Surgical Approaches and Their Outcomes in the Treatment of Cubital Tunnel Syndrome

Abstract

Purpose: This review was undertaken in order to provide an updated summary of the current literature on outcomes for various surgical treatments for cubital tunnel syndrome.Methods: Studies reporting outcomes for surgical treatment of cubital tunnel syndrome were collected through the PubMed database. Study structure, number of participants/procedures, mean follow-up times, scoring scales, and outcomes were collected according to the type of surgery: open decompression, endoscopic decompression, minimal incision, subcutaneous transposition, intramuscular transposition, and submuscular transposition.Results: Our findings indicate varying but comparable levels of success among all surgical techniques reviewed. Many different scoring scales were utilized, limiting direct quantitative comparison between most studies.Discussion: While some studies directly compared two or more techniques, there was rarely a statistically significant difference between groups. In comparisons that did reach statistically significant differences, there were others yet that found no difference in comparing the same techniques.Conclusions: None of the techniques in this review has demonstrated universal superiority above all others, but all appear to be effective in the treatment of cubital tunnel syndrome. The only consensus seems to be that transposition is preferred where the ulnar nerve tends to subluxate either on preoperative or intraoperative examination.

Percutaneous ultrasound-guided ulnar nerve release technique compared to open technique: A cadaveric study

“…Cubital tunnel syndrome affects 1.8-5.9% of the general population [17], with inconsistent success rates for conservative measures (splinting, activity modification, steroid injection) [18]. When the latter fails, and surgical treatment is warranted, a wide variety of surgical options are available, with no consensus as to which is the most efficient or reliable [8,9].…”

“…From this perspective, many techniques have been described. First, the open release of the ulnar nerve allows direct visualization of compressive sites to ensure freedom of the nerve's movement along its entire course [9]. Though it was found to be an effective technique with generally good results [29], complications such as superficial infections, wound dehiscence, incisional tenderness, and MABC nerve numbness was reported [30,31], in addition to increased post-operative pain and delayed healing time [9].…”

“…First, the open release of the ulnar nerve allows direct visualization of compressive sites to ensure freedom of the nerve's movement along its entire course [9]. Though it was found to be an effective technique with generally good results [29], complications such as superficial infections, wound dehiscence, incisional tenderness, and MABC nerve numbness was reported [30,31], in addition to increased post-operative pain and delayed healing time [9]. The vast majority of surgeons still prefer open in situ decompression of the ulnar nerve at the elbow for its ease, low cost, and accessibility [32], with transposition progressively falling out of favor as multiple studies demonstrated an increased risk of complications with no added benefits [33][34][35][36][37].…”

“…Optimal surgical treatment of ulnar nerve entrapment at the elbow is still controversial as none of the techniques mentioned above has demonstrated clear long-term superiority over the others [7][8][9].…”

Safety and Outcomes of Different Surgical Techniques for Cubital Tunnel Decompression

“… 9 During the last decade, at least 15 systematic reviews and pairwise meta-analyses have failed to resolve uncertainty about the efficacy and safety of these different operations for primary cubital tunnel syndrome, 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 which is manifested in persistent variation in practice. 23 This uncertainty is important to resolve because as many as 30% of patients do not improve after surgery 24 and many are subject to revision surgery, which is rarely curative. 25 …”