Treatment Of Cubital Tunnel Syndrome Research Articles

Cubital tunnel syndrome: a surgical modification to in situ decompression to improve results

BackgroundThe gold standard for surgical treatment of cubital tunnel syndrome is in situ decompression. However, this procedure does not come without complications. Subluxation of the ulnar nerve and ulnar nerve neuritis from adhesion formation remain 2 potential complications after this procedure. It has been shown in the literature that young, active, male patients are most likely to have these complications postoperatively. We have developed a modification to in situ decompression by developing a fascial turnover flap and using a porcine submucosa extracellular matrix (Axogen) to help reduce both ulnar nerve subluxation and adhesion formation postoperatively.MethodsThirteen patients underwent cubital tunnel surgery by the highlighted technique to prevent postoperative ulnar nerve subluxation and adhesion formation. Patient outcomes including elbow range of motion, functional status, paresthesia, and grip strength were recorded.ResultsOf the 13 patients, 10 had excellent results, 1 had a good result, and 2 required revision with anterior transposition of the nerve. The mean Mayo Elbow Performance Score of the 11 patients not needing revision was 92.7.ConclusionThe described surgical technique provides surgeons with the ability to directly decompress the ulnar nerve while decreasing postoperative complications such as instability and adhesion formation.

Management of cubital tunnel syndrome by anterior trans-muscular transposition of the ulnar nerve

BackgroundVarious surgical options are used for the treatment of ulnar nerve entrapment at the elbow. In this study, anterior trans-muscular transposition of the ulnar nerve was used for the treatment of cubital tunnel syndrome.ObjectivesTo evaluate the surgical results of anterior trans-muscular transposition technique for the treatment of cubital tunnel syndrome with particular emphasis on clinical outcome.MethodsForty patients with cubital tunnel syndrome were operated using anterior trans-muscular transposition technique. Patients were classified into post-operative clinical outcome grades according to the Wilson & Krout criteria, and they were followed up by visual analog scale (VAS), the Disability of Arm Shoulder and Hand (DASH) questionnaire, electrophysiological study, and post-operative clinical evaluation.ResultsForty patients with cubital tunnel syndrome who underwent anterior trans-muscular transposition of the ulnar nerve show a significant clinical improvement at 24 months post-surgery regarding visual analog scale (VAS), the Disability of Arm Shoulder and Hand (DASH) questionnaire, electrophysiological study, and the Wilson & Krout grading as 87.5% of the patients recorded excellent and good outcome.ConclusionAnterior transmuscular transposition of the ulnar nerve is a safe and effective treatment for ulnar nerve entrapment at the elbow.

Conservative treatment of cubital tunnel syndrome: A systematic review.

Cubital tunnel syndrome (CuTS) is one of the most common compression neuropathies of the upper extremity. Conservative management of cubital tunnel syndrome is often considered first line therapy for mild or moderate symptoms; however, there is little evidence-based literature to guide physicians in this regard. As such, the objective of this study is to complete a comprehensive literature search of the conservative therapies available for treatment of CuTS. Additionally, we hope to assess the evidence for each therapy so that we can make evidence- based recommendations regarding the type and duration of optimal treatment. The databases MEDLINE, EMBASE, and CINAHL were search using a sensitive search strategy. Eligibility for studies included any studies or conference abstracts in which patients were treated conservatively for primary CuTS. Any form of non-operative treatment was acceptable. A data extraction form was developed to collect all information and outcomes of interest, including study design, level of evidence, number of patients, treatment modalities, follow- up time, patient reported outcomes, and electrophysiological markers. Qualitative and quantitative analysis was then completed based on the data extraction form. Given the heterogeneity of the included studies, results were summarized as best evidence available.Our sensitive literature search produced 6484 studies. Initial screening based on title and abstract resulted in the selection of 40 studies that underwent full text review. From these 19 studies were included for analysis in our systematic review. There were 3 level I studies, 4 level II studies, 3 level III studies, and 9 level IV studies. In total this included 844 patients. The most commonly reported outcomes included subjective patient reported outcomes and nerve conduction studies. The most common treatment modalities, from most to least common, included education and activity modification, splinting, steroid/lidocaine injection, nerve mobilization/gliding, pulsed ultrasound, laser therapy, non-steroidal antiinflammatory drugs, and physiotherapy. The most common duration of therapy was 3 months with a median follow-up time of 3 months. There was moderate strength evidence to recommend the use of education/activity modification or splinting in mild or moderate CuTS.There is a paucity of literature and highquality studies regarding the conservative management of CuTS. Regardless, there appears to be a role for non-operative management in CuTS, although further studies are needed to delineate this role further. In the cases of mild or moderate CuTS it is reasonable to trial education/activity modification or splinting as both appear to be equally effective.

