Comparative outcomes of ulnar nerve transposition versus neurolysis in patients with entrapment neuropathy at the cubital tunnel: a 20-year analysis

Abstract

In cases of ulnar nerve compression at the cubital tunnel, both neurolysis and transposition are effective in improving clinical outcome. The only statistically significant advantage of neurolysis over transposition seems to be relief of localized elbow pain. We recommend neurolysis as the preferred procedure.

Autogenous Vein Wrapping versus In Situ Decompression for Management of Secondary Cubital Tunnel Syndrome after Surgical Fixation of Elbow Fractures: Short-Term Functional and Neurophysiological Outcome

“…12,13 When the main underlying cause of the secondary CuTS is heavy scarring, the objective of surgical intervention will be relieving compression, which is basically achieved either via formal open in situ decompression of the ulnar nerve with or without external/internal neurolysis throughout the entire cubital tunnel together with preserving neural vascularity or via more conservative endoscopic technique that would avoid more scarring. [13][14][15][16][17] However, in the authors' view, the formal open in situ decompression will be more suitable for the cases of both groups involved in this study due to the heavy tough scarring encountered in all cases that could not be amenable to release via endoscopic technique. Currently, the goals are expanded to include relieving compression neuropathy of the ulnar nerve and preventing postoperative adhesions, thus minimizing recurrence rate which puts the foundation for orthobiologic nerve insulators.…”

“…A retrospective analysis over a 20-year period was performed which included 480 patients who underwent neurolysis (179) and anterior subcutaneous transposition (301). 17 They found that the only statistically significant advantage of neurolysis over transposition was the relief of localized elbow pain. On our study, all examined clinical parameters were better in group II patients, with the statistically significant results achieved in the sensory domain.…”

Comparison of two medial epicondylectomy techniques in cubital tunnel syndrome

“…Simple decompression and anterior transposition of the ulnar nerve are claimed to be the most commonly applied surgical treatment options for CuTS. [15,16] However, it is well-documented that the medial epicondyle plays an important role in pathophysiology of CuTS by causing traction and stretching of the nerve. [4,10,17] Satisfactory clinical results have been reported in the literature for simple in situ decompression of the ulnar nerve for CuTS.…”

“…[4,10,17] Satisfactory clinical results have been reported in the literature for simple in situ decompression of the ulnar nerve for CuTS. [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.…”

“…[31] In many studies dealing with CuTS, the SWM test was not used for clinical evaluation of treatment alternatives. [6,7,9,16,20,28] It was demonstrated that the SWM test is a valuable quantitative test for assessing sensations in different types of compression neuropathies and there is a significant relationship between sensory nerve conduction studies and this test. [32] Thus, the use of SWM test strengthens the clinical outcomes of our study and we believe that it must be used for clinical follow-up of neural recovery, not only in peripheral nerve injuries, but also in compression neuropathies of the peripheral nerves.…”