Surgical Treatment of Cubital Tunnel Syndrome: Trends and the Influence of Patient and Surgeon Characteristics

Abstract

Purpose Cubital tunnel syndrome is the second most common compression neuropathy in the upper extremity. A variety of procedures are used for treatment of cubital tunnel syndrome. There is a lack of consensus regarding the most appropriate procedure owing to similar rates of operative success and strong proponents for each technique. Our aim was to examine trends in and determinants of the use of different procedures for treatment of cubital tunnel syndrome. Methods We performed a retrospective cross-sectional analysis of the Healthcare Cost and Utilization Project Florida State Ambulatory Surgery Database for 2005 to 2012. We selected all patients who underwent in-situ decompression, transposition, or other surgical treatments for cubital tunnel syndrome. We tested trends in the use of these techniques and performed a multivariable analysis to examine associations between patient characteristics and surgeon case volume and the use of different techniques. Results Of the 26,164 patients who underwent surgery for cubital tunnel syndrome, 79.7% underwent in-situ decompression, 16.2% underwent transposition, and 4.1% underwent other surgical treatment. Over the study period, there was a statistically significant increase in the use of in-situ release and a decrease in the use of transposition. Females and patients treated by surgeons with a higher cubital tunnel surgery case volume underwent in-situ release at a statistically higher rate than other techniques. Conclusions In Florida, surgeon practice reflects the widespread adoption of in-situ release as the primary treatment for cubital tunnel syndrome and these numbers are increasing. Patient demographics and surgeon-level factors influence procedure selection. Level of Evidence III, Therapeutic

Comparative Morbidity of Cubital Tunnel Surgeries: A Prospective Cohort Study

“…The popularity of in situ decompression has increased in recent years as randomized controlled trials have not demonstrated the superiority of any single surgical procedure for cubital tunnel syndrome. 39 We believe our data indicating reduced surgical morbidity associated with open in situ decompression versus transposition offers another factor to consider when choosing a primary surgery for cubital tunnel syndrome. Although patient-reported health measures indicate similar outcomes after 8 weeks, earlier improvement or more rapid return to function may be highly valued by some patients.…”

So You Have a Research Idea

“…14 Free to surgeons and American Association for Accreditation of Ambulatory Surgery Facilities-accredited surgery centers. 15 American Society for Plastic Surgeons fee, $125 application; $1274 annual. (Table 3).…”

“…Squiteri et al 14 found racial and insurancebased disparities in pediatric replantation rates using the KID database. Using the 2006 through 2012 Florida SASD, Adkinson et al 15 found that rates of in situ release for ulnar nerve decompression are rising, and rates of nerve transposition are decreasing. In addition, surgeons in the highest category of cubital tunnel surgery case volume were substantially more likely to perform in situ release.…”

Predictors of surgical outcomes after in situ ulnar nerve decompression for cubital tunnel syndrome

“…Conservative treatment is firstly recommended to CuTS patients with mild symptoms, and if conservative treatment fails, operative treatment is indicated. 5 There are three main surgical procedures for CuTS patients, including in situ decompression, medial epicondylectomy, and intramuscular, submuscular, or subcutaneous anterior transposition of the ulnar nerve, but which one is the optimal procedure remains controversial. 6 – 8 Among these procedures, anterior transposition of the ulnar nerve is commonly used by many surgeons.…”

“…In consideration of this situation, simple in situ decompression of the ulnar nerve, which seems to achieve similar postoperative results to transposition of the ulnar nerve, has gained popularity gradually. 5 , 9 …”