Treatment Of Cubital Tunnel Syndrome Research Articles

Subcutaneous vs Submuscular Ulnar Nerve Transposition in Moderate Cubital Tunnel Syndrome

Background:The surgical treatment of Cubital tunnel syndrome (CubTS) is still a matter of debate. No consensus exists about the necessity of anterior transposition of the ulnar nerve after decompression. However, this technique is fairly common in clinical practice. Material and Methodology:In the present study we compared the operative technique (incision length, 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.Between March 2004 and March 2007, twenty six patients with moderate CubTS (according to Dellon’s grading system) were stratified according to age and gender into these two surgical techniques. The two groups were prospectively followed up 2 weeks, 6 months and 12 months postoperatively by the same observer and the operation outcome was assessed using the Bishop rating system.Results:We found 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:The authors recommend the subcutaneous technique when considering anterior transposition of the ulnar nerve in treating moderate CubTS.

Patient-Rated Outcome of Ulnar Nerve Decompression: A Comparison of Endoscopic and Open In Situ Decompression

To report patient-rated outcomes after ulnar nerve decompression at the elbow and to compare the outcome after open in situ decompression with that after endoscopic in situ decompression. Patients having ulnar nerve decompression were evaluated using patient-rated outcome measures. Fifty-five patients were recruited; 3 were lost to follow-up, and 18 were excluded because they had anterior transposition. Of the thirty-four patients followed up for 12 months, 19 had endoscopic decompression and 15 had open in situ decompression. Patient demographics, presenting symptoms, range of elbow movement, grip and pinch strength, and sensation were recorded preoperatively and at 12 months by an independent observer. Postoperative patient satisfaction, pain, and ongoing paresthesia were recorded using visual analog scales. Subgroup analysis was performed to compare the outcome of open in situ decompression with that of endoscopic in situ decompression. At 12 months after surgery, the proportion of patients satisfied with the outcome was 9 of 15 (60%) for open in situ surgery and 15 of 19 (79%) for endoscopic in situ surgery. The postoperative complication rate was significantly higher after open in situ decompression than that after endoscopic in situ decompression surgery (10%). Preoperative function scores were predictive of patient-rated satisfaction and were related to McGowan grade. The patient-reported outcome of surgical treatment of cubital tunnel syndrome is good but is affected by preoperative symptom severity. Outcomes after open and endoscopic in situ decompression, including the proportion of patients reporting satisfaction and functional improvement, are equivalent, but more patients reported complications after open decompression. Therapeutic III.

Is intraoperative luxation of the ulnar nerve a criterion for transposition?

The relevance of subcutaneous transposition of the ulnar nerve in the therapy of cubital tunnel syndrome is still under debate. The aim of this study was to compare the results after decompression to additional transposition in cases of intraoperative luxation. A total of 54 cases after surgery of cubital tunnel syndrome between 2000 and 2006 were analyzed. Nerve transposition was performed in cases of intraoperatively apparent nerve luxation. Of the patients 12 were treated by decompression alone and 42 by additional subcutaneous transposition. There was no significant difference concerning symptom amelioration, usage properties of the hand, sensation impairment and duration of disability. Force measurements of grip strength and pinch strength revealed no significant differences between either hand in both groups. The 2-point discrimination ability of the 8th to 10th finger nerves was not significantly different between the groups either. Nerve transposition revealed no benefits in the treatment of cubital tunnel syndrome when performed in cases of intraoperative nerve luxation.

Incidence of Re-Operation and Subjective Outcome Following in Situ Decompression of the Ulnar Nerve at the Cubital Tunnel

The purpose of this investigation was to determine the failure rate of in situ decompression for cubital tunnel syndrome as determined by the need for additional surgery. We performed a comprehensive chart review of 56 adult patients who had undergone in situ decompression for cubital tunnel syndrome in 69 extremities with more than 1 year follow-up. The patients completed a comprehensive questionnaire concerning preoperative and postoperative pain, numbness, and weakness. After decompression, symptoms were improved substantially or resolved. Five limbs (7%) with persistent symptoms postoperatively were treated successfully with anterior submuscular transposition. These data suggest that in situ decompression of the ulnar nerve is a reliable treatment for cubital tunnel syndrome and has a low failure rate. The uncommon patient with continued symptoms after decompression can be treated effectively with transposition of the ulnar nerve.

