Lock Knife in placeLock Knife in place

Surgical techniqueSurgical technique Endoscopic visualizationEndoscopic visualizationSurgical techniqueSurgical technique Endoscopic visualizationEndoscopic visualization

Surgical TechniqueSurgical TechniqueSurgical TechniqueSurgical TechniqueProximal DissectionProximal DissectionProximal DissectionProximal Dissection

Surgical TechniqueSurgical TechniqueSurgical TechniqueSurgical TechniqueProximal insertion of Proximal insertion of

obturator cannulaobturator cannulaProximal insertion of Proximal insertion of

obturator cannulaobturator cannula

Endoscopic visualizationEndoscopic visualizationEndoscopic visualizationEndoscopic visualization

Surgical TechniqueSurgical TechniqueSurgical TechniqueSurgical Technique

Endoscopic VisualizationEndoscopic VisualizationArcade of StruthersArcade of Struthers

Endoscopic VisualizationEndoscopic VisualizationArcade of StruthersArcade of Struthers

If nerve subluxes on flexionIf nerve subluxes on flexionMedial epicondyletomyMedial epicondyletomyAnterior transposition Anterior transposition

If nerve subluxes on flexionIf nerve subluxes on flexionMedial epicondyletomyMedial epicondyletomyAnterior transposition Anterior transposition




ResultsResultsResultsResults

17 patients17 patients 6 Females6 Females 11 Males11 Males

17 patients17 patients 6 Females6 Females 11 Males11 Males


2 pt. underwent Med. 2 pt. underwent Med. EpicondylectomyEpicondylectomy

1 pt. had anterior 1 pt. had anterior transpositiontransposition

2 pt. underwent Med. 2 pt. underwent Med. EpicondylectomyEpicondylectomy

1 pt. had anterior 1 pt. had anterior transpositiontransposition


ComplicationsComplications2 haematomas2 haematomasNo ulna nerve injuryNo ulna nerve injuryNo injury to M A B cutaneous nerveNo injury to M A B cutaneous nerveNo recurrenceNo recurrence1 hypertrophic scar1 hypertrophic scar

ComplicationsComplications2 haematomas2 haematomasNo ulna nerve injuryNo ulna nerve injuryNo injury to M A B cutaneous nerveNo injury to M A B cutaneous nerveNo recurrenceNo recurrence1 hypertrophic scar1 hypertrophic scar


Tsai et alTsai et al endoscopic cubital tunnel endoscopic cubital tunnel

85 elbows in 76 patients 85 elbows in 76 patients 32 months follow up32 months follow up 42% had excellent results, 45% had good results, 42% had excellent results, 45% had good results,

11% had fair results, and 2% had poor results. 11% had fair results, and 2% had poor results. ConclusionConclusion

These results are comparable to the other These results are comparable to the other decompressive techniques, which overall result in decompressive techniques, which overall result in 85-90% good-to-excellent results.85-90% good-to-excellent results.

Tsai et alTsai et al endoscopic cubital tunnel endoscopic cubital tunnel

85 elbows in 76 patients 85 elbows in 76 patients 32 months follow up32 months follow up 42% had excellent results, 45% had good results, 42% had excellent results, 45% had good results,

11% had fair results, and 2% had poor results. 11% had fair results, and 2% had poor results. ConclusionConclusion

These results are comparable to the other These results are comparable to the other decompressive techniques, which overall result in decompressive techniques, which overall result in 85-90% good-to-excellent results.85-90% good-to-excellent results.


Hoffmann et alHoffmann et al 75 patients (76 cases).75 patients (76 cases).Release the U nerve release 17 cm Release the U nerve release 17 cm Incision averaging 2.8 cm in length. Incision averaging 2.8 cm in length. The mean follow-up 11 months The mean follow-up 11 months Good to excellent results in 94% of Good to excellent results in 94% of

patients. patients.

Hoffmann et alHoffmann et al 75 patients (76 cases).75 patients (76 cases).Release the U nerve release 17 cm Release the U nerve release 17 cm Incision averaging 2.8 cm in length. Incision averaging 2.8 cm in length. The mean follow-up 11 months The mean follow-up 11 months Good to excellent results in 94% of Good to excellent results in 94% of

patients. patients.

ConclusionsConclusionsConclusionsConclusions

Minimally invasiveMinimally invasive No manipulation of the nerve No manipulation of the nerve No interruption of blood supplyNo interruption of blood supply Avoids sacrifice of the Avoids sacrifice of the

articular/muscular Br.articular/muscular Br.

Minimally invasiveMinimally invasive No manipulation of the nerve No manipulation of the nerve No interruption of blood supplyNo interruption of blood supply Avoids sacrifice of the Avoids sacrifice of the

articular/muscular Br.articular/muscular Br.

New DesignNew DesignNew DesignNew Design Winged Design Winged Design Will open and close the slot at any time and then lock into placeWill open and close the slot at any time and then lock into place Protect the nerve and gently move it from the cutting bladeProtect the nerve and gently move it from the cutting blade Will be out in Four WeeksWill be out in Four Weeks

Winged Design Winged Design Will open and close the slot at any time and then lock into placeWill open and close the slot at any time and then lock into place Protect the nerve and gently move it from the cutting bladeProtect the nerve and gently move it from the cutting blade Will be out in Four WeeksWill be out in Four Weeks





Thank youThank youThank youThank you

Endoscopic cubital release Financial interest G Inventor G Stock holder.

Documents

degree g

epicondylectomy g

results g complications

epicondyle g olecrenon

g problems g dissections

females g

patients g

haematomas g