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Córdoba-Mosqueda ME, Rasulić L, Savić A, Grujić J, Vitošević F, Lepić M, Mićić A, Radojević S, Mandić-Rajčević S, Jovanović I, Rodríguez-Aceves CA. Quality of life and satisfaction in patients surgically treated for cubital tunnel syndrome. Neurol Res 2023; 45:138-151. [PMID: 36130919 DOI: 10.1080/01616412.2022.2126163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Cubital tunnel syndrome (CuTS) results from compression of the ulnar nerve at the elbow, resulting in pain, weakness, and numbness of the hand and forearm. This work describes the Quality of Life (QoL) and satisfaction after CuTS surgery and identifies the factors associated with those outcomes. METHODS This cross-sectional study included patients surgically treated for CuTS from January 2011 to September 2021 at the Neurosurgery Clinic of the Clinic Center in Serbia. The questionnaires applied were the Short Form 36 (SF-36), EuroQol instrument (EQ-5D-5 L), Bishop's score and Patient-Rated Ulnar Nerve Evaluation (PRUNE). RESULTS Sixty-two patients met the inclusion criteria. Bishop's score: The median score was 10 (7.75-11), 54.8% of the cases presented excellent results. PRUNE: The median score for symptoms was 19 (6-38.5); for functional, was 14 (0.75-38); and the total was 18.25 (5.87-34.12). SF-36: The subscale with the best result was social functioning (84.68 ± 22.79). The scale with the worst value was emotional well-being (49.35 ± 7.87). EQ-5D-5L: Over 50% patients did not present problems with mobility, self-care, activity, and anxiety. The average EQ-VAS was 72.77 ± 18.70; and 0.72 ± 0.21 of the EQ-index, revealing a good QoL. Models for QoL and satisfaction: Ten models showed statistical significance. The variables with major involvement were body mass index and time evolution of the symptoms. CONCLUSION Surgical decompression has proved to diminish the symptoms, improving QoL and satisfaction. Many fixed and changeable factors can affect the satisfaction levels after surgery.
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Affiliation(s)
- María Elena Córdoba-Mosqueda
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Lukas Rasulić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Andrija Savić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jovan Grujić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Filip Vitošević
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Neuroradiology Department, Center for Radiology and MRI, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Lepić
- Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Aleksa Mićić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Stefan Mandić-Rajčević
- School of Public Health and Health Management and Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Jovanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
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Classifying the Severity of Cubital Tunnel Syndrome: A Preoperative Grading System Incorporating Electrodiagnostic Parameters. Plast Reconstr Surg 2022; 150:115e-126e. [PMID: 35544306 DOI: 10.1097/prs.0000000000009255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current classifications for cubital tunnel syndrome have not been shown to reliably predict postoperative outcomes. In this article, the authors introduce a new classification that incorporates clinical and electrodiagnostic parameters, including compound muscle action potential amplitude, to classify the preoperative severity of cubital tunnel syndrome. The authors compare this to established classifications and evaluate its association with patient-rated improvement. METHODS The authors reviewed 44 patients who were treated surgically for cubital tunnel syndrome. Patients were retrospectively classified using their proposed classification and the Akahori, McGowan-Goldberg, Dellon, and Gu classifications. Correlation of grades was assessed by Spearman coefficients and agreement was assessed by weighted kappa coefficients. Patient-reported impairment was assessed using the Disabilities of the Arm, Shoulder, and Hand questionnaire before and after surgery. RESULTS The classifications tended to grade patients in a similar way, with Spearman coefficients of 0.60 to 0.85 ( p < 0.0001) and weighted kappa coefficients of 0.46 to 0.71 ( p < 0.0001). Preoperative Disabilities of the Arm, Shoulder, and Hand scores increased with severity grade for most classifications. In multivariable analysis, the authors' classification predicted postoperative Disabilities of the Arm, Shoulder, and Hand score improvement, whereas established classifications did not. CONCLUSIONS Established classifications are imperfect indicators of preoperative severity. The authors introduce a preoperative classification for cubital tunnel syndrome that incorporates electrodiagnostic findings in addition to classic signs and symptoms. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, III.
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Patient Expectations for Symptomatic Improvement before Cubital Tunnel Release. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4174. [PMID: 35265448 PMCID: PMC8901200 DOI: 10.1097/gox.0000000000004174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
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Kim JS, Shah GM, Chae YJ, Hwang JS, Ahn JM, Gong HS. Ulnar nerve morphology on magnetic resonance imaging predicts nerve recovery after surgery for cubital tunnel syndrome. HAND SURGERY & REHABILITATION 2021; 41:90-95. [PMID: 34763114 DOI: 10.1016/j.hansur.2021.10.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
Magnetic resonance imaging (MRI) can evaluate nerve morphology in cubital tunnel syndrome (CuTS), but its value in predicting surgical outcome is unclear. The purpose of this study was to determine whether ulnar nerve morphology on MRI correlated with outcome after CuTS surgery. We reviewed 40 patients who had preoperative MRI and electrodiagnostic (EDX) examinations for CuTS and outcome evaluation 6 months and 2 years postoperatively. Using MRI, ulnar nerve cross-sectional area (UNCSA), changes in signal intensity, and any space-occupying lesion were evaluated. Other factors assessed were age, symptom duration and severity, type-2 diabetes and EDX parameters. Factors associated with unfavorable surgical outcome were identified. At 6 months postoperatively, 12 patients (30%) had excellent, 19 (47.5%) good, 8 (20%) fair and 1 (2.5%) poor results on modified Wilson-Krout criteria. On univariate analysis, unfavorable outcomes were associated with increased UNCSA, space-occupying lesion, and decreased motor nerve conduction velocity (mNCV), and on multivariate analysis with increased UNCSA 1 cm distal from the epicondyle only (model 1) or increased UNCSA 1 cm proximal from the epicondyle and decreased mNCV (model 2). At 2 years, 15 patients (37.5%) had excellent, 21 (52.5%) good, 3 (7.5%) fair and 1 (2.5%) poor results, and no factors correlated with unfavorable outcome. Increased UNCSA on MRI was associated with unfavorable outcome at 6 months but not at 2 years. This study suggests that morphologic ulnar nerve changes can predict delayed nerve recovery after surgery for CuTS.
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Affiliation(s)
- J S Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - G M Shah
- Department of Orthopedics and Trauma Surgery, Patan Academy of Health Sciences, Lagankhel-5, 44700 Bagmati, Nepal
| | - Y J Chae
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - J S Hwang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
| | - J M Ahn
- Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - H S Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
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Dibbs RP, Ali K, Sarrami SM, Koshy JC. Revision Peripheral Nerve Surgery of the Upper Extremity. Semin Plast Surg 2021; 35:119-129. [PMID: 34121947 DOI: 10.1055/s-0041-1727290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Peripheral nerve injuries of the upper extremity can result from a wide array of etiologies, with the two most common being compression neuropathy and traumatic injuries. These types of injuries are common and can be psychologically, functionally, and financially devastating to the patient. A detailed preoperative evaluation is imperative for appropriate management. Traumatic injuries can typically be treated with local burial techniques, targeted muscle reinnervation, and regenerative peripheral nerve interfaces. Median nerve compression is frequently managed with complete release of the antebrachial fascia/transverse carpal ligament and/or use of flap coverage such as the hypothenar fat pad flap and local muscle flaps. Ulnar nerve compression is commonly managed via submuscular transposition, subcutaneous transposition, neurolysis, and nerve wrapping. In this review, we discuss the preoperative evaluation, surgical techniques, and advantages and disadvantages of each treatment modality for patients with compressive and traumatic upper extremity nerve injuries.
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Affiliation(s)
- Rami P Dibbs
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Texas
| | - Kausar Ali
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Texas
| | - Shayan M Sarrami
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Texas
| | - John C Koshy
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Texas
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Izadpanah A, Gibbs C, Spinner RJ, Kakar S. Comparison of In Situ Versus Subcutaneous Versus Submuscular Transpositions in the Management of McGowan Stage III Cubital Tunnel Syndrome. Hand (N Y) 2021; 16:45-49. [PMID: 30907136 PMCID: PMC7818036 DOI: 10.1177/1558944719831387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: The objective of the study was to evaluate and compare the clinical outcomes of in situ decompression with subcutaneous and submuscular transpositions for surgical management of advanced (McGowan stage III) cubital tunnel syndrome (CuTS). Methods: A retrospective review of patients in our institution undergoing primary surgery for CuTS from February 1989 to May 2009 was performed. Patients with advanced CuTS with a minimum of 12 months of follow-up without any previous bony or soft tissue procedures around the elbow were included. Seventy-four patients underwent 80 primary ulnar nerve surgeries. Patients' demographics, presenting symptoms, physical examination, electrodiagnostic findings, and perioperative complications were recorded. Primary surgical techniques were compared and the risk factors for revision surgery were assessed. Results: Of the 80 surgical procedures, there were 17 decompressions (21%), 47 subcutaneous transpositions (59%), and 16 submuscular transpositions (20%). Fifty-two percent of patients had resolution of their symptoms after primary surgery. The overall complication rate after primary surgery was 12.5%. Nineteen patients (24%) had revision surgery at a median of 30 months after their primary procedure. Eight patients (42%) had symptomatic improvement after revision surgery. Patients with their dominant extremity affected, static 2-point discrimination (S2PD) greater than 10 mm, and age less than 50 years at presentation had a higher rate of revision surgery. Three patients had a second revision surgery and neurolysis for persistent symptoms. Conclusions: The overall revision rate in advanced CuTS was 24%. Forty-two percent of patients had reported subjective symptomatic improvement after revision surgery. Younger age at presentation and a greater S2PD were associated with a higher rate of revision surgery.
