Comparison of the long-term results of anterior transposition of the ulnar nerve or simple decompression in the treatment of cubital tunnel syndrome—a prospective study

Keiner, Doerthe; Gaab, M. R.; Schroeder, Henry W. S.; Oertel, Joachim

doi:10.1007/s00701-009-0218-4

Cited by 57 publications

(43 citation statements)

References 29 publications

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“…A recent article reported that the patients treated with AT had inferior outcome when compared with patients treated with SD and partial epicondylectomy [11]. Meanwhile, another article reported that although both SD and AT had a good outcome, the SD should be preferred due to less invasion [12]. However, two previous meta-analyses have suggested that there was no statistically significant difference between SD and AT [13,14].…”

Section: Introductionmentioning

confidence: 90%

“…The average follow-up duration ranged from 12 to 76 months. Four out of 13 studies [6,12,21,26] were the high quality studies with the score over 3.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…These studies including 6 prospective studies [6,12,20,21,26] and 7 retrospective studies [11,[22][23][24][25]27,28] were published from 1970 to 2010. Among them, 5 studies investigated the comparison of SD vs. AST [12,[20][21][22]26] and 8 studies investigated the comparison of SD vs. ACT [6,11,20,[23][24][25]27,28]. The studies were conducted in America [20,23,27,28], Europe [3,5,6,20,22,23] and Australia [21,24].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…After this, 28 remaining articles were full-text reviewed. Finally, 12 articles [6,11,12,[20][21][22][23][24][25][26][27][28] including 13 studies met the inclusion criteria and were included in the meta-analysis.…”

Section: Literature Searchmentioning

confidence: 99%

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Clinical efficacy of simple decompression versus anterior transposition of the ulnar nerve for the treatment of cubital tunnel syndrome: A meta-analysis

Chen¹,

Ou²,

Liu³

et al. 2014

Clinical Neurology and Neurosurgery

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Section: Introductionmentioning

confidence: 90%

“…The average follow-up duration ranged from 12 to 76 months. Four out of 13 studies [6,12,21,26] were the high quality studies with the score over 3.…”

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

See 2 more Smart Citations

Clinical efficacy of simple decompression versus anterior transposition of the ulnar nerve for the treatment of cubital tunnel syndrome: A meta-analysis

Chen¹,

Ou²,

Liu³

et al. 2014

Clinical Neurology and Neurosurgery

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“…We asked patients about their current complaints in the 3 clinical modalities, and we asked them how they felt about their current symptoms overall compared with their symptoms before the revision surgery, similar to several other studies but more elaborate. 2,12,18 Satisfaction was graded on a 6-point scale: 1, complete resolution of symptoms; 2, moderate resolution of symptoms; 3, no change; 4, slight increase in symptoms; 5, moderate increase in symptoms; 6, severe increase in symptoms. The patients also indicated if, in hindsight, they would opt for revision surgery again, considering their current outcome.…”

Section: Data Collectionmentioning

confidence: 99%

Anterior subcutaneous transposition for persistent ulnar neuropathy after neurolysis

Gent¹,

Datema

Groen³

et al. 2017

FOC

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OBJECTIVE Little is known about optimal treatment if neurolysis for ulnar nerve entrapment at the elbow fails. The authors evaluated the clinical outcome of patients who underwent anterior subcutaneous transposition after failure of neurolysis of ulnar nerve entrapment (ASTAFNUE). METHODS A consecutive series of patients who underwent ASTAFNUE performed by a single surgeon between 2009 and 2014 was analyzed retrospectively. Preoperative and postoperative complaints in the following 3 clinical modalities were compared: pain and/or tingling, weakness, and numbness. Six-point satisfaction scores were determined on the basis of data from systematic telephonic surveys. RESULTS Twenty-six patients were included. The median age was 56 years (range 22–79 years). The median duration of complaints before ASTAFNUE was 23 months (range 8–78 months). The median interval between neurolysis and ASTAFNUE was 11 months (range 5–34 months). At presentation, 88% of the patients were experiencing pain and/or tingling, 46% had weakness, and 50% had numbness of the fourth and fifth fingers. Pain and/or tingling improved in 35%, motor function in 23%, and sensory disturbances in 19% of all the patients. Improvement in at least 1 of the 3 clinical modalities was found in 58%. However, a deterioration in 1 of the 3 modalities was noted in 46% of the patients. On the patient-satisfaction scale, 62% reported a good or excellent outcome. Patients with a good/excellent outcome were a median of 11 years younger than patients with a fair/poor outcome. No other factor was significantly related to satisfaction score. CONCLUSIONS A majority of the patients were satisfied after ASTAFNUE, even though their symptoms only partly resolved or even deteriorated. Older age is a risk factor for a poor outcome. Other factors that affect outcome might play a role, but they remain unidentified. One of these factors might be earlier surgical intervention. The modest results of ASTAFNUE should be mentioned when counseling patients after failure of neurolysis of ulnar nerve entrapment to manage their expectations. Patients, especially those who are elderly, might even consider not undergoing a secondary procedure. A randomized trial that includes a conservative treatment group and groups undergoing one of the several possible surgical procedures is needed to find the definitive answer for this clinical problem.

