The impact of pre-existing ulnar nerve instability on the surgical treatment of cubital tunnel syndrome: a systematic review

Osborne’s modified decompression involves repairing Osborne’s ligament beneath the ulnar nerve after simple decompression for idiopathic cubital tunnel syndrome. In this retrospective interrupted time series, 31 patients underwent modified simple decompression and 20 patients underwent conventional simple decompression. In the modified simple decompression group, the ulnar nerve length was measured at operation in full elbow flexion and extension before and after repair of Osborne’s ligament. Ulnar nerve instability during elbow motion was measured using ultrasonography before operation and at 12 months after operation. In patients treated by modified simple decompression, the ulnar nerve length in full elbow flexion reduced significantly after repair of Osborne’s ligament. At 12 months after surgery, the grade of ulnar nerve instability was lower in the modified simple decompression group than in the conventional simple decompression group. The clinical outcomes did not differ significantly between the groups at 24 months after operation. Level of evidence: III

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Beyond the Cubital Tunnel: Use of Adjunctive Procedures in the Management of Cubital Tunnel Syndrome

Hand ◽

10.1177/1558944721998022 ◽

2021 ◽

pp. 155894472199802

Author(s):

Adam Evans ◽

William M. Padovano ◽

J. Megan M. Patterson ◽

Matthew D. Wood ◽

Warangkana Fongsri ◽

...

Keyword(s):

Electrical Stimulation ◽

Ulnar Nerve ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Pinch Strength ◽

Control Group ◽

Historical Cohort ◽

Patient Reported ◽

Tunnel Syndrome ◽

The Impact

Background: Our management of cubital tunnel syndrome has expanded to involve multiple adjunctive procedures, including supercharged end-to-side anterior interosseous to ulnar nerve transfer, cross-palm nerve grafts from the median to ulnar nerve, and profundus tenodesis. We also perform intraoperative brief electrical stimulation in patients with severe disease. The aims of this study were to evaluate the impact of adjunctive procedures and electrical stimulation on patient outcomes. Methods: We performed a retrospective review of 136 patients with cubital tunnel syndrome who underwent operative management from 2013 to 2018. A total of 38 patients underwent adjunctive procedure(s), and 33 received electrical stimulation. A historical cohort of patients who underwent cubital tunnel surgery from 2009 to 2011 (n = 87) was used to evaluate the impact of adjunctive procedures. Study outcomes were postoperative improvements in Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, pinch strength, and patient-reported pain and quality of life. Results: In propensity score–matched samples, patients who underwent adjunctive procedures had an 11.3-point greater improvement in DASH scores than their matched controls ( P = .0342). In addition, patients who received electrical stimulation had significantly improved DASH scores relative to baseline (11.7-point improvement, P < .0001), whereas their control group did not. However, when compared between treatment arms, there were no significant differences for any study outcome. Conclusions: Patients who underwent adjunctive procedures experienced greater improvement in postoperative DASH scores than their matched pairs. Additional studies are needed to evaluate the effects of brief electrical stimulation in compression neuropathy.

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Predictors of Surgical Outcomes Following Anterior Transposition of Ulnar Nerve for Cubital Tunnel Syndrome: A Systematic Review

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2011.09.024 ◽

2011 ◽

Vol 36 (12) ◽

pp. 1996-2001.e6 ◽

Cited By ~ 35

Author(s):

Qiyun Shi ◽

Joy C. MacDermid ◽

P. Lina Santaguida ◽

Hmwe Hmwe Kyu

Keyword(s):

Systematic Review ◽

Ulnar Nerve ◽

Surgical Outcomes ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Anterior Transposition ◽

Tunnel Syndrome

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Outcomes of ulnar nerve anterior transmuscular transposition and significance of ulnar nerve instability in cubital tunnel syndrome

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2018.11.054 ◽

2019 ◽

Vol 28 (6) ◽

pp. 1120-1129 ◽

Cited By ~ 2

Author(s):

Lisa M. Frantz ◽

Jessica M. Adams ◽

G. Stephen Granberry ◽

Sarah M. Johnson ◽

Bernard F. Hearon

Keyword(s):

Ulnar Nerve ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Tunnel Syndrome ◽

Ulnar Nerve Instability

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Trends in the Surgical Treatment for Cubital Tunnel Syndrome: A Survey of Members of the American Society for Surgery of the Hand

Hand ◽

10.1177/1558944717725377 ◽

2017 ◽

Vol 13 (5) ◽

pp. 516-521 ◽

Cited By ~ 10

Author(s):

Ayesha Yahya ◽

Andrew R. Malarkey ◽

Ryan L. Eschbaugh ◽

H. Brent Bamberger

Keyword(s):

Surgical Treatment ◽

Ulnar Nerve ◽

Conservative Management ◽

Online Survey ◽

Cubital Tunnel Syndrome ◽

Sensory Loss ◽

Cubital Tunnel ◽

Tunnel Syndrome ◽

American Society

Background: Cubital tunnel syndrome is the second most common compression neuropathy affecting the upper extremity. The aim of this study was to determine the preferred surgical treatment for cubital tunnel syndrome by members of the American Society for Surgery of the Hand (ASSH). Methods: We invited members of the ASSH research mailing list to complete our online survey. They were presented with 6 hypothetical cases and asked to choose their preferred treatment from the following options: open in situ decompression, endoscopic decompression, submuscular transposition, subcutaneous transposition, medial epicondylectomy, and conservative management. This was assessed independently and anonymously through an online survey (SurveyMonkey). Results: 1069 responses were received. Seventy-three percent of the respondents preferred to continue conservative management when a patient presented with occasional paresthesias for greater than 6 months with a normal electromyogram (EMG) or nerve conduction velocity (NCV). Sixty-five percent picked open in situ decompression if paresthesias, weakness of intrinsics, and EMG/NCV reports of mild to moderate ulnar nerve entrapment was present. More than 50% of respondents picked open in situ decompression, as their preferred treatment when sensory loss of two-point discrimination of less than 5 or more than 10 was present in addition to the findings mentioned above. Seventy-nine percent of the respondents said their treatment algorithm would change if ulnar nerve subluxation was present. Conclusions: Our survey results indicate that open in situ decompression is the preferred operative procedure, if there is no ulnar nerve subluxation, among hand surgeons for cubital tunnel syndrome.

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Anterior Subfascial Transposition of the Ulnar Nerve

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2002.0867 ◽

2003 ◽

Vol 28 (1) ◽

pp. 73-76 ◽

Cited By ~ 14

Author(s):

L. C. TEOH ◽

F. C. YONG ◽

S. H. TAN ◽

Y. H. ANDREW CHIN

Keyword(s):

Surgical Treatment ◽

Ulnar Nerve ◽

Cubital Tunnel Syndrome ◽

Muscle Group ◽

Rating System ◽

Cubital Tunnel ◽

Operative Outcome ◽

Tunnel Syndrome ◽

Time Of Operation

After anterior subfascial transposition, the ulnar nerve lies superficial to the flexor-pronator muscle group but deep to its fascia. Eight patients with cubital tunnel syndrome were treated with this method and reviewed retrospectively. The average age at the time of operation was 52 years. All patients had severe cubital tunnel syndrome based on Dellon’s classification. The average follow-up period was 2 years and 9 months. Post-operative outcome assessment was based on the modified Bishop rating system. Six patients had excellent and two had good outcomes. All were back at work by the 5th post-operative week. There were no complications or recurrence of symptoms. Anterior subfascial transposition of the ulnar nerve is an effective method of surgical treatment for patients with severe cubital tunnel syndrome.

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