Studies on Cubital Tunnel Syndrome

There have been numerous medical studies of cubital tunnel syndrome patients, treatments and surgeries. The results can be found on the Web and in medical journals. The Journal of Bone and Joint Surgery is a terrific source of cubital tunnel studies.

This article lists some of the major cubital tunnel studies and briefly summarizes their results and conclusions. This list is an overview only and has not been certified by a medical organization. Please click through to the studies for the official and complete results, conclusions and details.

Note: In spite of trends found in these studies, each case of cubital tunnel syndrome is unique. Do not rely solely on this website, any other website, or your family doctor. Please see a hand doctor or surgeon, and get a second opinion if you have any doubts.

Ulnar Nerve Decompression vs. Anterior Transposition (2007)

Title: Anterior Transposition Compared with Simple Decompression for Treatment of Cubital Tunnel Syndrome: A Meta-Analysis of Randomized, Controlled Trials

Study: Reviewed four previously reported trials that evaluated ulnar nerve decompression with an anterior transposition (two submuscular and two subcutaneous).

Results: There were no significant differences between simple decompression and anterior transposition in terms of clinical scores.

Conclusion: Since ulnar nerve transposition is more invasive than simple ulnar nerve decompression, decompression is preferred for patients with no prior traumatic injury or surgical procedures.

Decompression With vs. Without Subcutaneous Anterior Transposition (2007)

Title: Cubital tunnel syndrome–simple nerve decompression or decompression with subcutaneous anterior transposition?

Study: Reviewed 66 patients with clinically and EMG-proven cubital tunnel syndrome. 32 patients had nerve decompression surgery without transposition, whereas 34 also had subcutaneous transposition of the nerve. There were no significant differences between the outcomes of the two groups.

Conclusion: Decompression alone may be sufficient for treating mild to moderate cases of cubital tunnel syndrome.

Medial Epicondylectomy vs. Anterior Subcutaneous Transposition (2006)

Title: Comparative Study Between Minimal and Medial Epicondylectomy and Anterior Subcutaneous Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome

Study: Reviewed 56 patients and two surgical methods: 1) medial epicondylectomy and 2) anterior subcutaneous transposition along with partial medial epicondylectomy.

Results: Excellent results in 14 patients, good in 13 patients, fair in 6 and poor in 1 patient. No statistically significant difference between the two groups.

Conclusion: Medial epicondylectomy and anterior subcutaneous transposition offer similar benefit.

Endoscopic Ulnar Nerve Decompression (2006)

Title: The Endoscopic Management of Cubital Tunnel Syndrome

Study: Reviewed results of endoscopic ulnar nerve decompression in 75 patients and 12 cadavers.

Results: Good to excellent results in 94% of patients. Average incision length of 2.8 cm.

Conclusion: Recommend decompression for cubital tunnel using an endoscopic technique.

Postoperative Results (2006)

Title: Postoperative clinical results in cubital tunnel syndrome

Study: Reviewed 107 patients who had surgery for cubital tunnel syndrome.

Results: Excellent results in 37 limbs, good in 39 limbs, fair in 26 limbs, and poor in 9 limbs.

Conclusion: The patient’s age, duration of cubital tunnel syndrome, preoperative severity, and MCV test results one month after surgery are important factors that determine ultimate success.

Partial Medial Epidcondylectomy (2006)

Title: Outcome of partial medial epicondylectomy for cubital tunnel syndrome

Study: Reviewed 80 patients who had partial medial epicondylectomies for cubital tunnel syndrome. The main purpose was to compare clinical outcomes among partial, minimal, and total epicondylectomies.

Results: There was improvement in 86% of the patients, with a 67% improvement in severely impaired patients. However, 45% of patients reported mild pain at the 6-month follow-up.

Conclusion: Partial medial epicondylectomy is a safe and reliable treatment of cubital compression neuropathy at the elbow.

MCV Tests; Various Causes (2004)

Title: Pathogenesis and electrodiagnosis of cubital tunnel syndrome

Study: Reviewed 21 patients with cubital tunnel symptoms who had motor and sensory conduction velocity tests and then had anterior transposition surgery.

Results: All but one patient had EMG abnormalities in the elbow, 13 patients had reduced velocity in the forearm, and 14 patients had absent or abnormal sensory nerve action in the little finger. The main causes of cubital tunnel syndrome were: 15 patients had compression by ligaments, muscle tendons, or bone hyperplasia; 2 involved fibrous adhesion; 3 involved compression by a thick vein; and 2 involved compression by cysts.

Conclusion: MCV tests indicating decreased velocity across the elbow segment of the ulnar nerve are useful to diagnose cubital tunnel syndrome. There are many different causes for cubital tunnel syndrome.

Surgery Results for Patients with No Sensory Nerve Conduction (2004)

Title: Outcomes of cubital tunnel surgery among patients with absent sensory nerve conduction

Study: Reviewed 34 cubital tunnel syndrome patients with no sensory nerve conduction.

Results: Symptoms improved in 53% of patients, and muscle strength improved in 13%. Improvements were significantly less among patients who had experienced cervical disease for more than 1 year and patients with symptoms in both arms. Improvements were similar among patients who had neurolysis or subcutaneous transposition.

Conclusion: Patients with no sensory nerve conduction experience less improvement after surgery.

