Endoscopic cubital tunnel release: a systematic review

Abstract

Introduction: Theoretical advantages of endoscopic cubital tunnel release are the short incision, lower risk of nerve damage, reduced manipulation of the nerve and possible faster recovery.

Sources of data: We systematically searched Medline (PubMed), Web of Science and Scopus databases using the following keywords: 'endoscopic ulnar nerve', 'endoscopic cubital nerve', 'endoscopic ulnar compression' and 'endoscopic ulnar neuropathy'. Twenty-one studies were included in this review. The quality of the studies was assessed using the Coleman Methodological Score.

Areas of agreement: Endoscopic release is effective for cubital tunnel entrapment and allows adequate visualization of the site of entrapment. There is a negative association between the severity of the compression and reported outcomes. Injury to the medial branch of the antebrachial cutaneous nerve is less frequent thanks to the limited dissection. The most frequent complication is the development of a hematoma.

Areas of controversy: It is unclear whether ulnar nerve instability is a contraindication to simple decompression.

Growing points: The shorter time to return to work and the cosmetic appearance of the scar can be considered advantages of the endoscopic technique.

Areas timely for developing research: There is a need to perform randomized clinical trials with common and validated scoring system with a longer duration of follow-up. The literature pertinent to endoscopic cubital tunnel release is lacking in the evaluation of the learning curve. Further investigations are necessary to assess the role of ulnar nerve instability.

Keywords: cubital canal; endoscopic release; neuropathy; systematic review; ulnar nerve.