History of the surgical treatment of cubital tunnel syndrome

Cubital tunnel syndrome is a widespread form of peripheral neuropathy. This article presents chronological overview of the surgical treatment methods of cubital tunnel syndrome along with authors who described them for the first time.
 The historical review provides for better understanding of existent surgical methods und for development new surgical approaches of treatment cubital tunnel syndrome

MR imaging of the postsurgical cubital tunnel: an imaging review of the cubital tunnel, cubital tunnel syndrome, and associated surgical techniques.

Ulnar nerve compression at the elbow, specifically the cubital tunnel, is the second most common upper extremity compression neuropathy. Many patients presenting with compression symptoms will subsequently undergo surgical intervention. We review the open surgical treatment of cubital tunnel syndrome and review the expected postoperative imaging appearance of those treatments on magnetic resonance imaging (MR), including: simple or in situ decompression, medial epicondylectomy, and anterior transposition, including subcutaneous, intramuscular, and submuscular variants. We discuss the relevant anatomy of the presurgical cubital tunnel and common sites and causes of ulnar nerve compression at and about the cubital tunnel. The imaging appearance of the preoperative and postoperative ulnar nerve and postoperative complications are reviewed.

Retrospective, nonrandomized analysis of subcutaneous anterior transposition versus in situ decompression of the ulnar nerve of military service members

The objective of this study was to compare the subjective and objective midterm functional clinical outcomes of subcutaneous anterior transposition (SAT) vs. in situ decompression (SD) of the ulnar nerve for the treatment of cubital tunnel syndrome. The US Military Health System was queried to identify all cases of ulnar neuroplasty (Current Procedural Terminology code 64718) between 2006 and 2010. Patient charts were reviewed to identify cases of isolated SAT and SD, and demographic and surgical variables were collected. The primary outcome variable was the Disabilities of the Arm, Shoulder and Hand score. The inclusion criteria were isolated primary SAT or SD and adult active-duty service members with a minimum6-year telephone follow-up. Terminal follow-up was determined by a telephone interview. The exclusion criteria were revision procedures, trauma, cases that included other procedures (eg, medial epicondylectomy, submuscular transposition, arthroscopy, or fracture fixation), non-active-duty service members, patients without a minimum 6-year telephone follow-up, and patients who had incomplete medical records or could not be reached to complete the survey. A total of 65 SD and 67 SAT patients met the inclusion and exclusion criteria, with a 72% telephone interview response rate. The average age was 32.3 years for all patients, with an average follow-up period of 6.5 years for SD patients and 6.3 years for SAT patients. SD patients had a lower mean Disabilities of the Arm, Shoulder and Hand score than SAT patients. No difference in reoperation rate was found. The active-duty cohort reported positive outcomes and a low reoperation rate at 6-year follow-up both after SAT and after SD. SD patients had mildly superior clinical outcomes compared with SAT patients.

Novel minimally invasive technique in the treatment of cubital tunnel syndrome.

Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper extremity in the United States. Most cases are idiopathic and symptoms consist of a combination of weakness, pain, and sensory disturbances ranging from paresthesias and dysesthesias to numbness or complete anesthesia. The purpose of this study is to report results of a novel, minimally invasive surgical procedure for cubital tunnel syndrome with comparison to existing interventions including full open or endoscopic approaches. A total of 41 consecutive patients underwent the procedure, their ages ranged from ages 36 to 81 with an average age of 60.52±12.18 years. The procedure consists of a 1.0-2.0-cm incision with decompression of the ulnar nerve under direct visualization proximally with Metzenbaum scissors as a dilator for distal decompression. Patients were evaluated for improvements in pain, numbness, paresthesias, weakness, and muscle atrophy and was measured utilizing the Gabel/Amadio scale. Fifty-three point two percent (n=25) of patients were found to have excellent outcomes, 36.2% (n=17) had good outcomes, 8.5% (n=4) had fair outcomes, and 2.1% (n=1) had poor outcomes as determined by the Gabel/Amadio scale. The greatest improvement in all patients was the reduction in sensory symptoms: pain, numbness, and paresthesia. There were no operative or postoperative complications. This novel procedure provided symptom relief comparable to the most effective existing techniques without significant complications, and with rapid recovery and minimal scar formation. The authors assert that this technique demonstrates optimal results for patients with relative ease of adoption for surgeons.

Analysis of Subcutaneous Anterior Transposition versus in-situ Decompression of Ulnar Nerve with Force Transducer in Cadaver Specimen.

To evaluate the changes in the pressure values of the ulnar nerve after in-situ decompression and anterior subcutaneous transposition of the ulnar nerve. The ulnar nerve was released in the postcondylar groove. An ultrathin (100 lm) force transducer was embedded between the posterior of the ulnar nerve and the anterior of the medial epicondyle. The elbow joint was flexed from full extension position to maximum flexion and was measured to obtain the maximum stress at 0°, 45°, 90°, and 135° of flexion. Then, the ulnar nerve was transposed anterior subcutaneously. The same measurement was applied to the two procedures. Data were compared between the two surgical techniques. Our study was performed on the right upper extremities of eight (seven men and one woman) fresh frozen cadavers. The mean age of the cadavers was 67.25 ± 12.2 years. Mean values of 0°, 45°, 90°, and 135° of flexion after the ulnar nerve insitu decompression were 0.41, 0.9, 1.7, and 4.3 N, respectively. Mean values of 0°, 45°, 90°, and 135° of flexion after anterior transposition of the ulnar nerve were 0.3, 0.73, 1.63, and 2.15 N, respectively. No significant difference was noted between the two groups in terms of 0°, 45°, and 90° of flexion values. However, there was a significant difference between the two groups in the 135° of flexion measurement values. Anterior transposition is a more appropriate technique than in-situ decompression in the treatment of cubital tunnel syndrome that does not respond to conservative treatment regardless of the severity of the symptom.

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

Subcutaneous Anterior Transposition Versus In Situ Decompression of the Ulnar Nerve in an Active Duty Military Population

