Effective Surgical Treatment of Cubital Tunnel Syndrome Based on Provocative Clinical Testing without Electrodiagnostics

Background Resolution of symptoms including pain, numbness, and tingling outside of the median nerve distribution has been shown to occur following carpal tunnel release. We hypothesized that a similar effect would be found after release of the ulnar nerve at the elbow. Methods Twenty patients with isolated cubital tunnel syndrome were prospectively enrolled. The upper extremity was divided into six zones, and the location of pain, numbness, tingling, or strange sensations was recorded pre-operatively. Two-point discrimination, Semmes-Weinstein monofilament testing, and validated questionnaires were collected. The same data were collected at 6-week follow-up. Paired t tests or nonparametric Wilcoxon Signed-Rank tests were used where appropriate to examine for significant (p≤0.05) changes between pre-and post-operative scores. Results Probability of resolution was greater outside of the ulnar nerve distribution than within at early follow-up. There was a decrease in pain, numbness, and tingling symptoms both within and outside the ulnar distribution after cubital tunnel release. There was a decrease in pain as measured by several validated questionnaires. Conclusion This study documents resolution of symptoms in an extra-ulnar distribution after cubital tunnel release. Improvement in pain and function after cubital tunnel release may be associated with an improvement in symptoms both within and outside the ulnar nerve distribution. Future studies could be directed at correlating pre-operative disease severity with probability of extra-territorial symptom resolution using a larger sample population.

Section: Discussionmentioning

confidence: 93%

Prospective Cohort Study of Symptom Resolution outside of the Ulnar Nerve Distribution following Cubital Tunnel Release

Chimenti

McIntyre

Childs

et al. 2014

“…However, Greenwald demonstrated that excellent surgical outcomes can be obtained without electrodiagnostics. 5 Therefore, clinical examination alone is likely sufficient to establish the diagnosis. Finally, patient's reporting of duration of symptoms prior to initial presentation is potentially subject to recall bias.…”

Section: Discussionmentioning

confidence: 99%

Muscle Atrophy at Presentation of Cubital Tunnel Syndrome

Drake

Hensley

Chen

et al. 2016

Background: The purpose of this study is to describe the demographics and duration of symptoms of patients with cubital tunnel syndrome who present with muscle atrophy. Methods: We identified 146 patients who presented to the hand surgery clinic at a single institution over a 5-year period with an initial diagnosis of cubital tunnel syndrome based on history and physical examination. Medical records were retrospectively reviewed to determine if there was a difference in demographic data, physical examination findings, and duration of symptoms in patients who presented with muscle atrophy from those with sensory complaints alone. Results: A total of 17/146 (11.6%) of patients presented with muscle atrophy, all of which were men. In all, 17.2% of men presented with atrophy. Age by itself was not a predictor of presentation with atrophy; however, younger patients with atrophy presented with significantly shorter duration of symptoms. Patients under the age of 29 years presenting with muscle atrophy on average had symptoms for 2.4 months compared with 16.2 months of symptoms for those over 55 years of age. Conclusions: Men with cubital tunnel syndrome are more likely to present with muscle atrophy than women. Age is not necessarily a predictor of presentation with atrophy. There is a subset population of younger patients who presents with extremely short duration of symptoms that rapidly develops muscle atrophy.

“…Much of the controversy of the operative procedure for carpal tunnel syndrome is the method by which to release the ligament but most surgeons would agree that successful management of patients with carpal tunnel syndrome depends on complete release of the flexor retinaculum [1,3,6,17,22]. In contrast for cubital tunnel syndrome, there are numerous operative procedures that have been described for the treatment of cubital tunnel syndrome ranging from simple decompression, medial epicondylectomy to transposition of the ulnar nerve [2,4,7,9,12,13,14,15,16,19,21,23,24,25,26,27,29,30,31]. These procedures vary not only in surgical technique but also in the correction of the etiologic factors.…”

Section: Discussionmentioning

confidence: 99%

“…There are numerous operative procedures described for the treatment of cubital tunnel syndrome ranging from simple decompression, medial epicondylectomy to transposition of the ulnar nerve [2,4,7,9,12,13,14,15,16,19,21,23,24,25,26,27,29,30,31]. With each operative procedure, there have been reports of excellent patient outcome as well as postoperative complications [10,11,18,28].…”

Section: Introductionmentioning

confidence: 99%

Selection of Operative Procedures for Cubital Tunnel Syndrome

Novak

Mackinnon²

2008

The purpose of this study was to investigate the primary operative procedures that are performed by hand surgeons for cubital tunnel syndrome and their reported satisfaction with these procedures. The survey consisted of 22 questions regarding primary operative treatment of cubital tunnel syndrome and demographics and was sent by email to the 459 active members of the American Association for Hand Surgery. One hundred sixty-four surgeons completed the survey (36% response rate). The total sample included 154 hand surgeons (143 males, 11 females) who operated on cubital tunnel syndrome and the majority of surgeons were in private practice (n=100) followed by academic practice (n=50). The most prevalent factors that influence the decision to operate include evidence of muscle atrophy (84%), abnormal nerve conduction studies (51%), and failed non-operative treatment (49%). Most surgeons (n=133) reported using more than one operative procedure for their patients with cubital tunnel syndrome. Factors that influenced the operative procedure selected included the degree of nerve compression (60%), medical comorbidities (30%), patient's occupation (28%), and obesity (22%). Following carpal tunnel surgery, 88% of the surgeons were "very satisfied" with their patient outcome and following surgery for cubital tunnel syndrome, only 44% were "very satisfied" with their patient outcome. Most surgeons use more than one operative procedure in their treatment of patients with cubital tunnel syndrome and the selection of the operative procedure is influenced by patient factors and surgeon preference.