Comparison of the long-term results of anterior transposition of the ulnar nerve or simple decompression in the treatment of cubital tunnel syndrome—a prospective study

In order to assess their late benefits we present the long-term results of a comparison of treating cubital tunnel syndrome with anterior submuscular transposition or simple decompression. Of 40 patients initially recruited to this study 33 were available for long term follow-up. Sixteen patients underwent anterior submuscular transposition (group A); simple decompression was performed in 17 of the patients (group B). The indications for inclusion were a typical clinical presentation confirmed by abnormal nerve conduction studies. The mean duration of the symptoms before operation was 13 months (range 2 to 84 months) in group A and 8.4 months (range 1.5 to 36 months) in group B. All patients were seen 2 months after surgery and at least 3 years later. The mean duration of follow-up was 63.1 month in the first group and 52 months in the second group. No complications were seen in either group. In the group treated by anterior transposition, ten of 16 patients were completely free of signs and symptoms; slight residual hypesthesia or paresthesia was observed in two patients. Paresis and atrophy was observed in only one person. In the simple decompression group, 11 of 17 patients were completely free of signs and symptoms. In five patients slight residual symptoms were observed; no paresis or atrophy was reported in any of this group. These long-term results show that both surgical techniques have a good outcome. Thus, the less invasive simple decompression should be preferred.

Minimally Invasive Ulnar Nerve Decompression for Cubital Tunnel Syndrome

Objective: The purpose of this study is to present the efficacy of the surgical technique using a minimal skin incision for the treatment of cubital tunnel syndrome. Ulnar nerve entrapment at the elbow is the second most common compression neuropathy of the upper extremity. Surgical treatment of conventional simple decompression of ulnar nerve is considered to be relatively safe and reliable. However, this surgical technique is needed a relatively long incision and often can result in significant postoperative scarring and delay in return to work. Methods: Ten patients with cubital tunnel syndrome underwent simple decompression using a 2 cm or less skin incision. According to Dellon’s criteria, one elbow was classified as grade 1, four as grade 2, and five as grade 3. Preoperative electrodiagnostic studies were performed on all patients and 6 of them were rechecked postoperatively. Results: Preoperative motor conduction velocity (MCV) within the segment was 35.5±16.2 m/s and decreased than the result of MCV in the below the elbow-wrist segment (59.3±5.9 m/s, p< 0.05). Postoperative results of MCV were improved in all patients from 37.1±13.2 m/s to 51.9±8.9 m/s (p<0.05). After an average follow-up of 5.9±5.0 months, all patients were reported to be in good or excellent condition. Conclusion: We could observe an enough distance of the ulnar nerve from proximal to distal area without difficulty using manual retraction. Simple decompression through a small skin incision can be recommended for the treatment of cubital tunnel syndrome, if the indication is appropriate. (J Kor Neurotraumatol Soc 2009;5:16-21)

Anterior transposion of the ulnar nerve with its accompanying artery for treatment of cubital tunnel syndrome

Objective To explore the clinical results of treatment of cubital tunnel syndrome by nerve decompression and anterior transposition of the ulnar nerve with its accompanying artery.Methods Twenty-eight cases of cubital tunnel syndrome were treated by means of decompression and anterior transposition of the ulnar nerve with its aeeompanying artery.The characteristics of blood supply distribution to the ulnar nerve in the cubital tunnel were observed during the operation.The treatment outcomes were evaluated postoperatively.Results The patients were followed-up for an average of 8.9 months.Based on the severity of subjective complaints and objective findings,the results were graded.Seventeen cases were greed as excellent,10 cases as good,1 case as fair and none as poor.The overall excellent or good rate was 96%.There were no postoperative complications and recurrences.Conclusion Decompression and anterior transposition of the ulnar nerve with its accompanying artery is an effective method for treatment of cubital tunnel syndrome. Key words: Cubital tunnel syndrome; Surgical procedures,operative; Inferior ulnar collateral artery

Endoscopic Anatomical Nerve Observation and Minimally Invasive Management of Cubital Tunnel Syndrome

