Endoscopic treatment of ulnar nerve compression syndrome - Causes, symptoms and treatment. MF.
Apr 13, 2018
Syndrome of compression of the ulnar nerve - tunnel syndrome - compression-ischemic neuropathy is a syndrome of squeezing( pinching) of the ulnar nerve in anatomically narrow places - tunnels.
Surgical treatment - endoscopic - is performed with ineffective therapeutic treatment for decompression of the nerve in anatomically narrow places: the Staser's arch( fascia in the form of a bridge between the medial muscular septum and the medial head of the triceps muscle), the medial muscular septum, the medial epicondyle, in the cubital canal, the fascia.
The ulnar nerve can be restrained and in the area of the hand - Guyon's syndrome.
Preparing for operation
When preparing for surgery, general clinical tests are given - blood, urine, coagulogram, blood group, blood sugar, AIDS, DAC;electroneuromyography, x-ray of the joint( elbow or wrist), ultrasound of the joint( elbow or wrist) is performed.
The advantage of the endoscopic method is a small cut of the skin - up to 2 cm, the ability to provide a more complete release of the nerve with less trauma to the nerve and surrounding tissues.
The hemostatic tourniquet is placed under local anesthesia( the anesthesia variant is discussed individually with the anesthesiologist depending on the expected volume and duration of the intervention, the general somatic condition, the presence of drug allergy, the conductive anesthesia or blockade of the brachial plexus), the cut of the skin along the nerve stroke by the elbow and innerepicondylosis, aponeurosis is dissected, a nerve is located and labeled, a retractor is inserted. With the help of optics, all the anatomy of the lesion is visible. Dissection epinevria is carried out only in the event that a clear stricture of the nerve with edema proximal to it is visible. Neurolysis is carried out, all places of compression are unloaded, scar and altered tissues are excised. .. blood vessels coagulate. It is possible to conduct nerve displacement( transposition) anteriorly, either subcutaneously, or axillary or intramuscularly. The nerve is placed parallel to the median nerve, the muscles are hemmed.
With Guyon syndrome, a minimally invasive excision of the "roof" of the tunnel is performed.
Retractors have ergonomic handles and built-in suction, they are available in two sizes( 8 mm and 15 mm).The endoscope smoothly moves and provides excellent image quality and constant visual control of the nerve, its branches, blood vessels.
This reduces the traumatic nature of the intervention, reducing the time of surgery. The entire system is processed in an autoclave.
Time of intervention is individual and depends on the cause of compression of the ulnar nerve.
After endoscopic operation
After the operation, pain syndrome disappears. Depending on the cause, the duration of the disease, the severity of the disease in the postoperative period, anticholinesterase drugs - proserine, neuromidine, B vitamins, lipoic acid, drugs that improve microcirculation and physiotherapy - stimulus, myoton, water mud.
The length of stay in the hospital varies individually, up to a maximum of 7 days.
Doctor neurologist Kobzeva S.V.