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Affiliation(s)
| | | | | | - Sanjeev Kakar
- Mayo Clinic, Rochester, MN, USA,Sanjeev Kakar, Department of Orthopedic
Surgery, Division of Hand Surgery, Mayo Clinic, 200 First Street SW, Rochester,
MN 55905, USA.
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7
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Wade RG, Griffiths TT, Flather R, Burr NE, Teo M, Bourke G. Safety and Outcomes of Different Surgical Techniques for Cubital Tunnel Decompression: A Systematic Review and Network Meta-analysis. JAMA Netw Open 2020; 3:e2024352. [PMID: 33231636 PMCID: PMC7686867 DOI: 10.1001/jamanetworkopen.2020.24352] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Cubital tunnel syndrome is the second most common compressive neuropathy, affecting 6% of the population. Numerous different operations are performed globally to treat it; however, prior conventional (pairwise) meta-analyses have been unable to determine which procedure is associated with the best outcomes and fewest complications. OBJECTIVE To evaluate which operation for cubital tunnel syndrome is associated with the greatest likelihood of symptomatic cure. DATA SOURCES PubMed, EMBASE, and CENTRAL were searched from database inception to March 2, 2019, with no restrictions on the setting or design of studies. STUDY SELECTION Experimental and observational studies directly comparing the outcomes of at least 2 surgical treatments for adults with primary cubital tunnel syndrome were included. Case reports were excluded, and when comparative studies had subgroups with 1 participant, the single-participant subgroup was excluded. The treatments had to be in situ decompression with or without medial epicondylectomy or an anterior subcutaneous, subfascial, intramuscular, or submuscular transposition. The access could be open, minimally invasive, or endoscopic. The comparator could be sham surgery or any operation mentioned earlier. DATA EXTRACTION AND SYNTHESIS Data were extracted by 2 independent reviewers, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline and the PRISMA Network Meta-analysis extension statement. Network meta-analysis was used to estimate the relative efficacy and safety associated with interventions using relative risks. Surgical techniques were ranked by their probability of being the best (P score) and interpreted in terms of their clinical impact. MAIN OUTCOMES AND MEASURES The primary outcome was response to treatment (ie, symptomatic improvement). The secondary outcomes were perioperative complications, reoperation, and recurrence. RESULTS A total of 30 studies of 2894 limbs undergoing 8 different operations were included. Across the studies, 56% of participants were men, the mean (SD) age was 48 (8) years, and patients had symptoms for a mean (SD) of 15 (7) months. Overall, 87% (95% CI, 92%-91%) of patients improved with surgery; all forms of in situ decompression were more effective than any type of transposition procedure; for example, open in situ decompression with epicondylectomy was associated with higher success rates than subcutaneous transposition (relative risk, 1.13; 95% CI, 1.01-1.25). Postoperatively, 3% (95% CI, 2%-4%) of patients developed complications, and in situ decompressions were ranked as the least risky, although there was considerable uncertainty in this outcome. Overall, 2% (95% CI, 1%-3%) of patients required reoperation; open in situ decompression was associated with the fewest reoperations; in comparison, submuscular transposition was associated with 5 times the risk of reoperation (relative risk, 5.08; 95% CI, 2.06-12.52). During surveillance, 3% (95% CI, 1%-4%) of patients developed recurrence, and open in situ decompression with epicondylectomy was ranked as the safest operation, although there was uncertainty in the estimates. CONCLUSIONS AND RELEVANCE In this network meta-analysis, open in situ decompression (with or without medial epicondylectomy) appeared to be the safest operation and also was associated with the best outcomes for patients with primary cubital tunnel syndrome. Future research should focus on better defining this disorder and developing core outcome measures.
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Affiliation(s)
- Ryckie G. Wade
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
- Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom
| | - Timothy T. Griffiths
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
- Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom
| | - Robert Flather
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
- Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom
| | - Nicholas E. Burr
- Cancer Epidemiology Group, Institute of Cancer and Pathology and Institute of Data Analytics, University of Leeds, United Kingdom
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Mario Teo
- Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
| | - Grainne Bourke
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
- Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom
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Gallo L, Gallo M, Murphy J, Waltho D, Baxter C, Karpinski M, Mowakket S, Copeland A, Thoma A. Reporting Outcomes and Outcome Measures in Cubital Tunnel Syndrome: A Systematic Review. J Hand Surg Am 2020; 45:707-728.e9. [PMID: 32591175 DOI: 10.1016/j.jhsa.2020.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/29/2020] [Accepted: 04/03/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Comparison between studies assessing outcomes after surgical treatment of cubital tunnel syndrome (CuTS) has proven to be difficult owing to variations in outcome reporting. This study aimed to identify outcomes and outcome measures used to evaluate postoperative results for CuTS. METHODS We performed computerized database searches of MEDLINE and EMBASE. Studies with 20 or more patients aged 18 and older who were undergoing medial epicondylectomy, endoscopic decompression, open simple decompression, or decompression with subcutaneous, submuscular, or intramuscular transposition for ulnar neuropathy at the elbow were included. Outcomes and outcome measures were extracted and tabulated. RESULTS Of the 101 studies included, 45 unique outcomes and 31 postoperative outcome measures were identified. These included 7 condition-specific, clinician-reported instruments; 4 condition-specific, clinician-reported instruments; 8 patient-reported, generic instruments; 11 clinician-generated instruments; and one utility measure. Outcome measures were divided into 6 unique domains. Overall, 60% of studies used condition-specific outcome measures. The frequency of any condition-specific outcome measure ranged from 1% to 37% of included studies. CONCLUSIONS There is marked heterogeneity in outcomes and outcome measures used to assess CuTS. A standardized core outcome set is needed to compare results of various techniques of cubital tunnel decompression. CLINICAL RELEVANCE This study builds on the existing literature to support the notion that there is marked heterogeneity in outcomes and outcome measures used to assess CuTS. The authors believe that a future standardized set of core outcomes is needed to limit heterogeneity among studies assessing postoperative outcomes in CuTS to compare these interventions more easily and pool results in the form of systematic reviews and meta-analyses.
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Affiliation(s)
- Lucas Gallo
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matteo Gallo
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Murphy
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Waltho
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Charmaine Baxter
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marta Karpinski
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sadek Mowakket
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Copeland
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Achilleas Thoma
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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Schickendantz MS, Yalcin S. Conditions and Injuries Affecting the Nerves Around the Elbow. Clin Sports Med 2020; 39:597-621. [PMID: 32446578 DOI: 10.1016/j.csm.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Sports-related peripheral neuropathies account for 6% of all peripheral neuropathies and most commonly involve the upper extremity. The routes of the median, radial, and ulnar nerves are positioned in arrangements of pulleys and sheaths to glide smoothly around the elbow. However, this anatomic relationship exposes each nerve to risk of compression. The underlying mechanisms of the athletic nerve injury are compression, ischemia, traction, and friction. Chronic athletic nerve compression may cause damage with moderate or low pressure for long or intermittent periods of time.
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Affiliation(s)
- Mark S Schickendantz
- Cleveland Clinic Sports Health Center, 5555 Transportation Boulevard, Garfield Heights, Ohio 44125, USA.
| | - Sercan Yalcin
- Cleveland Clinic Sports Health Center, 5555 Transportation Boulevard, Garfield Heights, Ohio 44125, USA
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Features of the Ulnar Nerve Predicting Postoperative Prognosis in Idiopathic Cubital Tunnel Syndrome: Three Distinct Features of the Ulnar Nerve. Ann Plast Surg 2020; 85:50-55. [PMID: 31977531 DOI: 10.1097/sap.0000000000002236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE This retrospective case-control study was performed to determine the relationships between features of the ulnar nerve and postoperative outcomes following in situ decompression in idiopathic cubital tunnel syndrome (CuTS). METHODS The study population consisted of 86 patients who had undergone surgery for CuTS. We evaluated demographic factors, hand dominance, symptom onset time, time from diagnosis to surgery, findings of electrodiagnosis (nerve conduction velocity/electromyography), and preoperative clinical status. Intraoperatively, the ulnar nerve was defined as a definitively compressed, abnormally enlarged, or inflammatory lesion. Clinical improvements were evaluated at least 2 years after surgery. RESULTS Fifty-four patients showed improvement after surgery in terms of the modified McGowan grade and were designated as group 1. Meanwhile, 32 patients with unchanged or aggravated status were classified as group 2. Preoperative status, as determined by the modified McGowan grade, Boston Symptom Severity Scale score, severity of electrodiagnosis, and predominant symptoms were similar between the groups (all, P > 0.05). On regression analysis, only the classification of nerve lesions and the time from diagnosis to surgery had an impact on postoperative outcome (all, P < 0.05). Especially, enlarged ulnar lesion predicted poor prognosis (P = 0.003). CONCLUSIONS Ulnar nerve enlargement, grossly detected intraoperatively, and long interval between diagnosis and surgery were independently associated with poor prognosis of CuTS. Among the anatomic structures involved in the generation of CuTS, the medial epicondyle showed a strong association with enlarged nerve lesions.
