Comparison of Simple Decompression and Anterior Subcutaneous Transposition of the Ulnar Nerve for the Treatment of Cubital Tunnel Syndrome

Background. In this study, we aim to evaluate clinical and functional results in patients with cubital tunnel syndrome who were treated with subcutaneous anterior transposition vs simple decompression of the ulnar nerve. Material and methods. Fifty-five patients were separated into two groups according to surgical technique. Group 1 comprised 35 patients (23 males, 12 females; mean age, 42.1 years; range, 28–56 years) who underwent anterior subcutaneous transposition of the ulnar nerve, whereas Group 2 included 20 patients (11 males, 9 females; mean age, 47.4 years; range, 25–59 years) who underwent simple decompression of the ulnar nerve. Results. The mean modified Bishop scores were 7.26 and 7.85 in Group 1 and Group 2, respectively (P< .05). The mean Q-DASH scores were 16.94 in Group 1 and 15.80 in Group 2 (P> .05). Postoperatively, paraesthesia regressed in 17 (85.7%) and 30 (85%) patients in Group 1 and Group 2, respectively (P> .05). Both groups demonstrated improvement in ulnar nerve function in comparison with the preoperative period, and ulnar nerve paralysis was not seen in any of our patients. A postsurgical incision scar developed in six (17.1%) and three patients (15%) in Group 1 and Group 2, respectively. Conclusion. Both simple decompression and anterior subcutaneous transposition of the ulnar nerve are effective and safe for the treatment of cubital tunnel syndrome, so we would favour simple decompression as it is a less extensive procedure.

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

Hand Surgery ◽

10.1142/s0218810414500233 ◽

2014 ◽

Vol 19 (03) ◽

pp. 329-333 ◽

Cited By ~ 2

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.

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Clinical Outcomes of Cubital Tunnel Syndrome after Transmuscular Anterior Transposition of the Ulnar Nerve

Clinics in Shoulder and Elbow ◽

10.5397/cise.2011.14.2.207 ◽

1970 ◽

Vol 14 (2) ◽

pp. 207-213

Author(s):

Soo Min Cha ◽

Kyung Cheon Kim ◽

Dong Hun Kang ◽

Hyun Dae Shin

Keyword(s):

Ulnar Nerve ◽

Motor Function ◽

Significant Degree ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Anterior Transposition ◽

Tunnel Syndrome ◽

Group 3 ◽

Group 2 ◽

Group 1

PURPOSE: To retrospectively analyze the clinical results of the cubital tunnel syndrome after ulnar nerve transmuscular anterior transposition according to the severity of the disease.MATERIALS AND METHODS: From January 2003 to December 2008, the 94 cases that underwent ulnar nerve anterior transposition using modified Mackinnon method after diagnosed as cubital tunnel syndrome were enrolled for this study. The severity of each cases was classified using McGowan classification before surgery, and were divided into grade I of 35 cases (group 1), grade II of 37 cases (group 2), and grade III of 22 cases (group 3).RESULTS: All groups showed significant degree of pain improvement, and which was more statistically significant in group 1 and 2 compared to group 3. All groups showed significant degree of sensory function improvement. The degree showed no difference between group 1 and 2, and 2 and 3, however, group 1 showed higher degree of improvement compared to group 3. All groups showed significant degree of motor function improvement, and which showed no difference between group 1 and 2, and compared to group 3, group 1 and 2 showed significant improvement of disease severity (p<0.05). In evaluation using Akahori classification after surgery, 28 cases in group 1 (80%), 27 cases in group 2 (73%), and 13 cases in group 3 (59%) showed results of "good" or "excellent". In the whole group, the age and Akahori classification after surgery showed significant negative correlation (p<0.05, r=-0.512).CONCLUSION: In the retrospective analysis regarding the cubital tunnel syndrome using modified Mackinnon method, postoperative pain, sensory, and motor function was improved compared to which before surgery, however, the degree of improvement decreased as the disease was more severe. Especially, as the age is older, the degree of improvement more decreases.

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Cubital tunnel syndrome treated with ulnar nerve simple decompression, anterior intramuscular or subcutaneous transposition: a parallel randomized controlled clinical trial

Clinical and Translational Orthopedics ◽

10.4103/2468-5674.178845 ◽

2016 ◽

Vol 1 (1) ◽

pp. 15

Author(s):

Rui Li ◽

Qian-qian Liu

Keyword(s):

Clinical Trial ◽

Ulnar Nerve ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Controlled Clinical Trial ◽

Randomized Controlled Clinical Trial ◽

Randomized Controlled ◽

Tunnel Syndrome ◽

Subcutaneous Transposition ◽

Simple Decompression

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Ulnar Nerve Neuropathy Secondary to “Snapping Triceps Syndrome”

