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Erschienen in:
01.11.2013 | Original Paper
Surgical management of cubital tunnel syndrome: a comparative analysis of outcome using four different techniques
Erschienen in: European Journal of Plastic Surgery | Ausgabe 11/2013
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Background
Various options exist for the surgical management of cubital tunnel syndrome. The goals of this study were to compare the outcome of four different surgical techniques: (1) simple decompression, (2) endoscopic decompression, (3) anterior subcutaneous transposition, and (4) anterior sub-muscular transposition for the treatment of cubital tunnel syndrome.
Methods
One hundred ten patients (117 cases) with cubital tunnel syndrome were reviewed from 1986 to 2000. Parameters measured included signs and symptoms, medical comorbidity, other nerve compressions, and anatomical pathology. Severity was evaluated using the Dellon classification and the symptom severity score (SSS). SSS included evaluation of pain, clawing, the Froment sign, and the Wartenberg sign. Bishop's rating was measured at final follow-up. Statistical analysis included ANOVA, Kruskal–Wallis tests, and Spearman's Rho for correlation.
Results
Correlation between severity of nerve compression and symptom duration was not statistically significant. A significant weak positive correlation existed between Dellon score and SSS. Bishop's rating was 46.5 % excellent, 39.5 % good, 7.9 % fair, and 6.1 % poor overall. A significant weak negative correlation existed between the Dellon score and Bishop's rating. The average Bishop score was 1.74 ± 0.85, and no significant difference existed when comparing each surgical technique to one another. No significant association was found between the severity of compression (Dellon) and the surgery type performed. A weak negative correlation existed between severity of ulnar nerve compression and clinical outcome. No significant differences were found between the type of surgeries performed in regard to outcome and Dellon score.
Conclusions
We found patients with the most severe compressive symptoms benefited the least from operative intervention regardless of surgical technique used. However, for mild to moderate disease, performing any of the purposed surgical techniques in accordance with the physician’s experience and comfort level is adequate in treating ulnar nerve compression at the elbow joint.
Level of Evidence Level IV, therapeutic study