There is no financial information to disclose. The objective of this study was to compare the subjective and objective midterm functional clinical outcomes of subcutaneous anterior transposition (SAT) versus in situ decompression (SD) of the ulnar nerve for the treatment of cubital tunnel syndrome (CuTS). We hypothesized that there would be no difference between the 2 cohorts with respect to outcome scores, return to full military duty, and complications. The United States Military Health System was queried to identify all cases of ulnar neruoplasty (CPT:64718) between 2006 and 2010. Primary outcome variables included Disability of the Arm Shoulder, and Hand (DASH) score, Mayo Elbow Performance Score (MEPS), and reoperation rates. Inclusion criteria were isolated primary SAT or SD and adult active duty service members with a minimum of 6-year follow-up. Terminal follow-up was determined by a telephone interview. Exclusion criteria were revision procedures, trauma, cases which included other procedures (to include medial epicondylectomy, submuscular transposition, arthroscopy, or fracture fixation) nonactive duty service members, those without a minimum 6-year follow-up, or those with an incomplete medical record or who could not be reached for the survey. Minor complications included those such as pain and parathesias, while major complications required a return to the operating room. The power of this analysis was determined to be 126 participants. The analysis of variance for the continuous variables and Fisher test for the binary variables were used to compare means or percentages. Sixty-five SD and 67 SAT met inclusion and exclusion criteria. The average age was 32.3 years for all patients with an average follow-up of 6.5 years for SD and 6.3 years for SAT. As compared to SAT, SD had superior of DASH (11, 21) and a lower rate of minor complications (45%, 70%) (P < .05). There was no difference in reoperation rate. Preoperative ulnar nerve subluxation was reported for half of each cohort and one-third of each cohort had a preoperative subluxating ulnar nerve (SAT: 13 of 37; 35% - SD: 18 of 51; 35%). Preoperative subluxation affected neither postoperative outcome nor reoperation rate. •SD had improved DASH and a lower rate of complications as compared to SAT.•For those had had a preoperative subluxating ulnar nerve, SD had a lower DASH score, equivalent grip strength, a lower minor complication rate, and an equivalent major complication rate.•In the active duty population there is no benefit for transposing the ulnar nerve for the surgical treatment of primary cubital tunnel syndrome, regardless of preoperative nerve stability.

Cubital Tunnel Syndrome Caused by Anconeus Epitrochlearis Muscle.

ObjectiveWe evaluated the clinical manifestation and surgical results following operative treatment of cubital tunnel syndrome (CuTS) caused by anconeus epitrochlearis (AE) muscle. MethodsAmong 142 patients who underwent surgery for CuTS from November 2007 to October 2015, 12 were assigned to the AE group based on discovery of AE muscle; 130 patients were assigned to the other group. We analyzed retrospectively; age, sex, dominant hand, symptom duration, and weakness in hand. Severity of the disease was evaluated using the Dellon classification and postoperative symptom were evaluated using disability of arm shoulder and hand (DASH) and visual analogue scale (VAS) scores. Surgery consisted of subfascial anterior transposition following excision of AE muscle. ResultsAE muscle was present in 8.5% of all patients, and was more common in patients who were younger and with involvement of their dominant hand; the duration of symptom was shorter in patients with AE muscle. All patients showed postoperative improvement in symptoms according to DASH and VAS scores. ConclusionThe possibility of CuTS caused by AE muscle should be considered when younger patients have rapidly aggravated and activity-related cubital tunnel symptoms with a palpable mass in the cubital tunnel area. Excision of AE muscle and anterior ulnar nerve transposition may be considered effective surgical treatment.

Comparing endoscopic and open decompression of the ulnar nerve in cubital tunnel syndrome: a prospective randomized study

Prospective randomized data is currently lacking which compares endoscopically assisted surgery with open surgical techniques in the treatment of cubital tunnel syndrome (CUTS). The aim of this study is to compare patient outcome in both techniques. This prospective study comprised of 45 patients who, between October 2014 and February 2017, were randomly assigned to undergo either endoscopic or open surgery (22 and 23 patients respectively) for decompression of the ulnar nerve. Patients were followed up at 3 and 12months postoperation. McGowan classification was used to determine the severity of symptoms. Surgical outcome was evaluated by Bishop classification. Pain levels were monitored according to gender from 0 to 10days postoperation. Other factors investigated were chronic scar pain, working status, operation duration, and patient satisfaction regarding postoperative scarring and the procedure itself. Both methods are equally effective in the treatment of CUTS (Bishop score excellent or good 90% vs 96%). Postoperative pain is significant particularly in the first few days following surgery, but with no significant difference depending on procedure. In the open group, postoperative pain was significantly higher in women than in men; pain did not differ between the sexes in the endoscopic group. The tendency to lower levels of pain among endoscopically operated women in comparison with women in the open group was not statistically notable. Patients who underwent open decompression experienced notably higher levels of postoperative chronic scar pain. Although working status and satisfaction with the surgical outcome were the same in both groups, satisfaction with scarring was higher in the endoscopy group. Operation time was significantly longer by endoscopy. Both studied methods produced equal satisfactory outcomes in the treatment of CUTS. Endoscopy has the potential to minimize chronic scar pain and improve scarring esthetics, at the expense of longer operating time. Supported by Ministry of Health, Czech Republic-conceptual development of research organization (FNOs/2014, project number 20). Graphical abstract Median postoperative pain from 0 to 10days by group.

