Cubital Tunnel Syndrome Research Articles

Base of the Third Metacarpal as a Palpable and Reliable Landmark for Identifying the Median Nerve’s Thenar Branch

The objective of this study was to investigate whether the base of the third metacarpal can predict the location of the thenar branch (TB) of the median nerve and the accuracy of palpating the base of the third metacarpal. In 15 patients with ulnar nerve lesions around the elbow, we transferred the opponens motor branch to repair the deep terminal division of the ulnar nerve (DTDUN). Before surgery, we located the TB by palpating the base of the third metacarpal volarly. During surgery, we placed three needles at the following places: one at the entrance of the TB into the abductor pollicis brevis, another at the point where the TB contacted the thenar muscles, and third at the DTDUN's trajectory over the third metacarpal. We obtained fluoroscopic images and measured distances between the needles and structures with image software. We also examined the relationship between the TB, DTDUN, and the volar tubercle of the base of the third metacarpal in cadaver hands. Finally, we invited 22 surgeons to palpate the base of the third metacarpal on volunteer hands and verified their accuracy using fluoroscopy. During surgery, after dissection and palpation of the TB, under fluoroscopy, we confirmed that the palpable bone prominence was the base of the third metacarpal. In cadaver dissections, we observed the TB crossing the volar tubercle of the base of the third metacarpal superficially from proximal to distal and from ulnar to radial. The DTDUN was, on average, 14 mm distal to the base of the third metacarpal distal limit. In total, 19 of the 22 surgeons correctly identified the base of the third metacarpal and consequently the trajectory of the TB. The palpable base of the third metacarpal can be used to determine the trajectory of both the TB and DTDUN. Diagnostic II.

Cubital Tunnel Syndrome: Does a Consensus Exist for Diagnosis?

Cubital tunnel syndrome (CuTS) is the second most common compressive neuropathy of the upper extremity. We aimed to determine a consensus among experts using the Delphi method for clinical criteria that could be validated further for the diagnosis of CuTS. The Delphi method was used for establishing a consensus among a group of expert panelists, comprising 12 hand and upper-extremity surgeons, who ranked the diagnostic clinical importance of 55 items related to CuTS on a scale from 1 (least important) to 10 (most important). The average and SDs of each item were calculated, and Cronbach α was used to assess homogeneity among the panelist-ranked items. All panelists answered the 55-item questionnaire. A Cronbach α value of 0.963 was obtained on the first iteration. The top criteria that were considered most clinically relevant to the diagnosis of CuTS among the group were determined based on the most highly ranked and correlated items among the expert panelist group. The criteria based on which there was agreement were as follows: (1) paresthesias in ulnar nerve distribution, (2) symptoms precipitated by increased elbow flexion/positive elbow flexion tests, (3) positive Tinel sign at the medial elbow, (4) atrophy/weakness/ late findings (eg, claw hand of the ring/small finger and Wartenberg or Froment sign) of ulnar nerve-innervated muscles of the hand, (5) loss of two-point discrimination in ulnar nerve distribution, and (6) similar symptoms on the involved side after successful treatment on the contralateral side. Our study demonstrated a consensus among an expert panelist group of hand and upper-extremity surgeons on potential diagnostic criteria for CuTS. This consensus on diagnostic criteria may help clinicians readily diagnose CuTS in a standardized form; however, further weighting and validation are necessary prior to the development of a formal diagnostic scale. This study is the first step in producing a consensus on how to diagnose CuTS.

Functional Outcomes of Cubital Tunnel Release in Patients with Negative Electrodiagnostic Studies.

