Trends in the Surgical Treatment for Cubital Tunnel Syndrome: A Survey of Members of the American Society for Surgery of the Hand

Yahya, Ayesha; Malarkey, Andrew; Eschbaugh, Ryan L.; Bamberger, H. Brent

doi:10.1177/1558944717725377

Cited by 34 publications

(26 citation statements)

References 36 publications

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“…Our response rate was 27%; however, this is equivalent to or greater than other published surveys involving the ASSH membership. 22,23 Furthermore, our questionnaire classified ulnar entrapment severity based on the presence of muscle weakness; however, other factors may be taken into account in assessing disease severity, including symptom frequency and constancy and duration, sensibility, paresthesias, patient-reported outcomes measures, electrodiagnostic testing, and various classification schema including Gu's, Dellon's, and McGowan's, which were not reflected in the study design.…”

Section: Discussionmentioning

confidence: 99%

Decision-Making Factors for Ulnar Nerve Transposition in Cubital Tunnel Surgery

DeGeorge

2018

Jnl Wrist Surg

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Background We designed a survey to ascertain the current perspectives of hand surgeons on the evaluation and management of ulnar nerve instability at the elbow. The secondary aim was to assess the concordance of hand surgeons on definitions of the terms “subluxated” and “dislocated” for classification of ulnar nerve instability. Methods A questionnaire, including demographic practice variables, cubital tunnel practice patterns, preoperative imaging and electrodiagnostic evaluation, and a series of standardized intraoperative photographs of ulnar nerve instability at the elbow were developed and distributed to the current American Society for Surgery of the Hand (ASSH) membership. Results A total of 690 (26.8%) members completed the survey; 84.2% of respondents indicated that they evaluate for ulnar nerve instability preoperatively with clinical examination, whereas only 6.1% indicated they routinely obtained dynamic ultrasound. Respondents indicated that the factors most strongly influencing their decision to proceed with anterior transposition of the ulnar nerve were subluxation on physical examination (89.6%), history consistent with ulnar nerve subluxation (85.8%), and muscle atrophy (43.2%). On review of clinical photographs, respondents demonstrated varying degrees of agreement on the terms “subluxated” or “dislocated” and recommendations for ulnar nerve transposition at intermediate degrees of ulnar nerve instability. Conclusion ASSH members routinely evaluate for ulnar nerve instability with history and clinical examination without uniform use of preoperative ultrasound, and nearly half of the time the decision to transpose the ulnar nerve is made intraoperatively. Definitions for the degree of ulnar nerve instability at the elbow are not uniformly agreed upon, and further development of a classification system may be warranted to standardize treatment.

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Section: Discussionmentioning

confidence: 99%

Decision-Making Factors for Ulnar Nerve Transposition in Cubital Tunnel Surgery

DeGeorge

2018

Jnl Wrist Surg

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“…Greater then 70% of hand surgeons surveyed preferred trialing conservative therapy for patients with intermittent symptoms and normal electrophysiological parameters; however, there is a critical lack of high quality literature on this topic. 5…”

Section: Introductionmentioning

confidence: 99%

Conservative treatment of cubital tunnel syndrome: A systematic review

Kooner¹,

Cinats²,

Kwong³

et al. 2019

Orthop Rev (Pavia)

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Cubital tunnel syndrome (CuTS) is one of the most common compression neuropathies of the upper extremity. Conservative management of cubital tunnel syndrome is often considered first line therapy for mild or moderate symptoms; however, there is little evidence-based literature to guide physicians in this regard. As such, the objective of this study is to complete a comprehensive literature search of the conservative therapies available for treatment of CuTS. Additionally, we hope to assess the evidence for each therapy so that we can make evidence-based recommendations regarding the type and duration of optimal treatment. The databases MEDLINE, EMBASE, and CINAHL were search using a sensitive search strategy. Eligibility for studies included any studies or conference abstracts in which patients were treated conservatively for primary CuTS. Any form of non-operative treatment was acceptable. A data extraction form was developed to collect all information and outcomes of interest, including study design, level of evidence, number of patients, treatment modalities, follow-up time, patient reported outcomes, and electrophysiological markers. Qualitative and quantitative analysis was then completed based on the data extraction form. Given the heterogeneity of the included studies, results were summarized as best evidence available. Our sensitive literature search produced 6484 studies. Initial screening based on title and abstract resulted in the selection of 40 studies that underwent full text review. From these 19 studies were included for analysis in our systematic review. There were 3 level I studies, 4 level II studies, 3 level III studies, and 9 level IV studies. In total this included 844 patients. The most commonly reported outcomes included subjective patient reported outcomes and nerve conduction studies. The most common treatment modalities, from most to least common, included education and activity modification, splinting, steroid/lidocaine injection, nerve mobilization/gliding, pulsed ultrasound, laser therapy, non-steroidal anti-inflammatory drugs, and physiotherapy. The most common duration of therapy was 3 months with a median follow-up time of 3 months. There was moderate strength evidence to recommend the use of education/activity modification or splinting in mild or moderate CuTS. There is a paucity of literature and high-quality studies regarding the conservative management of CuTS. Regardless, there appears to be a role for non-operative management in CuTS, although further studies are needed to delineate this role further. In the cases of mild or moderate CuTS it is reasonable to trial education/activity modification or splinting as both appear to be equally effective.

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“…Modern surgical treatment for idiopathic ulnar neuropathy of the elbow has evolved through several phases, the two most prevalent techniques in use today being in situ decompression and transposition of the nerve anterior to the medial epicondyle, with several common permutations of each. Unless subluxation of the nerve is noted on preoperative or intraoperative examination, in which case anterior transposition is generally preferred, ( 4 , 5 ) the choice of technique is largely left to surgeon preference with no clearly superior procedure having been identified to date. Medial epicondylectomy is generally only indicated when structural abnormalities of the anatomy are present, often due to either trauma or degenerative changes, and may be performed in combination with other techniques.…”

Section: Introductionmentioning

confidence: 99%

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

Carlton

Khalid

2018

Front. Surg.

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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.

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Trends in the Surgical Treatment for Cubital Tunnel Syndrome: A Survey of Members of the American Society for Surgery of the Hand

Abstract: Our survey results indicate that open in situ decompression is the preferred operative procedure, if there is no ulnar nerve subluxation, among hand surgeons for cubital tunnel syndrome.

Cited by 34 publications

References 36 publications

Decision-Making Factors for Ulnar Nerve Transposition in Cubital Tunnel Surgery

Decision-Making Factors for Ulnar Nerve Transposition in Cubital Tunnel Surgery

Conservative treatment of cubital tunnel syndrome: A systematic review

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

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