Severe Cubital Tunnel Syndrome Research Articles

Exploring Outcomes and Mediating Factors Following Supercharged End-to-Side Anterior Interosseous Nerve to Ulnar Nerve Transfer: A Scoping Review With Expert Insight

This scoping review with expert insight aims to map outcome measures following supercharged end-to-side anterior interosseous nerve to ulnar nerve transfer procedures, integrating clinical, patient-reported, and electrodiagnostic measures. It also explores surgical rationale and recovery trajectories, aiming to standardize methodologies and enhance patient care in nerve transfer surgeries. Our search encompassed multiple online databases, including MEDLINE, Embase, PubMed, and Google Scholar, ensuring rigor and comprehensiveness in identifying relevant literature. Through scrutiny of 17 studies involving 300 patients from 300 articles, along with expert consultations on supercharged end-to-side nerve transfer for ulnar nerve entrapment, promising outcomes emerge, particularly in cubital tunnel syndrome. Primary measures such as Medical Research Council scale assessments and Disabilities of the Arm, Shoulder, and Hand scores demonstrate notable postsurgery improvements, with minor complications noted. Factors influencing recovery include preoperative dysfunction duration and surgical technique. Surgery indications prioritize high ulnar nerve injuries and severe cubital tunnel syndrome. The review highlights the importance of standardized outcome measures, early intervention, and comprehensive rehabilitation for optimizing supercharged end-to-side anterior interosseous nerve to ulnar nerve transfer outcomes. Therapeutic IIIa.

Median to ulnar nerve transfer in severe cubital tunnel syndrome

Median to ulnar nerve transfer in severe cubital tunnel syndrome

End-To-Side Transfer of the Anterior Interosseous Nerve (Supercharged End-To-Side) In Severe Compressive Neuropathies of the Ulnar Nerve

Cubital tunnel syndrome is the second most common compressive neuropathy in the upper extremity after carpal tunnel syndrome. Severe cubital tunnel syndrome is confirmed by axonal loss in electromyography and conduction velocity less than 40 meters/second in the nerve conduction study. As the severity of compressive neuropathy of the ulnar nerve increases, the results of surgical treatment worsen. Axonal regeneration progresses at a rate of 1 to 3 millimeters per day; However, the muscle is irreversibly denervated after 12 to 18 months. Due to the great distance between the location of the compression, the elbow, and the intrinsic muscles of the hand, reinnervation race against time so that irreversible degeneration of the motor plate and subsequent muscle atrophy does not occur. The supercharged end-to-side transfer of the anterior interosseous nerve to the motor fascicle of the ulnar nerve, to treat severe compressive neuropathies, allows earlier neuroregeneration of the intrinsic muscles of the hand, maintaining the viability of the motor plate, while the affected ulnar nerve regenerates throughout its journey.

Anterior Interosseus to Ulnar Motor Nerve Transfers: A Canadian Perspective.

The anterior interosseus nerve (AIN) to ulnar motor nerve transfer has been popularized as an adjunct to surgical decompression in patients with severe cubital tunnel syndrome (CuTS) and high ulnar nerve injuries. The factors influencing its implementation in Canada have yet to be described. An electronic survey was distributed to all members of the Canadian Society of Plastic Surgery (CSPS) using REDCap software. The survey examined 4 themes: previous training/experience, practice volume of nerve pathologies, experience with nerve transfers, and approach to the treatment of CuTS and high ulnar nerve injuries. A total of 49 responses were collected (12% response rate). Of all, 62% of surgeons would use an AIN to ulnar motor supercharge end-to-side (SETS) transfer for a high ulnar nerve injury. For patients with CuTS and signs of intrinsic atrophy, 75% of surgeons would add an AIN-SETS transfer to a cubital tunnel decompression. Sixty-five percent would also release Guyon's canal, and the majority (56%) use a perineurial window for their end-to-side repair. Eighteen percent of surgeons did not believe the transfer would improve outcomes, 3% cited lack of training, and 3% would preferentially use tendon transfers. Surgeons with hand fellowship training and those less than 30 years in practice were more likely to use nerve transfers in the treatment of CuTS (P < .05). Most CSPS members would use an AIN-SETS transfer in the treatment of both a high ulnar nerve injury and severe CuTS with intrinsic atrophy.

Ulnar Groove Plasty Guided by a 3D Printing Technique for Moderate to Severe Cubital Tunnel Syndrome Caused by Elbow Osteoarthritis.

