Skip to main content
SpringerLink
Log in

Surgical outcome for severe cubital tunnel syndrome in patients aged >70 years: a mean follow-up of 4.5 years

  • Original Article - Functional
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Surgical outcomes for cubital tunnel syndrome have been reported to be satisfactory, but could be compromised by advanced age and severe nerve compression. We aim to evaluate the prognosis of severe cubital tunnel syndrome in patients aged >70 years.

Methods

This retrospective study included 25 patients (26 extremities, all McGowan grade III, age >70 years); 21 underwent subcutaneous transposition and 5 in situ decompression. Postoperative follow-up lasted >2 years. Demographic data, clinical symptoms, physical examination findings, and the Disabilities of the Shoulder, Arm, and Hand Questionnaire were evaluated preoperatively and at final follow-up. Pain and weakness were evaluated using the visual analog scale and overall functional recovery using the modified Bishop’s Score and McGowan Grade.

Results

Significant improvements were seen in both sensory and motor function. VAS pain and weakness, 2-PD, key-pinch strength, grip strength, first dorsal interosseous muscle strength, the Wartenberg sign, and claw hand all improved significantly. DASH scores improved from an average of 45.2 points preoperatively to 15.9 points postoperatively. According to the modified Bishop scoring system, 10 extremities were graded excellent; 12, good; 2, fair; and 2, poor. Improvement of at least one McGowan Grade was seen in 18 cases, but only 2 extremities recovered to normal.

Conclusion

For patients aged >70 years with severe cubital tunnel syndrome, surgical treatment is effective, but complete recovery is unlikely, and the recovery process is long.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Adelaar RS, Foster WC, McDowell C (1984) The treatment of the cubital tunnel syndrome. J Hand Surg [Am] 9(1):90–95

    Article  Google Scholar 

  2. Biggs M, Curtis JA (2006) Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition. Neurosurgery 58(2):296–304

    Article  PubMed  Google Scholar 

  3. Byron PM (1995) Upper extremity nerve gliding: programs used at the Philadelphia Hand Center. Rehabilitation of the hand: surgery and therapy, 4th edn. Mosby, St. Louis, pp 951–958

    Google Scholar 

  4. Chung KC (2008) Treatment of ulnar nerve compression at the elbow. J Hand Surg [Am] 33(9):1625

    Article  Google Scholar 

  5. Dawson DM (1993) Entrapment neuropathies of the upper extremities. N Engl J Med 329(27):123–134

    Article  Google Scholar 

  6. 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(2):181–192

    Article  CAS  Google Scholar 

  7. 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(1):108–117

    Article  PubMed  Google Scholar 

  8. Goldberg BJ, Light TR, Blair SJ (1989) Ulnar neuropathy at the elbow: results of medial epicondylectomy. J Hand Surg [Am] 14(1):182–188

    Article  CAS  Google Scholar 

  9. Harrison MJ, Nurick S (1970) Results of anterior transposition of the ulnar nerve for ulnar neuritis. Br Med J 1(5687):27–29

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Jariwala A, Bansal N, Nicol GM, Shelton J, Wigderowitz CA (2015) Outcome analysis of cubital tunnel decompression. Scott Med J 60(3):136–140

    Article  CAS  PubMed  Google Scholar 

  11. 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):115–122

    Article  CAS  Google Scholar 

  12. Kleinman WB, Bishop AT (1989) Anterior intramuscular transposition of the ulnar nerve. J Hand Surg 14(6):929–979

    Article  Google Scholar 

  13. Learmonth JR (1942) A technique for transplanting the ulnar nerve. Surg Gynecol Obstet 75:792–793

    Google Scholar 

  14. Markus B, Stephan D, Nourdin R, Johanna Q, Volker S, Gerhard M (2017) Muscular atrophy in severe cases of cubital tunnel syndrome: prognostic factors and outcome after surgical treatment. Acta Neurochir. doi:10.1007/s00701-017-3086-3

    Google Scholar 

  15. 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(3):373–378

    Article  Google Scholar 

  16. Mondelli M, Giannini F, Ballerini M, Ginanneschi F, Martorelli E (2005) Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci 234(1–2):5–10

    Article  PubMed  Google Scholar 

  17. 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):575–580

    Article  Google Scholar 

  18. Mowlavi A, Andrews K, Lille S, Verhulst S, Zook EG, Milner S (2000) The management of cubital tunnel syndrome: a meta-analysis of clinical studies. Plast Reconstr Surg 106(2):327–334

    Article  CAS  PubMed  Google Scholar 

  19. 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(1):127–131

    Article  CAS  Google Scholar 

  20. Osborne GV, Parkes AR, Apley AG et al (1957) The surgical treatment of tardy ulnar neuritis. J Bone Joint Surg (Br) 39(4):782

    Google Scholar 

  21. Radka N, Oldřich V, Edvard E, Kanta M, Schreiber M, Procházka A, Pavel K, Vališ M (2015) The dependence of age on ulnar nerve conductive study parameter adaptation after compressive ulnar neuropathy operations in the elbow. Acta Neurochir 157(8):1405–1409

    Article  PubMed  Google Scholar 

  22. Seddon HJ (1954) Peripheral nerve injuries, London

  23. Verdú E, Ceballos D, Vilches JJ, Navarro X (2000) Influence of aging on peripheral nerve function and regeneration. J Peripher Nerv Syst 5(4):191–208

    Article  PubMed  Google Scholar 

  24. Yamamoto K (1996) Study of postoperative results in cubital tunnel syndrome. J Jpn Soc Surg Hand 13:704–707

    Google Scholar 

  25. Yamamoto K, Shishido T, Masaoka T, Katori Y, Tanaka S (2006) Postoperative clinical results in cubital tunnel syndrome. Orthopedics 29(4):347–353

    PubMed  Google Scholar 

  26. Zimmerman RM, Jupiter JB, González Del Pino J (2013) Minimum 6-year follow-up after ulnar nerve decompression and submuscular transposition for primary entrapment. J Hand Surg [Am] 38(12):2398–2404

    Article  Google Scholar 

Download references

Acknowledgements

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

Author information

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

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

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

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

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

Authors
  1. Jinsong Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bin Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhen Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chenggang Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yudong Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhen Dong.

Ethics declarations

Funding

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

Conflict of Interest

None.

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.

Presentation at a conference

None.

Clinical Trial Registration number

Not required.

Additional information

Comments

A well-done and convincing study showing that ulnar nerve decompression, either simple or combined with a subcutaneous transposition, can produce recovery in the majority of patients even when over 70 years of age and with evidence of axonal loss. An important finding is that recovery occurs over a several year period so both patients and surgeons must be patient.

Michel Kliot

Illinois, USA

Jinsong Tong and Bin Xu contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tong, J., Xu, B., Dong, Z. et al. Surgical outcome for severe cubital tunnel syndrome in patients aged >70 years: a mean follow-up of 4.5 years. Acta Neurochir 159, 917–923 (2017). https://doi.org/10.1007/s00701-017-3113-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-017-3113-4

Keywords

Search

Navigation