Experience with the use of the Universal Subcutaneous Endoscope (USE) system in surgical treatment of cubital tunnel syndrome in 35 patients is reported. Patients included in the study had pre- and postoperative clinical and electrophysiological data, and had undergone a minimum follow-up period of 13 months. Mean patient age was 59.5 years and the mean follow-up period was 25.9 months. The operation was performed under local anaesthesia without pneumatic tourniquet and on an out-patient basis. A 1.5 cm portal is made at the cubital tunnel and the USE system is inserted next to the ulnar nerve, first distally and then proximally. The nerve is endoscopically assessed and only the tissue that compresses the nerve is released, in keeping with the principles of minimally invasive treatment. Preoperative tingling sensations disappeared postoperatively in 63% of cases. Pain and sensory disturbance recovered to normal in 92% and 89% of cases, respectively. Abnormal motor nerve conduction velocities improved in 77%. Abductor digiti minimi weakness MMT 0, 1, 2 in 16 hands recovered to MMT 4 or 5 in eight. First-dorsal interosseous weakness in 18 hands recovered to MMT 4 or 5 in seven. There were no complications in this series. The endoscopic approach facilitates inspection of the ulnar nerve so that selective release of the tissue that compresses the nerve can readily be performed. The technique has proven effective in the treatment of cubital tunnel syndrome.

Selection of Operative Procedures for Cubital Tunnel Syndrome

The purpose of this study was to investigate the primary operative procedures that are performed by hand surgeons for cubital tunnel syndrome and their reported satisfaction with these procedures. The survey consisted of 22 questions regarding primary operative treatment of cubital tunnel syndrome and demographics and was sent by email to the 459 active members of the American Association for Hand Surgery. One hundred sixty-four surgeons completed the survey (36% response rate). The total sample included 154 hand surgeons (143 males, 11 females) who operated on cubital tunnel syndrome and the majority of surgeons were in private practice (n = 100) followed by academic practice (n = 50). The most prevalent factors that influence the decision to operate include evidence of muscle atrophy (84%), abnormal nerve conduction studies (51%), and failed non-operative treatment (49%). Most surgeons (n = 133) reported using more than one operative procedure for their patients with cubital tunnel syndrome. Factors that influenced the operative procedure selected included the degree of nerve compression (60%), medical comorbidities (30%), patient's occupation (28%), and obesity (22%). Following carpal tunnel surgery, 88% of the surgeons were "very satisfied" with their patient outcome and following surgery for cubital tunnel syndrome, only 44% were "very satisfied" with their patient outcome. Most surgeons use more than one operative procedure in their treatment of patients with cubital tunnel syndrome and the selection of the operative procedure is influenced by patient factors and surgeon preference.

The diagnosis and treatment of cubital tunnel syndrome

Purpose of review Cubital tunnel syndrome is a commonly encountered compressive neuropathy of the upper extremity. Upon failure of conservative treatment, many patients may require surgical intervention. This article reviews recent studies on the evaluation and treatment of cubital tunnel syndrome. Recent findings Randomized trials have not shown a benefit to ulnar nerve transposition when compared with simple decompression in the short to mid-term follow-up periods. Summary The optimal method for cubital tunnel syndrome treatment is still unclear. Recently, there has been an increased interest in less invasive procedures. Adequately powered randomized studies with longer follow-up are required to develop more stringent treatment guidelines.

Anterior Transposition Compared with Simple Decompression for Treatment of Cubital Tunnel Syndrome

There is currently no consensus on the optimal operative treatment for cubital tunnel syndrome. The objective of this meta-analysis of randomized, controlled trials was to evaluate the efficacy of simple decompression compared with that of anterior transposition of the ulnar nerve in the treatment of this condition. Multiple databases were searched for randomized, controlled trials on the outcome of operative treatment of cubital tunnel syndrome in patients who had not previously sustained trauma or undergone a surgical procedure involving the elbow. Two reviewers abstracted baseline characteristics, clinical scores, and motor nerve-conduction velocities independently. Data were pooled across studies, standard mean differences in effect sizes weighted by study sample size were calculated, and heterogeneity across studies was assessed. We identified four randomized, controlled trials comparing simple decompression with anterior ulnar nerve transposition (two submuscular and two subcutaneous). In three studies that included a total of 261 patients, a clinical scoring system was used as the primary clinical outcome. There were no significant differences between simple decompression and anterior transposition in terms of the clinical scores in those studies (standard mean difference in effect size = -0.04 [95% confidence interval = -0.36 to 0.28], p = 0.81). We did not find significant heterogeneity across these studies (I(2) = 34.2%, p = 0.22). Two reports, on a total of 100 patients, presented postoperative motor nerve-conduction velocities; they showed no significant differences between the procedures (standard mean difference in effect size = 0.24 [95% confidence interval -0.15 to 0.63] in favor of simple decompression, p = 0.23; I(2) = 0%, p = 0.9). The results of this meta-analysis suggest that there is no difference in motor nerve-conduction velocities or clinical outcome scores between simple decompression and ulnar nerve transposition for the treatment of ulnar nerve compression at the elbow in patients with no prior traumatic injuries or surgical procedures involving the affected elbow. Confidence intervals around the points of estimate were narrow, which probably exclude the possibility of clinically meaningful differences. These data suggest that simple decompression of the ulnar nerve is a reasonable alternative to anterior transposition for the surgical management of ulnar nerve compression at the elbow.