BackgroundThe purpose of this study was to explore the feasibility of ulnar groove plasty guided by a three-dimensional (3D) printing technique for treatment of moderate to severe cubital tunnel syndrome (CuTS) caused by elbow osteoarthritis.Material/MethodsPatients with moderate to severe CuTS secondary to osteoarthritis of the elbow were enrolled in our hospital from April 2015 to March 2018. Based on a previously proposed “elbow canal index”, a 1: 1 model of the elbow joint was printed using CT image data collected preoperatively. After computer-aided measurement, the standard for enlargement of the ulnar nerve groove was calculated and a personalized “trial model” was created by 3D reconstruction. After intraoperative exposure of the ulnar nerve sulcus, the proliferative osteoid was burred with a grinding drill, and the cubital enlargement was verified by the trial model. The ulnar nerve was decompressed and reincorporated into the enlarged cubital canal, and the Osborne ligament was zig-zag elongated and reconstructed.ResultsNone of the patients reported experiencing medial elbow instability, medial elbow pain, ulnar nerve subluxation, flexor-pronator weakness, or incision infection. There was significant improvement of the motor nerve conduction velocity, sensory nerve conduction velocity, two-point discrimination of the little finger, grip strength, pinch strength of the thumb and index finger, VAS score, and DASH score in this study (P<0.001).ConclusionsUlnar groove plasty guided by a 3D printing technique may be another effective treatment of moderate to severe CuTS caused by elbow osteoarthritis.

Severe Cubital Tunnel Syndrome: Considerations for Nerve Transfer Surgery.

Cubital tunnel syndrome is the second most common compressive neuropathy, next to only carpal tunnel syndrome in its incidence. Severe states of disease do not respond to nonoperative management. Likewise, functional outcomes of cubital tunnel surgery decline as the disease becomes more severe. The relatively long distance from site of nerve compression at the elbow to the hand intrinsic muscles distally makes it a race between reinnervation of the muscle and irreversible motor endplate degeneration with muscle atrophy. Loss of intrinsic function can lead to severe functional impairment with poor dexterity and clawing of the hand. While decompressing the nerve at the site of compression is important to prevent further axonal injury, until recently, the only option to restore intrinsic function was tendon transfers. Tendon transfers aim to restore thumb side pinch and control clawing with addition surgery. They also require the sacrifice of wrist extensors or finger flexors. In the past decade, nerve transfers to the distal portion of the ulnar nerve innervating these intrinsic muscles, originally described for proximal ulnar nerve injury or transections, have become increasingly popular as an adjunct procedure in severe cubital tunnel syndrome. Physicians treating severe ulnar neuropathy must be aware of these nerve transfers, as well as their indications and expected outcomes. The so-called supercharged anterior interosseous nerve (AIN)-to-ulnar motor nerve transfer has become a mainstay for distal nerve transfers for ulnar neuropathy and/or injury. Ideal patients to undergo such a procedure demonstrate severe ulnar neuropathy on nerve conduction and electromyography studies, with reduced compound muscle action potential (CMAP) amplitude and fibrillations at rest. Recent studies demonstrate nerve transfers to be superior in intrinsic muscle reinnervation compared with nerve graft in the setting of large segmental nerve defects. Likewise, compared with decompression alone, patients undergoing the supercharge procedure are more likely to regain intrinsic function and less likely to need secondary tendon transfer surgeries. Finally, initial results for sensory nerve transfer to recover sensation in the ulnar-sided digits in severe cubital tunnel are more advantageous than for decompression alone. Distal nerve transfers offer a reliable, reproducible treatment option for the restoration of intrinsic hand function and protective sensation in the setting of severe cubital tunnel syndrome.

Supercharge End-to-Side Anterior Interosseous-to-Ulnar Motor Nerve Transfer Restores Intrinsic Function in Cubital Tunnel Syndrome.