Cubital tunnel syndrome (CuTS) is the second most common compression neuropathy of the upper extremity. Electrodiagnostic studies (EDSs) are often used to confirm diagnosis. However, negative EDSs can present a difficult clinical challenge. The purpose of this study was to determine the functional outcomes and symptom improvement for patients with a clinical diagnosis of CuTS, but with negative EDSs, who are treated surgically. Patients who had EDSs before ulnar nerve surgery were identified by means of database search. Chart review was performed on 867 cases to identify those with negative EDSs. Twenty-five ulnar nerve operations in 23 patients were included in analysis. Chart review was performed to record preoperative and postoperative symptoms, physical examination findings, and outcome measures (ie, Disabilities of the Arm, Shoulder and Hand questionnaire and the Patient-Rated Ulnar Nerve Evaluation). At a mean follow-up period of 20.7 ± 14.9 months, 15 of 25 cases (60.0%) had complete resolution of all preoperative symptoms. All 10 patients who had residual symptoms endorsed improvement in their preoperative complaints. The median preoperative Disabilities of the Arm, Shoulder and Hand score was 40.0 [interquartile range (IQR), 23.9 to 58.0], which significantly decreased to a median of 6.8 (IQR, 0 to 22.7) at final follow-up ( P < 0.01). The median postoperative Patient-Rated Ulnar Nerve Evaluation score was 9.5 (IQR, 1.5 to 19.5). Patients with CuTS and normal EDSs treated surgically can be expected to have favorable outcomes with respect to symptoms and improvement in functional outcome scores. After ruling out confounding diagnoses, the authors continue to offer surgical intervention for these patients when nonoperative treatment has failed. Therapeutic, IV.

Application of ulnar nerve diameter changes examined by HRUS in patients with cubital tunnel syndrome

To evaluate the value of high-resolution ultrasound the diagnosis and prognosis of cubital tunnel syndrome. From January 2018 to June 2019, 47 patients with cubital tunnel syndrome were treated with ulnar nerve release and anterior subcutaneous transposition. There were 41 males and 6 females, aged from 27 to 73 years old. There were 31 cases on the right, 15 cases on the left, and 1 case on both sides. The diameter of ulnar nerve was measured by high-resolution ultrasound pre-and post-operatively, and measured directly during the operation. The recovery status of the patients was evaluated by the trial standard of ulnar nerve function assessment, and the satisfaction of the patients was assessed. All the 47 cases were followed up for an average of 12 months and the incisions healed well. The diameter of ulnar nerve at the compression level was (0.16±0.04) cm pre-operatively, and the diameter of ulnar nerve was (0.23±0.04) cm post-operatively. The evaluation of ulnar nerve function:excellent in 16 cases, good in 18 cases and fair in 13 cases. Twelve months post-operatively, 28 patients were satisfied, 10 patients were general and 9 patients were dissatisfied. The preoperative examination of ulnar nerve by high-resolution ultrasound is consistent with the intuitive measurement during operation, and the result of postoperative examination of ulnar nerve by high-resolution ultrasound is consistent with follow-up results. High-resolution ultrasound is an effective auxiliary method for the diagnosis and treatment of cubital tunnel syndrome.

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.

Endoscopic Versus Open Carpal Tunnel Surgery: Risk Factors and Rates of Revision Surgery

The purpose of our study was to compare the 1-year revision surgery rates and outcomes of open versus endoscopic carpal tunnel release. Our hypothesis was that, compared to open release, endoscopic carpal tunnel release was an independent risk factor for revision surgery within 1-year. This was a retrospective cohort study of 4338 patients undergoing isolated endoscopic or open carpal tunnel release. Demographic data, medical comorbidities, surgical approach, need for revision surgery, hand dominance, history of prior injection, and Patient Reported Outcomes Measurement Information System upper extremity (UE), pain interference (PI) and physical function scores were analyzed. Multivariable analysis was used to identify the risk factors for revision surgery within one year of the index procedure. In total, 3280 patients (76%) underwent open and 1058 (24%) underwent endoscopic carpal tunnel release. Within one year of the index procedure, 45 patients required revision carpal tunnel release. The average time to revision was 143 days. The rate of revision carpal tunnel release in the open group was 0.71% compared to 2.08% in the endoscopic group. Multivariable analysis demonstrated that endoscopic surgery, male sex, cubital tunnel syndrome, tobacco use, and diabetes were associated independently with revision surgery. In this study, we found that endoscopic carpal tunnel release was associated independently with a 2.96 times greater likelihood of requiring revision carpal tunnel release within one year, compared to open carpal tunnel release. Male sex, concurrent cubital tunnel syndrome, tobacco use, and diabetes also were associated independently with greater risk of needing revision carpal tunnel release within one year. Prognostic II.