Surgical Approaches and Their Outcomes in the Treatment of Cubital Tunnel Syndrome.

Purpose: This review was undertaken in order to provide an updated summary of the current literature on outcomes for various surgical treatments for cubital tunnel syndrome.Methods: Studies reporting outcomes for surgical treatment of cubital tunnel syndrome were collected through the PubMed database. Study structure, number of participants/procedures, mean follow-up times, scoring scales, and outcomes were collected according to the type of surgery: open decompression, endoscopic decompression, minimal incision, subcutaneous transposition, intramuscular transposition, and submuscular transposition.Results: Our findings indicate varying but comparable levels of success among all surgical techniques reviewed. Many different scoring scales were utilized, limiting direct quantitative comparison between most studies.Discussion: While some studies directly compared two or more techniques, there was rarely a statistically significant difference between groups. In comparisons that did reach statistically significant differences, there were others yet that found no difference in comparing the same techniques.Conclusions: None of the techniques in this review has demonstrated universal superiority above all others, but all appear to be effective in the treatment of cubital tunnel syndrome. The only consensus seems to be that transposition is preferred where the ulnar nerve tends to subluxate either on preoperative or intraoperative examination.

The 7 Structures Distal to the Elbow That Are Critical to Successful Anterior Transposition of the Ulnar Nerve.

Background: Ulnar nerve transposition (UNT) surgery is performed for the treatment of cubital tunnel syndrome. Improperly performed UNT can create iatrogenic pain and neuropathy. The aim of this study is to identify anatomical structures distal to the medial epicondyle that should be recognized by all surgeons performing UNT to prevent postoperative neuropathy. Methods: Ten cadaveric specimens were dissected with attention to the ulnar nerve. Intramuscular UNT surgery was simulated in each. Distal to the medial epicondyle, any anatomical structure prohibiting transposition of the ulnar nerve to a straight-line course across the flexor-pronator mass was noted and its distance from the medial epicondyle was measured. Results: Seven structures were found distal to the medial epicondyle whose recognition is critical to ensuring a successful anterior transposition of the ulnar nerve: (1) Branches of the medial antebrachial cutaneous (MABC) nerve; (2) Osborne's fascia; (3) branches from the ulnar nerve to the flexor carpi ulnaris (FCU); (4) crossing vascular branches from the ulnar artery to the FCU; (5) the distal medial intermuscular septum between the FCU and flexor digitorum superficialis (FDS); (6) the combined muscular origins of the flexor-pronator muscles; and (7) the investing fascia of the FDS. Measurements are given for each structure. Conclusions: Poor outcomes and unnecessary revision surgeries for cubital tunnel syndrome can be avoided with intraoperative attention to 7 structures distal to the medial epicondyle. Surgeons should expect to dissect up to 12 cm distal to the medial epicondyle to adequately address these and prevent kinking of the nerve in transposition.

Anterior Subcutaneous Transposition of the Ulnar Nerve Affects Elbow Range of Motion: A Mean 13.5 Years of Follow-up.

