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

  • Jinsong Tong
  • Zhen Dong
  • Bin Xu
  • Chenggang Zhang
  • Yudong Gu
Original Article - Functional

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.

Keywords

Severe cubital tunnel syndrome Prognostic factors Surgical outcomes In situ decompression Subcutaneous transposition McGowan grade 

Notes

Acknowledgements

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

Compliance with ethical standards

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.

References

  1. 1.
    Bartels RH, Verhagen WI, van der Wilt GJ, Meulstee J, van Rossum LG, Grotenhuis JA (2005) Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: part 1. Neurosurgery 56:522–530CrossRefPubMedGoogle Scholar
  2. 2.
    Bruder M, Dützmann S, Rekkab N, Quick J, Seifert V, Marquardt G (2017) Muscular atrophy in severe cases of cubital tunnel syndrome: prognostic factors and outcome after surgical treatment. Acta Neurochir 159(3):1–6CrossRefGoogle Scholar
  3. 3.
    Charles YP, Coulet B, Rouzaud JC, Daures JP, Chammas M (2009) Comparative clinical outcomes of submuscular and subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg [Am] 34A:866–874CrossRefGoogle Scholar
  4. 4.
    Dellon AL, Coert JH (2003) Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow. J Bone Joint Surg 85(7):1314–1320CrossRefPubMedGoogle Scholar
  5. 5.
    Foster RJ, Edshage S (1981) Factors related to the outcome of surgically managed compressive ulnar neuropathy at the elbow level. J Hand Surg [Am] 6:181–192CrossRefGoogle Scholar
  6. 6.
    Gervasio O, Gambardella G, Zaccone C, Branca D (2005) Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: a prospective randomized study. Neurosurgery 56:108–117 discussion 117CrossRefPubMedGoogle Scholar
  7. 7.
    Goldberg BJ, Light TR, Blair SJ (1989) Ulnar neuropathy at the elbow: results of medial epicondylectomy. J Hand Surg [Am] 14:182–188CrossRefGoogle Scholar
  8. 8.
    Karthik K, Nanda R, Storey S, Stothard J (2012) Severe ulnar nerve entrapment at the elbow: functional outcome after minimally invasive in situ decompression. J Hand Surg Eur 37(2):115–122CrossRefGoogle Scholar
  9. 9.
    Kleinman WB, Bishop AT (1989) Anterior intramuscular transposition of the ulnar nerve. J Hand Surg [Am] 14:929–979Google Scholar
  10. 10.
    Listed NA (1999) Practice parameter: electrodiagnostic studies in ulnar neuropathy at the elbow. American Association of Electrodiagnostic Medicine, American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation. Neurology 52(4):688–690CrossRefGoogle Scholar
  11. 11.
    Matsuzaki H, Yoshizu T, Maki Y, Tsubokawa N, Yamamoto Y, Toishi S (2004) Long-term clinical and neurologic recovery in the hand after surgery for severe cubital tunnel syndrome. J Hand Surg [Am] 29:373–378CrossRefGoogle Scholar
  12. 12.
    Mcgowan AJ (1950) The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg (Br) 32-B(3):293–301Google Scholar
  13. 13.
    Mortazavi SM, Heidari P, Asadollahi S, Farzan M (2008) Severe tardy ulnar nerve palsy caused by traumatic cubitus valgus deformity: functional outcome of subcutaneous anterior transposition. J Hand Surg Eur 33(5):575–580CrossRefGoogle Scholar
  14. 14.
    Nouhan R, Kleinert JM (1997) Ulnar nerve decompression by transposing the nerve and Z-lengthening the flexor-pronator mass: clinical outcome. J Hand Surg [Am] 22:127–131CrossRefGoogle Scholar
  15. 15.
    Novak CB, Mackinnon SE, Stuebe AM (2002) Patient self-reported outcome after ulnar nerve transposition. Ann Plast Surg 48:274–280CrossRefPubMedGoogle Scholar
  16. 16.
    Pasque CB, Rayan GM (1995) Anterior submuscular transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg (Br) 20(4):447–453CrossRefGoogle Scholar
  17. 17.
    Shi Q, Macdermid JC, Santaguida PL, Kyu HH (2011) Predictors of surgical outcomes following anterior transposition of ulnar nerve for cubital tunnel syndrome: a systematic review. J Hand Surg [Am] 36(12):1–6CrossRefGoogle Scholar
  18. 18.
    Taha A, Galarza M, Zuccarello M, Jamal T (2004) Outcomes of cubital tunnel surgery among patients with absent sensory nerve conduction. Neurosurgery 54:891–895CrossRefPubMedGoogle Scholar
  19. 19.
    Tong J, Xu B, Dong Z, Liu J, Zhang C, Gu Y (2017) Cubital tunnel syndrome caused by ganglion cysts: a review of 59 cases. Acta Neurochir 159:1265–1271CrossRefPubMedGoogle Scholar
  20. 20.
    Tong J, Xu B, Dong Z, Zhang C, Gu Y (2017) Surgical outcome for severe cubital tunnel syndrome in patients aged > 70 years: a mean follow-up of 4.5 years. Acta Neurochir 159(5):917–923CrossRefPubMedGoogle Scholar
  21. 21.
    Verdú E, Ceballos D, Vilches JJ, Navarro X (2000) Influence of aging on peripheral nerve function and regeneration. J Peripher Nerv Syst 5:191–208CrossRefPubMedGoogle Scholar
  22. 22.
    Wessel LE, Fufa DT, Canham RB, La Bore A, Boyer MI, Calfee RP (2017) Outcomes following peripheral nerve decompression with and without associated double crush syndrome: a case control study. Plast Reconstr Surg 139(1):119–127CrossRefPubMedGoogle Scholar
  23. 23.
    Yamamoto K, Kanai H, Shishido T, Imakiire A, Miura Y (1996) Study of postoperative results in cubital tunnel syndrome. J Jpn Soc Surg Hand 13(4):704–707Google Scholar
  24. 24.
    Yamamoto K, Shishido T, Masaoka T, Katori Y, Tanaka S (2006) Postoperative clinical results in cubital tunnel syndrome. Orthopedics 29:347–353PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2017

Authors and Affiliations

  • Jinsong Tong
    • 1
    • 2
    • 3
  • Zhen Dong
    • 1
    • 2
    • 3
  • Bin Xu
    • 1
    • 2
    • 3
  • Chenggang Zhang
    • 1
    • 2
    • 3
  • Yudong Gu
    • 1
    • 2
    • 3
  1. 1.Department of Hand Surgery, Huashan HospitalFudan UniversityShanghaiPeople’s Republic of China
  2. 2.Key Laboratory of Hand Reconstruction, Ministry of HealthShanghaiPeople’s Republic of China
  3. 3.Shanghai Key Laboratory of Peripheral Nerve and MicrosurgeryShanghaiPeople’s Republic of China

Personalised recommendations