The supercharge end-to-side anterior interosseous nerve-to-ulnar motor nerve transfer offers a viable option to enhance recovery of intrinsic function following ulnar nerve injury. However, in the setting of chronic ulnar nerve compression where the timing of onset of axonal loss is unclear, there is a deficit in the literature on outcomes after supercharge end-to-side anterior interosseous nerve-to-ulnar motor nerve transfer. A retrospective study of patients who underwent supercharge end-to-side anterior interosseous nerve-to-ulnar motor nerve transfer for severe cubital tunnel syndrome over a 5-year period was performed. The primary outcomes were improvement in first dorsal interosseous Medical Research Council grade at final follow-up and time to reinnervation. Change in key pinch strength; grip strength; and Disabilities of the Arm, Shoulder and Hand questionnaire scores were also evaluated using paired t tests and Wilcoxon signed rank tests. Forty-two patients with severe cubital tunnel syndrome were included in this study. Other than age, there were no significant clinical or diagnostic variables that were predictive of failure. There was no threshold of compound muscle action potential amplitude below which supercharge end-to-side anterior interosseous nerve-to-ulnar motor nerve transfer was unsuccessful. This study provides the first cohort of outcomes following supercharge end-to-side anterior interosseous nerve-to-ulnar motor nerve transfer in chronic ulnar compression neuropathy alone and underscores the importance of appropriate patient selection. Prospective cohort studies and randomized controlled trials with standardized outcome measures are required. Therapeutic, IV.

THE CUBITAL TUNNEL SYNDROME CAUSED BY MULTIPLE GANGLION CYSTS-A CASE REPORT

Cubital tunnel syndrome (CuTS) is the second most common nerve compression neuropathy in the upper extremity. Intraneural ganglion cyst (IGC) within the ulnar nerve around the elbow, might present as CuTS. A 51-year-old Chinese man presented with paresthesia at the ulnar two digits of the left hand for one year. He was clinically diagnosed as severe CuTS. Nerve conduction study revealed marked axonal damage of the left ulnar nerve and ultrasonography showed a mass along the ulnar nerve, three centimetres proximal to the medial epicondyle, which was highly suggestive of Schwannoma. The mass was explored by a longitudinal incision. Intraoperatively, multiple cystic lesions were found within the epineurium of the ulnar nerve. Communication was seen between the elbow joint and the cyst. Swellings were partially excised under microscope. Decompression or partial excision of the cyst along with ligation of the articular branch should be the treatment of choice to prevent recurrence in case of IGC.

Postsurgical Electrical Stimulation Enhances Recovery Following Surgery for Severe Cubital Tunnel Syndrome: A Double-Blind Randomized Controlled Trial.

Patients with severe cubital tunnel syndrome often have poor functional recovery with conventional surgical treatment. Postsurgical electrical stimulation (PES) has been shown to enhance axonal regeneration in animal and human studies. To determine if PES following surgery for severe cubital tunnel syndrome would result in better outcomes compared to surgery alone. Patients with severe cubital tunnel syndrome in this randomized, double-blind, placebo-controlled trial were randomized in a 1:2 ratio to the control or stimulation groups. Control patients received cubital tunnel surgery and sham stimulation, whereas patients in the stimulation group received 1-h of 20 Hz PES following surgery. Patients were assessed by a blinded evaluator annually for 3 yr. The primary outcome was motor unit number estimation (MUNE) and secondary outcomes were grip and key pinch strength and McGowan grade and compound muscle action potential. A total of 31 patients were enrolled: 11 received surgery alone and 20 received surgery and PES. Three years following surgery, MUNE was significantly higher in the PES group (176±23, mean+SE) compared to controls (88±11, P<.05). The mean gain in key pinch strength in the PES group was almost 3 times greater than in the controls (P<.05). Similarly, other functional and physiological outcomes showed significantly greater improvements in the PES group. PES enhanced muscle reinnervation and functional recovery following surgery for severe cubital tunnel syndrome. It may be a clinically useful adjunct to surgery for severe ulnar neuropathy, in which functional recovery with conventional treatment is often suboptimal.

The effect of injecting mouse nerve growth factor on the recovery of hand function in patients with cubital tunnel syndrome

