Cubital Tunnel Syndrome – a Review of Surgical Treatments and Comparison of their Outcomes

Česká verzia

Authors: I. Humhej; M. Sameš
Authors place of work: Neurochirurgická klinika Univerzity J. E. Purkyně, Krajská zdravotní a. s., Masarykova nemocnice v Ústí nad Labem, o. z.
Published in the journal: Cesk Slov Neurol N 2010; 73/106(5): 510-516
Category: Review Article

Summary

This review describes surgical approaches to cubital tunnel syndrome (CuTS). It includes historical notes, together with an account of the advantages and disadvantages of each surgical modality. It provides a literature review of the results of surgical methods treating CuTS, focusing especially on those studies that compare particular surgical modalities. Although there is no consensus as to the most effective type of surgery for CuTS, there is a growing tendency towards simple decompression leaving the nerve in situ, without transposition. This involves minimum damage to neighbouring structures, especially the blood vessels of the nerve. Other advantages include relative simplicity of procedure and short operation time. Further, it enables immediate rehabilitation and speedy recovery with only minimum absence from normal life. This review also mentions development of the endoscopic and endoscopically-assisted techniques in the therapy of the CuTS (similar to those of other entrapment syndromes) that contribute to minimization of invasive procedures. In patients in whom it is necessary to perform a transposition of the nerve (due to subluxation of the nerve in elbow flexion, elbow deformity or local anatomical circumstances), many authors prefer anterior subcutaneous or submuscular transposition (with or without Z-plastic). In patients with relapsing or persistent CuTS, most authors use anterior submuscular transposition.

Key words:
ulnar nerve – sulcus nervi ulnaris syndrome – cubital tunnel syndrome – surgery

Zdroje

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

2. Dellon AL, Hament W, Gittelshon A. Nonoperative management of cubital tunnel syndrome: an 8-year prospective study. Neurology 1993; 43(9): 1673–1677.

3. Ehler E, Amber Z. Mononeuropatie. Edice Trendy soudobé neurologie a neurochirurgie, sv. 3. Praha: Galén 2002.

4. Bartels RH. History of the surgical treatment of ulnar nerve compression at the elbow. Neurosurgery 2001; 49(2): 391–400.

5. Lowe JB jr, Novak CB, Mackinnon SE. Current approach to cubital tunnel syndrome. Neurosurg Clin N Am 2001; 12(2): 267–284.

6. Huang JH, Samadani U, Zager EL. Ulnar nerve entrapment at the elbow: simple decompression. Neurosurgery 2004; 55(5): 1150–1153.

7. Bartels RH, Menovsky T, Van Overbeeke JJ, Verhagen WI. Surgical management of ulnar nerve compression at the elbow: an analysis of the literature. J Neurosurgery 1998; 89(5): 722–727.

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

9. Taha A, Galarza M, Zuccarello M, Taha J. Outcomes of cubital tunnel surgery among patients with absent sensory nerve conduction. Neurosurgery 2004; 54(4): 891–896.

10. Filippi R, Farag S, Reisch R, Grunert P, Böcher-Schwarz H. Cubital tunnel syndrome. Treatment by decompression without transposition of ulnar nerve. Minim Invasive Neurosurg 2002; 45(3): 164–168.

11. Nathan PA, Keniston RC, Meadows KD. Outcome study of ulnar nerve compression at the elbow treated with simple decompression and an early programme of physical therapy. J Hand Surg Brit 1995; 20(5): 628–637.

12. Steiner HH, von Haken MS, Steiner-Milz HG. Entrapment neuropathy at the cubital tunnel: simple decompression is the method of choice. Acta Neurochir (Wien) 1996; 138: 308–313.

13. Pavelka M, Rhomberg M, Estermann D, Löscher WN, Piza-Katzer H. Decompression without anterior transposition: an effective minimally invasive technique for cubital tunnel syndrome. Minim Invas Neurosurg 2004; 47(2): 119–123.

14. Assmus H. Simple decompression of the ulnar nerve in the cubital tunnel syndrome with and without morphologic changes. Report of experiences based on 523 cases. Nervenarzt 1994; 65(12): 846–853.