Background:Surgical decompression of the ulnar nerve is effective for cubital tunnel syndrome. However, deep approaches may result in iatrogenic elbow stiffness. This long-term study was to evaluate the range of motion (ROM) of the elbow and functional outcomes after anterior subcutaneous transposition.Methods:A total of 115 patients (78 male and 37 female; mean age: 46.6 years) who underwent anterior subcutaneous transposition of the ulnar nerve between 2001 and 2005 were evaluated retrospectively; mean follow-up was 13.5 years. Elbow ROM was measured as flexion arc, flexion, and extension preoperatively and at the final follow-up, and compared via a mixed analysis of variance adjusting for age. Neuropathy was assessed preoperatively using a modified McGowan neuropathy grade and postoperatively using modified Wilson–Krout criteria. An ordinal logistic regression analysis used postoperative modified Wilson–Krout criteria as the outcome and preoperative factors as predictors.Results:Preoperative McGowan grades were Grade 1 in 14 patients (12.2%), Grade 2A in 28 (24.3%), Grade 2B in 53 (46.1%), and Grade 3 in 20 (17.4%) patients. Postoperatively, 66 patients (57.4%) had excellent results, 26 (22.6%) had good results, 16 (13.9%) had fair results, and 7 (6.1%) had poor results at the final follow-up, as per the Wilson–Krout criteria. There were no complications. Pre- and postoperative elbow ROM was significantly decreased in patients with previous trauma or surgery of the elbow compared with those without (P < 0.05). Anterior subcutaneous transposition of the ulnar nerve did not significantly affect elbow ROM regardless of previous trauma or surgical history nor preoperative ROM (P > 0.05), after adjusting for age. Patients with prolonged symptoms prior to surgery and worse neuropathy tended to have less satisfactory functional outcomes (P < 0.05), after adjusting for covariates.Conclusions:Anterior subcutaneous transposition of the ulnar nerve is an effective and reliable treatment of cubital tunnel syndrome with satisfactory outcomes and minimal effect on elbow ROM.

Modified simple decompression of ulnar nerve in the treatment of cubital tunnel syndrome: Report of a series of cases.

Ulnar compressive neuropathy is the second most common nerve compression in the upper extremity. Although numerous operative procedures have been defined for the treatment of cubital tunnel syndrome (CuTS), the best operative intervention remains controversial. The aim of this study is to discuss the efficacy of a modified simple decompression (MSD) of the ulnar nerve in the treatment of CuTS. Each patient was preoperatively examined, and the following data were recorded: initial complaint, duration of symptoms, and presence of Tinel's sign around the elbow, results of provocation by the elbow flexion test, and results of electrodiagnostic studies. Patients' preoperative clinical manifestations were determined based on Dellon's staging system and Bishop scores. Pre- and post-operative motor conduction velocity (MCV) of the ulnar nerve were also recorded. Under the regional anesthesia, 4 cm long curved skin incision, above and below the elbow, was made posterior to the medial epicondyle of the humerus and the ulnar nerve was seen. The nerve was released proximally as it passed through the medial intermuscular septum. The cubital tunnel retinaculum and flexor carpi ulnaris aponeurosis were then cut distally. Only the compressive fascial bands are released. Then, the cubital tunnel reticulum was sutured to subcutaneous tissue loosely to prevent subluxation of the ulnar nerve. A total of 15 patients were operated. Postoperative electrophysiological study assessed at 3 months following surgery in 8 patients. In 7 of these patients (86%), the mean value of MCV had improved from 38.9 ± 12.0 m/s to 48.1 ± 11.9 m/s (P < 0.05). According to Bishop scoring system, 13 patients (86.7%) were clinically graded as excellent, 1 patient (6.7%) was graded as good, and only 1 patient (6.7%) was graded as fair. MSD is a technically simple, safe, and effective method without annoying complications.

