Minimal medial epicondylectomy and decompression for cubital tunnel syndrome.

Sixty-four patients (66 elbows) treated for refractory cubital tunnel syndrome had minimal medial epicondylectomy and in situ decompression to minimize the potential disadvantages of classic medial epicondylectomy. After a mean followup of 27 months results were excellent in 27 patients (44%), good in 23 patients (35%), fair in 10 patients (15%), and poor in four patients (6%). No ulnar nerve palsy, ulnar nerve subluxation, or medial elbow instability were seen. The main complaint of patients regarding the procedure was tenderness at the osteotomy site. The results show that minimal medial epicondylectomy and in situ decompression of the ulnar nerve is a safe and effective method to treat patients with cubital tunnel syndrome. This procedure minimizes the disadvantage of medial instability and recurrent symptoms attributable to nerve trauma after a classic medial epicondylectomy.     

Objective outcome of partial medial epicondylectomy in cubital tunnel syndrome

Aim  

Goal of the study was to evaluate the clinical outcome in cubital tunnel syndrome (CuTS) after partial medial epicondylectomy (pME) with objective parameters.     

Partial medial epicondylectomy for cubital tunnel syndrome: Outcome and complications

The results of partial medial epicondylectomy for cubital tunnel syndrome were evaluated in 60 elbows of 54 patients. Preoperatively, 8 patients were grade I, 24 grade IIA, 16 grade IIB, and 12 grade III according to the modified McGowan score (Goldberg BJ et al. JHand Surg [Am] 1989;14:182-8). Mean follow-up was 38.8 months. Special emphasis was placed on evaluation of 5 commonly reported drawbacks: medial elbow pain was related to the end result (P <.01), nerve vulnerability/subluxation might contribute to pain (P <.05), loss of force (approximately 15%) had no clinical implication, and flexion contracture and valgus instability were present in only 1 elbow. Eighty-three percent of our patients were better according to the Wilson and Krout score,(22) with 75% having excellent and good results. An improvement of at least 1 McGowan grade was obtained in 88.3%. The chance for complete recovery was inversely related to the initial neuropathy grade, as is consistently found throughout the literature for all types of cubital tunnel surgery. Partial medial epicondylectomy is a valuable surgical procedure for treating grade I to IIB ulnar neuropathy.     

Distal medial epicondylectomy. A modification of partial medial epicondylectomy for cubital tunnel syndrome: preliminary results

Introduction

The medial epicondyle behaves as a fulcrum and a pulley that tethers the ulnar nerve during flexion. Excision of the distal half of the medial epicondyle sets the point of contact of the bone with the nerve proximally and decreases the traction effect of the medial epicondyle on the ulnar nerve. In this study, we aim to investigate the surgical and clinical results of excision of the distal half of the medial epicondyle in cubital tunnel syndrome (CuTS).

Patients and methods

Cubital tunnel release with excision of the distal half of the medial epicondyle was performed in 19 patients. The patients were evaluated preoperatively and postoperatively with clinical examinations, McGowan and Wilson–Krout scores, Semmes–Weinstein monofilament and two-point discrimination tests, and grip and pinch strength measurements.

Results

A one-grade improvement in McGowan classification was observed in 79?% of patients and a two-grade improvement in 21?% of patients at the time of the first postoperative examination. At 24?months after surgery, 18 patients reported the Wilson–Krout scores as excellent (95?%). Statistically significant improvements in sensory and motor strength measurements were achieved at all postoperative examinations.

Conclusion

The objective and subjective outcome measures achieved with distal medial epicondylectomy are comparable with other epicondylectomy techniques. The complication rates seem to be lower than those of total or partial medial epicondylectomy. This procedure is an acceptable and safe alternative for the surgical treatment of CuTS.     

