The second most common peripheral nerve compressive neuropathy, cubital tunnel syndrome has unique features clinically and anatomically which make it a more challenging problem to deal with. |
The second most common peripheral nerve compression neuropathy, the cubital tunnel syndrome has unique clinical and anatomical characteristics that make it a more challenging problem to deal with. |
From the standpoint of surgical intervention there are minimalists who favor in situ decompression and there are are those who might be characterized as traditionalists who favor submuscular transposition. |
From the point of view of surgical intervention, there are minimalist who advocate decompression in situ and there are those who can be characterized as traditionalists who advocate submuscular transposition. |
The other options are intermediate, consisting of epicondylectomy, anterior subcutaneous transposition, usually accompanied by a fascial sling. |
The other options are intermediate, consisting of epicondylectomy, anterior subcutaneous transposition, usually accompanied by a fascial sling. |
Then there is the hybrid operation of sort which is referred to as an intramuscular transposition in which rotated flaps of muscle fascia form the roof of the tunnel, the floor is the fleshy muscle bellies left attached, while fibrous bands that might produce kinking or compression of the nerve within the muscular bed are released. |
Then there is the hybrid type operation which is referred to as an intramuscular transposition in which rotated flaps of the muscular fascia form the tunnel roof, the floor being the belly of the fleshy muscles left fixed, while fibrous bands that can produce nerve torsion or compression inside the muscle bed are released. |
With all the transposition options it has become customary to excise the distal aspect of the medial intermuscular septum. |
With all transposition options, it became common to excise the distal face of the medial intermuscular septum. |
This tissue may be left attached distally and use to augment a fascial sling for a subcutaneous transposition, or the fascial roof of a submuscular or intramuscular transposition. |
This tissue can be left distally trapped and used to increase a fascial band for subcutaneous transposition, or the fascial roof of a submuscular or intramuscular transposition. |
When the flexor pronator origin is taken down it is desirable to reconstruct in a fashion that will allow for early motion at least through a limited arc to promote gliding of the nerve in its new bed and to avert stiffness in the elbow. |
When the origin of the pronator flexor is removed, it is desirable to reconstruct in a way that allows the initial movement at least through a limited arch to promote nerve sliding in its new bed and to avoid elbow stiffness. |
From the standpoint of diagnostic criteria and surgical intervention there are those who contend that unless there are electical studies to document the problem then it is not cubital tunnel syndrome and certainly not a problem to be addressed by surgical intervention to decompress the ulnar nerve. |
From the point of view of diagnostic criteria and surgical intervention, there are those who claim that, unless there are electronic studies to document the problem, then it is not the cubital tunnel syndrome and it is certainly not a problem to be treated by the surgical intervention for decompress the ulnar nerve. |
From the standpoint of pathophysiology there are those who consider this a nerve compression and those who emphasize the importance of local strain as a potential souce for symptoms. |
From the pathophysiological point of view, there are those who consider this to be a nervous compression and those who emphasize the importance of local distension as a potential source of symptoms. |
In the latter case, this is considered an additional rationale for anterior transposition over any method which may leave the nerve posterior to the flexion axis of the elbow where it will remain subject to more strain. |
In the latter case, this is considered an additional reason for the anterior transposition over any method that may leave the nerve posterior to the elbow flexion axis, where it will remain subject to further efforts. |
Causation with regard to work relatedness can be controversial and especially in cases wherein electrodiagnostic studies are negative but symptoms severe. |
Causality in relation to the relationship with work can be controversial, especially in cases where electrodiagnostic studies are negative, but the symptoms are severe. |
A contentious situation can arise leading to protracted work loss and litigation. |
A contentious situation can arise leading to prolonged loss of work and litigation. |
The situation is more difficult because an appropriately cautious surgeon will be reticent to embark upon surgical intervention in the absence of objective verification in the form of an abnormal electical study. |
The situation is more difficult because an appropriately cautious surgeon will be reluctant to initiate a surgical intervention in the absence of objective verification in the form of an abnormal elective study. |
The prudent surgeon will recognize that surgery for cubital tunnel has a mixed track record for success. |
The prudent surgeon will recognize that surgery for the cubital tunnel has a mixed record of success. |
In the event of an unsatisfactory outcome with surgical intervention followup electordiagnostic studies and likely and not unexpectedly may indeed show changes after a surgery where none were present before. |
In case of an unsatisfactory result with the surgical intervention, studies of electronic diagnosis and probably, and not unexpectedly, may in fact show changes after a surgery where none was present before. |
This is liable to be characterized as an iatrogenic worsening of the condition. |
This can be characterized as an iatrogenic worsening of the condition. |
Despite this and other hazards having to do with the medico-legal and social issues surrounding the problem, it is widely held that early surgical intervention for cubital tunnel is associated with a more favorable outcome than late surgery. |
Despite this and other risks related to medico-legal and social issues surrounding the problem, it is widely accepted that early surgical intervention for the cubital tunnel is associated with a more favorable outcome than late surgery. |
Ultimately insight in patient selection in conjunction with sound technique will allow successful navigation of these hazards. |
Ultimately, insight into patient selection in conjunction with sound technique will allow successful navigation of these hazards. |