Ist eine unterschiedliche Behandlung bei verschiedenen Schweregraden des Sulcus nervi ulnaris-Syndroms sinnvoll?

Abstract

Cubital tunnel syndrome is the second most common chronic nerve entrapment of the upper extremity, yet both diagnosis and staging of the severity of the progression of the disease rely mostly on the keen observation and interpretation of clinical signs and symptoms. To be valid, a staging system must correlate well with the known pathophysiological mechanisms of chronic nerve compression, have objective parameters available to quantify differing degrees of sensory and motor dysfunction, and finally must allow different therapeutic consequences. In this study we have prospectively evaluated 44 patients who presented with the clinical diagnosis of cubital tunnel syndrome. Quantitative Sensory Testing was performed using a computer-assisted testing system (Sensory-Management Services L. L. C., Baltimore). Classic two-point discrimination, one point pressure threshold, pinch and grip strength were measured. Progression of disease was staged according to the gradual loss of sensory and motor function. After an average of 15 months postoperatively, ulnar nerve function was re-evaluated using the same parameters and outcome measured with the modified Bishop rating scale. The results of this study indicate that 100 % of patients in the moderate group had a good and excellent outcome, whereas only 74 % of the severe group were rated as good and excellent with 17 % moderate and 9 % poor outcome.