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21.01.2017 | Original Article - Neurosurgical Techniques | Ausgabe 3/2017

Acta Neurochirurgica 3/2017

Muscular atrophy in severe cases of cubital tunnel syndrome: prognostic factors and outcome after surgical treatment

Zeitschrift:
Acta Neurochirurgica > Ausgabe 3/2017
Autoren:
Markus Bruder, Stephan Dützmann, Nourdin Rekkab, Johanna Quick, Volker Seifert, Gerhard Marquardt
Wichtige Hinweise

Comments

This paper looks at the results of ulnar decompressive surgery, with or without transposition, in patients with a severe grade of nerve injury characterized by having atrophy of ulnar supplied intrinsic hand muscles. The authors conclude that many of these patients improved with surgery, especially if the surgery was performed within 8.5 months of symptom onset and the patients did not suffer from diabetes. Despite several shortcomings, such as the lack of EMG data and a more objective assessment of clinical outcomes by individuals not directly involved with the surgery, it is an important study with an important conclusion.
Michel Kliot
IL, USA

Abstract

Background

Cubital tunnel syndrome (CuTS) is a frequent neuropathy, leading to sensor-motoric dysfunction. Many patients even present with muscular atrophy as a sign for severe and long-lasting nerve impairment, usually suggesting unfavourable outcome. We analysed if those patients benefit from surgical treatment on a long-term basis.

Methods

Between January 2010 and March 2015, 42 consecutive cases of CuTS with atrophy of the intrinsic hand muscles were surgically treated in our department. Clinical data of the treatment course and postoperative results were collected. Follow-up was prospectively assessed according to McGowen grading and Bishop outcome score. Mean follow-up time was 39.8 (±17.0) months.

Results

All patients were treated with in situ decompression; in 33%, submuscular transposition was performed. Forty-five percent showed improvement of sensory deficits and 57% showed improvement of motor deficits 6 months after the operation. Atrophy improved in 76%. At the time of follow-up, 79% were satisfied with the postoperative result and 77% of patients reached good or excellent outcome according to modified Bishop rating scale. Patients with improvement of atrophy had significantly shorter symptom duration period (7 ± 10 months vs 26 ± 33 months; p < 0.05). In the case of intraoperative pseudoneuroma observation, atrophy improvement was less likely (p < 0.05).

Conclusions

In severe cases of CuTS with atrophy of the intrinsic hand muscles, surgical treatment enables improvement of sensory function, motor function and atrophy even in cases with muscular atrophy. Atrophy improvement was more likely in cases of short symptom duration and less likely in cases with pseudoneuroma.

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