Medial Epicondylectomy or Ulnar-Nerve Transposition for Ulnar Neuropathy at the Elbow?

Abstract

W e carried out a prospective randomised study comparing medial epicondylectomy with anterior transposition for the treatment of ulnar neuropathy at the elbow. The mean follow-up period was 4.5 years and we assessed the patients neurologically and orthopaedically.Neither procedure appeared to have a significant effect on elbow function. Our study showed better results after medial epicondylectomy; in particular patient satisfaction was higher than after ulnar nerve transposition. There were no significant differences in motor power or nerve-conduction rates and sensory fibres appeared to be more vulnerable to devascularisation. [Br] 1996;78-B:777-9. Received 15 August 1995; Accepted after revision 6 February 1996 The place of surgery in the treatment of lesions of the ulnar nerve at the elbow is uncertain: a variety of procedures has been recommended. There have been several reports of good results for medial epicondylectomy (King and Morgan 1959;Craven and Green 1980;Froimson and Zahwari 1980;Robinson, Aghasi and Halperin 1992), but none of these includes comparison with other operations, such as the commonly performed anterior transposition of the nerve (Macnicol 1979;Adelaar, Foster and McDowell 1984;Lundborg 1992). J Bone Joint SurgWe have performed a prospective randomised study of medial epicondylectomy and anterior transposition for the treatment of lesions of the ulnar nerve at the elbow. PATIENTS AND METHODSFrom 1985 to 1992, a total of 52 patients had operations for ulnar neuropathy and were entered into the study. Nine were lost to follow-up of whom two had died, records were untraceable in four, and three had moved away and could not be contacted. This left 43 patients, four of whom had bilateral operations, giving 47 cases. The mean age at operation was 58 years (36 to 85). Seven patients had preexisting osteoarthritis of the elbow, but there was no apparent cause in 36. For entry into the study, patients had to fulfil the following criteria: 1) clinical evidence of a lesion of the ulnar nerve at the elbow; 2) demonstrable slowing of conduction of the ulnar nerve at the elbow; 3) persistent symptoms for at least three months; 4) no rheumatoid disease at the elbow; and 5) no valgus deformity, defined as a carrying angle of more than 5° greater than the opposite elbow.All patients had a detailed neurological assessment (DJ) and nerve-conduction studies (NJS) before operation and at 12 months. They were randomly allocated to one of the two operations by the use of sealed envelopes which were only opened in the operating theratre just before the procedure. All surgery was performed by one of two surgeons (NJB or CJH), so that both procedures were performed by both surgeons, thus avoiding any technical bias.Neurological assessments, made before operation and at follow-up, included muscle strength rated on a scale of 0 to 5, muscle atrophy and sensation evaluated by light touch and static two-point discrimination. Pain in the hand was scored from 5 for severe nocturnal pain to zero. Follow-up review w...

Surgical Treatment for Ulnar Nerve Entrapment at the Elbow

“…6,7,13,17) Deciding on the most effective procedure can be difficult, given the excellent results claimed. 1,2,14,18) Despite the high frequency of UNE, there is no clear consensus on the indications for surgery or the most appropriate surgical technique. [14][15][16]19,20,[23][24][25]30,41) Operative management includes simple decompression (or``decompression in situ''); medial epicondylectomy, either alone or in combination with simple decompression; and anterior transposition.…”

Minimal Epicondylectomy Improves Neurologic Deficits in Moderate to Severe Cubital Tunnel Syndrome

“…For partial epicondylectomy, improvement percentages have been reported as 67% good to excellent results in 27 patients [21], 75% good to excellent results in 60 patients [30], 75% good to excellent results in 55 patients [37], 79% good to excellent results in 80 patients [8], and 80% good to excellent results in 45 patients [28]. Several studies have shown that after total epicondylectomy, patients experienced an overall subjective improvement of approximately 90% [9,14,16,25,40]. In studies of anterior transposition of ulnar nerve in patients with severe-stage cubital tunnel syndrome, the improvement percentages were reported as 72% to 100% [12,13,15,23].…”

Selection of Operative Procedures for Cubital Tunnel Syndrome

“…Much of the controversy of the operative procedure for carpal tunnel syndrome is the method by which to release the ligament but most surgeons would agree that successful management of patients with carpal tunnel syndrome depends on complete release of the flexor retinaculum [1,3,6,17,22]. In contrast for cubital tunnel syndrome, there are numerous operative procedures that have been described for the treatment of cubital tunnel syndrome ranging from simple decompression, medial epicondylectomy to transposition of the ulnar nerve [2,4,7,9,12,13,14,15,16,19,21,23,24,25,26,27,29,30,31]. These procedures vary not only in surgical technique but also in the correction of the etiologic factors.…”

“…There are numerous operative procedures described for the treatment of cubital tunnel syndrome ranging from simple decompression, medial epicondylectomy to transposition of the ulnar nerve [2,4,7,9,12,13,14,15,16,19,21,23,24,25,26,27,29,30,31]. With each operative procedure, there have been reports of excellent patient outcome as well as postoperative complications [10,11,18,28].…”