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Patient Characteristics in Ulnar Nerve Compression at the Elbow at a Tertiary Referral Hospital and Predictive Factors for Outcomes of Simple Decompression versus Subcutaneous Transposition of the Ulnar Nerve. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5302462. [PMID: 31950042 PMCID: PMC6948284 DOI: 10.1155/2019/5302462] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/19/2019] [Indexed: 11/18/2022]
Abstract
Patient characteristics and predictive factors for outcomes were analysed in 202 cases undergoing simple decompression, primary subcutaneous transposition, or secondary subcutaneous transposition for ulnar nerve compression at the elbow at a tertiary referral hospital. Data from medical charts and a survey were evaluated. The mean patient age was 49 years with revision surgery cases being significantly younger. Sixty-one percent of cases were female, and 31% were smokers. The comorbidity was extensive, including other nerve compression lesions as well as neck and shoulder problems. Overall, 53% reported being pleased with the result of surgery and 57% of the cases rated function as better or completely recovered after surgery. The median postoperative DASH (Disabilities of the Arm, Shoulder and Hand) score was 26 (IQR 11–49), which is in accordance with unpublished national data. No significant differences in DASH scores were found between surgical groups, but a higher preoperative McGowan grade was significantly associated with a poorer postoperative DASH score. Women scored greater disability postoperatively than men. There was a significantly increased risk of complications, which was doubled for smokers, following primary and secondary transposition compared to simple decompression. Surgical cases with ulnar nerve compression treated at a tertiary referral hospital constitute a heterogeneous group with great comorbidity and frequent concomitant nerve compression lesions. We suggest simple decompression as the procedure of first choice. Transposition can be used in selected cases or when simple decompression fails. All patients should be strongly recommended to stop smoking considering the remarkably increased risk for complications among smokers.
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Power HA, Sharma K, El-Haj M, Moore AM, Patterson MM, Mackinnon SE. Compound Muscle Action Potential Amplitude Predicts the Severity of Cubital Tunnel Syndrome. J Bone Joint Surg Am 2019; 101:730-738. [PMID: 30994591 DOI: 10.2106/jbjs.18.00554] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cubital tunnel syndrome has a spectrum of presentations ranging from mild paresthesias to debilitating numbness and intrinsic atrophy. Commonly, the classification of severity relies on clinical symptoms and slowing of conduction velocity across the elbow. However, changes in compound muscle action potential (CMAP) amplitude more accurately reflect axonal loss. We hypothesized that CMAP amplitude would better predict functional impairment than conduction velocity alone. METHODS A retrospective cohort of patients who underwent a surgical procedure for cubital tunnel syndrome over a 5-year period were included in the study. All patients had electrodiagnostic testing performed at our institution. Clinical and electrodiagnostic variables were recorded. The primary outcome was preoperative functional impairment, defined by grip and key pinch strength ratios. Multivariable regression identified which clinical and electrodiagnostic variables predicted preoperative functional impairment. RESULTS Eighty-three patients with a mean age of 57 years (75% male) were included in the study. The majority of patients (88%) had abnormal electrodiagnostic studies. Fifty-four percent had reduced CMAP amplitude, and 79% had slowing of conduction velocity across the elbow (recorded from the first dorsal interosseous). On bivariate analysis, older age and longer symptom duration were significantly associated (p < 0.05) with reduced CMAP amplitude and slowing of conduction velocity across the elbow, whereas body mass index (BMI), laterality, a primary surgical procedure compared with revision surgical procedure, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores, and visual analog scale (VAS) scores for pain were not. Multivariable regression analysis demonstrated that reduced first dorsal interosseous CMAP amplitude independently predicted the loss of preoperative grip and key pinch strength and that slowed conduction velocity across the elbow did not. CONCLUSIONS Reduced first dorsal interosseous amplitude predicted preoperative weakness in grip and key pinch strength, and isolated slowing of conduction velocity across the elbow did not. CMAP amplitude is a sensitive indicator of axonal loss and an important marker of the severity of cubital tunnel syndrome. It should be considered when counseling patients with regard to their prognosis and determining the necessity and timing of operative intervention. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hollie A Power
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Ketan Sharma
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Madi El-Haj
- Department of Orthopedic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Amy M Moore
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Megan M Patterson
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Abstract
BACKGROUND The purpose of this study was to determine pain and functional outcomes following revision cubital tunnel surgery and to identify predictors of poor postoperative outcome. METHODS A retrospective cohort study was conducted of all patients undergoing revision cubital tunnel surgery over a 5-year period at a high-volume peripheral nerve center. Intraoperative findings, demographic and injury factors, and outcomes were reviewed. Average pain, worst pain, and impact of pain on self-perceived quality of life were each measured using a 10-cm visual analog scale (VAS). Function was evaluated using pinch and grip strength, as well as the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Differences in preoperative and postoperative pain, strength, and DASH were analyzed using nonparametric tests. Predictors of postoperative average pain were evaluated using odds ratios and linear regression analyses. RESULTS The final cohort consisted of 50 patients (mean age: 46.3 ± 12.5 years; 29 [68%] male) undergoing 52 revision ulnar nerve transpositions (UNTs). Pain VAS scores decreased significantly following revision UNT. Strength and DASH scores demonstrated nonsignificant improvements postoperatively. Worse preoperative pain and greater than 1 prior cubital tunnel procedure were significant predictors of worse postoperative average pain VAS scores. CONCLUSIONS Patients can and do improve following revision cubital tunnel surgery, particularly as it relates to pain. Intraoperative findings during the revision procedure suggest that adherence to specific principles in the primary operation is key to prevention of secondary cubital tunnel syndrome.
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Affiliation(s)
- Kristen M. Davidge
- SickKids Hospital, Toronto, Ontario, Canada,Kristen M. Davidge, Division of Plastic and Reconstructive Surgery, SickKids Hospital, 5th Floor Black Wing, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
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Clinical features affecting the patient-based outcome after minimal medial epicondylectomy for cubital tunnel syndrome. J Plast Reconstr Aesthet Surg 2018; 71:1446-1452. [DOI: 10.1016/j.bjps.2018.05.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/12/2018] [Accepted: 05/26/2018] [Indexed: 02/03/2023]
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Carlton A, Khalid SI. Surgical Approaches and Their Outcomes in the Treatment of Cubital Tunnel Syndrome. Front Surg 2018; 5:48. [PMID: 30094236 PMCID: PMC6071516 DOI: 10.3389/fsurg.2018.00048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/05/2018] [Indexed: 12/25/2022] Open
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.
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Affiliation(s)
- Adam Carlton
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL, United States
| | - Syed I Khalid
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL, United States.,Department of General Surgery, Rush University Medical Center, Chicago, IL, United States
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Bouhelo-Pam KPB, Louckou EAM, Abdulrazak S, Chaibou B, Boussakri H, Shimi M, El Idrissi M, El Ibrahimi A, El Mrini A. Ulnar nerve entrapment complicating radial head excision. Int J Surg Case Rep 2018; 41:511-515. [PMID: 29546029 PMCID: PMC5723363 DOI: 10.1016/j.ijscr.2017.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 11/17/2022] Open
Abstract
The cubital tunnel syndrome can be caused by iatrogenic elbow valgus after radial head excision. The radial head excision is a good procedure when indicated but must be followed by radial head replacement. A neurological examination should be systematically controlled for severe trauma to the elbow.
Introduction Several mechanisms are involved in ischemia or mechanical compression of ulnar nerve at the elbow. Presentation of case We hereby present the case of a road accident victim, who received a radial head excision for an isolated fracture of the radial head and complicated by onset of cubital tunnel syndrome. This outcome could be the consequence of an iatrogenic valgus of the elbow due to excision of the radial head. Hitherto the surgical treatment of choice it is gradually been abandoned due to development of radial head implant arthroplasty. However, this management option is still being performed in some rural centers with low resources. Discussion The radial head plays an important role in the stability of the elbow and his iatrogenic deformity can be complicated by cubital tunnel syndrome. Conclusion An ulnar nerve release was performed with favorable outcome.
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Affiliation(s)
| | | | - Saeed Abdulrazak
- Department of Trauma and Orthopedic Surgery B3, Hassan II University Hospital, Fès, Morocco
| | - Badarou Chaibou
- Department of Osteoarticular Surgery B4, Hassan II University Hospital, Fès, Morocco
| | - Hassan Boussakri
- Department of Osteoarticular Surgery B4, Hassan II University Hospital, Fès, Morocco
| | - Mohamed Shimi
- Department of Osteoarticular Surgery B4, Hassan II University Hospital, Fès, Morocco
| | - Mohamed El Idrissi
- Department of Osteoarticular Surgery B4, Hassan II University Hospital, Fès, Morocco
| | | | - Abdelmajid El Mrini
- Department of Osteoarticular Surgery B4, Hassan II University Hospital, Fès, Morocco
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Zheng W, Song J, Sun Z, Liu J, Chen S, Fan C. Effect of disease duration on functional outcomes and complications after arthrolysis in patients with elbow stiffness. J Shoulder Elbow Surg 2018; 27:381-386. [PMID: 29310915 DOI: 10.1016/j.jse.2017.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/31/2017] [Accepted: 11/06/2017] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose of this study was to determine the effect of a long duration of elbow stiffness on functional outcomes and complications after arthrolysis. METHODS Participants included consecutive patients with a long duration of elbow stiffness (≥5 years, n = 23) and control patients matched for age, sex, and initial injury type (n = 46). All patients underwent elbow arthrolysis combined with hinged external fixation between March 2014 and March 2016. At baseline and follow-up, we evaluated elbow motion (flexion, extension, supination, pronation, and range of motion) and patient-reported outcomes, including the Mayo Elbow Performance Score (MEPS) and visual analog scale for pain. Postoperative complications including infection, nerve dysfunction, and instability were recorded. RESULTS There were no significant differences in preoperative elbow pain, range of motion, or MEPS between groups. Postoperatively, pronation and the MEPS in patients with a long disease duration were inferior to those in control patients (P = .041 and P = .016, respectively). Patients with a long disease duration also had a significantly higher incidence of complications than control patients (P = .002). At final follow-up, 7 patients (30%) in the long disease duration group and 3 patients (7%) in the control group presented with nerve symptoms (P = .022). CONCLUSIONS A long duration of elbow stiffness may negatively influence functional outcomes and increase the risk of complications after arthrolysis.