Anterior Submuscular Transposition for Severe Cases (2004)

Title: Anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome

Study: Reviewed 18 patients who had anterior submuscular transposition surgery for severe cubital tunnel syndrome.

Results: Excellent results in 6 patients (40%), good results in 7 (47%), and fair results in 2 (13%). Complete recovery typically occurred about 6 months after surgery. No complications were observed.

Conclusion: Treatment of severe cubital syndrome by means of a technique of flexor-pronator mass Z-lengthening was linked to 87% rate of good to excellent results.

Anterior Submuscular Transposition Surgery (2004)

Title: Anatomical changes and dynamic analysis after anterior submuscular transposition in treating cubital tunnel syndrome

Study: Reviewed 32 patients with cubital tunnel syndrome, measuring the position, scope and diameter of ulnar nerve lesion and the volume of the new cubit tunnel after anterior submuscular transposition surgery.

Results: The ulnar collateral artery could be transposed with the ulnar nerve, and the new cubit tunnel was wide enough to contain the ulnar nerve. There was no significant difference in length of the ulnar nerves between pre- and post-operation.

Conclusion: Anterior submuscular transposition is a useful method to treat cubital tunnel syndrome.

Long-Term Recovery for Severe Cases (2004)

Title: Long-term clinical and neurologic recovery in the hand after surgery for severe cubital tunnel syndrome

Study: Reviewed outcomes after cubital tunnel release in 15 patients with muscle atrophy, claw-hand deformity, and absent nerve conduction velocities.

Results: At a median follow-up evaluation of 4.5 years, all outcomes had improved. Numbness was gone in 5 patients and greatly reduced in 9 patients. Nerve conduction velocity was measurable in all 15 patients.

Conclusion: Patients with severe cubital tunnel syndrome can expect satisfactory long-term functional results after surgery. Recovery requires several years and is not as good in the elderly.

Endoscopic Ulnar Nerve Decompression (1999)

Title: Cubital tunnel release with endoscopic assistance: results of a new technique

Study: Reviewed 76 patients who had cubital tunnel release surgery with endoscopic assistance.

Results: Excellent results in 42% of the patients, good in 45%, fair in 11%, and poor in 2%. Recurrence occurred in 3 patients. There were no serious complications.

Conclusion: Cubital tunnel release with endoscopic assistance is a safe and reliable technique for treating cubital tunnel syndrome, especially in patients with mild to moderate symptoms.

Collegiate Wrestler: Case Report (1997)

Title: Cubital Tunnel Syndrome in a Collegiate Wrestler: A Case Report

Study: Studies a 21-year-old male collegiate wrestler diagnosed with cubital tunnel syndrome.

Results: Subject was treated conservatively for 3 months but symptoms continued. Subject then had subcutaneous transposition surgery. Following surgery, the athlete participated in an aggressive rehabilitation program to restore function and strength to the elbow and adjacent joints. He was cleared for full unrestricted activity 15 days after surgery and returned to varsity athletic competition in 1 month. The literature review found no reported cases of cubital tunnel syndrome in wrestlers. Cubital tunnel syndrome is usually seen in throwing athletes and results from either acute trauma or repetitive activities.

Conclusion: When an athlete has associated symptoms, trainers and doctors should consider cubital tunnel syndrome as a possible cause of elbow injury for non-throwing athletes as well.

Surgery Helpful Regardless of Cause (1994)

Title: The relation between cubital tunnel syndrome and the elbow alignment

Study: Reviewed 43 surgical cases with varying causes for cubital tunnel syndrome: osteoarthritis, deformity, rheumatoid arthritis and trauma.

Results: The surgical procedures used depended on what caused the injury. Results for deformity patients was typically was not optimum. Although some patients continued to have symptoms, most improved motor strength and conduction velocities.

Conclusion: Surgery is usually desired regardless of the cause of cubital tunnel syndrome.

Carpal vs. Cubital Tunnel (1993)

Title: Relative frequency of nerve conduction abnormalities at carpal tunnel and cubital tunnel in France and the United States: importance of silent neuropathies and role of ulnar neuropathy after unsuccessful carpal tunnel syndrome release

Study: Evaluated over 1700 patients in France and the U.S. who had nerve conduction studies of the upper extremities.

Results: Abnormal median nerves in the wrist were twice as likely to be symptomatic as were abnormal ulnar nerves. In many cases of persistent hand symptoms following carpal tunnel release, the problem may actually be related to an undiagnosed ulnar nerve lesion.

Conclusion: The clinical risk for carpal tunnel syndrome relative to cubital tunnel syndrome was approximately 4 to 1. Patients with arm problems should have both median and ulnar nerve evaluations.

Failed Decompression Requiring Second Surgery (1990)

Title: Reoperation for failed decompression of the ulnar nerve in the region of the elbow

Study: Followed for 2+ years 30 postoperative patients who required a second surgery after failed decompression of the ulnar nerve.

Results: Submuscular transposition was the most common second surgery. Satisfactory results in 22 of the 30 patients. Exam showed ulnar nerve was still compressed at an average of 2.2 points. Poor results were associated with patients older than 50, had EMG evidence of denervation, or previous submuscular transposition surgery.

Conclusion: For re-operation to be successful, all compression points must be released.

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June 9th, 2008 Cubital Tunnel, Studies, Surgery

 

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