Clinical efficacy of simple decompression versus anterior transposition of the ulnar nerve for the treatment of cubital tunnel syndrome: A meta-analysis

2014 ◽  
Vol 126 ◽  
pp. 150-155 ◽  
Author(s):  
Hong-wei Chen ◽  
Shan Ou ◽  
Guo-dong Liu ◽  
Jun Fei ◽  
Gang-sheng Zhao ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Clinical Efficacy ◽  
Meta Analysis ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Anterior Transposition ◽  
Tunnel Syndrome ◽  
Simple Decompression

scholarly journals Challenging the dogma: anterior transposition of the ulnar nerve is indicated in recurrent cubital tunnel syndrome

2020 ◽  
Vol 46 (1) ◽  
pp. 45-449
Author(s):  
Mike Ruettermann
Keyword(s):  
Ulnar Nerve ◽  
Meta Analysis ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Current Evidence ◽  
Anterior Transposition ◽  
Tunnel Syndrome ◽  
Robust Evidence ◽  
Nerve Transposition

The current evidence for treatment of primary idiopathic cubital tunnel syndrome favours an in situ release. However, anterior transposition of the ulnar nerve remains a popular procedure in recurrent cubital tunnel syndrome. For more than 20 years, I have performed an extended in situ release only, and achieved similar or better results than with nerve transposition. In performing a systematic review of the evidence for surgery for recurrent cubital tunnel syndrome, I could only include 16 out of 296 studies regarding treatment of recurrent cases of cubital tunnel syndrome. A meta-analysis was not possible, due to selection bias and disparity of outcome measurements of the studies. However, I could not find robust evidence that supports the need of an anterior transposition of the ulnar nerve in recurrent cubital tunnel syndrome over an in situ decompression. My own experience of an extended in situ release with complete neurolysis with reasonable outcomes, in combination with the lack of literature support of anterior transposition in recurrent cases, have led me to the consideration that this dogma should be revised.

ASSOCIATIONS BETWEEN ULNAR NERVE STRAIN AND ACCOMPANYING CONDITIONS IN PATIENTS WITH CUBITAL TUNNEL SYNDROME

Hand Surgery ◽  
2014 ◽  
Vol 19 (03) ◽  
pp. 329-333 ◽  
Author(s):  
Kensuke Ochi ◽  
Yukio Horiuchi ◽  
Toshiyasu Nakamura ◽  
Kazuki Sato ◽  
Kozo Morita ◽  
...  
Keyword(s):  
Disease Severity ◽  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Tunnel Syndrome ◽  
The Mean ◽  
Simple Decompression

Pathophysiology of cubital tunnel syndrome (CubTS) is still controversial. Ulnar nerve strain at the elbow was measured intraoperatively in 13 patients with CubTS before simple decompression. The patients were divided into three groups according to their accompanying conditions: compression/adhesion, idiopathic, and relaxation groups. The mean ulnar nerve strain was 43.5 ± 30.0%, 25.5 ± 14.8%, and 9.0 ± 5.0% in the compression/adhesion, idiopathic, and relaxation groups respectively. The mean ulnar nerve strains in patients with McGowan's classification grades I, II, and III were 18.0 ± 4.2%, 27.1 ± 22.7%, and 33.7 ± 24.7%, respectively. The Jonckheere-Terpstra test showed that there were significant reductions in the ulnar nerve strain among the first three groups, but not in the three groups according to McGowan's classification. Our results suggest that the pathophysiology, not disease severity, of CubTS may be explained at least in part by the presence of ulnar nerve strain.

scholarly journals Subcutaneous Versus Submuscular Anterior Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome

Medicine ◽  
2015 ◽  
Vol 94 (29) ◽  
pp. e1207 ◽  
Author(s):  
Chun-Hua Liu ◽  
Shi-Qiang Wu ◽  
Xiao-Bin Ke ◽  
Han-Long Wang ◽  
Chang-Xian Chen ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Anterior Transposition ◽  
Tunnel Syndrome

RISK FACTORS FOR DISLOCATION OF THE ULNAR NERVE AFTER SIMPLE DECOMPRESSION FOR CUBITAL TUNNEL SYNDROME

Hand Surgery ◽  
2014 ◽  
Vol 19 (01) ◽  
pp. 13-18 ◽  
Author(s):  
K. Murata ◽  
S. Omokawa ◽  
T. Shimizu ◽  
Y. Nakanishi ◽  
K. Kawamura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ulnar Nerve ◽  
High Probability ◽  
Multiple Logistic Regression Analysis ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Anterior Dislocation ◽  
Multiple Logistic Regression ◽  
Tunnel Syndrome ◽  
Simple Decompression

Anterior dislocation of the ulnar nerve is occasionally encountered after simple decompression of the nerve for treatment of cubital tunnel syndrome. The purpose of this study was to determine whether the incidence of dislocation of the nerve following simple decompression of the nerve is correlated with the patient's preoperative characteristics and/or elbow morphology. We studied 51 patients with cubital tunnel syndrome who underwent surgery at our institution. Intraoperatively, we simulated dislocation of the nerve after simple decompression by flexing the elbow after releasing the nerve in each patient. Univariate and multiple logistic regression analysis showed that young age and a small ulnar nerve groove angle are positively correlated with dislocation of the nerve. Our results suggest that patients who are young and/or have a sharply angled ulnar nerve groove identified radiographically have a high probability of experiencing anterior dislocation of the ulnar nerve after simple decompression.

Functional Outcome of Anterior Transposition of the Vascularized Ulnar Nerve for Cubital Tunnel Syndrome

1998 ◽  
Vol 23 (5) ◽  
pp. 613-616 ◽  
Author(s):  
A. ASAMI ◽  
K. MORISAWA ◽  
T. TSURUTA
Keyword(s):  
Functional Outcome ◽  
Ulnar Nerve ◽  
Conduction Velocity ◽  
Nerve Conduction ◽  
Nerve Conduction Velocity ◽  
Clinical Results ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Anterior Transposition ◽  
Tunnel Syndrome

Anterior transposition of the ulnar nerve is a widely used treatment for cubital tunnel syndrome, but neurolysis performed at the time of surgery may impair the blood supply to the ulnar nerve. This study compared the results of intramuscular anterior transposition of the ulnar nerve with or without preserving the extrinsic vessels of the ulnar nerve in 35 patients. The postoperative nerve conduction velocity and the clinical results were better in the group in which the extrinsic vessels were presented.

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

Hand ◽  
2018 ◽  
Vol 14 (6) ◽  
pp. 776-781 ◽  
Author(s):  
John M. Felder ◽  
Susan E. Mackinnon ◽  
Megan M. Patterson
Keyword(s):  
Ulnar Nerve ◽  
Ulnar Artery ◽  
Cubital Tunnel Syndrome ◽  
Medial Epicondyle ◽  
Cubital Tunnel ◽  
Anterior Transposition ◽  
Straight Line ◽  
Tunnel Syndrome ◽  
Poor Outcomes ◽  
Flexor Digitorum

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.

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