Surgery for Cubital Tunnel Syndrome: A Comparative Study of Small Incision with Classic Anterior Nerve Transposition

Objective: To evaluate the clinical outcomes of ulnar neuropathy, and cubital tunnel syndrome (CuTS) surgery via a small incision with that of anterior transposition of the ulnar nerve. Materials &amp; Methods: In this comparative cross-sectional study, 108 patients were recruited from the Neurosurgery Department of Qazi Hussain Ahmad Medical Complex, Nowshera. Two Groups were made. Group A patients undergo either ulnar nerve anterior transposition or simple decompression via a small skin incision, while Group B patients undergo ulnar nerve subcutaneous anterior transposition through a classic skin incision. Results: Totally 108 patients were enrolled. Males were 67 and females were 41 with a mean age of 45.6 ± 12.97 years. During follow-up visits, an increase in clinical outcome measures was noted, but no statistically significant difference was seen in both groups. Nevertheless, in comparison to the two groups, complications were more in group B, in terms of superficial infection, numbness of skin at the medial elbow, revision surgery, and painful scar. Conclusion: It is concluded that keeping in view the stability/anatomical position of the ulnar nerve to undergo either simple decompression or anterior transposition through small skin incision is effective and an excellent procedure as compared to classic incision procedure in treating patients suffering from cubital tunnel syndrome.

Cost of surgical treatment for ulnar nerve entrapment in Finland, 2011–2015: a registry-based cost description study

ObjectivesThe aim of this study was to evaluate the cost of surgical treatment for primary ulnar nerve entrapment (UNE) borne by the public sector in Finland.DesignRegistry-based cost description study.SettingPrimary and...

Managing Ulnar Nerve Subluxation With a Medial Intermuscular Septum Sling.

Cubital tunnel syndrome (CuTS) is a lifestyle-altering peripheral neuropathy lacking a consensus for optimal surgical management. We describe creation of a fascial "V-sling" without ulnar nerve transposition, which is associated with increased surgical morbidity compared with decompression. The purpose of this study is to evaluate a novel technique with effective ulnar nerve decompression and subluxation prevention by creating a fascial sling in patients with CuTS and ulnar nerve subluxation. We reviewed records of 39 elbows in 35 patients who underwent in situ ulnar nerve decompression and creation of a fascial sling in a "V" configuration to stabilize the nerve in its native position. We examined patient demographics, Single Assessment Numeric Evaluation (SANE) scores, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, and patient outcomes. Chi-square and student's t test were used for all analysis. A total of 37 extremities in 33 patients undergoing nerve decompression had nerve subluxation confirmed intraoperatively. There was a statistically significant change in preoperative and postoperative SANE scores of 64.5 and 82.3, respectively. Mean QuickDASH scores decreased significantly from 49.3 preoperative to 10.8 postoperative. The long-term QuickDASH scores obtained at mean of 564 days were maintained at 10.76. This study describes a novel technique for treating CuTS by achieving in situ nerve decompression and addressing ulnar nerve subluxation with creation of an intermuscular septal sling. The technique improved functional outcomes and provided symptomatic relief, while avoiding risks commonly associated with nerve transposition.

The modified fascial sling technique for ulnar nerve anterior transposition: surgical techniques and results

Approaches to surgical treatment to cubital tunnel syndrome include simple decompression, decompression with medial epicondylectomy, and decompression with anterior transposition of the ulnar nerve. Transposition of the ulnar nerve involves decompression and transposition of the nerve anteriorly to a subcutaneous, intramuscular, or submuscular position. However, transposing the ulnar nerve to subcutaneous plane renders it more susceptible to external trauma. Hence, this technique article introduces the use of a modified fascial sling. The modified fascial sling technique for anterior transposition of the ulnar nerve involves careful dissection to identify the ulnar nerve, decompression of the nerve, then transposition of the ulnar nerve anterior to the medial epicondyle. An AlloWrap (Stryker, Kalamazoo, MI, USA) is first wrapped around the ulnar nerve, followed by wrapping a fascial sling fashioned from the flexor carpi ulnaris fascia. A prospective case series for this surgical technique was conducted. Wilcoxon signed-rank test compared preoperative and postoperative qDASH-9 scores, an abbreviated questionnaire to assess functional limitations of the upper limb. Five patients were included in this study, with a mean duration of follow-up of 530.4 days. The mean QuickDASH-9 functional disability score was 36.5 ± 25.1 preoperatively and 20.6 ± 12.8 postoperatively, demonstrating statistically significant improvement (P= .008). The modified fascial sling technique for anterior transposition of the ulnar nerve was developed to address the complications of perineural adhesions after transposition causing tethering of the ulnar nerve. At the same time, the fascial sling prevents posterior subluxation of the ulnar nerve back to its original location, thereby reducing the risk of recurrent symptoms.

