Modified simple decompression of ulnar nerve in treatment of cubital tunnel syndrome

There are two main surgical approaches, simple ulnar nerve decompression at the elbow, and anterior transposition of the nerve in treatment of cubital tunnel syndrome. Both techniques were reported in literature in details with similar reported success rates. Here, we present a modified simple decompression surgical technique in treatment of cubital tunnel syndrome. Fifty eight patients diagnosed with cubital tunnel syndrome undergoing the presented technique were enrolled. This procedure consisted of ulnar nerve decompression at the elbow and a supplementary procedure of inter-muscular septum transverse cut between triceps and brachialis muscle above the elbow. Complete sensory recovery was observed in 35 [60.3%] patients, however, mild and occasional sensory symptoms remained in 15 [25.9%], and moderate symptoms persisted in 6 [10.3%] patients. In two patients [3.4%], no sensory improvement was recorded. Post-operatively, muscular hypotrophy improved completely in 5 out of 12 patients [41.7%]. However, in the remaining 7 patients [58.3%] with muscular atrophy, motor recovery never took place. The presented modified simple decompression technique was shown to be an effective and safe procedure for the treatment of cubital tunnel syndrome without any complications

[Volkmann's syndrome]

Background and Aim: The volkmann syndrome is ischemia and muscular necrosis due to pressure augmentation in the closed aponeurotic compartments of the forearm region. The incidence of this syndrome in Iran is more than the normal incidence, since non-medical people perform bandage or casting too tightly, for the treatment of forearm lesions

Materials and Methods: A total of 67 patients, 64 male and three female, ranging in age from 7 to 18 years with the average of 13 years were treated by one of the four methods of Scaglietti, Latissimus dorsi Island flap, Gracilis free muscle transfer or Biceps tendon transfer

Results: From 33 patients with some muscle contracture who underwent flexor muscle advancement [Scaglietti technique] 25 [71.4%] resulted in excellent, and 10 [28.6%] resulted in good outcome. Latissimus dorsi Island flap resulted in 20 [90.9%] excellent, and 2 [9.1%] good results in total of 22 patients. Gracilis muscle transfer in 4 patients resulted in 4 good outcomes [100%]. Six biceps tendon transfer procedure resulted in 6 good outcomes [100%]

Conclusion: If some forearm muscle contraction is revealed in the physical examination, good results can be obtained by performing the Scaglietti procedure. We did not have any muscle necrosis of the transferred latisimuss dorsi island flap, or musculocutaneous gracillis free flaps transferred. The transfer of biceps tendon to the digital flexor tendon yields in acceptable results for the patients. But the patient needs good re-education and physiotherapy for adaptation to the new condition

[Thenar muscle anatomic variation in carpal tunnel syndrome]

Carpal tunnel syndrome [CTS] is the most common nerve compression neuropathy. It is a multifactorial syndrome and several systemic and local factors such as carpal tunnel anatomy and its variation change the size, shape and volume of this tunnel. In this study, we seek to explain the relation between anatomic variation of thenar muscle and CTS. This descriptive study was conducted on 155 patients with CTS undergoing operation. Care was taken to exclude patients with Rhumatoid Artritis, Hyperthyroidisem, Hypothyroidisom, Diabetic Melitus, acromegaly and previous fracture of distal wrist. During surgery thenar muscle anatomic variations of carpal tunnel have been observed. Of 155 patients, 140 were female [90.3%], and 15 male [9.7%] patients with the mean age of 57.9 years. The anatomic variations have been observed in 35[22.5%] patients. Thenar muscle anatomic variation in CTS is prevalent but further evidence is required