Purpose-Randomized controlled trials have not identified a superior surgical approach to cubital tunnel syndrome surgery. This study evaluates the early morbidity of open in situ decompression and transposition.Methods-This prospective cohort study enrolled 125 adult patients indicated for cubital tunnel surgery at a tertiary institution. Exclusion criteria included preoperative use of narcotics and concurrent elbow procedures. In situ decompressions (n=47) and ulnar nerve transpositions (n=78) were performed. Data were collected by independent clinicians at 3 postoperative intervals: 1-3 weeks, 4-8 weeks, and >8 weeks. Postoperative data quantified surgical morbidity: Visual Analog Scale (0-10) surgical site pain, narcotic consumption, patient-reported disability (Levine-Katz, Patient Reported Elbow Evaluation [PREE] scores). Olecranon paresthesia and wound complications (hematoma, drainage, infection) were recorded.Results-No preoperative differences in age, sex, or the presence of pain existed between the surgical groups. Surgical site pain was not significantly different at any time. Following transposition, a significantly greater percentage of patients were using narcotics at 4-8 weeks after surgery and the average total morphine equivalents consumed per patient was significantly greater. Both Levine-Katz and PREE scores indicated greater disability at 1-3 and 4-8 weeks after transposition, but this significant difference resolved by final follow-up. Olecranon paresthesias occurred after both procedures but were significantly less frequent at 4-8 weeks and >8 weeks after decompression. Twelve hematomas occurred following transposition (15%) with 1 requiring operative debridement and 5 hematomas resolved with non-operative treatment after in situ decompression (11%).Conclusions-Ulnar nerve transposition imparts greater surgical morbidity than decompression with greater narcotic consumption, more patient-reported disability up to 8 weeks postoperatively and more persistent olecranon paresthesia. However, most differences in surgical morbidity are transient with resolution after 8 weeks following surgery.
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