J Korean Neurosurg Soc.  2022 Mar;65(2):307-314. 10.3340/jkns.2021.0135.

A Cadaveric Study of Thread Cubital Tunnel Release with Newly Developed Threads

• Kang M
• Nam YS
• Kim IJ
• Park HY
• Ham JR
• Kim JM

• KMID: 2527187
• DOI: http://doi.org/10.3340/jkns.2021.0135

Abstract

Objective
: The percutaneous thread transection technique is a surgical dissecting method using a dissecting thread inserted through a needle under ultrasound guidance without skin incision. As the new dissecting threads were developed domestically, this cadaver study was conducted to compare the effectiveness and safety between the new threads (ultra V sswire and smartwire-01) and a pre-existing commercial dissecting thread (loop & shear) by demonstrating a modified looped thread cubital tunnel release.
Methods
: The percutaneous cubital tunnel release procedure was performed on 29 fresh cadaveric upper extremities. The preexisting commercial thread was used in 5 upper extremities. The two newly developed threads were used in 24 upper extremities. Two practitioners performed the procedures separately. After the modified looped thread cubital release, anatomical and histological analyses were performed by a blinded anatomist. The presence of the dissected cubital tunnel and damaged adjacent soft tissue was assessed.
Results
: Out of the 29 cadaveric upper extremities, 27 specimens showed complete dissection of the Osborne ligament and the proximal fascia of the flexor carpi ulnaris muscle. One specimen was incompletely dissected in each of the ultra V sswire and smartwire-01 groups. There were no injuries of adjacent structures including the ulnar nerve, ulnar artery, medial antebrachial cutaneous nerve, or flexor tendon with either the commercial thread or the newly developed threads. The anatomical analysis revealed clear and sharp incisional margins of the cubital tunnel in the Smartwire-01 and loop & shear groups. All three kinds of threads maintained proper linear elasticity for easy handling during the procedure. The smartwire-01 provided higher visibility in ultrasound than the other threads.
Conclusion
: The newly developed threads were effective and safe for use in the thread cubital tunnel release procedure.

Keyword

Cubital tunnel syndrome; Cadaver; Ultrasonography; Anatomy and histology

Figure

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  Fig. 1. Schematic drawing illustrating the percutaneous dissecting thread technique in the cubital tunnel release procedure. 1) The needle was inserted at the proximal to the medial epicondyle, passed under the cubital tunnel with hydrodissection around the nerve, and exited. 2) The dissecting thread passed through the needle. 3) The needle was removed, leaving the thread in the cubital tunnel. 4) The needle was reinserted at the same proximal entry point, passed above the cubital tunnel, and exited at the same distal point. 5) The distal dissecting thread, which remained in the cubital tunnel, was inserted into the distal needle tip. 6) After withdrawing the needle, the looped thread remained at the cubital tunnel. *Under cubital tunnel. †Above cubital tunnel.

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  Fig. 2. Ultrasound pictures of the cubital tunnel. A : Long-axis view of the cubital tunnel. Arrowhead indicates the looped thread surrounding the Osborne ligament. B : Short-axis view of the cubital tunnel. Blue arrow indicates the ulnar nerve. White arrow indicates discontinuity of the cubital tunnel, dissected by the thread.

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  Fig. 3. Histologic photograph of the cross section of the dissected tissue with Masson’s trichrome staining. Arrowheads indicate transected Osborne ligament. N indicates the ulnar nerve. D indicates dermis.

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  Fig. 4. Gross pictures of dissected elbows after performing the percutaneous dissecting thread technique in cubital tunnel release. Arrows indicated the proximal and distal end of the cubital tunnel. A : Dissected with loop & shear. B : Dissected with ultra V sswire. C : Dissected with smartwire-01.

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  Fig. 5. Ultrasound findings of the long-axis view of the cubital tunnel. Arrow indicates the looped thread surrounding the Osborne ligament. Smartwire-01 was more visible in ultrasound view than other threads. A : Loop & shear. B : Ultra V sswire. C : Smartwire-01.

Reference

References

1. Andrews K, Rowland A, Pranjal A, Ebraheim N. Cubital tunnel syndrome: anatomy, clinical presentation, and management. J Orthop. 15:832–836. 2018.

2. Boone S, Gelberman RH, Calfee RP. The management of cubital tunnel syndrome. J Hand Surg Am. 40:1897–1904. quiz 1904. 2015.

3. Buchanan PJ, Chieng LO, Hubbard ZS, Law TY, Chim H. Endoscopic versus open in situ cubital tunnel release: a systematic review of the literature and meta-analysis of 655 patients. Plast Reconstr Surg. 141:679–684. 2018.

4. Guo D, Guo D, Guo J, Schmidt SC, Lytie RM. A clinical study of the modified thread carpal tunnel release. Hand (N Y). 12:453–460. 2017.

5. Guo D, Guo D, Harrison R, McCool L, Wang H, Tonkin B, et al. A cadaveric study using the ultra-minimally invasive thread transection technique to decompress the superficial peroneal nerve in the lower leg. Acta Neurochir (Wien). 161:2133–2139. 2019.

6. Guo D, Kliot M, McCool L, Senk A, Tonkin B, Guo D. Percutaneous cubital tunnel release with a dissection thread: a cadaveric study. J Hand Surg Eur Vol. 44:920–924. 2019.

7. Kim JH, Won SJ, Rhee WI, Park HJ, Hong HM. Diagnostic cutoff value for ultrasonography in the ulnar neuropathy at the elbow. Ann Rehabil Med. 39:170–175. 2015.

8. McCool L, Guo D, Guo D, Harrison R, Tonkin B, Senk A, et al. Thread common peroneal nerve release-a cadaveric validation study. Acta Neurochir (Wien). 161:1931–1936. 2019.

9. Smeraglia F, Del Buono A, Maffulli N. Endoscopic cubital tunnel release: a systematic review. Br Med Bull. 116:155–163. 2015.

10. Staples JR, Calfee R. Cubital tunnel syndrome: current concepts. J Am Acad Orthop Surg. 25:e215–e224. 2017.