Objective To observe the effectiveness of injecting mouse nerve growth factor (mNGF) on the recovery of hand motor function among patients with cubital tunnel syndrome. Methods A total of 138 patients with moderate to severe cubital tunnel syndrome were randomly divided into groups designated as A, B and C, each of 46. Twenty micrograms of mNGF was injected daily 1 mm from the ulnar nerve at the cubital tunnel for the patients of group A and the injection site was moved 1 mm distally everyday along the nerve , but injected intramuscularly for those in group B. Those in group C received 500 μg of mecobalamin injected intramuscularly 3 times a week. The whole intervention consisted of two 4-week phases, with an interval of 2 months. Before and after the intervention, the function of internal hand muscles, hand function recovery rates and any electrophysiological changes in the ulnar nerve were measured and compared between the two groups. Results All of the patients showed significant improvement in hand muscle function and neuroelectrophysiology. The incidence of had muscle atrophy, Tinel′s sign, positiveness in the paper clamping test and claw hand all significantly improved compared with before the treatment in all three groups. The average Disability of Arm Shoulder and Hand score in group A after the treatment was significantly higher than the group B and group C averages. The average ulnar nerve conduction velocity, incubation period and amplitude of group A after the treatment were all significantly better than before the treatment and better than the other groups′ averages. After the treatment, the average hand function recovery in group A reached 91%, significantly higher than in groups B (76%) and C (59%). Conclusion Injecting mNGF next to the ulnar nerve is superior to injecting it intramuscularly in promoting the recovery of the ulnar nerve and hand function for patients with moderate to severe cubital tunnel syndrome. Key words: Cubital tunnel syndrome; Nerve growth factors; Muscle strength; Hand function

Surgical treatment for severe cubital tunnel syndrome with absent sensory nerve conduction.

For severe cubital tunnel syndrome, patients with absent sensory nerve action potential tend to have more severe nerve damage than those without. Thus, it is speculated that such patients generally have a poor prognosis. How absent sensory nerve action potential affects surgical outcomes remains uncertain owing to a scarcity of reports and conflicting results. This retrospective study recruited one hundred and fourteen cases (88 patients with absent sensory nerve action potential and 26 patients with present sensory nerve action potential) undergoing either subcutaneous transposition or in situ decompression. The minimum follow-up was set at 2 years. Primary outcome measures of overall hand function included their McGowan grade, modified Bishop score, and Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) score. For patients with absent sensory nerve action potential, 71 cases (80.7%) achieved at least one McGowan grade improvement, 76 hands (86.4%) got good or excellent results according to the Bishop score, and the average DASH score improved 49.5 points preoperatively to 13.1 points postoperatively. When compared with the present sensory nerve action potential group, they showed higher postoperative McGowan grades and DASH scores, but there was no statistical difference between the modified Bishop scores of the two groups. Following in situ decompression or subcutaneous transposition, great improvement in hand function was achieved for severe cubital tunnel syndrome patients with absent sensory nerve action potential. The functional outcomes after surgery for severe cubital tunnel syndrome are worse in patients with absent sensory nerve action potential than those without. This study was approved by the Ethical Committee of Huashan Hospital, Fudan University, China (approval No. 2017142).

Asymmetric anterior transposition of ulnar nerve in the treatment of cubital tunnel syndrome

Objective To explore the surgical method and clinical efficacy of asymmetric anterior transposition of ulnar nerve in the treatment of moderate and severe cubital tunnel syndrome. Methods Asymmetric anterior transposition of ulnar nerve was performed in 48 cases of moderate or severe cubital tunnel syndrome (group A). The postoperative follow-up included the symptoms of pain, sensation, grip, muscle atrophy and the recovery of claw hand. The two-point discrimination of distal finger pulp and the ulnar nerve motor nerve conduction velocity (MNCV) from 5 cm above the elbow to 5 cm below the elbow were measured before and after the operation. The follow-up results from 114 patients (group B) performed traditional subcutaneous transposition of the ulnar nerve were served as control. The difference of the clinical efficacy between the two methods was statistically analyzed. Results The postoperative follow-up period ranged from 12 to 35 months with an average of 24.8 months. For moderate cubital tunnel syndrome, there was no significant difference between the two kinds of surgical treatment (P>0.05). For severe cubital tunnel syndrome, the differences of the postoperative excellent and good rate, two-point discrimination and MNCV between the two groups were statistically significant (P<0.05). Conclusion For severe cubital tunnel syndrome, the clinical efficacy of asymmetric anterior transposition of ulnar nerve is better than traditional subcutaneous anterior transposition. Key words: Cubital tunnel syndrome; Treatment outcome; Asymmetric anterior transposition of ulnar nerve

V-Y Lengthening Technique of the Flexor-Pronator Mass for Anterior Submuscular Transposition of the Ulnar Nerve in Severe Cubital Tunnel Syndrome: A Long-Term Follow-Up Study.

