Entrapment neuropathy at the cubital tunnel: Simple decompression is the method of choice

Abstract

We present a retrospective study of 41 patients treated by simple decompression for ulnar neuropathy. Pre- and postoperatively, patients were evaluated clinically and electrophysiologically. The median follow-up was 2 years (minimum: 0.5 years, maximum: 5.1 years). The leading pre-operative sign was motor loss in the ulnar distribution (36 patients = 89%) with consecutive atrophy of ulnar innervated muscles (30 patients = 75%). The secondary complaint was sensory impairment in 59% of all cases, less frequently patients presented with pain or paraesthesia. In the majority of cases the aetiology remained unknown (27 patients = 65%). When aetiology was known, previous trauma to the elbow was reported most frequently (9 patients = 22%). Motor nerve conduction velocity (mNCV), compared to the contralateral, non-involved arm, was lower at least for 10 m/s. In cases with atrophy of the ulnar innervated muscles the difference was greater than 15 m/s. In 89%, postoperative results were good or even very good. In 8% (3 patients) no improvement was observed. Worsening due to surgery did not occur. We could demonstrate a significant increase in postoperative mNCV of 7.95 m/s in all patients (p < 0.05). There is still disagreement as to the correct surgical treatment of this disorder. We favour simple decompression (SD) as the appropriate operative technique for cubital tunnel syndrome.

Surgical Treatment for Ulnar Nerve Entrapment at the Elbow

“…There are three methods for transposition: subcutaneous transposition, intramuscular transposition, and submuscular transposition. 4,5,22,28,30,37) We did not perform submuscular transposition in our series.…”

Recovery of ulnar innervated intrinsic muscles following anterior transposition of the ulnar nerve

“…Of the 516 patients with symptoms that were rated as severe before treatment, 110 patients did not have atrophy after surgery. Steiner et al (15) reported outcomes for 41 patients undergoing simple decompression. At presentation, 30 patients had muscle atrophy (11 cases were severe), and after surgery, 17 patients had persistent muscle wasting (three cases were severe).…”

Selection of Operative Procedures for Cubital Tunnel Syndrome

“…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.…”

“…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].…”