Subcutaneous anterior transposition versus decompression and medial epicondylectomy for the treatment of cubital tunnel syndrome

A review of the literature often fails to uncover the best procedure for the treatment of cubital tunnel syndrome. This article compares 2 frequently used methods (subcutaneous anterior transposition vs decompression and medial epicondylectomy) for their effectiveness in relieving both subjective and objective symptoms of cubital tunnel syndrome. Between August 1991 and October 1993, nineteen patients underwent surgical decompression by a single surgeon for ulnar neuropathy at the elbow. Factors evaluated included upper extremity range of motion, elbow valgus stress, grip strength, pinch, 2-point discrimination, and pre- and postoperative nerve conduction. A standardized questionnaire was administered to assess subjective relief of symptoms.In the transposition group, grip strength averaged 71.2% of normal and pinch strength 86.6% of normal, and 2-point discrimination averaged 8.0 mm. The derived subjective assessment score was 23.2 of a possible 40. The average ulnar motor conduction velocity across the elbow was 50.1 m/sec preoperatively and 56.3 m/sec postoperatively. In the medial epicondylectomy group, grip strength averaged 79.5% of normal and pinch strength 81.7% of normal, and 2-point discrimination averaged 8.0 mm. The average ulnar motor conduction velocity across the elbow was 45.7 m/sec preoperatively and 55.7 m/sec postoperatively. No statistically significant difference existed between the 2 groups for the aforementioned indexes. These results do not indicate a difference between the outcomes of the patients undergoing either of the procedures. Because epicondylectomy is less technically demanding, with less soft tissue dissection of the nerve, it may be preferred over ulnar transposition.     

Comparison between partial and minimal medial epicondylectomy combined with decompression for the treatment of cubital tunnel syndrome

We have performed minimal medial epicondylectomy for cubital tunnel syndrome since 1990 to preserve the anterior medial collateral ligament. In this study we compared surgical outcomes between partial medial epicondylectomy (14 patients) and minimal medial epicondylectomy (18 patients) combined with ulnar nerve decompression for the treatment of cubital tunnel syndrome. Mean preoperative Yasutake scores were 57 +/- 17 points (+/-SD) in the partial epicondylectomy group and 60 +/- 15 points in the minimal medial epicondylectomy group. The postoperative scores were 79 +/- 19 points and 87 +/- 10 points, respectively. Both groups had significant improvement in their Yasutake scores following medial epicondylectomy. Similar improvements in motor conduction velocity were observed. There was no significant difference in improvement of either the Yasutake scores or the motor conduction velocity between the 2 groups. Valgus instability of the elbow was significantly greater in the partial epicondylectomy group. We therefore conclude that minimal medial epicondylectomy combined with ulnar nerve decompression is an effective treatment for cubital tunnel syndrome and that a larger excision of the medial epicondyle should be avoided.     

Comparative study between minimal medial epicondylectomy and anterior subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome

The purpose of this study was to review the results of 2 surgical methods for treating cubital tunnel syndrome. From 1994 to 2001, minimal medial epicondylectomy was performed on 22 elbows, and anterior subcutaneous transposition of the ulnar nerve was done on 34 elbows. In the group treated by medial epicondylectomy, 9 of the results (41%) were excellent, 10 (45%) were good, 2 (9%) were fair, and 1 result (5%) was poor. In the group treated by anterior subcutaneous transposition of ulnar nerve, 14 of the results (41%) were excellent, 13 (38%) were good, 6 (18%) were fair, and 1 result (3%) was poor. No significant difference was found between the 2 groups (P < .05). Both methods can be used for the treatment of cubital tunnel syndrome with a high rate of satisfaction.     

Results of surgical treatment for cubital tunnel syndrome]

The aim of this study was to evaluate the results of surgical treatment of cubital tunnel syndrome (CTS) and asses the efficiency of surgical techniques implemented in our Department. Fifty-one patients with CTS were treated with 3 different surgical techniques: submuscular transposition, anterior transposition, and ulnar nerve decompression (UND). Thirty-one patients were evaluated post-op: 4 patients after ST, 21 patients after AT and 7 after UND. UND relieves the pain, but numbness, paresthaesia, and decreased muscle power were observed post-op. Post-op tenderness and hyperaesthesia of the medial epicondyle were noted after AT procedures. A decrease in nerve conduction in EMG studies is probably the best quantitation method of ulnar nerve neuropathies. Our study did not indicate which surgical technique was most effective in the treatment of CTS.     

