Effective Surgical Treatment of Cubital Tunnel Syndrome Based on Provocative Clinical Testing without Electrodiagnostics

Abstract

This study demonstrates the effectiveness of surgical therapy in patients with lesions identified by clinical examination without electrodiagnostic testing. After the completion of this study, an additional 87 patients were treated (18 bilateral) with cubital tunnel release. The data from these patients confirm the effectiveness of surgical treatment of ulnar entrapment neuropathy based on provocative clinical testing.

Comparative Clinical Outcomes of Submuscular and Subcutaneous Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome

“…Pasque and Rayan 27 reported a normalized 2-point discrimination in 84% of their 50 cases after anterior submuscular nerve transposition. Greenwald et al 34 stressed the importance of an accurate preoperative clinical examination over electrodiagnostic testing and found a significant postoperative improvement of 2.5 mm in 2-point discrimination 6 months after submuscular transposition. An analogous effect on sensory recovery was described by Nabhan et al 15 who reviewed 34 patients 3, 6, and 9 months postoperatively after subcutaneous nerve transposition.…”

Comparative Study of Outcome of Simple Decompression Versus Anterior Transposition of Ulnar Nerve in the Treatment of Cubital Tunnel Syndrome

“…Although some reports suggest that anterior subcutaneous transposition has a higher trend towards improvement when compared to simple decompression [14,15], many other reports including large meta-analysis studies found no statistical difference in the outcome between both modalities. They concluded that simple decompression is a "reasonable alternative" to anterior transposition; having shorter operative time, lower cost and comparable outcome [33][34][35][36].…”

“…Proponents of simple decompression in the absence of an anatomical lesion argue that transposition of ulnar nerve involves an unnecessary risk of nerve injury or devascularization, and extensive dissection. In turn, proponents of anterior transposition argue that dynamic compression of the nerve with elbow flexion can only be properly resolved by this technique [14,15,23,24].…”

“…Additionally, the cubital tunnel retinaculum was sharply divided in proximal-to-distal direction. [13][14][15][16][17].…”

Predictors of Surgical Outcomes Following Anterior Transposition of Ulnar Nerve for Cubital Tunnel Syndrome: A Systematic Review

“…Four case series (1 low-quality 16 and 3 moderate-quality 17,25,26 ) and 1 cohort study (moderate quality) 23 concluded that the preoperative electrophysiological findings had no association with poor surgical outcome. On the other hand, Gervasio et al 20 conducted an RCT (moderate quality) 20 and declared that both preoperative and improvement of electrophysiological values help predict the functional outcome of the surgery.…”