15. Black BT, Barron OA, Townsend PF, Glickel SZ, Eaton RG. Stabilized subcutaneous ulnar nerve transposition with immediate range of motion. Long-term follow-up. J Bone Joint Surg Am 2000; 82A(11): 1544–1551.

16. Weirich SD, Gelberman RH, Best SA, Abrahamsson SO, Furcolo DC, Lins RE. Rehabilitation after subcutaneous transposition of the ulnar nerve: immediate versus delayed mobilization. J Shoulder Elbow Surg 1998; 7(3): 244–249.

17. Leone J, Bhandari M, Thoma A. Anterior intramuscular transposition with ulnar nerve decompression at the elbow. Clin Orthop Relat Res 2001; 387: 132–139.

18. Glowacki KA, Weiss AP. Anterior intramuscular transposition of the ulnar nerve for cubital tunnel syndrome. J Shoulder Elbow Surg 1997; 6(2): 89–96.

19. Kleinman WB, Bishop AT. Anterior intramuscular transposition of the ulnar nerve. J Hand Surg Am 1989; 14(6): 972–979.

20. Bartoš R, Sameš M. Výsledky léčby syndromu kubitálního kanálu pomocí přední intramuskulární transpozice. Retrospektivní studie 1990–1999, 86 pacientů. Cesk Slov Neurol N 2002; 65/98(2): 114–118.

21. Bartels RH, Grotenhuis JA. Anterior submuscular transposition of the ulnar nerve for post operative focal neuropathy at the elbow. J Bone Joint Surg [Br] 2004; 86: 998–1001.

22. Filippi R, Charalampaki P, Reisch R, Koch D, Grunert P. Recurrent cubital tunnel syndrome. Etiology and treatment. Minim Invasive Neurosurg 2001; 44: 197–201.

23. Davis GA, Bulluss KJ. Submuscular transposition of the ulnar nerve: review of safety, efficacy and correlation with neurophysiological outcome. J Clin Neurosci 2005; 12(5): 524–528.

24. Kim DH, Han K, Tiel RL, Murovic JA, Kline DG. Surgical outcomes of 654 ulnar nerve lesions. J Neurosurg 2003; 98(5): 993–1004.

25. Dellon A. Review of treatment results for ulnar nerve entrapment at the elbow. Am J Hand Surg 1989; 14(4): 688–700.

26. Gervasio O, Gambardella G. Anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome. J Neurosurg Sci 2004; 48(3): 113–116.

27. Artico M, Pastore FS, Nucci F, Giuffre R. 290 surgical procedures for ulnar nerve entrapment at the elbow: physiopathology, clinical experience and results. Acta Neurochir (Wien) 2000; 142(3): 303–308.

28. Macnicol MF. The results of operation for ulnar neuritis. J Bone Joint Surg Br 1979; 61(2): 159–164.

29. Chan RC, Paine KW, Varughese G. Ulnar neuropathy at the elbow: comparison of simple decompression and anterior transposition. Neurosurgery 1980; 7(6): 545–550.

30. Foster RJ, Edshage S. Factors related to the outcome of surgically managed compressive ulnar neuropathy at the elbow level. Am J Hand Surg 1981; 6(2): 181–192.

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

32. Stuffer M, Jungwirth W, Hussl H, Schmutzhardt E. Subcutaneous or submuscular anterior transposition of the ulnar nerve? J Hand Surg Br 1992; 17(3): 248–250.

33. Davies MA, Vonau M, Blum PW, Kwok BC, Matheson JM, Stening WA. Results of ulnar neuropathy at the elbow treated by decompression or anterior transposition. Aust N Z J Surg 1991; 61(12): 929–934.

34. Krahulík D, Vaverka M, Hrabálek L, Kalita O, Houdek M. Syndrom kubitálního kanálu. Srovnání operačních technik prosté dekomprese a přední transpozice ulnárního nervu. Cesk Slov Neurol N 2008; 71/104(6): 700–703.