Endoscopic Decompression of the Ulnar Nerve at the Elbow

The ideal operative treatment for cubital tunnel syndrome, the second most common form of peripheral compression neuropathy, remains controversial. We therefore reviewed our series of endoscopically assisted ulnar nerve decompression at the elbow to determine the effectiveness of the procedure, which was intended to minimize perioperative morbidity and scar discomfort. In 36 patients (ages 22-76 years) with clinical McGowan grade I (4 patients), II (21 patients), and III (11 patients) and electrophysiologic signs of cubital tunnel syndrome (35 primary, 1 recurrent), 20 cm of the ulnar nerve was released through a 3.5-cm-long skin incision above the medial epicondyle. A 4-mm, 30 degrees standard endoscope and custom-made guiding-dissecting tool were utilized during the procedure, and the mean postoperative follow-up examination was 14 months (range 6-19). No macroscopically visible nerves and vessels were injured during the procedure. The only postoperative complication was hematoma in one patient that resolved after conservative management. One case was converted from endoscopic to open because of a ganglion that surrounded the nerve in the forearm. There was no scar discomfort (ie, painful neuroma, impaired sensibility, or burning sensation) or elbow extension deficit after surgery, and surgical wounds all healed within a week. Outcomes were excellent in 21 of 36 cases and good in 12 of 36 cases. All patients improved electrophysiologically after surgery, were satisfied with the procedure, returned to full activities within 3 weeks, and would have the procedure again. By using a safe and reliable endoscopic technique characterized by a short incision, minimum soft tissue dissection, and early postoperative mobilization, we were able to preserve the benefits of conventional approaches (namely, complete release and good visualization), while avoiding problems such as painful scarring and elbow contracture.

The surgical treatment of cubital tunnel syndrome: a decision analysis

The objective of our study was to use decision analysis to compare four common surgical treatments for cubital tunnel syndrome: simple decompression of the cubital tunnel, medial epicondylectomy, anterior subcutaneous transposition and anterior submuscular transposition. The variables used for this decision analysis model were based on data from the literature. Extensive sensitivity analyses were carried out to test the impact of the values given to these variables on the outcome of the model. The highest expected utility, 0.973, was associated with simple decompression. The expected utility was 0.969 for subcutaneous transposition and 0.965 for submuscular transposition. Medial epicondylectomy had the lowest expected utility at 0.961. Simple decompression remained the preferred strategy in extensive one-way sensitivity analyses.

The application of ultrasonography in the diagnosis and treatment of cubital tunnel syndrome

目的 探讨超声检查在诊断和治疗肘管综合征中的临床意义.方法 对34例临床及肌电图检测确诊为肘管综合征的患者,分轻、中、重度三期,应用B超进行检测,与30例(60侧)健康人肘管B超检查结果进行对比研究;同时将B超发现的形态学异常表现与术中所见进行对比研究.结果 B超检查显示肘管综合征患者尺神经横截面积,尺神经厚度,尺神经横截面积肿胀率,尺神经厚度肿胀率平均值均大于对照组;随着临床症状逐渐加重,尺神经横截面积肿胀率增大,而尺神经肘段运动传导速度减慢.同时B超发现的形态学异常表现,与术中所见一致.结论 B超检查对肘管综合征的诊断、尺神经病变程度的分期,以及治疗方式的选择均有参考价值,为临床提供了一种简单、可靠、无创的检测方法。

Effective Surgical Treatment of Cubital Tunnel Syndrome Based on Provocative Clinical Testing without Electrodiagnostics

Effective Surgical Treatment of Cubital Tunnel Syndrome Based on Provocative Clinical Testing without Electrodiagnostics