Factors Influencing Patient Experience After Cubital Tunnel Syndrome Surgery

The purpose of this study was to use qualitative methodology to better understand patient experiences after cubital tunnel surgery, with the goal of identifying areas of improvement in delivery of care. Patients who underwent surgery (in situ decompression or anterior transposition) for cubital tunnel syndrome within the last 12 months, which was performed by one of three fellowship-trained hand surgeons, were identified. Participants were invited to an interview regarding "their experiences with ulnar nerve surgery." An interview guide with semistructured, open-ended questions regarding the decision for surgery, treatment goals, and the recovery process was used. Interim data analyses were conducted to assess emerging themes, and interviews were continued until thematic saturation was achieved. Seventeen participants completed interviews; the mean age of study participants was 57 years, and 71% were women. The mean time between surgery and the interview was 6 months. Participants identified the following two key areas that could improve their surgical experience: (1) the need for detailed preoperative education about the surgery and recovery process, (2) and the importance of discussing treatment goals and expectations. Participants suggested providing both written and online resources to patients, including specific details about incision size and recovery process in education materials, and setting expectations for symptom resolution. Although the overall patient experience after cubital tunnel surgery was positive, participants noted that there is a need for providing improved educational resources and counseling before surgery. Addressing education and counseling needs before cubital tunnel surgery will help surgeons to improve delivery of care.

Neurophysiological grading tool of ulnar nerve entrapment across the elbow

Ulnar nerve entrapment across the elbow (UNEAE) is the second most common entrapment of the hand after carpal tunnel syndrome. There are few grades available for UNEAE with their limitations. The aim of this research is to establish, using the best available evidence, a clinically appropriate revision of the current ulnar nerve conduction grading tool and to evaluate its effectiveness in terms of acceptability, without any invasive tests. To compare the recording from the first dorsal interosseous (FDI) muscles with the abductor digiti minimi (ADM) muscle to see which muscle is more sensitive and shows early changes in ulnar nerve entrapment. The revised scale is designed from a clinical physiologist’s perspective and is based on the numerical values of nerve conduction findings. It could also assist surgeons to use this as a tool for interventional prediction. The proposed revised grading system is based on more nuanced, descriptive categories, ranging from “normal, “early, “mild, “moderate, “severe,” and “complete” absence. An additional category of clinical grading is therefore proposed. Method: Data was collected based on the extensive and detailed grading system previously described by Padua. The tests were performed by a qualified clinical physiologist (neurophysiology) using a Keypoint 9033A07 machine, used in line with the departmental protocol (peripheral protocol 1, 2015). The Association of Neurophysiological Scientists (ANS) and British Society of Clinical Neurophysiology (BSCN) (2014) guidelines and minimum standards for the practice of clinical neurophysiology in the United Kingdom were followed. All data was recorded numerically to ensure methodological reliability. Result: The data was collected over the course of one year (2017). A total of 190 patients were involved in this study. A collection of 278 consecutive symptomatic hands was tested for conduction block across the elbow while recording from the first dorsal interosseous FDI muscles. Out of the 278 samples, 201 hands were graded as having normal conduction velocity: 9 hands showed early changes, 51 hands showed mild changes, 14 hands showed moderate changes, 2 hands showed severe changes, and 1 hand showed complete absence or no response from the wrist and across the elbow. Additional studies were carried out from the abductor digiti minimi (ADM) muscles for those patients who showed conduction block across the elbow while recording from the FDI muscles. Only 57 patients underwent a nerve conduction study for ADM. 77 symptomatic hands were tested for conduction block in the ADM muscle. 18 hands were graded as normal; 48 hands showed mild changes; 10 hands showed moderate changes; and 1 hand showed complete absence or no response from the wrist and across the elbow. Out of 278 hands, 266 hands were graded as having normal amplitude across the elbow while recording from FDI muscles; 7 hands showed early changes in amplitude; 1 hand showed moderate amplitude change; 4 hands showed severe amplitude changes; and 1 hand showed complete absence or no response from the wrist and across the elbow. Out of 77 hands, 73 hands showed normal amplitude across the elbow while recording from ADM muscles; 2 hands showed mild changes; 1 hand showed a moderate change; and 1 hand showed complete absence or no response from the wrist and across the elbow. Conclusion: Finding show that FDI is more sensitive in comparison to ADM to record early changes in ulnar nerve entrapment across the elbow. In addition, it shows that a drop in amplitude is not as significant when compared to a conduction block across the elbow.

