Second Review of Technique of "Subfascial Anterior Transposition" for Cubital Tunnel Syndrome (CuTS)

Abstract

Background: Chuang first reported using subfascial anterior trans- position technique to treat cubital tunnel syndrome (CuTS) in 1998 with a series of 76 patients between 1991 and 1996. This article was the second review of the same technique to re-evaluate how effective and durable of this technique after 1996. Patients and Methods: Between January 1997 and December 2005, 50 patients with CuTS were collected. They were all diagnosed as CuTS, and treated by subfascial anterior transposition by the same surgeon (Chuang). The average age at operation was 43.8 years old (6-81 years old). Base on the McGowan grading scale, preoperative evaluation showed 34 cases (68%) in grade Ⅲ (severe compression), 16 cases (32%) in grade Ⅰ (moderate compresion), and no one in grade Ⅰ. Results: All patients were evaluated for a minimum follow-up of 2 years. Fourty-five cases (90%) showed improving motor and sensory function after treatment. Five cases with non-improvement were all grade Ⅲ preoperatively and showed improved sensation and motor function, but persistent claw deformity (grade Ⅲ) postoperatively. There were no recurrent cases, nor any major complication in this study. Risk factors for non-improvement included grade Ⅲ nerve compression, prolonged symptoms and signs more than one year, and neuroma formation found intraoperatively. Besides, sliding of pronator-flexor muscle to create a trough did not induce any bad motor sequel. Conclusion: Subfascial anterior transposition is an effective and reliable method for cubital tunnel syndrome, especially for moderate to severe compression cases and recurrent cases treated by other method.