Endoscopically assisted decompression of the ulnar nerve

Compression of the ulnar nerve in the sulcus of the ulnar nerve (cubital tunnel) posterior to the medial epicondyle of the humerus is the second most common nerve compression after carpal tunnel syndrome.
Cubital tunnel syndrome (also known as ulnar sulcus syndrome) is a compression syndrome of the ulnar nerve. This syndrome involves a constriction of the cubital tunnel (ulnar sulcus) which leads to compression of the ulnar nerve.  
This may result in neuronal damage and a wide range of neuronal dysfunctions. Cases of advanced damage to the ulnar nerve may lead to impairment of motor functions, and the final stage takes the form of claw hand.

Various therapeutic treatments have been available such as nerve decompression without transposition (in situ decompression), nerve decompression with subcutaneous transposition of the nerve in a ventral direction (ventral transposition), and transposition of the nerve in a ventral direction into the muscle (submuscular transposition).

Endoscopically assisted decompression of the ulnar nerve offers a new option involving a small incision being made in the skin in order to release the proximal and distal constrictions of the nerve without having to make an incision of the same length in the skin.
The advantage of this endoscopic technique is that a much smaller incision can be used while at the same time extending the length of neurolysis. This leads to less morbidity, rapid improvement of the symptoms, and fast rehabilitation compared with conventional procedures.

Richard Wolf has cooperated with Professor Dr. Peter Hahn at Vulpiusklinik, Bad Rappenau, to create a special instrument set for endoscopically assisted decompression of the ulnar nerve.

Endoscopic carpal tunnel release

The "ENDO-CARTRIS" instrument set was designed in close cooperation with leading surgeons.
This instrument set enables a gentle procedure for endoscopic therapy of carpal tunnel syndrome to be carried out. The syndrome is the result of chronic pressure damage to the median nerve on the flexion (palmar) side of the wrist. The median nerve is compressed here beneath the flexor retinaculum (transverse carpal ligament).

Possible causes:

  • Trauma
    Fractures in the area of the wrist
    Hematoma / Edema
  • Excessive exertion of the hand
  • Tendosynovitis
  • Arthritis
  • Tumors (fibroma, lipoma)

When an endoscopic carpal tunnel intervention is carried out, the flexor retinaculum is divided while conserving the surrounding nerves and blood vessels and this provides mechanical relief for the pressure on the median nerve.
This procedure allows patients to resume normal activity at an earlier stage with the hand that has undergone surgery and there is a significant improvement in postoperative morbidity.
 
The background to the single-portal technique preferred by Richard Wolf is the desire to keep risks to a minimum. This intervention involves cutting from a proximal to distal point under continuous visual control. The telescope guide permits precise inspection of the flexor retinaculum over its entire width – without any change to the position of the instrument.

The "ENDO-CARTRIS" instrument set consists of: telescope guide, PANOVIEW telescope, 4 mm, direction of view 30°, insertion sheath with obturator, carpal tunnel dissection probe, and a handle for blades.
This basic system can be used for the single-port technique and for the double-port technique.