Effective Surgical Treatment of Cubital Tunnel Syndrome Based on Provocative Clinical Testing without Electrodiagnostics

This study evaluated the effectiveness of identifying surgically correctable ulnar nerve compression at the elbow based on provocative clinical testing alone in patients with cubital tunnel syndrome after failure of conservative treatment. Twenty-four patients were included in the study (mean age, 60 years). Three patients underwent bilateral procedures. Patients complaining of symptoms in the distribution of the ulnar nerve were tested by elicitation of Tinel's sign and combined flexion and pressure testing at the elbow and wrist. Two-point discrimination was determined. After a failed 6-week trial of conservative therapy patients underwent anterior submuscular transposition of the ulnar nerve with carpal tunnel release. Postoperatively, the change in two-point discrimination as measured at 6 months was significantly improved, with a mean improvement per digital nerve of 2.52 mm (p<0.001). Mean time to relief was 7.2 weeks. Complications included one hematoma and one seroma. A total of 26 of the 27 limbs chosen for surgical treatment by provocative clinical testing alone experienced relief of symptoms with anterior submuscular transposition of the ulnar nerve and carpal tunnel release. This study demonstrates the effectiveness of surgical therapy in patients with lesions identified by clinical examination without electrodiagnostic testing.

Sulcus-ulnaris-Syndrom: Einfache Dekompression oder subkutane Vorverlagerung?

The purpose of this prospective, randomised and controlled study was to evaluate which kind of operative technique for treatment of cubital tunnel syndrome is favourable: subcutaneous anterior transposition or nerve decompression without transposition. This study included 66 patients suffering from pain and/either neurological deficits with clinically and electrographically proven cubital tunnel syndrome. 32 patients underwent nerve decompression without transposition, whereas 34 underwent subcutaneous transposition of the nerve. Follow-up examinations evaluating pain, motor and sensory deficits as well as motor nerve conduction velocities were performed three, nine and 24 months postoperatively. Irrespectively of operative procedures (simple decompression vs. subcutaneous anterior transposition) there were no significant differences between the outcomes of the two groups at either postoperative follow-up examination (p > 0.05).

Anterior Intramuscular Transposition of the Ulnar Nerve

Entrapment neuropathy of the ulnar nerve at the elbow (cubital tunnel syndrome) has been recognized for over 100 years. Conservative treatment may not relieve symptoms associated with this neuropathy. Several techniques have been described for the surgical treatment of cubital tunnel syndrome. This article, describes the anterior intramuscular interposition of the ulnar nerve for the surgical treatment of cubital tunnel syndrome.

Anterior Submuscular Transposition of the Ulnar Nerve

Though the literature is unclear, ulnar nerve anterior submuscular transposition has a role in the surgical treatment of cubital tunnel syndrome in the primary and revision setting. Along with the submuscular transposition technique, this article reviews some of the history of cubital tunnel syndrome treatment, the strengths and criticisms of each of the procedures, and the literature as of 2006 in terms of treatment guidelines.

Comparison of Range-of-Motion Constraints Provided by Splints Used in the Treatment of Cubital Tunnel Syndrome—A Pilot Study

Nocturnal splinting of the elbow is commonly used to treat cubital tunnel syndrome (CBTS). Rationales are based on several studies, which suggest that proper nocturnal positioning of the elbow during sleep contributes to decreased cubital tunnel symptoms. Currently there is limited scientific evidence supporting the rationale for specific splinting protocols. Splints may be custom or prefabricated. The purpose of this article is to assess the range-of-motion constraints of five nighttime elbow orthoses commonly used in the treatment of CBTS. This preliminary study was conducted using a cadaveric model, using three arms to represent three human arm sizes, and compared five different splints, and no splint. Range-of-motion testing was performed using gravity alone and then testing was repeated using gravity plus a 1-pound weight in a standardized fashion. Results showed that all splints restricted elbow flexion significantly more than the unsplinted extremity. Of the five splints, the AliMed splint allowed the most elbow flexion both in the gravity assisted, and gravity plus a 1-pound weight assisted conditions. The only splint that restricted elbow extension was the Hely & Weber splint. The Pil-O-Splint Elbow Support with stay, Hely & Weber and the Folded Towel all restricted elbow flexion to less than 90° under all study conditions. The information provided may be helpful in making clinical decisions regarding splinting for CBTS.