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Predictors of surgical outcomes for severe cubital tunnel syndrome: a review of 146 patients

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Abstract

Background

Full recovery is unlikely for severe cubital tunnel syndrome, and prognostic factors remain uncertain. We aimed to identify predictors of surgical outcome for these patients.

Methods

One hundred forty-six patients with McGowan grade III cubital tunnel syndrome were evaluated retrospectively with a minimum follow-up of 2 years. All patients underwent either in situ decompression or subcutaneous transposition. The primary outcome measure was postoperative McGowan grade. Predictors included age, sex, dominant hand, disease duration, diabetes mellitus, smoking, alcohol, surgical procedure, follow-up time and preoperative electrophysiological data. Spearman’s rank correlation and ordinal logistic regression model were used to assess the effect of independent variables on the postoperative McGowan grade.

Results

At the last follow-up, improvement by at least one McGowan grade was reached in 118 cases (80.8%), and complete recovery was achieved in 40 hands (27.4%), while 28 extremities (19.2%) remained at grade III. Older age [per 10-year increase, odds ratio (OR) 2.10; 95% confidence interval (95% CI) 1.55–2.84, p < 0.001], longer disease duration (per 1-year increase, OR 1.31; 95% CI 1.16–1.49, p < 0.001), absent sensory nerve conduction (OR 2.55; 95% CI 1.25–5.21, p = 0.010) and shorter postoperative follow-up (per 1-year increase, OR 0.76; 95% CI 0.65–0.90, p = 0.001) were associated with a higher postoperative McGowan grade.

Conclusion

Significant improvement but not complete recovery could be expected following in situ decompression or subcutaneous transposition for severe cubital tunnel syndrome. Older age, longer disease duration, absent sensory nerve conduction and shorter postoperative follow-up are independent predictors of worse outcomes.

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Acknowledgements

This study was funded by a grant from the National Natural Science Foundation of China, grant no. 81371374.

Funding

The National Natural Science Foundation of China provided financial support in the form of the General Program of the National Natural Science Foundation, grant no. 81371374. The sponsor had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Rd, Shanghai, 200040, People’s Republic of China

    Jinsong Tong, Zhen Dong, Bin Xu, Chenggang Zhang & Yudong Gu

  2. Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People’s Republic of China

    Jinsong Tong, Zhen Dong, Bin Xu, Chenggang Zhang & Yudong Gu

  3. Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People’s Republic of China

    Jinsong Tong, Zhen Dong, Bin Xu, Chenggang Zhang & Yudong Gu

Authors
  1. Jinsong Tong
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  2. Zhen Dong
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  3. Bin Xu
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  4. Chenggang Zhang
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  5. Yudong Gu
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Corresponding author

Correspondence to Zhen Dong.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Comments

A well planned and executed study with a useful result to help set realistic expectations in patients undergoing surgical decompression of the ulnar nerves with a severe grade of injury.

Michel Kliot

CA, USA

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Tong, J., Dong, Z., Xu, B. et al. Predictors of surgical outcomes for severe cubital tunnel syndrome: a review of 146 patients. Acta Neurochir 160, 645–650 (2018). https://doi.org/10.1007/s00701-017-3420-9

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  • DOI: https://doi.org/10.1007/s00701-017-3420-9

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