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Affiliation(s)
- Wei Zheng
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jialin Song
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ziyang Sun
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiazhi Liu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shuai Chen
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Cunyi Fan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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Tong J, Dong Z, Xu B, Zhang C, Gu Y. Predictors of surgical outcomes for severe cubital tunnel syndrome: a review of 146 patients. Acta Neurochir (Wien) 2018; 160:645-650. [PMID: 29214401 DOI: 10.1007/s00701-017-3420-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/28/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Full recovery is unlikely for severe cubital tunnel syndrome, and prognostic factors remain uncertain. We aimed to identify predictors of surgical outcome for these patients. METHODS One hundred forty-six patients with McGowan grade III cubital tunnel syndrome were evaluated retrospectively with a minimum follow-up of 2 years. All patients underwent either in situ decompression or subcutaneous transposition. The primary outcome measure was postoperative McGowan grade. Predictors included age, sex, dominant hand, disease duration, diabetes mellitus, smoking, alcohol, surgical procedure, follow-up time and preoperative electrophysiological data. Spearman's rank correlation and ordinal logistic regression model were used to assess the effect of independent variables on the postoperative McGowan grade. RESULTS At the last follow-up, improvement by at least one McGowan grade was reached in 118 cases (80.8%), and complete recovery was achieved in 40 hands (27.4%), while 28 extremities (19.2%) remained at grade III. Older age [per 10-year increase, odds ratio (OR) 2.10; 95% confidence interval (95% CI) 1.55-2.84, p < 0.001], longer disease duration (per 1-year increase, OR 1.31; 95% CI 1.16-1.49, p < 0.001), absent sensory nerve conduction (OR 2.55; 95% CI 1.25-5.21, p = 0.010) and shorter postoperative follow-up (per 1-year increase, OR 0.76; 95% CI 0.65-0.90, p = 0.001) were associated with a higher postoperative McGowan grade. CONCLUSION Significant improvement but not complete recovery could be expected following in situ decompression or subcutaneous transposition for severe cubital tunnel syndrome. Older age, longer disease duration, absent sensory nerve conduction and shorter postoperative follow-up are independent predictors of worse outcomes.
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Affiliation(s)
- Jinsong Tong
- Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Rd, Shanghai, 200040, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
| | - Zhen Dong
- Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Rd, Shanghai, 200040, People's Republic of China.
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China.
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China.
| | - Bin Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Rd, Shanghai, 200040, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
| | - Chenggang Zhang
- Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Rd, Shanghai, 200040, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
| | - Yudong Gu
- Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Rd, Shanghai, 200040, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
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Liu XH, Gong MQ, Wang Y, Liu C, Li SL, Jiang XY. Anterior Subcutaneous Transposition of the Ulnar Nerve Affects Elbow Range of Motion: A Mean 13.5 Years of Follow-up. Chin Med J (Engl) 2018; 131:282-288. [PMID: 29363642 PMCID: PMC5798048 DOI: 10.4103/0366-6999.223851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Surgical decompression of the ulnar nerve is effective for cubital tunnel syndrome. However, deep approaches may result in iatrogenic elbow stiffness. This long-term study was to evaluate the range of motion (ROM) of the elbow and functional outcomes after anterior subcutaneous transposition. METHODS A total of 115 patients (78 male and 37 female; mean age: 46.6 years) who underwent anterior subcutaneous transposition of the ulnar nerve between 2001 and 2005 were evaluated retrospectively; mean follow-up was 13.5 years. Elbow ROM was measured as flexion arc, flexion, and extension preoperatively and at the final follow-up, and compared via a mixed analysis of variance adjusting for age. Neuropathy was assessed preoperatively using a modified McGowan neuropathy grade and postoperatively using modified Wilson-Krout criteria. An ordinal logistic regression analysis used postoperative modified Wilson-Krout criteria as the outcome and preoperative factors as predictors. RESULTS Preoperative McGowan grades were Grade 1 in 14 patients (12.2%), Grade 2A in 28 (24.3%), Grade 2B in 53 (46.1%), and Grade 3 in 20 (17.4%) patients. Postoperatively, 66 patients (57.4%) had excellent results, 26 (22.6%) had good results, 16 (13.9%) had fair results, and 7 (6.1%) had poor results at the final follow-up, as per the Wilson-Krout criteria. There were no complications. Pre- and postoperative elbow ROM was significantly decreased in patients with previous trauma or surgery of the elbow compared with those without (P < 0.05). Anterior subcutaneous transposition of the ulnar nerve did not significantly affect elbow ROM regardless of previous trauma or surgical history nor preoperative ROM (P > 0.05), after adjusting for age. Patients with prolonged symptoms prior to surgery and worse neuropathy tended to have less satisfactory functional outcomes (P < 0.05), after adjusting for covariates. CONCLUSIONS Anterior subcutaneous transposition of the ulnar nerve is an effective and reliable treatment of cubital tunnel syndrome with satisfactory outcomes and minimal effect on elbow ROM.
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Affiliation(s)
- Xing-Hua Liu
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Mao-Qi Gong
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yang Wang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Chang Liu
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Shao-Liang Li
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xie-Yuan Jiang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China
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20
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Lauretti L, D'Alessandris QG, De Simone C, Legninda Sop FY, Remore LM, Izzo A, Fernandez E. Ulnar nerve entrapment at the elbow. A surgical series and a systematic review of the literature. J Clin Neurosci 2017; 46:99-108. [PMID: 28890032 DOI: 10.1016/j.jocn.2017.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/10/2017] [Indexed: 12/30/2022]
Abstract
Chronic compression of the ulnar nerve at the elbow is the second most common entrapment neuropathy. Various surgical options have been described. Timing of surgery is also debated. In this study we report the long-term results of a consecutive surgical series of anterior subcutaneous transpositions and review the pertinent literature. Sixty consecutive patients underwent anterior subcutaneous transposition at our Institution to treat ulnar nerve compression at the elbow. McGowan scale was used in the neurological exam before surgery. Bishop rating system was used to assess outcome. Seventy-eight% of patients scored good-excellent. None of the patients worsened. No complications and no recurrences were reported. Young age and good pre-operative neurological status (McGowan grade 1) were predictive of favorable outcome both at univariate and at multivariate analysis. No differences in outcome were observed between patients with intermediate (McGowan grade 2) and severe (McGowan grade 3) neuropathy. Thirty-four studies assessing outcome of different surgical techniques were reviewed. Anterior subcutaneous transposition had the lowest recurrence rate with an excellent effectiveness and safety profile. The favorable predictive role for outcome of preoperative neurological status was confirmed. The good long-term clinical results of the present series and the results of literature analysis confirm the value of anterior subcutaneous transposition of the ulnar nerve at the elbow. This technique has a particular effectiveness in most severe compressions, where outcomes are comparable with intermediate neuropathy cases. Moreover, our results suggest an aggressive attitude towards ulnar nerve compression at the elbow, particularly in younger patients.
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Affiliation(s)
- Liverana Lauretti
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy; Neurosurgery Unit, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy.
| | | | - Celestino De Simone
- Neurosurgery Unit, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy.
| | - Francois Yves Legninda Sop
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy; Neurosurgery Unit, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy.
| | - Luigi M Remore
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
| | - Alessandro Izzo
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy; Neurosurgery Unit, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy.
| | - Eduardo Fernandez
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy; Neurosurgery Unit, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy.
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Tong J, Xu B, Dong Z, Liu J, Zhang C, Gu Y. Cubital tunnel syndrome caused by ganglion cysts: a review of 59 cases. Acta Neurochir (Wien) 2017; 159:1265-1271. [PMID: 28424917 DOI: 10.1007/s00701-017-3180-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cubital tunnel syndrome caused by ganglion cysts is rare and reports are few. This study aimed to review a patient cohort with ganglion cysts in the cubital tunnel and identify prognostic factors. METHODS Fifty-seven patients (59 extremities; McGowan grade I, 4; IIa, 4; IIb, 3; III, 48) were evaluated retrospectively with a minimum follow-up of 2 years. Extraneural cysts were excised completely, while intraneural cysts were incised and drained. All cases underwent subcutaneous transposition. Spearman's rank correlation and the ordinal logistic regression model were used to assess the effect of independent variables on the postoperative McGowan grade. RESULTS VAS pain and weakness, 2-PD, key-pinch strength, grip strength, first dorsal interosseous muscle strength, Wartenberg sign, and claw hand all improved significantly. DASH scores improved from an average of 43.8 points preoperatively to 10.7 points postoperatively. According to the modified Bishop scoring system, 55 extremities (93.2%) were graded good or excellent. At the last follow-up, 29 hands (49.2%) returned to normal, and improvement by at least one McGowan grade was reached in 51 cases (86.4%). Older age, smoking, and shorter postoperative follow-up were associated with a higher postoperative McGowan grade. CONCLUSIONS Satisfactory surgical outcomes could be expected in these patients following subcutaneous transposition with excision of extraneural cysts and draining of intraneural cysts. Older age, smoking, and shorter postoperative follow-up were found to be independent risk factors for poor outcomes.