Plastic Surgery Case Studies ◽

10.1177/2513826x17716452 ◽

2017 ◽

Vol 3 ◽

pp. 2513826X1771645

Author(s):

Stahs Pripotnev ◽

Colin White

Keyword(s):

Ulnar Nerve ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Dominant Male ◽

Ulnar Nerve Compression ◽

Compression Neuropathy ◽

History Of ◽

Tunnel Syndrome ◽

Subcutaneous Transposition ◽

Abnormal Anatomy

Cubital tunnel syndrome is the second most common compression neuropathy of the upper extremity and the most common point of compression for the ulnar nerve. We present a case of ulnar nerve compression neuropathy at the elbow secondary to an abnormal subluxating medial head of triceps. A 37-year-old right hand dominant male presented with a history of bilateral medial elbow pain and ulnar distribution hand numbness. During his left cubital tunnel release surgery, the abnormal anatomy was noted. Initial subfascial anterior transposition was insufficient and had to be revised to a subcutaneous transposition intraoperatively. Failure to recognize the contribution of triceps abnormalities can lead to incomplete resolution following surgery. Surgeons should be wary of uncommon findings and adjust their approach appropriately.

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Simple Decompression with Small Skin Incision for Cubital Tunnel Syndrome

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2002.0821 ◽

2002 ◽

Vol 27 (6) ◽

pp. 559-562 ◽

Cited By ~ 47

Author(s):

Y. TANIGUCHI ◽

M. TAKAMI ◽

T. TAMAKI ◽

M. YOSHIDA

Keyword(s):

Clinical Results ◽

Skin Incision ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Endoscopic Assistance ◽

Tunnel Syndrome ◽

Grade Ii ◽

The Mean ◽

Simple Decompression

Eighteen elbows in 17patients with cubital tunnel syndrome were treated by simple decompression using only a 1.5–2.5 cm skin incision with no endoscopic assistance. According to McGowan’s criteria, three elbows were classified preoperatively as grade I, six as grade II and nine as grade III. The mean follow-up period was 14 months (range 3–25). Clinical results were evaluated as excellent for four elbows, good for ten and fair for four. Improvement of symptoms occurred in all patients and dislocation of the ulnar nerve was not observed. Simple decompression through a small skin incision can be recommended for the treatment of cubital tunnel syndrome, if the indication is appropriate.

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

Hand Surgery ◽

10.1142/s0218810414500038 ◽

2014 ◽

Vol 19 (01) ◽

pp. 13-18 ◽

Cited By ~ 5

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.

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Anterior subcutaneous transposition of the ulnar nerve improves neurological function in patients with cubital tunnel syndrome

Neural Regeneration Research ◽

10.4103/1673-5374.167770 ◽

2015 ◽

Vol 10 (10) ◽

pp. 1690 ◽

Cited By ~ 4

Author(s):

Tian-bing Wang ◽

Bao-guo Jiang ◽

Wei Huang ◽

Pei-xun Zhang ◽

Zhang Peng ◽

...

Keyword(s):

Ulnar Nerve ◽

Cubital Tunnel Syndrome ◽

Neurological Function ◽

Cubital Tunnel ◽

Tunnel Syndrome ◽

Subcutaneous Transposition

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Cubital tunnel syndrome

EFORT Open Reviews ◽

10.1302/2058-5241.6.200129 ◽

2021 ◽

Vol 6 (9) ◽

pp. 743-750

Author(s):

Abdus S. Burahee ◽

Andrew D. Sanders ◽

Colin Shirley ◽

Dominic M. Power

Keyword(s):

Ulnar Nerve ◽

Motor Nerve ◽

Nerve Transfer ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Common Procedure ◽

Tunnel Syndrome ◽

Distal Nerve ◽

Denervated Muscles ◽

Simple Decompression

Cubital tunnel syndrome (CuTS) is the second most common compression neuropathy of the upper limb, presenting with disturbance of ulnar nerve sensory and motor function. The ulnar nerve may be dynamically compressed during movement, statically compressed due to reduction in tunnel volume or compliance, and tension forces may cause ischaemia or render the nerve susceptible to subluxation, further causing local swelling, compression inflammation and fibrosis. Superiority of one surgical technique for the management of CuTS has not been demonstrated. Different techniques are selected for different clinical situations with simple decompression being the most common procedure due to its efficacy and low complication rate. Adjunctive distal nerve transfer for denervated muscles using an expendable motor nerve to restore the axon population in the distal nerve is in its infancy but may provide a solution for severe intrinsic weakness or paralysis. Cite this article: EFORT Open Rev 2021;6:743-750. DOI: 10.1302/2058-5241.6.200129

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