Study Questions Transposition Surgery for Cubital Tunnel Syndrome

A new study published in the September 2008 issue of Current Orthopaedic Practice indicates that ulnar nerve transposition surgery often does not provide additional benefit over simple decompression surgery for cubital tunnel syndrome.

Cubital tunnel syndrome is the result of compression of the ulnar nerve in the human arm.  Conservative treatment is recommended first and includes exercises, splints, changed habits and pain medication.  If conservative treatment fails, then surgery is the next step. 

Surgery for Cubital Tunnel Syndrome

There are two main types of surgery:

  • Simple Decompression – Removes pressure on the ulnar nerve by incising the Osborne ligament and opening the cubital tunnel.  No immobilization is needed after surgery, active use of the arm is encouraged, and recovery is expected in 2-3 months.
     
  • Anterior Transposition – Removes the ulnar nerve from the cubital tunnel and places it in a more suitable position.  This effectively lengthens and decreases tension on the nerve.  Depending on where the nerve is ultimately moved, there are three variations of transposition surgery: subcutaneous, submuscular, and intramuscular.  After surgery, the arm is immobilized in a cast for 3-4 weeks, and recovery is expected in about 6 months.

A third type of surgery — medial epicondylectomy, or the shaving down of the bony point of the elbow — seems to be falling out of favor because the difficulty in removing the exact amount of bone required.  If too much bone is excised, damage may occur to the medial collateral ligament of the elbow.  If too little bone is removed, the procedure fails because the compressive area remains.

Bottom line: Transposition surgery is much more invasive, requires lengthy immobilization of the arm after surgery, and recovery is at least twice as long versus simple decompression surgery.  So why would anyone opt for transposition



surgery?  Turns out there are many valid reasons. 

Why Choose Transposition instead of Decompression

Anterior transposition surgery is recommended over simple decompression surgery for cubital tunnel syndrome when:

  • Cubital tunnel symptoms are severe and include neuropathy, a clawing of the hand.
  • Patient experiences chronic subluxation, a misalignment of the elbow bones or cubital tunnel.
  • Ulnar nerve is dislocated from the epicondylar groove.
  • There are soft tissue masses or cysts in the epicondylar groove.
  • Simple decompression surgery was already performed and failed.

What Should You Do?

If you are scheduled for transposition surgery for cubital tunnel syndrome, be sure to ask your doctor why you are having transposition surgery instead of simple decompression.  In your case, there may be a valid reason (as noted above).  But it’s important that you understand why you need a more invasive surgery with a longer recovery time.

In Conclusion

It’s still unclear which surgical procedure is best for cubital tunnel syndrome.  The current answer is "it depends."  Recently, there has been increased interest in less invasive procedures such as simple decompression and the new EndoRelease system.  Doctors and patients must follow these new medical advances and be sure to use the proper surgical procedure for cubital tunnel syndrome.

References

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Related posts:

  1. Study Shows Transposition Surgery Trending Better Than Decompression for Cubital Tunnel Syndrome
  2. Integra LifeSciences Develops EndoRelease for Cubital Tunnel Syndrome
  3. Questions to Ask Your Doctor About Cubital Tunnel Syndrome
  4. Studies on Cubital Tunnel Syndrome
  5. Top 10 Things You Need to Know About Cubital Tunnel Syndrome

October 1st, 2008 Cubital Tunnel, Studies, Surgery

 

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