19-SEPTEMBER-2025  NAJA HADI SALEH NAJEM  70 YEARS  LEFT CUBITAL AND CARPAL TUNNEL COMPRESSION.

The patient an Iraqi citizen came to the clinic to Dr. Ali Al-Bayyati 16-September-2025 complaining of chronic LBP without sciatica for long time  with pain and numbness of the left hand for several months with exacerbation of the last month. The patient is known diabetic, hypertensive and hypothyroid in L-Thyroxin 125 microgram daily and plavix 75 mg for 10 years.

On examination, there is moderate atrophy of interossii left hand with positive Tinel's sign at the cubital and carpal tunnel. the hypothenar with sensory impairment including the dorsal branch of the ulnar nerve with beginning clawing of the Vth finger with weak abduction of the thumb.

The patient was sent for investigations and EMG studies confirmed presence of left cubital and carpal tunnel syndrome left side. MRI cervical and lumbar showing mild degenerative changes.

Under G.A. left carpal tunnel release was done. Projectional incision over the left cubital tunnel. The ulnar nerve was exposed and it was severely compressed by the surrounding tissues. The nerve was dissected down to its peripheral branching and up. Inspection of the tunnel revealed no abnormality. The nerve was put back to its previous course and check for jumping of the nerve upon flexion and extension of the elbow was negative for what it was satisfactory to keep the procedure as it is. Using MultiGen, bipolar stimulation of the nerve was not responding even to 3.5 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the left ulnar nerve was achieved using 2 bended catheters 10 mm exposed length. Further bipolar stimulation of the nerve responded to 3.0 Volts. Closure of the wounds. The patient was sent to the ward.

Too early now.

If the ulnar nerve was severely compressed by the ligaments and thee canal was normal and after release, the nerve is not jumping with flexion and extension of the elbow, then release only is sufficient.

This is the 290th case using the MultiGen. This procedure regained routine acceptance.  It became a usual part of the spine and peripheral nerves surgery. Click here for reference. The patient showed improvement of the motor stimulation after BPRF, and the sciatic pain decreased in the right knee.

With accumulation of data, it became clear that the irritated nerve with aberrant currents running in the C fibers up, not only causing no change or elevation of the required voltage to achieve motor response, but they could cause the preoperative weakness. Ablation of such currents results in facilitation of the motor response and improvement of function with disappearance of pain.

It is unclear why the roots have several motor response with different patients, despite the fact that the neurological status was the same and the anesthesia protocol also the same.

It could be that the nerve is recovering minute by minute after decompression and this can explain why the motor conductivity is improving after the BPRF application, which require 5 minute session in most cases.

After the 172d case, the elevation of motor stimulation above 5 V was abandoned to avoid delayed dural tear with subsequent CSF leak, which take place at the contact at the lower electrode shaft with the dura below or above the level of the axilla.

Before doing motor stimulation in peripheral nerve surgery with tourniquet. always release the tourniquet before performing motor stimulation.