Cubital compressive neuropathy in the elbow: in situ neurolysis versus anterior transposition – comparative study

Abstract

ObjectiveTo compare the results from two of the most commonly used surgical techniques: in situ decompression and subcutaneous transposition. The processes of patients treated surgically in a public university hospital between January 2004 and December 2011 were reviewed. Cases of proximal compression of the nerve, angular deformity of the elbow and systemic diseases associated with non-compressive neuropathy were excluded.MethodsNinety-seven cases were included (96 patients). According to the modified McGowan score, 14.4% of the patients presented grade Ia, 27.8% grade II, 26.8% grade IIb and 30.9% grade III. In situ neurolysis of the cubital was performed in 64 cases and subcutaneous anterior transposition in 33.ResultsAccording to the modified Wilson and Knout score, the results were excellent in 49.5%, good in 18.6%, only satisfactory in 17.5% and poor in 14.4%. In comparing the two techniques, we observed similar numbers of excellent and good results. Grades IIb and III were associated with more results that were less satisfactory or poor, independent of the surgical technique.ConclusionBoth techniques were shown to be efficient and safe for treating cubital tunnel syndrome.

Ulnar Nerve In Situ Decompression versus Transposition for Idiopathic Cubital Tunnel Syndrome: An Updated Meta-Analysis

“…Ultimately, 17 studies met the inclusion and exclusion criteria. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The included studies are summarized in reverse chronological order in ►Table 1. One study included 103 endoscopic patients in a prospective comparison study along with SD and UNT procedures.…”

Comparison of two medial epicondylectomy techniques in cubital tunnel syndrome

“…[16,18,19] The main clinical problem of this technique seems to be the recurrence of the symptoms and limited improvement in Wilson-Krout scores especially in grade IIB and III patients. [20,21] Of revision surgery, the 19% in Krogue's [22] series and about 50% worsening or persistent two-point discrimination test in Song's [23] series support the relatively low effectiveness of simple in situ decompression. In our opinion, these problems occur due to continuing traction effect of medial epicondyle on ulnar nerve with in situ decompression.…”

“…However, in some studies, this technique was reported to have less favorable results and increased risk of complications when compared with both in situ decompression and medial epicondylectomy. [18][19][20][21]25] These drawbacks of transposition techniques are related to compromised vascularity and intraneural microcirculation of the ulnar nerve. [25,26] Medial epicondylectomy has been shown to decrease ulnar nerve strain at the elbow which is accepted as a cause of CuTS.…”

Surgical Approaches and Their Outcomes in the Treatment of Cubital Tunnel Syndrome

“…The studies with the poorest outcomes as defined by combined good and excellent outcome percentages (CGE) were Bartels et al with 65.3% ( n = 75, U) and Sousa et al 67.2% ( n = 64, WK) ( 20 , 21 ). Those with the best CGE outcomes, both limited by notably small sample sizes, were Cho et al and Keiner et al with 100% ( n = 10, B) and 94.1% ( n = 17, U) ( 22 , 23 ).…”