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Comparison of the long-term results of anterior transposition of the ulnar nerve or simple decompression in the treatment of cubital tunnel syndrome—a prospective study

  • Clinical Article
  • Published:
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Abstract

Objective

In order to assess their late benefits we present the long-term results of a comparison of treating cubital tunnel syndrome with anterior submuscular transposition or simple decompression.

Methods

Of 40 patients initially recruited to this study 33 were available for long term follow-up. Sixteen patients underwent anterior submuscular transposition (group A); simple decompression was performed in 17 of the patients (group B). The indications for inclusion were a typical clinical presentation confirmed by abnormal nerve conduction studies. The mean duration of the symptoms before operation was 13 months (range 2 to 84 months) in group A and 8.4 months (range 1.5 to 36 months) in group B. All patients were seen 2 months after surgery and at least 3 years later. The mean duration of follow-up was 63.1 month in the first group and 52 months in the second group.

Results

No complications were seen in either group. In the group treated by anterior transposition, ten of 16 patients were completely free of signs and symptoms; slight residual hypesthesia or paresthesia was observed in two patients. Paresis and atrophy was observed in only one person. In the simple decompression group, 11 of 17 patients were completely free of signs and symptoms. In five patients slight residual symptoms were observed; no paresis or atrophy was reported in any of this group.

Conclusion

These long-term results show that both surgical techniques have a good outcome. Thus, the less invasive simple decompression should be preferred.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Universitaetsklinikum, Johannes Gutenberg Universität, Langenbeckstrasse 1, 55131, Mainz, Germany

    Dörthe Keiner & Joachim Oertel

  2. Department of Neurosurgery, Hannover Nordstadt Hospital, Affiliated Hospital Hannover Medical School, Hannover, Germany

    Michael R. Gaab

  3. Department of Neurosurgery, Ernst Moritz Arndt University, Greifswald, Germany

    Henry W. S. Schroeder

Authors
  1. Dörthe Keiner
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  2. Michael R. Gaab
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  3. Henry W. S. Schroeder
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  4. Joachim Oertel
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Corresponding author

Correspondence to Joachim Oertel.

Additional information

Comment

About 50 years ago, Feindel and Stratford [1] and Osborne [2] proposed simple decompression of the ulnar nerve at the elbow as an alternative to transposition or other more complex procedures. Simple decompression was advocated on the premise that the nerve was compressed between the two heads of the flexor carpi ulnaris. Several subsequent intraoperative electrophysiological studies have demonstrated that the abnormality in the nerve is usually in its course through a bony groove proximal to the cubital tunnel. Nevertheless the present study and several others have shown that simple decompression is as effective as nerve transposition in the treatment of ulnar neuropathy at the elbow. Perhaps the pioneers of this operation were right for the wrong reason.

Decompression of the ulnar nerve at the elbow by any technique is notably less successful than decompression of the median nerve at the wrist. In approximately 50% of cases of ulnar neuropathy, sensory symptoms are relieved by surgery as compared to 20% resolution without surgery [3]. At least two prognostic factors have shown some predictive value in the natural history of ulnar neuropathy. Swelling of the nerve on ultrasonography denotes a bad prognosis [3], whereas the natural history with >50% motor conduction block is so good as to suggest to some physicians that such lesions not be treated surgically [4]. At present, the decision as to whether or not to operate on the ulnar nerve at the elbow tends to be arbitrary: perhaps in future, this decision can be placed on a more rational basis.

Where the results of surgery are unpredictable, a simple operation which can be performed under local anaesthesia is clearly a more attractive option than a more complicated operation requiring general anaesthesia. The authors are to be congratulated for demonstrating that the simple and complex operations are of similar efficacy.

References

1. Feindel W, Stratford J. The role of the cubital tunnel in tardy ulnar palsy. Can J Surg 1958; 1(4):287–300.

2. Osborne G. Ulnar neuritis. Postgrad Med J 1959; 35:392–396.

3. Beekman R, Wokke JH, Schoemaker MC, Lee ML, Visser LH. Ulnar neuropathy at the elbow: follow-up and prognostic factors determining outcome. Neurology 2004; 63(9):1675–1680.

4. Dunselman HH, Visser LH. The clinical, electrophysiological and prognostic heterogeneity of ulnar neuropathy at the elbow. J Neurol Neurosurg Psychiatry 2008; 79(12):1364–1367.

Peter Richardson

University of London

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Keiner, D., Gaab, M.R., Schroeder, H.W.S. et al. Comparison of the long-term results of anterior transposition of the ulnar nerve or simple decompression in the treatment of cubital tunnel syndrome—a prospective study. Acta Neurochir 151, 311–316 (2009). https://doi.org/10.1007/s00701-009-0218-4

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  • DOI: https://doi.org/10.1007/s00701-009-0218-4

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