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

Abstract

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.

Intraoperative electrical stimulation promotes the short-term recovery of patients with cubital tunnel syndrome after surgery

“…In both animal and human studies, electrical stimulation can enhance axonal regeneration after the surgery [ 12 ]. Another research has demonstrated that intraoperative electrical stimulation improves the scores of Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire in severe cubital tunnel syndrome patients [ 13 ]. Herein, this research aimed to explore whether intraoperative electrical stimulation has beneficial effects on the short-term recovery of cubital tunnel syndrome patients.…”

Reply: Supercharge End-to-Side Anterior Interosseous–to–Ulnar Motor Nerve Transfer Restores Intrinsic Function in Cubital Tunnel Syndrome

“…3 Based on extensive research from our translational nerve research laboratory, we performed the first “supercharge” end-to-side nerve transfer of the terminal branch of the anterior interosseous nerve to the motor component of the ulnar nerve in the distal forearm over 12 years ago 4 ; in the United States, we have yet to reach the “tipping point” of adoption, 5,6 although there continue to be reports from early adopters. 7–11 In an effort to safely translate this procedure to eligible patients, we have published previously on our technique, 4,12 preoperative assessment, 13 indications, 14 outcomes, 1,15,16 and educational 17 studies.…”

“…However, this is secondary and addressed with physiotherapy in addition to the main procedures that address the cubital tunnel. 16,19 In the rare case of neurogenic thoracic outlet syndrome, where the primary compression is proximal to the cubital tunnel, an anterior interosseous nerve–to–ulnar motor nerve transfer may also be indicated in cases of severe axonal loss, but these patients were not included in the current study. In fact, the more proximal the compression leading to axonal loss, the more reason to use this nerve transfer to restore intrinsic function, as there is less hope for regeneration to a distal target.…”