On-line version ISSN 2309-8309
SA orthop. j. vol.8 n.1 Pretoria Jan. 2009
Y RamguthyI; M CaridesII
IBMedSc(UDW), MBChB (Medunsa); Orthopaedic Registrar*
IIMBBCh(Rand), DipPEC(SA), FCS(SA)Orth; Senior Consultant, Department of Orthopaedics, University of the Witwatersrand
BACKGROUND: The procedure of choice in the surgical treatment of cubital tunnel syndrome remains controversial. The aim of this study is to report the results of simple decompression and decompression with anterior subcutaneous transposition.
METHODS: A retrospective review (July 2002-January 2007) using the Bishop Score to assess outcome. A total of 102 procedures (91 patients, 11 bilateral) were performed with a minimum of 9 months' post-operative follow-up. The procedure was selected intra-operatively. All cases were operated by the senior author (MC).
RESULTS: In the simple decompression group (n=47, average age 45.9 years), the average Bishop Score was 11.3 (5-13) with an average time to recovery of 3.7 months (1-6). Good to excellent results were obtained in 94% and fair results in 6%.
In the anterior transposition group (n=55, average age 43.3 years) the average Bishop Score was 10.6 (5-13) with average time to recovery of 4.2 months (1-6). Good to excellent results were obtained in 93% and fair results in 7%. Complications included subluxation of the ulnar nerve in two cases, one wound dehiscence and one post-operative haematoma.
CONCLUSIONS: The outcome in both groups was the same. Recovery is often prolonged. It took 3-6 months for 69% of patients to recover. Younger patients recovered sooner and the transposition and elderly groups took longer to recover. Simple decompression is adequate unless the nerve is unstable or the bed unsuitable.
“Full text available only in PDF format”
1. Green's operative hand surgery. Green, Hotchkiss, Pederson, Wolfe (eds). Fifth edition, vol 1, 1024. Churchill Livingstone 2005. [ Links ]
2. Dellon AL, Chang E, Coert JH, Campbell KR. Intraneural ulnar nerve pressure changes related to operative techniques for cubital tunnel decompression. J Hand Surg(Am) 1994;19A:923-30. [ Links ]
3. Botenza DJ. Cubital tunnel syndrome pathophysiology. Clin Orthop Rel Res 1998;351:90-4. [ Links ]
4. Nabhan A, Ahlhelm F, Kelm J, Reith W, Schwergtfeger, Steudel WI. Simple decompression or subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg (Br and Eur) 2005;30B(5):521-4. [ Links ]
5. Bartels RHMA, Verhagen WIM, van der Wilt GJ, Meulstee J, Rossum LGM, Grotenhuis JA. Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: Part 1. Neurosurgery 2005;56:522-30. [ Links ]
6. Biggs M, Curtis JA. Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition. Neurosurgery 2005;58:296-304. [ Links ]
7. Gervasio O, Gambardella G, Zaccone C, Branca D. Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: A prospective randomized study. Neurosurgery 2005;56:108-17. [ Links ]
8. Nathan PA, Keniston RA, Meadows KD. Outcome study of ulnar nerve compression at the elbow treated with simple decompression and an early programme of physical therapy. J Hand Surg (Br) 1995;20B(5):628-37. [ Links ]
9. Lascar T, Laulan J. Cubital tunnel syndrome: A retrospective review of 53 anterior subcutaneous transpositions. J Hand Surg Br 2000;25B(5):453-6. [ Links ]
10. Ogata K, Manske PR, Lesker PA. The effect of surgical dissection on regional blood flow to the ulnar nerve in the cubital tunnel. Clin Orthop Rel Res 1985;193:195-8. [ Links ]
Dr Y Ramguthy
Department of Orthopaedics
Faculty of Health Sciences, University of the Witwatersrand
Tel: (011) 717-2538; Fax: (011) 447-6148
This article was not submitted to an ethical committee for approval. The content of this article is the sole work of the authors. No benefits of any form have been derived from any commercial party related directly or indirectly to the subject of this article.
*This article was awarded 1st prize in the GT du Toit Registrars' Competition.