This study aimed to retrospectively analyze the clinical results of anterior submuscular transposition of the ulnar nerve using a flexor-pronator V-Y lengthening technique in patients with severe cubital tunnel syndrome (CTS). From January 2007 to May 2015, 36 patients with grade III CTS based on McGowan's classification were enrolled. All patients were treated with anterior submuscular transposition of the ulnar nerve using a flexor-pronator V-Y lengthening technique. To evaluate clinical outcomes, all patients underwent preoperative and final follow-up assessments of disabilities of the arm, shoulder, and hand scores, nerve conduction velocity, 2-point discrimination, and pinch and grip strength. Overall functional outcomes were evaluated after a mean follow-up of 53 months using the Modified Bishop rating system. We analyzed the statistical correlation of patients' duration of symptom and age with clinical results. At the final follow-up, the average disabilities of the arm, shoulder, and hand, nerve conduction velocity, 2-point discrimination, and grip and pinch strengths significantly improved in all patients. At least a 1-McGowan grade improvement was achieved in 34 extremities (94.4%). According to the modified Bishop scores, 30 patients (83.3%) achieved good or excellent outcomes and 2 extremities (5.5%) had poor outcomes. There was a significant negative correlation between prolonged symptom duration and the Modified Bishop score at the final follow-up, but age did not affect the functional outcome. In McGowan grade III severe CTS, anterior submuscular transposition of the ulnar nerve using a flexor-pronator V-Y lengthening technique leads to satisfactory outcomes. Longer symptom duration is associated with poorer results, and the outcome is not correlated with age. Therefore, active surgical treatment should be considered regardless of age before severe disease occurs.

Anterior subcutaneous transposition versus anterior subfascial transposition of the ulnar nerve in the treatment of cubital tunnel syndrome

Objective To compare the clinical effects of anterior subcutaneous transposition and anterior subfascial transposition of the ulnar nerve in the treatment of cubital tunnel syndrome. Methods A total of 37 patients with cubital tunnel syndrome were retrospectively analyzed. 18 cases were treated with subcutaneous transposition of ulnar nerve, and 19 cases with anterior transposition of ulnar nerve. The scores of sensory deficits in the ulnar nerve innervation area, the intrinsic muscle strength, claw deformity and ulnar nerve conduction velocity were compared between the two groups. Results Postoperative follow-up period ranged from 6 to 18 months. There was no significant difference between anterior subcutaneous and anterior subfascial transposition of the ulnar nerve. The clinical effects of patients with moderate cubital tunnel syndrome treated by the two anterior transposition operations were much better than that of patients with severe cubital tunnel syndrome. Conclusion There was no difference between the two methods of anterior subcutaneous transposition and anterior subfascial transposition. However, the anterior subfascial transposition combines the advantages of anterior subcutaneous transposition and anterior submuscular transposition. Cubital tunnel syndrome should be actively intervened after being definitely diagnosed. Key words: Cubital tunnel syndrome; Treatment outcome; Anterior subcutaneous transposition; Anterior subfascial transposition

Clinical effect observation of vascularized anterior transposition of ulnar nerve for treatment of severe cubital tunnel syndrome

Objective To evaluate the clinical outcomes of a modified procedure of ulnar nerve anterior transposition in the treatment of severe cubital tunnel syndrome. Methods From September 2015 to May 2016, 25 patients with cubital tunnel syndrome underwent vascularized ulnar nerve anterior transposition were followed up after operation. All the patients had severe muscular atrophy and deformity of elbow joint before operation. According to Gu Yudong's classification of cubital tunnel syndrome, they were graded as severe. In this modified procedure, the sufficient neurolysis of ulnar nerve as well as the anterior transposition of ulnar nerve accompanied with superior ulnar collateral artery were conducted. Results All the 25 patients were follow-up from 12 to 21 months with an average of 15.3 months. All the patients achieved sensory recovery in different degrees without temporary worsening of clinical symptoms. Completely sensory recovery was observed in 20 patients (80%). 4 patients (16%) remained occasional sensory symptoms while only 1 patient (4%) remained persistently moderate sensory symptoms. The mean two-point discrimination of little finger pulp was improved from preoperative 6.08 mm to postoperative 2.93 mm. Obvious improvement of intrinsic muscular atrophy was observed in 17 patients (68%). According to the Gu Yudong's function evaluation standard of cubital tunnel syndrome, the results were excellent in 16 patients, good in 6 patients and fair in 3 patients with the excellent and good rate being 88%. Conclusion The modified technique of vascularized anterior transposition of unlar nerve appears to be an effective and safe procedure for the treatment of severe cubital tunnel syndrome. It might reduce the incidence of postoperative nerve symptoms caused by devascularization of ulnar nerve. Key words: Cubital tunnel syndrome; Ulnar nerve; Vascularized; Anterior transposition

Predictors of surgical outcomes for severe cubital tunnel syndrome: a review of 146 patients.

