1. Endoscopic cubital release Financial interest G Inventor G Stock holder

2. Endoscopic cubital tunnel release G Treatment of cubital tunnel syndrome G Conservative treatment G Surgical options G Open cubital tunnel release G Anterior transposition of ulna nerve G Submuscular G Subcutanoeous G Medial epicondylectomy

3. Endoscopic cubital tunnel release G Platt in Br J Surg, 1926 G Anterior transposition of ulna nerve G Widely practiced today G Problems G Dissections and mobilization of the ulna N

4. Endoscopic cubital tunnel release G Problems with dissection and mobilization G Interfering with the blood supply G Compromising articular branches G Compromising muscular branches G Jeopardizing antebrachial cutaneous nerves G Creates large area of scar bed

5. Endoscopic cubital tunnel release G Regional blood flow to the UN G Smith 1966, Arch. Surg. G 5-8cm detachment of mesoneurium G Impaired segmental circulation G Not maintained anastomotic channels

6. Endoscopic cubital tunnel release G Regional blood flow to the UN G K Ogata and Manske 1984, Cl Orth R Research G Vascular injection studies G Anterior transposition associated with significant decrease in blood flow

7. Endoscopic cubital tunnel release G Goals G Minimize extensive soft tissue dissections G Minimize manipulation of the nerve G Minimize mobilization of the nerve G Preserve the mesoneurium

8. Endoscopic cubital tunnel release G ECUTR may be the answer

9. Endoscopic cubital tunnel release G instrumentation Compliments of AMS

10. Clear cannula G 360 degree visualization

11. Endoscopic cubital tunnel release G Standard G 4mm scope G Locking device G Sleeve knife Compliments of AMS

12. Land Marks G Landmarks G Med. Epicondyle G Olecrenon G 3-5 cm incision

13. Surgical technique G Incision G Landmarks G Med. Epicondyle G Olecrenon G 3-5 cm incision

14. Surgical technique G Division Osborns ligament G Identification of Ant. Br. Cut. Nerve G Identification of unla nerve

15. Surgical technique G Distal dissection G Clamp or scissor dissection

16. Surgical technique G Distal dissection G Dissector

17. Surgical technique G Follow the pathway G Created by dissector G Obturator cannula assembly G Remove the obturator

18. Endoscopic Visualization & Division

19. Surgical technique G Arthroscope 4mm 30 degree G Visualize G Knife sleeve assembly G Division

20. Surgical technique Endoscopic visualization

21. Surgical Technique Fix Knife to Endoscope G Slide knife over scope G Lock Knife in place

22. Surgical technique Endoscopic visualization

23. Surgical Technique G Proximal Dissection

24. Surgical Technique G Proximal insertion of obturator cannula

25. Endoscopic visualization

26. Surgical Technique G Endoscopic Visualization G Arcade of Struthers

28. G If nerve subluxes on flexion G Medial epicondyletomy G Anterior transposition Surgical technique

29. Results G 17 patients G 6 Females G 11 Males

30. Results G 2 pt. underwent Med. Epicondylectomy G 1 pt. had anterior transposition

31. Results G Complications G 2 haematomas G No ulna nerve injury G No injury to M A B cutaneous nerve G No recurrence G 1 hypertrophic scar

32. Results G Tsai et al G endoscopic cubital tunnel G 85 elbows in 76 patients G 32 months follow up G 42% had excellent results, 45% had good results, 11% had fair results, and 2% had poor results. G Conclusion G These results are comparable to the other decompressive techniques, which overall result in 85-90% good-to-excellent results.

33. Results G Hoffmann et al G 75 patients (76 cases). G Release the U nerve release 17 cm G Incision averaging 2.8 cm in length. G The mean follow-up 11 months G Good to excellent results in 94% of patients.

34. Conclusions G Minimally invasive G No manipulation of the nerve G No interruption of blood supply G Avoids sacrifice of the articular/muscular Br.

35. New Design G Winged Design G Will open and close the slot at any time and then lock into place G Protect the nerve and gently move it from the cutting blade G Will be out in Four Weeks G Winged Design G Will open and close the slot at any time and then lock into place G Protect the nerve and gently move it from the cutting blade G Will be out in Four Weeks

36. Thank you