35. Geutjens GG, Langstaff RJ, Smith NJ, Jefferson D, Howell CJ, Barton NJ. Medial epicondylectomy or ulnar nerve transposition for ulnar neuropathy at the elbow? J Bone Joint Surg Br 1996; 78(5): 777–779.

36. Bimmler D, Meyer VE. Surgical treatment of the ulnar nerve entrapment neuropathy: submuscular anterior transposition or simple decompression of the ulnar nerve? Long-term results in 79 cases. Ann Chir Main Memb Super 1996; 15(3): 148–157.

37. Gervasio O, Gambardella G, Zaccone C, Branca D. Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: a prospective randomized study. Neurosurgery 2005; 56(1): 108–117.

38. Nabhan A, Ahlhelm F, Kelm J, Reith W, Schwerdtfeger K, Steudel WI. Simple decompression or subcutaneous anterior transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg Br 2005; 30(5): 521–524.

39. Bartels RH, Verhagen WI, van der Wilt GJ, Meulstee J, van Rossum LG, Grotenhuis JA. Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: part 1. Neurosurgery 2005; 56(3): 522–530.

40. Bartels RH, Termeer EH, Wilt GJ, van Rossum LG, Meulstee J, Verhagen WI et al. Simple decompression or anterior subcutaneous transposition for ulnar neuropathy at the elbow: a cost-minimization analysis – part 2. Neurosurgery 2005; 56(3): 531–536.

41. Baek GH, Kwon BC, Chung MS. Comparative study between minimal medial epicondylectomy and anterior subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Shoulder Elbow Surg 2006; 15(5): 609–613.

42. Nabhan A, Kelm J, Steudel WI, Shariat K, Sova L, Ahlhelm F. Cubital tunnel syndrome- simple nerve decompression or decompression with subcutaneous transposition? Fortschr Neurol Psychiatr 2007; 75(3): 168–171.

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

44. Zlowodzki M, Chan S, Bhandari M, Kalliainen L, Schubert W. Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am 2007; 89(12): 2591–2598.

45. Macadam SA, Gandhi R, Bezuhly M, Lefaivre KA. Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a meta-analysis. J Hand Surg Am 2008; 33(8): 1–12.

46. Tsai TM, Bonczar M, Tsuruta T, Syed SA. A new operative technique: cubital tunnel decompression with endoscopic assistance. Hand Clin 1995; 11(1): 71–80.

47. Tsai TM, Chen IC, Majd ME, Lim BH. Cubital tunnel release with endoscopic assistance: results of a new technique. J Hand Surg Am 1999; 24(1): 21–29.

48. Krishnan KG, Pinzer T, Schackert G. A novel endoscopic technique in treating single nerve entrapment syndromes with special attention to ulnar nerve transposition and tarsal tunnel release: clinical application. Neurosurgery 2006; 59 (Suppl 1): 89–100.

49. Nakao Y, Takayama S, Toyama Y. Cubital tunnel release with lift-type endoscopic surgery. Hand Surgery 2001; 6(2): 199–203.

50. Hoffmann R, Siemionow M. The endoscopic management of cubital tunnel syndrome. J Hand Surg Br 2006; 31(1): 23–29.

51. Lowry WE jr, Follender AB. Interfascicular neurolysis in the severe carpal tunnel syndrome. A prospective, randomized, double-blind, controlled study. Clin Orthop Relat Res 1988; 227: 251–254.

52. Paine KW. Tardy ulnar nerve palsy. Can J Surg 1970; 13(3): 255–261.

53. Eaton RG, Crowe JF, Parkes JC jr. Anterior transposition of the ulnar nerve using a non-compressing fasciodermal sling. J Bone Joint Surg Am 1980; 62(5): 820–825.

54. Lascar T, Laulan J. Cubital tunnel syndrome: a retrospective review of 53 anterior subcutaneous transpositions. J Hand Surg Br 2000; 25(5): 453–456.

55. Hashiguchi H, Ito H, Sawaizumi T. Stabilized subcutaneous transposition of the ulnar nerve. Int Orthop 2003; 27(4): 232–234.