eMedicine Specialties > Orthopedic Surgery > Elbow

Cubital Tunnel Syndrome: Follow-up

Author: James R Verheyden, MD, Consulting Surgeon, Department of Orthopedic Surgery, The Orthopedic and Neurosurgical Center of the Cascades
Coauthor(s): Andrew K Palmer, MD, Chair, Professor, Department of Orthopedics, State University of New York-Upstate Medical University
Contributor Information and Disclosures

Updated: Jun 26, 2009

Outcome and Prognosis

In general, every method described results in 85-90% good-to-excellent results.

Bartels et al performed a meta-analysis literature review from 1970-1997 including 3024 patients.76 Irrespective of preoperative status, simple decompression resulted in the best outcome. Subcutaneous and submuscular transposition had the worst outcomes. For severe compression (McGowan grade 3), anterior intramuscular transposition had the best outcome, and simple decompression and submuscular transposition had the next best outcomes.

Heithoff reviewed 14 clinical studies, covering 516 patients, in which a simple decompression was performed for cubital tunnel syndrome. Results were satisfactory in 75-92% of the patients.77

Steiner et al monitored 41 patients with a simple ulnar nerve decompression for an average follow-up period of 2 years.78 Results were good or very good in 89% of the patients; 8% of the patients had no improvement.

Lluch studied 20 patients with an in situ decompression through a transverse incision.79 He noted a 24% incidence of complications from unsightly scarring and injury to the posterior branches of the medial antebrachial cutaneous nerve (MACN) in a retrospective review of 22 patients. To avoid this complication, he performed a transverse incision for the in situ decompressions. This allowed easier identification and protection of the nerve branches. In 20 patients, no problems with dysesthesia or amputation neuromas occurred, and a good cosmetic result was obtained.

Heithoff and Millender reviewed 12 clinical studies involving 350 patients in which a medial epicondylectomy was performed for cubital tunnel syndrome. Results were satisfactory in 72-94% of the patients.75

Kaempffe and Farbach reviewed 27 patients with partial medial epicondylectomies who were monitored for an average of 13 months.80 Subjective improvement was noted in 93% of cases. Results were excellent in 8 patients, good in 10 patients, and fair in 8 patients; 1 patient had a poor result.

Seradge examined factors that influence the outcome after a medial epicondylectomy.69 He studied 160 patients over a 10-year period and monitored patients for 3 years postoperatively. Twenty-one patients had a recurrence, defined as a return of symptoms 3 months or longer after surgery. Of these recurrences, 44% occurred in patients in their fourth decade of life. The rate of recurrence was 18% in females and 10% in males. The rate of recurrence was double in patients who did not return to work within 3 months. When concomitant ipsilateral carpal tunnel syndrome was present, the recurrence rate was 17%, versus 9% when carpal tunnel was not present. When concomitant thoracic outlet syndrome was present, the recurrence rate was 20%, versus 9% when concomitant thoracic outlet syndrome was not present. In conclusion, he noted a high recurrence rate after medial epicondylectomy in women of middle age who had ipsilateral carpal tunnel syndrome or thoracic outlet syndrome and who did not return towork  within  3 months postoperatively.

Seradge also examined the results of medial epicondylectomy in patients on workers' compensation.70 These patients stayed out of work longer, used a longer period of conservative treatment without a positive impact on surgical outcome, had a less favorable surgical result, and had a higher recurrence rate.

Glowacki and Weiss reviewed the results of anterior intramuscular transpositions in patients receiving workers' compensation.81 Patients receiving workers' compensation had a 33% complete resolution of symptoms. In contrast, patients who were not receiving workers' compensation had a 57% complete resolution of symptoms.

Geutjens et al conducted a prospective study of 52 patients, comparing medial epicondylectomy with anterior transposition.82 Better results were found with medial epicondylectomy. More patients were satisfied and more stated they would have the operation again; additionally, fewer patients complained of mild pain in their hand postoperatively. No significant differences were present in motor power or nerve conduction rates at follow-up visits.

Kleinman and Bishop monitored 47 patients after anterior intramuscular transposition for an average of 28 months.83 Results were good or excellent in 87%, with return of normal grip strength and 2-point discrimination. No patient required reoperation.

Similarly, Glowacki and Weiss monitored 45 patients after anterior intramuscular transposition for an average of 15 months and noted resolution or improved symptoms in 87%.81

Asami et al monitored 35 patients for an average of 70-72 months after an anterior intramuscular transposition, with and without preservation of the extrinsic vasculature.84 Nerve conduction velocities and clinical results were better in the group in which extrinsic vessels were preserved. When the extrinsic vessels were sacrificed, 3 excellent, 3 good, 4 fair, and no poor results were obtained. When the extrinsic vessels were preserved, 16 excellent, 12 good, 3 fair, and no poor results were obtained.

Nouhan and Kleinert monitored 33 limbs in 31 patients after an anterior submuscular transposition for an average of 49 months.85 A flexor-pronator z-lengthening technique was performed without internal neurolysis, with 36% excellent, 61% good, and 3% poor results.

Tsujino et al followed 16 patients after cubital tunnel reconstruction for ulnar nerve neuropathy in osteoarthritic elbows.86 A simple decompression with resection of the osteophytes from the retrocondylar groove was performed. Patients were monitored for an average of 36 months. All patients were relieved of their preoperative discomfort and had complete or partial recovery of their motor and sensory function.

Future and Controversies

Endoscopy of nonjoint cavities is widely performed, and endoscopic carpal tunnel release is a popular, although debated, method to release the median nerve at the wrist.87 With this experience, authors have attempted endoscopic cubital tunnel release. Endoscopic release allows local decompression with the ability to decompress the nerve at all potential sites of compression. The possible advantages of this technique include limited invasiveness, reduced complication rates, and quicker rehabilitation.88,89

Tsu-Min Tsai et al performed an endoscopic cubital tunnel release on 85 elbows in 76 patients and monitored them for an average of 32 months; 42% had excellent results, 45% had good results, 11% had fair results, and 2% had poor results.90 These results are comparable to the other decompressive techniques used, which overall result in 85-90% good-to-excellent results.

 


More on Cubital Tunnel Syndrome

Overview: Cubital Tunnel Syndrome
Workup: Cubital Tunnel Syndrome
Treatment: Cubital Tunnel Syndrome
Follow-up: Cubital Tunnel Syndrome
References
Further Reading
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Keywords

cubital tunnel syndrome, ulnar nerve entrapment, ulnar nerve, ulnar nerve compression, ulnar nerve neuropathy at the elbow, nerve entrapment syndromes, numb finger, compressive neuropathy

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Contributor Information and Disclosures

Author

James R Verheyden, MD, Consulting Surgeon, Department of Orthopedic Surgery, The Orthopedic and Neurosurgical Center of the Cascades
James R Verheyden, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, and American Society for Surgery of the Hand
Disclosure: Nothing to disclose.

Coauthor(s)

Andrew K Palmer, MD, Chair, Professor, Department of Orthopedics, State University of New York-Upstate Medical University
Andrew K Palmer, MD is a member of the following medical societies: American Osteopathic College of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Mark D Lazarus, MD, Associate Professor of Orthopedic Surgery, Medical College of Pennsylvania-Hahnemann University, Chief of Shoulder and Elbow Service, Department of Orthopedic Surgery, Hahnemann University Hospital
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael Yaszemski, MD, PhD, Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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