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Osma-Rueda JL, Amaya-Mujica J. Entrapment of the ulnar nerve in cubital tunnel by free intra-articular body-a case report. JSES OPEN ACCESS 2017; 1:109-112. [PMID: 30675550 PMCID: PMC6340862 DOI: 10.1016/j.jses.2017.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- José L Osma-Rueda
- Department of Surgery, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Julián Amaya-Mujica
- Grupo de investigación en Cirugía y Especialidades GRICES, Universidad Industrial de Santander, Bucaramanga, Colombia
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Suzuki T, Iwamoto T, Shizu K, Suzuki K, Yamada H, Sato K. Predictors of postoperative outcomes of cubital tunnel syndrome treatments using multiple logistic regression analysis. J Orthop Sci 2017; 22:453-456. [PMID: 28153376 DOI: 10.1016/j.jos.2017.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 12/20/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND This retrospective study was designed to investigate prognostic factors for postoperative outcomes for cubital tunnel syndrome (CubTS) using multiple logistic regression analysis with a large number of patients. METHODS Eighty-three patients with CubTS who underwent surgeries were enrolled. The following potential prognostic factors for disease severity were selected according to previous reports: sex, age, type of surgery, disease duration, body mass index, cervical lesion, presence of diabetes mellitus, Workers' Compensation status, preoperative severity, and preoperative electrodiagnostic testing. Postoperative severity of disease was assessed 2 years after surgery by Messina's criteria which is an outcome measure specifically for CubTS. Bivariate analysis was performed to select candidate prognostic factors for multiple linear regression analyses. Multiple logistic regression analysis was conducted to identify the association between postoperative severity and selected prognostic factors. RESULTS Both bivariate and multiple linear regression analysis revealed only preoperative severity as an independent risk factor for poor prognosis, while other factors did not show any significant association. CONCLUSIONS Although conflicting results exist regarding prognosis of CubTS, this study supports evidence from previous studies and concludes early surgical intervention portends the most favorable prognosis.
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Affiliation(s)
- Taku Suzuki
- Department of Orthopaedic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kanae Shizu
- Department of Orthopaedic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Katsuji Suzuki
- Department of Orthopaedic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Harumoto Yamada
- Department of Orthopaedic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kazuki Sato
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
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Henn CM, Patel A, Wall LB, Goldfarb CA. Outcomes Following Cubital Tunnel Surgery in Young Patients: The Importance of Nerve Mobility. J Hand Surg Am 2016; 41:e1-7. [PMID: 26906941 DOI: 10.1016/j.jhsa.2016.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/14/2016] [Accepted: 01/20/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the outcomes following surgical management of unstable and stable ulnar nerves at the elbow in young patients. METHODS We retrospectively reviewed the charts of 67 patients who were 30 years old or younger when they underwent primary cubital tunnel surgery at our institution over a 10-year period. In 34 (45%) of these patients, the ulnar nerve either subluxated or perched on the medial epicondyle with elbow flexion and made up the "unstable" cohort. The remaining 42 patients made up the "stable" cohort. Preoperative, intraoperative, and postoperative data were obtained from the patients' charts. Thirty-nine patients completed the following outcome measures: Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), visual analog scale (VAS) for pain and treatment satisfaction, return to sport or full activities, and the presence of persistent symptoms. RESULTS At an average of 5.6 years following surgery, the unstable cohort had a significantly lower QuickDASH score (6.4 vs 18.6) and a significantly higher VAS for treatment satisfaction (8.7 vs 5.9) compared with the stable cohort. The unstable cohort was also significantly less likely to experience residual symptoms (43% vs 94%), persistent numbness (39% vs 44%), or persistent tingling (22% vs 56%) compared with the stable cohort. Within the stable cohort, patients who underwent simultaneous carpal tunnel release exhibited improved VAS and QuickDASH scores compared with patients who did not. There were no differences in time to return to sports or full activities or pain VAS between the two groups. CONCLUSIONS Surgical management of young patients with symptomatic, unstable ulnar nerves results in superior subjective outcomes compared with surgery in young patients with stable ulnar nerves. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Curtis M Henn
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Aalok Patel
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO.
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25
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Gaspar MP, Jacoby SM, Osterman AL, Kane PM. Risk factors predicting revision surgery after medial epicondylectomy for primary cubital tunnel syndrome. J Shoulder Elbow Surg 2016; 25:681-7. [PMID: 26803932 DOI: 10.1016/j.jse.2015.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/20/2015] [Accepted: 10/24/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Medial epicondylectomy (ME) is one of several accepted surgical options for the treatment of cubital tunnel syndrome (CuTS). Although reported outcomes after ME are generally favorable, few data exist regarding which patients are prone to poorer outcomes requiring revision surgery. The goal of this study was to identify risk factors predicting the need for revision surgery after ME for the treatment of CuTS. METHODS We conducted a retrospective chart review of all patients treated at our institution with ME for CuTS from 2006 through 2011. We identified patients who underwent additional operations for recurrent or persistent ulnar nerve symptoms as the revision cohort. We performed bivariate analysis to determine which variables had a significant influence on the need for revision surgery. We examined qualitative factors associated with revision, including the degree of bony resection performed during the index ME, and intraoperative findings at the time of revision surgery. RESULTS Revision surgery was required in 13.3% of cases (11 of 83). On bivariate analysis, younger age, associated workers' compensation claims, lesser disease severity, and preoperative opioid use were all significant predictors of the need for revision surgery. Perineural scarring and heterotopic bone formation about the elbow were the 2 most common findings at the time of revision. CONCLUSIONS For patients with CuTS, the risk of revision surgery after ME is higher in younger patients, patients with less severe disease, patients taking opioid medications preoperatively, and patients with associated workers' compensation claims. LEVEL OF EVIDENCE Level IV; Case Series; Treatment Study.
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Affiliation(s)
- Michael P Gaspar
- The Philadelphia Hand Center, PC, Philadelphia, PA, USA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Sidney M Jacoby
- The Philadelphia Hand Center, PC, Philadelphia, PA, USA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - A Lee Osterman
- The Philadelphia Hand Center, PC, Philadelphia, PA, USA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Patrick M Kane
- The Philadelphia Hand Center, PC, Philadelphia, PA, USA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Predicting Revision Following In Situ Ulnar Nerve Decompression for Patients With Idiopathic Cubital Tunnel Syndrome. J Hand Surg Am 2016; 41:427-35. [PMID: 26787404 DOI: 10.1016/j.jhsa.2015.12.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the incidence of revision and potential risk factors for needing revision surgery following in situ ulnar nerve decompression for patients with idiopathic cubital tunnel syndrome (CTS). METHODS We conducted a retrospective chart review of all patients treated at 1 specialty hand center with an open in situ ulnar nerve decompression for idiopathic CTS from January 2006 through December 2010. Revision incidence was determined by identifying patients who underwent additional surgeries for recurrent or persistent ulnar nerve symptoms. Bivariate analysis was performed to determine which variables had a significant influence on the need for revision surgery. RESULTS Revision surgery was required in 3.2% (7 of 216) of all cases. Age younger than 50 years at the time of index decompression was the lone significant predictor of need for revision surgery. Other patient factors, including gender, diabetes, smoking history, and workers' compensation status were not predictive of the need for revision surgery. Disease-specific variables including nerve conduction velocities, McGowan grading, and predominant symptom type were also not predictive of revision. CONCLUSIONS For patients with idiopathic CTS, the risk of revision surgery following in situ ulnar nerve decompression is low. However, this risk was increased in patients who were younger than 50 years at the time of the index procedure. The findings of this study suggest that, in the absence of underlying elbow arthritis or prior elbow trauma, in situ ulnar nerve decompression is an effective, minimal-risk option for the initial surgical treatment of CTS. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic III.
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Szekeres M, MacDermid JC, King GJW, Grewal R. The relationship between the Patient-rated Ulnar Nerve Evaluation and the common impairment measures of grip strength, pinch strength, and sensation. J Hand Ther 2016; 28:39-44; quiz 45. [PMID: 25727009 DOI: 10.1016/j.jht.2014.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/09/2014] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective cohort study. INTRODUCTION Grip strength, pinch strength, and sensory threshold are common evaluations used on a daily basis. Identifying how these variables relate to function for patients allows these assessments to be used for screening to identify who may benefit from surgical intervention, and provides valuable information about what impairments patients think are important with respect to functional use of their upper extremity. Therapists can use this information to focus rehabilitation programs on the most important impairments. PURPOSE To evaluate the relationship between the Patient-rated Ulnar Nerve Evaluation (PRUNE) and impairment measures of grip strength, pinch strength, and one-point sensory threshold. METHODS Data was prospectively collected from 77 patients before surgery and during regular time points for 2 years following surgery. Patients completed the PRUNE, grip and pinch strength measures, and a one-point sensory threshold evaluation. Correlations between these variables were calculated at baseline, 2 years after surgery, and for change scores during the 2-year follow up. A multiple regression analysis was used to determine the contribution of the impairment variables for determining functional change. RESULTS Grip strength showed moderate, statistically significant correlation with PRUNE scores at both baseline (r = -0.38) and at two years (r = -0.29). There was also a statistically significant correlation between one point sensory threshold for the small finger at two years (r = 0.36), but not at baseline. Change in grip strength (r = -0.28) and pinch strength (r = -0.30) both demonstrated significant correlations with PRUNE change scores. Overall, changes in grip strength, pinch strength, and sensation accounted for 20% of the variance in PRUNE changes. CONCLUSION Since grip strength was most highly correlated with PRUNE scores at baseline and at two years, rehabilitation programs that target grip strengthening is supported. While neither grip nor pinch strength were significant contributors to the regression when used together, each showed significant contributions to PRUNE variability when used in the model independently. Therefore, a combination of grip and pinch strengthening may be important during rehabilitation for improving functional results in patients that undergo surgical intervention for cubital tunnel syndrome. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Mike Szekeres
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.
