Surgical Decision Making for Mild-to-Moderate Cubital Tunnel Syndrome

Abstract

PurposeThe management of ulnar (UN) neuropathy remains unclear as there are neither consensus guidelines nor compelling data available to inform optimal treatment. Identifying patients in the mild to moderate group that would benefit most from surgery is challenging as their symptoms can be subtle and less debilitating. This study investigated predictors of surgical intervention among patients presenting with McGowan mild and moderate cubital tunnel syndrome (CuTS). MethodsThis is an institutional review board–approved study. Patients evaluated from March 2016 to July 2022 were included if they were diagnosed with McGowan mild or moderate CuTS and underwent concurrent electrodiagnostic and ultrasound (US) evaluations. Patient demographics, symptom presentation, clinical and diagnostic test findings were analyzed. Variables were analyzed using Student’s t-test, Mann-Whitney U-Test or Pearson’s χ2 test. Multivariable logistic regression was used to assess the association of covariates and surgery. Results73 patients and 103 elbows were identified. The mean age and BMI were 51 and 26 respectively. Most patients were male, right-hand dominant, and unilaterally symptomatic in the dominant hand. Twenty-six elbows were surgically treated. Bivariable analyses by surgical treatment showed that patients who underwent surgery more often had positive electrodiagnostic findings including motor nerve conduction velocity (CVm) <50m/s and a >10m/s CVm difference across the forearm compared to elbow.Fifty-nine cases were categorized as electrodiagnostically normal. Of the electrodiagnostically normal cases 29 had positive findings of CuTS on US. Logistic regression model showed that electrodiagnostically severe cases had 3.7 times higher odds of being surgically treated than normal counterparts (OR: 3.7, 95%CI: 1.11-12.6; p=0.03). ConclusionNot many differences in objective findings identify patients who should receive operative treatment. In addition to test results, more subjective findings from the patient such as patient-reported level of impairment may be able to bridge this gap in surgical decision making. Clinical RelevanceThis study contributes to treatment decision-making for mild and moderate cubital tunnel syndrome.