Simple Decompression (In Situ and Endoscopic)

Simple decompression of the ulnar nerve does not have a long history; however, in recent years, it has become the first-line treatment of idiopathic ulnar neuropathy at the elbow. Since the original description by Geoffrey Vaughan Osborne in 1957, open in situ decompression now refers to release of all possible areas of constriction of the ulnar nerve about the elbow. The more recent approach of endoscopic decompression has multiple reported techniques and specific instrumentation. In comparing anterior transposition to simple decompression, similar outcomes have been reported with fewer complications, shorter operating room time, and faster return to work seen for simple decompression. In comparing simple and endoscopic decompression, equal outcomes have again been reported with more complications, shorter operating room time, and slower return to work seen for the simple approach. Despite this, while the literature has fueled the changed paradigm from anterior transposition to simple decompression as the first-line treatment, it has not yet done so for endoscopic decompression.