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Subcutaneous Ulnar Nerve Transposition Using Osborne’s Ligament as a Ligamentodermal or Ligamentofascial Sling

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TAKE-HOME POINTS

  • Optimal management of cubital tunnel syndrome is controversial.
  • There are many different techniques for ulnar nerve transposition, each with their own set of pitfalls.
  • Goal of any surgery for ulnar nerve compression is to eliminate all sites of compression and create a tension-free nerve that glides freely.
  • Osborne’s ligament is a transverse fibrous band as the fascial connection between the 2 heads of the flexor carpi ulnaris that forms the roof of the cubital tunnel.
  • Osborne’s ligament can be used in ulnar nerve transposition to create a broad based, smooth-gliding sling for tension-free excursion of the ulnar nerve.


 

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ABSTRACT

The ulnar nerve is most commonly compressed at the elbow in the cubital tunnel. Conservative and operative treatments have been applied for cubital tunnel syndrome. Surgical management options include decompression, medial epicondylectomy, and various anterior transposition techniques. We describe a novel technique of anterior transposition of the ulnar nerve by using Osborne’s ligament as a sling to avoid subluxation. Osborne’s ligament is incised posteriorly and medially on the olecranon to create a sling with 2 to 3 cm width. The sling is tailored to wrap around the ulnar nerve and attached to the flexor-pronator fascia or dermis to create a smooth gliding surface without causing compression. Ten patients with cubital tunnel syndrome, established by physical examination findings and electromyography/nerve conduction studies underwent ulnar nerve transposition using this technique and were able to participate in a phone survey. The average follow-up was 15.6 months (range, 4-28 months). The average time to become subjectively “better” after surgery was 4.2 weeks. The pain intensity was reduced from an average of 7.5 preoperatively to <1, on a 10-point scale, at the time of the survey. All patients had symptomatic relief without any complication. The proposed technique using Osborne’s ligament as a ligamentofascial or ligamentodermal sling offers a unique way of creating a non-compressive sling with the component of the cubital tunnel itself and has an additional benefit of creating a smooth gliding surface for early return of function.

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