| | - Joy C MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; The Roth McFarlane Hand and Upper Limb Centre, London, Ontario, Canada
| | - Graham J W King
- The Roth McFarlane Hand and Upper Limb Centre, London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Ruby Grewal
- The Roth McFarlane Hand and Upper Limb Centre, London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
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Mitchell J, Dunn JC, Kusnezov N, Bader J, Ipsen DF, Forthman CL, Dykstra A. The effect of operative technique on ulnar nerve strain following surgery for cubital tunnel syndrome. Hand (N Y) 2015; 10:707-11. [PMID: 26568727 PMCID: PMC4641079 DOI: 10.1007/s11552-015-9770-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of this study is to compare the amount of strain on the ulnar nerve based on elbow position after in situ release, subcutaneous transposition, submuscular transposition, and medial epicondylectomy. METHODS Six matched cadaver upper extremity pairs underwent ulnar nerve decompression, transposition in a sequential fashion, while five elbows underwent medial epicondylectomy. A differential variable reluctance transducer (DVRT) was placed in the ulnar nerve. An in situ release, a subcutaneous transposition, and a submuscular transposition were performed sequentially with the strain being measured after each procedure in neutral, full elbow flexion, and extension positions. The strain was then averaged and compared for each procedure. Five cadavers underwent medial epicondylectomy and were similarly tested. RESULTS After the in situ release, there was no statistically significant change in strain in either flexion or extension. After a subcutaneous transposition, there was a statistically significant decrease in strain in full elbow flexion but not in extension. Similarly after a submuscular transposition, there was a statistically significant decrease in strain in full flexion but not in extension. There was not a statistically significant change in strain with medial epicondylectomy. CONCLUSION An in situ release of the ulnar nerve at the elbow may relieve pressure on the nerve but does not address the problem of strain which may be the underlying pathology in many cases of ulnar neuropathy at the elbow (UNE). Transposition of the ulnar nerve anterior to the medial epicondyle addresses the problem of strain on the ulnar nerve. In addition, it does not create an increased strain on the ulnar nerve with elbow extension.
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Affiliation(s)
- Justin Mitchell
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, 5055 N. Piedras, Fort Bliss, TX 79920 USA
| | - John C. Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, 5055 N. Piedras, Fort Bliss, TX 79920 USA
| | - Nicholas Kusnezov
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, 5055 N. Piedras, Fort Bliss, TX 79920 USA
| | - Julia Bader
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, 5055 N. Piedras, Fort Bliss, TX 79920 USA
| | - Derek F. Ipsen
- Department of Orthopaedic Surgery, National Capital Consortium, 8901 Rockville Pike, Bethesda, MD 20889 USA
| | | | - Aaron Dykstra
- Department of Orthopaedic Surgery, National Capital Consortium, 8901 Rockville Pike, Bethesda, MD 20889 USA
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SUBCUTANEOUS ANTERIOR TRANSPOSITION FOR TREATMENT OF CUBITAL TUNNEL SYNDROME: IS THIS METHOD SAFE AND EFFECTIVE? Rev Bras Ortop 2015; 47:748-53. [PMID: 27047895 PMCID: PMC4799481 DOI: 10.1016/s2255-4971(15)30033-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 04/12/2012] [Indexed: 11/22/2022] Open
Abstract
Objective: To evaluate the results from subcutaneous anterior transposition of the cubital nerve for treating cubital tunnel syndrome (CTS) and the influence of prognostic factors such as preoperative McGowan stage, age and duration of symptoms. Methods: 36 patients with CTS who underwent subcutaneous anterior transposition of the cubital nerve between 2006 and 2009 were evaluated after an average follow-up of 28 months. Their mean age was 41.6 years. Nine patients were in McGowan stage I, 18 in stage II and nine in stage III. Results: There was a statistically significant improvement in sensory and motor deficits. 78% of the patients with severe neuropathy improved after surgery. According to the modified Bishop score, 21 patients (58.3%) had excellent results, seven (19.4%) good, six (16.7%) satisfactory and two (5.55%) poor. The satisfaction rate was 86% and 72% of the patients recovered their daily activities without limitations. Conclusion: The severity of neuropathy and preoperative duration of symptoms, but not age, had a negative influence on the outcome. The subcutaneous anterior transposition of the cubital nerve is safe and effective for treating CTS of different degrees of severity. Given the major prognostic factors identified, surgical treatment should be advised as soon as axonal loss has become clinically evident.
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Liu CH, Wu SQ, Ke XB, Wang HL, Chen CX, Lai ZL, Zhuang ZY, Wu ZQ, Lin Q. Subcutaneous Versus Submuscular Anterior Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies. Medicine (Baltimore) 2015. [PMID: 26200640 PMCID: PMC4602994 DOI: 10.1097/md.0000000000001207] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Subcutaneous and submuscular anterior ulnar nerve transposition have been widely used in patients with cubital tunnel syndrome. However, the reliable evidence in favor of 1 of 2 surgical options on clinical improvement remains controversial. To maximize the value of the available literature, we performed a systematic review and meta-analysis to compare subcutaneous versus submuscular anterior ulnar nerve transposition in patients with ulnar neuropathy at the elbow. PubMed, Cochrane Library, and EMBASE databases were searched for randomized and observational studies that compared subcutaneous transposition with submuscular transposition of ulnar nerve for cubital tunnel syndrome. The primary outcome was clinically relevant improvement in function compared to the baseline. Randomized and observational studies were separately analyzed with relative risks (RRs) and 95% confidence intervals (CIs). Two randomized controlled trials (RCTs) and 7 observational studies, involving 605 patients, were included. Our meta-analysis suggested that no significant differences in the primary outcomes were observed between comparison groups, both in RCT (RR, 1.16; 95% CI 0.68-1.98; P = 0.60; I2= 81%) and observational studies (RR, 1.01; 95% CI 0.95-1.08; P = 0.69; I2 = 0%). These findings were also consistent with all subgroup analyses for observational studies. In the secondary outcomes, the incidence of adverse events was significantly lower in subcutaneous group than in submuscular group (RR, 0.54; 95% CI 0.33-0.87; P = 0.01; I2 = 0%), whereas subcutaneous transposition failed to reveal more superiority than submuscular transposition in static two-point discrimination (MD, 0.04; 95% CI -0.18-0.25; P = 0.74; I = 0%). The available evidence is not adequately powered to identify the best anterior ulnar nerve transposition technique for cubital tunnel syndrome on the basis of clinical outcomes, that is, suggests that subcutaneous and submuscular anterior transposition might be equally effective in terms of postoperative clinical improvement. However, differences in clinical outcomes metrics should be noted, and these findings largely rely on the outcomes data from observational studies that are potentially subject to a high risk of selection bias. Therefore, more high-quality and adequately powered RCTs with standardized clinical outcomes metrics are necessary for proper comparison of these techniques.
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Affiliation(s)
- Chun-Hua Liu
- From the Department of Orthopaedic Surgery, Quanzhou Orthopedic-Traumatological Hospital, Fujian university of Traditional Chinese Medicine (C-HL, X-BK, H-LW, C-XC, Z-LL, Z-YZ, Z-QW); Department of Orthopaedic Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou (S-QW); and Department of Orthopaedic Surgery, Fuzhou Second Hospital of Xiamen University, Xiamen, Fujian province, China (QL)
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Krogue JD, Aleem AW, Osei DA, Goldfarb CA, Calfee RP. Predictors of surgical revision after in situ decompression of the ulnar nerve. J Shoulder Elbow Surg 2015; 24:634-9. [PMID: 25660241 DOI: 10.1016/j.jse.2014.12.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/01/2014] [Accepted: 12/06/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study was performed to identify factors associated with the need for revision surgery after in situ decompression of the ulnar nerve for cubital tunnel syndrome. METHODS This case-control investigation examined all patients treated at one institution with open in situ decompression for cubital tunnel syndrome between 2006 and 2011. The case patients were 44 failed decompressions that required revision, and the controls were 79 randomly selected patients treated with a single operation. Demographic data and disease-specific data were extracted from the medical records. The rate of revision surgery after in situ decompression was determined from our 5-year experience. A multivariate logistic regression model was used based on univariate testing to determine predictors of revision cubital tunnel surgery. RESULTS Revision surgery was required in 19% (44 of 231) of all in situ decompressions performed during the study period. Predictors of revision surgery included a history of elbow fracture or dislocation (odds ratio [OR], 7.1) and McGowan stage I disease (OR, 3.2). Concurrent surgery with in situ decompression was protective against revision surgery (OR, 0.19). DISCUSSION The rate of revision cubital tunnel surgery after in situ nerve decompression should be weighed against the benefits of a less invasive procedure compared with transposition. When considering in situ ulnar nerve decompression, prior elbow fracture as well as patients requesting surgery for mild clinically graded disease should be viewed as risk factors for revision surgery. Patient factors often considered relevant to surgical outcomes, including age, sex, body mass index, tobacco use, and diabetes status, were not associated with a greater likelihood of revision cubital tunnel surgery.
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Affiliation(s)
- Justin D Krogue
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Alexander W Aleem
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel A Osei
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryan P Calfee
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
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Abstract
This review discusses key diagnostic points and treatment guidelines for compression neuropathies of the wrist, forearm, and elbow. Recent treatment progress is reviewed, controversies are highlighted, and consensus is summarized. Limited or mini-open releases and endoscopic carpal tunnel releases are considered equally safe and efficient. Both methods are currently mainstays of surgical treatment.
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Abstract
High valgus and extension loads imparted to the athlete's elbow during repetitive overhead throwing can lead to acute and chronic pathology. Over time, normal soft tissue and bony stabilizing structures of the elbow undergo progressive structural changes and can succumb to injury. Modern diagnostic modalities, including plain radiographs, computed tomography, and magnetic resonance imaging, in addition to arthroscopy, can aid in diagnosis. Although nonoperative management is often successful, surgical intervention may be necessary before allowing return to play.