Computerized adaptive testing for the patient evaluation measure (PEM) in patients undergoing cubital tunnel syndrome surgery.

In outcome measures, item response theory (IRT) validation can deliver interval-scaled high-quality measurement that can be harnessed using computerized adaptive tests (CATs) to pose fewer questions to patients. We aimed to develop a CAT by developing an IRT model for the Patient Evaluation Measure (PEM) for patients undergoing cubital tunnel syndrome (CuTS) surgery. Nine hundred and seventy-nine completed PEM responses of patients with CuTS in the United Kingdom Hand Registry were used to develop and calibrate the CAT. Its performance was then evaluated in a simulated cohort of 1000 patients. The CAT reduced the original PEM length from ten to a median of two questions (range two to four), while preserving a high level of precision (median standard error of measurement of 0.27). The mean error between the CAT score and full-length score was 0.08%. A Bland-Altman analysis showed good agreement with no signs of bias. The CAT version of the PEM can substantially reduce patient burden while enhancing construct validity by harnessing IRT for patients undergoing CuTS surgery.

Ulnar Nerve Transposition (Cadaver)

Ulnar nerve transposition is a surgical procedure performed to treat ulnar nerve compression of the elbow, also known as cubital tunnel syndrome. This procedure is utilized after both non-operative management and in situ decompression fails, or if these procedures are deemed inappropriate based on patient pathology or ulnar nerve instability. Transposition of the ulnar nerve involves not only decompression of the nerve but also its anterior repositioning to reduce compression and irritation while maintaining nerve integrity. This video outlines the operative technique used by Dr. Asif Ilyas for performing an ulnar nerve transposition using either a subcutaneous or a submuscular technique.

Ulnar neuropathy at the elbow: associations of pre-operative DTI parameters with clinical outcomes after cubital tunnel decompression.

To evaluate whether DTI parameters of the ulnar nerve at the elbow are associated with clinical outcomes in patients receiving cubital tunnel decompression (CTD) surgery for ulnar neuropathy. This retrospective study included 21 patients with cubital tunnel syndrome who received CTD surgery between January 2019 and November 2020. All patients underwent pre-operative elbow MRI, including DTI. Region-of-interest analysis was performed on the ulnar nerve at three levels around the elbow: above (level 1), cubital tunnel (level 2), and below (level 3). Fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were calculated on three sections at each level. Clinical data on symptom improvement in respect to pain and tingling sensation after CTD were recorded. Logistic regression analysis was used to compare DTI parameters of the nerve at three levels and the entire nerve course between patients with and without symptom improvement after CTD. After CTD, 16 patients showed improvement in symptoms, but five did not. ROC analysis of DTI parameters showed that AUCs of FA, AD, and MD were higher at level 1 than at levels 2 and 3, with FA showing the highest AUC (level 1: FA, 0.7104 [95% CI, 0.5206-0.9002] vs AD, 0.6521 [95% CI, 0.4900-0.8142] vs MD, 0.6153 [95% CI, 0.4187-0.8119]). In patients who underwent CTD surgery for ulnar neuropathy at the elbow, the DTI parameters of FA, AD, and MD above the cubital tunnel level were associated with clinical outcomes, with FA showing the strongest associations. • After CTD surgery for ulnar neuropathy at the elbow, persistent symptoms may be observed, depending on symptom severity. • DTI parameters of the ulnar nerve at the elbow showed differences in their capacity for discriminating between patients with and without symptom improvement following CTD surgery, with this capacity depending on the nerve level at the elbow. • FA, AD, and MD measured above the cubital tunnel on pre-operative DTI may be associated with surgical outcomes, with FA showing the strongest association (AUC at level 1, 0.7104 [95% CI, 0.5206-0.9002]).