Anatomical basis for a surgical treatment of cubital tunnel syndrome]

The paper presents anatomical basis for a surgical treatment of cubital tunnel syndrome. There are five major anatomical locations where the ulnar nerve may be compressed near the elbow. Transfer of the ulnar nerve decompresses all five locations simultaneously and thus theoretically may be more reliable.     

Treatment of cubital tunnel syndrome by frontal partial medial epicondylectomy. A retrospective series of 55 cases

The outcomes of 55 cases of cubital tunnel syndrome treated by a partial frontal epicondylectomy are presented at a mean follow-up of 38 months follow-up. According to McGowan classification, 25 cases were grade I (45%), 12 grade II (22%) and 18 grade III (33%). The results (Wilson and Krout classification) were excellent or good in 41 patients (75%), fair in nine patients and unchanged in five, without any worsening or recurrence. Total relief was reported in 80% of grade I, 75% of grade II and 66% of grade III patients. Seven painful scars and one persistent 15( composite function) elbow extension deficit were the only complications. The satisfaction rate was 93%. This technique preserves bony protection, the blood supply and gliding tissues for the nerve and nerve recovery were comparable to other surgical procedures. Residual pain at the osteotomy site was not a serious problem.     

Medial epicondylectomy in cubital tunnel syndrome: an electrodiagnostic study.

Prospective analysis of 27 medial epicondylectomies in 22 patients with McGowan grade I ulnar neuropathy demonstrated an improvement in clinical symptoms. In all patients a N.C.V. study, in which compression of the ulnar nerve at the cubital tunnel was evident, has been a prerequisite for operation. Conduction velocity across the cubital tunnel averaged 48% of normal (26.4 +/- 8.7 metres per second) preoperatively and increased to 85% of normal (46.7 +/- 9.7 metres per second) postoperatively. A preoperative N.C.V. study allows the achievement of a high success rate, especially in the less well clinically defined group of patients with grade I neuropathy (subjective complaints without any objective signs of muscle atrophy). Medial epicondylectomy is safe and predictable in the treatment of cubital tunnel syndrome.     

The surgical treatment of cubital tunnel syndrome: a decision analysis

The objective of our study was to use decision analysis to compare four common surgical treatments for cubital tunnel syndrome: simple decompression of the cubital tunnel, medial epicondylectomy, anterior subcutaneous transposition and anterior submuscular transposition. The variables used for this decision analysis model were based on data from the literature. Extensive sensitivity analyses were carried out to test the impact of the values given to these variables on the outcome of the model. The highest expected utility, 0.973, was associated with simple decompression. The expected utility was 0.969 for subcutaneous transposition and 0.965 for submuscular transposition. Medial epicondylectomy had the lowest expected utility at 0.961. Simple decompression remained the preferred strategy in extensive one-way sensitivity analyses.     

Subjective outcome,neurophysiological investigations,postoperative complications and recurrence rate of partial medial epicondylectomy in cubital tunnel syndrome

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.     

Minimal epicondylectomy improves neurologic deficits in moderate to severe cubital tunnel syndrome

Background  

Previous studies of minimal medial epicondylectomy for cubital tunnel syndrome included patients with mild disease, making it difficult to determine how much this procedure improved sensory and motor impairments in patients with moderate to severe disease.     

History of the surgical treatment of cubital tunnel syndrome]

The paper presents history of surgical treatment of ulnar nerve compression at the elbow. Chronological overview the history surgical techniques is presented. This article to provide information of history surgical treatment of ulnar nerve decompression in Poland.