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Affiliation(s)
- Vamsi K Kancherla
- Department of Orthopaedic Surgery, St. Luke's University Hospital, 801 Ostrum Street, PPHP2, Bethlehem, PA 18015, USA
| | - Nicholas M Caggiano
- Department of Orthopaedic Surgery, St. Luke's University Hospital, 801 Ostrum Street, PPHP2, Bethlehem, PA 18015, USA
| | - Kristofer S Matullo
- Department of Orthopaedic Surgery, St. Luke's University Hospital, 801 Ostrum Street, PPHP2, Bethlehem, PA 18015, USA.
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Sakamoto SM, Hausman MR. Ulnar Neuropathy About the Elbow. OPER TECHN SPORT MED 2014. [DOI: 10.1053/j.otsm.2014.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zimmerman RM, Jupiter JB, González del Pino J. Minimum 6-year follow-up after ulnar nerve decompression and submuscular transposition for primary entrapment. J Hand Surg Am 2013; 38:2398-404. [PMID: 24183405 DOI: 10.1016/j.jhsa.2013.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 09/09/2013] [Accepted: 09/12/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To retrospectively evaluate patients with 6-year minimum follow-up after submuscular transposition of the ulnar nerve for primary entrapment. METHODS From 1992 to 2005, 142 patients were treated surgically for ulnar neuropathy at the elbow by 2 senior surgeons using a technique that preserved nerve vascularity. A total of 99 cases were eligible, and 82 elbows in 76 patients, average age 48 years, were followed for at least 6 years (average, 8.3 y). Thirty-two (42%) were male, and the dominant limb was involved in 49 (64%). The average duration of symptoms before surgery was 25 months. Clinical records were reviewed, and sensory (S0-2) and motor (M0-5) testing was performed. Dellon scores were determined, and visual analog scale and modified questionnaires from Novak et al and Kleinman and Bishop were completed. Preoperatively, 48 elbows were Dellon grade III, 33 were grade II, and one was grade I. RESULTS There were clinically and statistically significant improvements in patient and surgeon-reported data regardless of the preoperative disease severity. Visual analog scale questionnaires, sensory scale, and motor strength all improved, with at least antigravity strength in all subjects. Dellon scores also improved, and 38 elbows had normalized to Dellon 0. Of the 33 preoperative elbows that were grade III, 15 improved to grade II, 13 to grade I, and 5 normalized. Of the 48 preoperative elbows that were grade II, 16 improved to grade I and 32 normalized. Preoperative Dellon III elbows had more residual symptoms than grade II elbows. A total of 73 elbows (89%) had a good or excellent outcome. There were no reoperations or infections. CONCLUSIONS Submuscular transposition is a safe and durable option for primary ulnar neuropathy at the elbow. Overall, good or excellent results were achieved in 89% of patients with a low complication rate. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Ryan M Zimmerman
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; and the Division of Hand Surgery, Department of Orthopedic Surgery, Santa Cristina University Hospital, Madrid, Spain.
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Burns PB, Kim HM, Gaston RG, Haase SC, Hammert WC, Lawton JN, Merrell GA, Nassab PF, Yang LJ, Chung KC. Predictors of functional outcomes after simple decompression for ulnar neuropathy at the elbow: a multicenter study by the SUN study group. Arch Phys Med Rehabil 2013; 95:680-5. [PMID: 24252584 DOI: 10.1016/j.apmr.2013.10.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 10/31/2013] [Accepted: 10/31/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify predictors of surgical outcome for ulnar neuropathy at the elbow (UNE). DESIGN Prospective cohort followed for 1 year. SETTING Clinics. PARTICIPANTS Patients diagnosed with UNE (N=55). INTERVENTION All subjects had simple decompression surgery. MAIN OUTCOME MEASURES The primary outcome measure was patient-reported outcomes, such as overall hand function through the Michigan Hand Outcomes Questionnaire (MHQ). Predictors included age, duration of symptoms, disease severity, and motor conduction velocity across the elbow. RESULTS Multiple regression models with change in the overall MHQ score as the dependent variable showed that at 3 months postoperative time, patients with <3 months duration of symptoms showed 12 points (95% confidence interval [CI], 0.9-23.5) greater improvement in MHQ scores than those with ≥3 months symptom duration. Less than 3 months of symptoms was again associated with 13 points (95% CI, 2.9-24) greater improvement in MHQ scores at 6 months postoperative, but it was no longer associated with better outcomes at 12 months. A worse baseline MHQ score was associated with significant improvement in MHQ scores at 3 months (coefficient, -0.38; 95% CI, -.67 to -.09), and baseline MHQ score was the only significant predictor of 12 month MHQ scores (coefficient, -.40; 95% CI, -.79 to -.01). CONCLUSIONS Subjects with <3 months of symptoms and worse baseline MHQ scores showed significantly greater improvement in functional outcomes as reported by the MHQ. However, duration of symptoms was only predictive at 3 or 6 months because most patients recovered within 3 to 6 months after surgery.
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Affiliation(s)
- Patricia B Burns
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI
| | - H Myra Kim
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI
| | - R Glenn Gaston
- OrthoCarolina Hand Center, Department of Orthopedic Surgery, Charlotte, NC
| | - Steven C Haase
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Warren C Hammert
- Department of Orthopedic Surgery, University of Rochester Medical Center, Rochester, NY
| | - Jeffrey N Lawton
- Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, MI
| | | | - Paul F Nassab
- Drisko Fee and Parkins Orthopedics, North Kansas City, MO
| | - Lynda J Yang
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
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Abstract
Ulnar neuropathy at the elbow is the second most common compression neuropathy of the upper extremity and poses a challenge for treating physicians. Lack of a standardized grading system, outcome measures, or surgical indications can make treatment decisions difficult to justify. Conclusions drawn from the available literature include similar rates of good to excellent outcomes for in situ decompression; transposition in the subcutaneous, submuscular, or intramuscular planes; and endoscopic decompression. Outcomes for revision surgery are generally less favorable. Development of standardized outcomes measures will be important in improving the quality and comparability of the literature on this subject.
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Affiliation(s)
- Peter C Chimenti
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA
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Soltani AM, Best MJ, Francis CS, Allan BJ, Panthaki ZJ. Trends in the surgical treatment of cubital tunnel syndrome: an analysis of the national survey of ambulatory surgery database. J Hand Surg Am 2013; 38:1551-6. [PMID: 23830676 DOI: 10.1016/j.jhsa.2013.04.044] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/23/2013] [Accepted: 04/29/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To ascertain trends in the surgical treatment of ulnar nerve compression at the elbow within the United States. METHODS We analyzed the National Survey of Ambulatory Surgery to study trends in the treatment of cubital tunnel syndrome from 1994 to 2006. The National Survey of Ambulatory Surgery provides a comprehensive overview of ambulatory surgical procedures performed in the United States. Patients identified in the database with surgically treated cubital tunnel syndrome were verified by members of our research staff and compiled into these 3 groups: decompression, transposition, and other. The data were then statistically analyzed for trends in treatment, utilization, and demographics. RESULTS A total of 52,133 surgical procedures were recorded in the National Survey of Ambulatory Surgery for the treatment of ulnar nerve compression in 2006. This represents an increase from 26,283 in 1994 and 35,406 in 1996. In the 11 years from 1996 to 2006, the total surgical procedures on the ulnar nerve increased by 47%. Transposition went from 49% of all cubital tunnel procedures in the 1990s to 38% in 2006. In 2006, women were much more likely to have a simple decompression (70%) than a transposition or other technique. Decompression had a mean surgical time of 48 minutes, and transposition had a mean surgical time of 59 minutes. CONCLUSIONS The percentage of transpositions used in the treatment of cubital syndrome has decreased to 37% in the last survey. Possible reasons include expanded indications or changing surgical preferences. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Ali M Soltani
- Department of Surgery, Division of Plastic, Aesthetic, and Reconstructive Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
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Validity and Responsiveness of the DASH Questionnaire as an Outcome Measure following Ulnar Nerve Transposition for Cubital Tunnel Syndrome. Plast Reconstr Surg 2013; 132:81e-90e. [DOI: 10.1097/prs.0b013e318290faf6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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40
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Outcomes following modified oblique medial epicondylectomy for treatment of cubital tunnel syndrome. J Hand Surg Am 2013; 38:336-43. [PMID: 23291082 DOI: 10.1016/j.jhsa.2012.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 11/02/2012] [Accepted: 11/05/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify and define objective and patient-rated outcomes after our modification of medial epicondylectomy for the treatment of cubital tunnel syndrome. Although medial epicondylectomy has been previously studied, data are lacking regarding elbow-specific outcomes after our technique that aims to minimize complications historically associated with medical epicondylectomy. METHODS A total of 27 subjects with clinical and electrodiagnostic evidence of cubital tunnel syndrome underwent a modified oblique medial epicondylectomy that was designed to minimize bony resection and preserve the origin of the ulnar collateral ligament of the elbow. Average age was 57 years, mean duration of symptoms was 24 months, and mean postoperative follow-up was 29 months. Eight patients had McGowan stage I disease, 14 had stage II, and 5 had stage III. Preoperatively, we measured intrinsic hand strength, 2-point discrimination, and residual medial elbow pain, and assessed for continuing signs and symptoms of nerve compression. Postoperatively, we added to the clinical examination elbow stability testing, elbow range of motion, and assessment of medial antebrachial cutaneous nerve injury. We collected patient-reported outcomes, including Quick Disabilities of the Shoulder, Arm, and Hand; Levine-Katz Severity Score; and Patient-Rated Elbow Evaluation. RESULTS We noted improvement of at least 1 McGowan grade in 20 of 27 patients (74%). Three of the 7 patients who had no change in McGowan grade still reported excellent patient-rated outcomes. Good to excellent results were achieved in 25 of 27 patients (93%). One patient had long-term severe medial elbow pain. Three patients had postoperative medial elbow pain that resolved with a single corticosteroid injection. One patient had a 30° flexion contracture; preoperative motion was not available for comparison. No patients had signs of elbow instability or numbness in the medial antebrachial cutaneous nerve distribution. CONCLUSIONS Modified oblique medial epicondylectomy was effective in improving symptoms in cubital tunnel syndrome. This medial collateral ligament sparing technique minimized complications previously associated with the original technique. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Shi Q, MacDermid J, Grewal R, King GJ, Faber K, Miller TA. Predictors of Functional Outcome Change 18 Months After Anterior Ulnar Nerve Transposition. Arch Phys Med Rehabil 2012; 93:307-12. [DOI: 10.1016/j.apmr.2011.08.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 08/30/2011] [Accepted: 08/30/2011] [Indexed: 10/14/2022]