Possible Points of Ulnar Nerve Entrapment in the Arm and Forearm: An Ultrasound, Anatomical, and Histological Study.

Ulnar nerve entrapment is one of the most common entrapment neuropathies, usually occurring in the cubital tunnel of the elbow and in Guyon's canal of the wrist. However, it can also occur at other anatomical locations. Our aim was to review other possible locations of ulnar nerve entrapment in an ultrasound and anatomical study. Eleven upper limbs from eight adult corpses were ultrasonographically examined and subsequently dissected in a dissection laboratory. Four specific anatomical points were analysed, and any anatomical variations were documented. Moreover, six samples of the nerve were taken for histological analysis. Distinct anatomical relationships were observed during ultrasound and dissection between the ulnar nerve and the medial intermuscular septum, the triceps aponeurosis, Osborne's fascia at the elbow, the arcuate ligament of Osborne and the intermuscular aponeurosis between the flexor carpi ulnaris and the flexor digitorum superficialis muscles. A statistical study showed that these locations are potential areas for ulnar nerve compression. In addition, a fourth head of the triceps brachii muscle was found in some specimens. Results demonstrate that ultrasound is a good tool to investigate ulnar nerve entrapment neuropathy and to identify other anatomical points where the nerve can remain compressed.

Intraoperative electrical stimulation promotes the short-term recovery of patients with cubital tunnel syndrome after surgery

BackgroundThis study was designed to investigate whether intraoperative electrical nerve stimulation has effects on the short-term recovery of cubital tunnel syndrome patients after ulnar nerve release.MethodsPatients diagnosed as cubital tunnel syndrome were selected. At the same time, they received conventional surgery treatment. The patients were divided by a randomized digits table into two groups. The control group underwent conventional surgery, and the electrical stimulation (ES) group underwent intraoperative electrical stimulation. All the patients were tested for sensory and motor functions, grip strength, key pinch strength, motor conductivity velocity (MCV), and maximum compound muscle action potential (CMAP) before operation and 1 month and 6 months after operation.ResultsIn patients treated with intraoperative ES, the sensory and motor functions and the strength of muscle were significantly improved after 1-month and 6-month follow-up than the control group. After the follow-up, the patients in the ES group had significantly higher grip strength and key pinch strength than the control group. After the follow-up, the patients in the ES group had significantly higher MCV and CMAP than the control group.ConclusionIntraoperative electrical stimulation of nerve muscle can significantly promote the short-term recovery of nerve and muscle functions after the surgery in cubital tunnel syndrome patients.

A complete analysis of the surgical treatment for cubital tunnel syndrome: an umbrella review.

Numerous original studies have been presented regarding various surgical treatments for cubital tunnel syndrome (CubTS). The results of these analyses regarding the different surgical treatments for CubTS frequently differ and, in some cases, contradict each other, creating confusion. Therefore, our umbrella review aimed to summarize the evidence from meta-analyses and systematic reviews regarding the surgical treatments of CubTS, and along with the new, more detailed outcomes, provide an evidence-based tool for surgeons performing these procedures. To perform this umbrella review, a systematic search was conducted for meta-analyses investigating CubTS in PubMed, Scopus, Embase, Web of Science, Google Scholar, Cochrane Library, BIOSIS, and EBSCO medical databases. Detailed comparison of surgical outcomes, such as clinical improvement, complications, or reoperation rates, of different treatment methods for CubTS was performed. New risk ratios in all categories were established based on all of the primary studies available in the literature. The goal of the present umbrella review was to gather and summarize all data about the surgical treatments for CubTS in the available literature and provide new outcomes and an evidence-based tool for surgeons performing these procedures. Each comparison of the surgical techniques has been discussed, and the present study's results were compared with the outcomes of the previous studies.

Therapeutic Potentials of Radial Shock Wave in Cubital Tunnel Syndrome

Therapeutic Potentials of Radial Shock Wave in Cubital Tunnel Syndrome

Role of High-Resolution Ultrasonography in Evaluation of Ulnar Nerve Entrapment Disorder

Role of High-Resolution Ultrasonography in Evaluation of Ulnar Nerve Entrapment Disorder