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Safety and Outcomes of Different Surgical Techniques for Cubital Tunnel Decompression

et al. 2020

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IMPORTANCE Cubital tunnel syndrome is the second most common compressive neuropathy, affecting 6% of the population. Numerous different operations are performed globally to treat it; however, prior conventional (pairwise) meta-analyses have been unable to determine which procedure is associated with the best outcomes and fewest complications. OBJECTIVE To evaluate which operation for cubital tunnel syndrome is associated with the greatest likelihood of symptomatic cure. DATA SOURCES PubMed, EMBASE, and CENTRAL were searched from database inception to March 2, 2019, with no restrictions on the setting or design of studies. STUDY SELECTION Experimental and observational studies directly comparing the outcomes of at least 2 surgical treatments for adults with primary cubital tunnel syndrome were included. Case reports were excluded, and when comparative studies had subgroups with 1 participant, the singleparticipant subgroup was excluded. The treatments had to be in situ decompression with or without medial epicondylectomy or an anterior subcutaneous, subfascial, intramuscular, or submuscular transposition. The access could be open, minimally invasive, or endoscopic. The comparator could be sham surgery or any operation mentioned earlier. DATA EXTRACTION AND SYNTHESIS Data were extracted by 2 independent reviewers, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline and the PRISMA Network Meta-analysis extension statement. Network meta-analysis was used to estimate the relative efficacy and safety associated with interventions using relative risks. Surgical techniques were ranked by their probability of being the best (P score) and interpreted in terms of their clinical impact. MAIN OUTCOMES AND MEASURES The primary outcome was response to treatment (ie, symptomatic improvement). The secondary outcomes were perioperative complications, reoperation, and recurrence. RESULTS A total of 30 studies of 2894 limbs undergoing 8 different operations were included. Across the studies, 56% of participants were men, the mean (SD) age was 48 (8) years, and patients had symptoms for a mean (SD) of 15 (7) months. Overall, 87% (95% CI, 92%-91%) of patients improved with surgery; all forms of in situ decompression were more effective than any type of transposition procedure; for example, open in situ decompression with epicondylectomy was (continued) Key Points Question For adults with primary cubital tunnel syndrome, which operation is associated with the best chance of symptomatic cure and lowest risk of complications? Findings This network meta-analysis included 30 studies comparing 8 different operations in 2894 limbs. It found that 87% of patients improve with surgery and that open in situ decompression (with or without a medial epicondylectomy) was associated with the greatest response to treatment and lowest complication risk. Meaning The findings of this study suggest that for adults with primary cubital tunnel syndrome, the most beneficial operation appears to be ope...

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Comparison of the long-term results of anterior transposition of the ulnar nerve or simple decompression in the treatment of cubital tunnel syndrome—a prospective study

Abstract: These long-term results show that both surgical techniques have a good outcome. Thus, the less invasive simple decompression should be preferred.

Cited by 57 publications

References 29 publications

Clinical efficacy of simple decompression versus anterior transposition of the ulnar nerve for the treatment of cubital tunnel syndrome: A meta-analysis

Clinical efficacy of simple decompression versus anterior transposition of the ulnar nerve for the treatment of cubital tunnel syndrome: A meta-analysis

Anterior subcutaneous transposition for persistent ulnar neuropathy after neurolysis

Safety and Outcomes of Different Surgical Techniques for Cubital Tunnel Decompression

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