Subcutaneous versus submuscular ulnar nerve transposition in cubital tunnel syndrome

Introduction There are different surgical procedures for treatment of cubital tunnel syndrome (CubTS), which can be divided into two types, decompression and transposition procedures. Decompressive procedures include simple decompression with or without medial epicondylectomy without mobilizing the nerve. The transposition procedures mobilize the nerve anteriorly for more protection by subcutaneous, intramuscular, and submuscular methods, depending on the position in which the ulnar nerve is placed. Patients and methods A total of 24 patients with moderate CubTS (according to Dellon’s grading system) between March 2011 and April 2013 were classified according to age and sex into anterior subcutaneous transposition and anterior submuscular transposition groups. The two groups were prospectively followed up for 2 weeks, 6 months, and 12 months postoperatively, and outcome was assessed using the Bishop rating system. Results A total of 24 patients with moderate CubTS were used in this study to compare the operative technique (incision length and operative time), postoperative care (postoperative pain and complications), and the outcome between subcutaneous transposition and submuscular transposition of the ulnar nerve as two surgical modalities in treating moderate CubTS. Final results present that the subcutaneous transposition of the ulnar nerve was associated with shorter incision, shorter operative time, less postoperative pain, less postoperative complication, and better outcome compared with the submuscular transposition. Conclusion Subcutaneous ulnar nerve transposition in the treatment of CubTS, as compared with the submuscular approach, is an easier surgical technique with less operative time and postoperative pain, earlier postoperative mobilization, and better postoperative outcome.

Predictors of surgical outcomes after in situ ulnar nerve decompression for cubital tunnel syndrome.

BackgroundIn the treatment of cubital tunnel syndrome (CuTS), in situ ulnar nerve decompression is commonly used. This study aims to investigate predictive factors for poor recovery and ulnar nerve instability following this procedure.MethodsWe enrolled 235 patients who underwent in situ ulnar nerve decompression for the treatment of CuTS from January 2010 to December 2014. All patients underwent >2 years’ follow-up. The primary outcome was postoperative recovery, which was assessed by Messina’s criteria, and the secondary outcome was postoperative ulnar nerve instability. Potential risk factors were collected from demographic data and electrodiagnostic test, which included age, gender, body mass index, history of tobacco or alcohol use, history of major medical comorbidities, disease duration, preoperative severity, motor conduction velocity, and sensory conduction velocity.ResultsA total of 208 patients (88.5%) had satisfactory outcomes, while the other 27 patients (11.5%) had not. There were 25 patients (10.6%) showing postoperative ulnar nerve instability during follow-up. The multivariate analysis showed that only severe preoperative symptom (odds ratio [OR], 3.06; 95% confidence interval [CI], 2.16–4.32) was associated with unsatisfactory postoperative outcomes in patients with CuTS (P<0.001). In the model investigating independent factors associated with postoperative ulnar nerve instability, we found that young age (OR, 2.41; 95% CI, 1.63–3.58) was associated with the incidence of postoperative ulnar nerve instability (P<0.001).ConclusionWe found that severe preoperative symptom was associated with unsatisfactory postoperative outcomes, and young age was a risk factor for the incidence of postoperative ulnar nerve instability. Patients with these risk factors should be informed of the possibility of worse surgical outcomes.

Clinical Result of Endoscopically Assisted Mini-incision Ulnar Nerve Anterior Subcutaneous Transposition for the Treatment of Cubital Tunnel Syndrome

Clinical Result of Endoscopically Assisted Mini-incision Ulnar Nerve Anterior Subcutaneous Transposition for the Treatment of Cubital Tunnel Syndrome

Efffectiveness of Conservative Treatment for Cubital Tunnel Syndrome: A Systematic Review

Activity modification and splinting are the two mainstays of conservative treatment of Cubital Tunnel Syndrome (CuTS). The purpose of this systematic review is to evaluate the effectiveness of splinting and/or activity modification in adults and children with CuTS. We hypothesize that splinting and/or activity modification will be more effective in reducing signs and symptoms of CuTS than other conservative treatment methods, but less effective than surgical treatment.