Obese Patient Ulnar Nerve Decompression
Lee Hunter MD, MBA
Hunter Medical Founder and Chief Medical Officer
Ulnar nerve decompression in the cubital tunnel, usually a very straightforward and simple procedure, is made much more technically difficult by obesity. The relatively deeper position of the nerve, the abundance of subcutaneous fat, and the inevitable visual blending of the fatty tissue with the bridging subcutaneous nerves and the ulnar nerve make things more difficult. A stiff ipsilateral shoulder, even mildly so, can make the case that much more frustrating!
45 year old female patient with BMI of 55 and chronic cubital tunnel syndrome
As the elbow is held vertically by the ElbowLOC® (in the supine positioning mode), gravity helps the fatty tissue separate more easily and the ulnar nerve is held closely to the distal humerus during the exposure. This makes identification and protection of the many bridging subcutaneous nerves easier, and visualization and release of the ulnar nerve in the cubital tunnel straightforward. The surgeon doesn’t have to strain and lower his/her head to look around to the posteromedial corner of the elbow and find the ulnar nerve in a “sea” of fat, which is generally the case with the surgery performed utilizing an arm board. Visualization of the ulnar nerve can be particularly frustrating if the patient has ipsilateral shoulder stiffness and assistants find it difficult to maximally externally rotate the shoulder.
This case is another great example of how the ElbowLOC® simplifies and accelerates procedural times for many elbow surgeries and makes surgery easier for the surgeon, patient, and staff!