Full recovery is unlikely for severe cubital tunnel syndrome, and prognostic factors remain uncertain. We aimed to identify predictors of surgical outcome for these patients. One hundred forty-six patients with McGowan grade III cubital tunnel syndrome were evaluated retrospectively with a minimum follow-up of 2years. All patients underwent either in situ decompression or subcutaneous transposition. The primary outcome measure was postoperative McGowan grade. Predictors included age, sex, dominant hand, disease duration, diabetes mellitus, smoking, alcohol, surgical procedure, follow-up time and preoperative electrophysiological data. Spearman's rank correlation and ordinal logistic regression model were used to assess the effect of independent variables on the postoperative McGowan grade. At the last follow-up, improvement by at least one McGowan grade was reached in 118 cases (80.8%), and complete recovery was achieved in 40 hands (27.4%), while 28 extremities (19.2%) remained at grade III. Older age [per 10-year increase, odds ratio (OR) 2.10; 95% confidence interval (95% CI) 1.55-2.84, p < 0.001], longer disease duration (per 1-year increase, OR 1.31; 95% CI 1.16-1.49, p < 0.001), absent sensory nerve conduction (OR 2.55; 95% CI 1.25-5.21, p = 0.010) and shorter postoperative follow-up (per 1-year increase, OR 0.76; 95% CI 0.65-0.90, p = 0.001) were associated with a higher postoperative McGowan grade. Significant improvement but not complete recovery could be expected following in situ decompression or subcutaneous transposition for severe cubital tunnel syndrome. Older age, longer disease duration, absent sensory nerve conduction and shorter postoperative follow-up are independent predictors of worse outcomes.

Surgical outcome for severe cubital tunnel syndrome in patients aged >70years: a mean follow-up of 4.5years.

Surgical outcomes for cubital tunnel syndrome have been reported to be satisfactory, but could be compromised by advanced age and severe nerve compression. We aim to evaluate the prognosis of severe cubital tunnel syndrome in patients aged >70years. This retrospective study included 25 patients (26 extremities, all McGowan grade III, age >70years); 21 underwent subcutaneous transposition and 5 in situ decompression. Postoperative follow-up lasted >2years. Demographic data, clinical symptoms, physical examination findings, and the Disabilities of the Shoulder, Arm, and Hand Questionnaire were evaluated preoperatively and at final follow-up. Pain and weakness were evaluated using the visual analog scale and overall functional recovery using the modified Bishop's Score and McGowan Grade. Significant improvements were seen in both sensory and motor function. VAS pain and weakness, 2-PD, key-pinch strength, grip strength, first dorsal interosseous muscle strength, the Wartenberg sign, and claw hand all improved significantly. DASH scores improved from an average of 45.2 points preoperatively to 15.9 points postoperatively. According to the modified Bishop scoring system, 10 extremities were graded excellent; 12, good; 2, fair; and 2, poor. Improvement of at least one McGowan Grade was seen in 18 cases, but only 2 extremities recovered to normal. For patients aged >70years with severe cubital tunnel syndrome, surgical treatment is effective, but complete recovery is unlikely, and the recovery process is long.

The Relationship between Early Improvement of Subjective Symptom and Surgical Outcomes in Moderate to Severe Cubital Tunnel Syndrome

Purpose: Moderate to severe cubital tunnel syndrome usually requires surgical treatment. Most surgical outcomes are evaluated 6 months after the procedure; however, subjective symptoms begin to show improvement much earlier. In this study, we explored whether patients who experience early improvement of subjective symptoms have different clinical characteristics and surgical outcomes than those without early improvement. Materials and Methods: Between January 2012 and February 2015, 36 surgical cases of moderate- to severe-stage cubital tunnel syndrome (modified McGowan grade IIA, IIB, or III) were included. Nineteen patients (15 males and 4 females with a mean age of 54.3±12.0 years) reported subjective symptom improvements within 14 days postoperatively. Seventeen patients (15 males and 2 females with a mean age of 53.4±11.9 years) did not report any early symptom improvements. Clinical characteristics-hand dominance, sex, smoking history, type of surgery, age, symptom duration, elbow range of motion, grip strength, key pinch strength, 2 point discrimination, pain, quick disabilities of the arm, shoulder and hand (DASH) score, and modified McGowan grade-were analyzed retrospectively using a Mann-Whitney test or chi square test. Surgical outcomes were measured at postoperative 3 and 12 months using repeated-measures ANOVA, and Wilson and Krout criteria were analyzed using a chi-square test. Results: There was a difference in key pinch strength (p＜0.001) between the groups. At postoperative 12 months, Wilson and Krout criteria (p=0.029) were associated with early improvement of subjective symptoms. The subjects’ quick DASH scores and grip strengths improved over time, but no difference was observed between the groups. Conclusion: After surgical treatments of moderate to severe cubital tunnel syndrome, patients who presented early improvement of subjective symptoms, compared with those who did not, had significantly higher preoperative key pinch strength and better surgical outcomes at postoperative 12 months.