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Shi Q, MacDermid JC, Santaguida PL, Kyu HH. Predictors of surgical outcomes following anterior transposition of ulnar nerve for cubital tunnel syndrome: a systematic review. J Hand Surg Am 2011; 36:1996-2001.e1-6. [PMID: 22123047 DOI: 10.1016/j.jhsa.2011.09.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 09/20/2011] [Accepted: 09/22/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Although cubital tunnel syndrome is the second most common nerve entrapment neuropathy, few studies explore potential predictor(s) of surgical outcomes. The purpose of this systematic review was to determine which factors affect the postoperative outcome for patients who undertake anterior transposition of the ulnar nerve. METHODS We included all studies reporting predictor(s) of clinical, electrophysiological study, or functional outcome after any anterior transposition of the ulnar nerve. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and CINAHL from 1980 to April 2011 and reference lists of articles. Two reviewers performed study selection, assessment of methodological quality, and data extraction independently of each other. RESULTS We assessed 26 studies including 2 randomized controlled trials, 10 cohort studies, and 14 case series. Overall, the methodological quality of the studies ranged from low to moderate. Six aspects of prognosis were sufficiently studied for a narrative evidence synthesis on age, duration of symptom, severity of operative status, preoperative electrodiagnostic testing results, type of surgery, and work compensation status. Evidence was conflicting across studies in terms of both the direction and intensity of the impact of these 6 potential predictors on surgical outcomes. CONCLUSIONS Because of conflicting results, we were unable to conclude which predictor(s) affect surgical outcomes after anterior transposition of the ulnar nerve. Surgeons who are aware of only a limited number of prognostic studies and their limited scope of evidence may not appreciate the extent of the inconsistency about whether factors commonly viewed as prognostic actually have a noteworthy impact on outcomes achieved. Such factors may be identified in the future with higher-quality studies, because limitations in the current research undoubtedly contribute to the controversies observed.
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Affiliation(s)
- Qiyun Shi
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
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Svernlöv B, Nylander G, Adolfsson L. Patient-reported outcome of surgical treatment of nerve entrapments in the proximal forearm. Adv Orthop 2011; 2011:727689. [PMID: 21991420 PMCID: PMC3170897 DOI: 10.4061/2011/727689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 06/23/2011] [Indexed: 11/20/2022] Open
Abstract
The outcome of decompression for long-standing symptoms of nerve entrapments in the proximal forearm was investigated in a retrospective study of 205 patients using a self-assessment questionnaire, 45 months after the operation. The questionnaire consisted of visual analogue scale recordings of pre- and postoperative pain during rest and activity, questions about remaining symptoms and appreciation of the result and the Disabilities of Arm, Shoulder and Hand form (DASH). Altogether, 59% of the patients were satisfied, 58% considered themselves improved, and 3% as being entirely relieved of all symptoms. Pain decreased significantly (P = 0.001). There was a significant correlation between preoperative duration and patient perceived post-operative pain. Preoperative pain was a chief complaint, and pain reduction appears to be the principal gain of the operation. Although the majority of the patients benefited from the operation, a substantial proportion was not satisfied. There is apparently room for improvement of the diagnostic and surgical methods applied in this study.
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Affiliation(s)
- Birgitta Svernlöv
- Department of Plastic Surgery, Hand Surgery and Burns, Linköping University Hospital, 581 85 Linköping, Sweden
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Göran Nylander
- Department of Plastic Surgery, Hand Surgery and Burns, Linköping University Hospital, 581 85 Linköping, Sweden
| | - Lars Adolfsson
- Department of Orthopaedics and Sports Medicine, Linköping University Hospital, 581 85 Linköping, Sweden
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Schnabl SM, Kisslinger F, Schramm A, Dragu A, Kneser U, Unglaub F, Horch RE. Subjective outcome, neurophysiological investigations, postoperative complications and recurrence rate of partial medial epicondylectomy in cubital tunnel syndrome. Arch Orthop Trauma Surg 2011; 131:1027-33. [PMID: 21203767 DOI: 10.1007/s00402-010-1250-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Indexed: 11/25/2022]
Abstract
The aim of the study was to evaluate the clinical outcome with subjective and neurophysiological parameters following partial medial epicondylectomy (pME) and to evaluate complications and recurrence rates. A retrospective analysis was performed in 29 patients (18 males and 11 females) with cubital tunnel syndrome (CuTS) who underwent pME. Mean time follow-up was 41.4 months. For subjective parameters, DASH (Disabilities of Arm, Shoulder and Hand), a self-created questionnaire about postoperative satisfaction and a visual pain scale (VAS) have been used. All patients were classified according to the Mc Gowan Classification (McG) and Wilson & Krout Classification (WKC). The patients were examined by nerve conduction velocity. Total mean of the DASH score was 24.8 points. In a questionnaire with integrated pain score (1-5), 96% of the patients declared a postoperative improvement, whereas 41.4% patients of the latter group were very contented with the results, 37.9% were contented, 17.2% were less contented and 3.4% were discontented. The VAS for evaluation of postoperative pain showed an average of 2.36 (0-5.9) out of 10. Of the patients, 68.0% were classified as grade I according to McG and 68.0% as excellent or good according to WKC. Motor nerve conduction velocity improved from 34.8 m/s preoperatively to 48.2 m/s postoperatively. One patient developed a haematoma and three patients (10.3%) had to be classified as recurrence. High postoperative rates of patient satisfaction and improved neurophysiological results could be achieved by pME.
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Affiliation(s)
- Saskia M Schnabl
- Department of Plastic and Hand Surgery, Friedrich-Alexander-University of Erlangen, Krankenhausstrasse 12, Erlangen, Germany
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Objective outcome of partial medial epicondylectomy in cubital tunnel syndrome. Arch Orthop Trauma Surg 2010; 130:1549-56. [PMID: 20730441 DOI: 10.1007/s00402-010-1160-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Indexed: 02/09/2023]
Abstract
AIM Goal of the study was to evaluate the clinical outcome in cubital tunnel syndrome (CuTS) after partial medial epicondylectomy (pME) with objective parameters. METHOD A retrospective analysis was performed in 29 (18 male/11 female) patients with CuTS who underwent pME. Mean time follow-up was 41.4 months. Parameters assessed sensibility (two point discrimination (2PD) and Semmes Weinstein Monofilaments (SW)) of the fifth finger and grip and pinch strength. In addition, elbow range of motion, elbow instability, medial elbow pain, Froment sign and Tinel`s sign were evaluated. RESULTS Postoperative static 2PD of the fifth finger was 12.6 mm. SW values on the operated side (mean 3.58; 2.44-6.65) were comparable to the non-operated side (mean 3.28; 2.44-4.93). Tinel's sign over the ulnar sulcus was positive in 13 cases preoperative and in 16 cases postoperatively. Range of motion of the elbow joint achieved normal values in flexion/extension and pronation/supination with no significant difference in comparison to the non-operated side. Froment sign was positive in 2 cases, negative in 23 cases. Grip strength averaged 48.1 kg in man versus 24.4 kg in women. Pinch strength was 8.6 versus 5.3 kg. Grip strength on the operated side reached up to 91.0% values of the opposite arm. CONCLUSION Good postoperative objective results were reached by pME. pME is an adequate treatment option in CuTS.
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Abstract
Cubital tunnel syndrome is the second most common compression neuropathy in the upper extremity. Patients complain of numbness in the ring and small fingers, as well as hand weakness. Advanced disease is complicated by irreversible muscle atrophy and hand contractures. Ulnar nerve decompression can help to alleviate symptoms and prevent more advanced stages of dysfunction. Many surgical treatments exist for the treatment of cubital tunnel syndrome. In situ decompression, transposition of the ulnar nerve into the subcutaneous, intramuscular, or submuscular plane, or medial epicondylectomy have all been shown to be affective in the treatment of this disease process. Comparative studies have shown some short-term advantages to one or another technique, but overall results between the treatments have essentially been equivocal. The choice of surgical treatment is based on multiple factors, and a single surgical approach cannot be applied to all clinical situations. Through careful consideration of the potential sites of nerve compression and the etiologies for these local irritations, the appropriate surgical technique can be selected and a good outcome anticipated in most patients.
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Mackinnon SE. Comparative clinical outcomes of submuscular and subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg Am 2009; 34:1574-5; author reply 1575. [PMID: 19801113 DOI: 10.1016/j.jhsa.2009.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 07/23/2009] [Indexed: 02/02/2023]
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