The Relationship Between Early Symptom Relief and Surgical Outcomes in Moderate to Severe Cubital Tunnel Syndrome

Introduction: Moderate to severe cubital tunnel syndrome usually need surgical treatment. Some patients feel subjective symptom relief shortly after the surgery while others do not. In this study, we want to know whether patients with early symptom relief had different clinical characteristics and surgical outcomes compared with patients without early symptom relief. Materials and Methods: From January 2013 to February 2015, 39 surgical cases with moderate to severe stage cubital tunnel syndrome (Mcgowan grade IIA, IIB, III) were included. In all, 21 patients (17 male, 4 female, mean age 54.6 ± 12.6) reported subjective symptom relief within 14 days from surgery. In addition, 18 patients (16 male, 2 female, mean age 54.7 ± 11.4) did not report early symptom relief. Clinical characteristics including hand dominance, gender, smoking history, type of surgery, age, symptom duration, range of motion, grip strength, key pinch strength, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and Mcgowan grade were analyzed retrospectively using t test or chi-square test. Surgical outcomes measured at 3 months, 6 months, 12 months after the operation were analyzed using repetitive measured analysis of variance (ANOVA) or chi-square test. Results: The key pinch strength ( P &lt; .001) was different between groups. Postoperative 12 months Krout Wilson criteria ( P = .039) were associated with the early symptom relief. The QuickDASH score and grip strength was improved as time passed, but no difference was observed between groups. Conclusion: Early symptom relief was associated with key pinch strength and surgical outcomes in patients with moderate to severe cubital tunnel syndrome.

ANTERIOR SUBCUTANEOUS TRANSPOSITION OF ULNAR NERVE AND HAND INTRINSIC MUSCLES FUNCTION RECONSTRUCTION FOR SEVERE CUBITAL TUNNEL SYNDROME

To study the effectiveness of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle in the treatment of severe cubital tunnel syndrome. Between March 2006 and May 2015, 22 cases (23 hands) of severe cubital tunnel syndrome were treated by use of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle. There were 15 males and 7 females, aged 45-60 years (mean, 55 years). The causes were valgus deformity of elbow joint in 12 cases, ulnar nerve subluxation in 4 cases, and osteoarthritis in 6 cases. The disease duration was 10 months to 3 years (mean, 17 months). According to Akahori classification, 14 cases were rated as type 4 and 9 cases as type 5. The ring/little finger's numbness, hand intrinsic muscle atrophy, recovery of thumb adduction function, and improvement of claw hand deformity were observed after operation. Thumb and index finger's pinch strength was measured by use of pinch device; postoperative hand function was evaluated by the standards of Chinese Medical Society of Hand Surgery of upper limb assessment protocol. All incisions healed well and all cases were successfully followed up 8 to 24 months (mean, 14 months). Numbness of ring/little finger was significantly reduced at 1 day after operation in 10 hands; numbness disappeared completely at 1 month after operation in 12 hands; mild numbness remained at 14 months after operation in 11 hands. At last follow-up, hand intrinsic muscle atrophy partially improved (+++) in 1 hand, no improvement in 22 hands; improvement of claw hand deformity was achieved in 17 hands, no improvement in 6 hands; pinch strength of thumb and index finger was significantly improved to (5.07±1.11) kg from preoperative (2.91±0.63) kg (t=-12.340, P=0.032). At last follow-up, the results were excellent in 11 hands, good in 8 hands, fair in 3 hands, and poor in 1 hand, and the excellent and good rate was 82.6%. Anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle is a simple, effective, and reliable surgical treatment for severe cubital tunnel syndrome.