Abstract
This study was conducted to compare the results of anterior transposition methods and to determine the time needed to attain subjective well-being in patients with cubital tunnel syndrome. A total of 49 cases were retrospectively evaluated. Patients were called for follow-up, completed a questionnaire, and were reexamined. They were assigned to one of 3 groups: subcutaneous transposition (SCT), submuscular transposition (SMT), or intramuscular transposition (IMT). The McCowan classification and Wilson-Krout criteria were used for classification and outcomes assessments. Categorical variables were analyzed with the χ2 test, and metric variables by analysis of variance or through Kruskal-Wallis variance analysis. Improvement of at least 1 McCowan grade was observed in 87.63% of patients. The least responsive group was assigned a McCowan grade of III. The most effective procedure for resolving clawing was SMT. Clinical results were excellent in 26 patients (53.06%), good in 12 (24.48%), fair in 4 (8.16%), and poor in 7 (14.28%). At the latest follow-up, overall grip and pinch strength had improved by 23% and 34%, respectively, compared with the contralateral side. Thirty-six patients exhibited an improvement in grip power and 38 in fine dexterity. Complete resolution of numbness was observed in 32 patients, and complete resolution of pain was noted in 30 patients. The preoperative mean visual analog scale score of 6.82 improved to 3.36 postoperatively. Clawing improved in 4 patients and atrophy in 7. The mean time to subjective improvement was shortest in the SMT group and longest in the IMT group. The greatest pain relief was reported in the IMT group and the least in the SMT group. One case with IMT required reoperation because of recompression of the nerve. The most frequent complication in the SMT and IMT groups was muscular tenderness. In conclusion, SCT offers an alternative to other anterior transposition methods because of its simplicity and quicker recovery time, especially in mild to moderate cases.
Similar content being viewed by others
References
Lowe JB III, Mackinnon SE. Management of secondary cubital tunnel syndrome.Plast Reconstr Surg. 2004;113:El-E16.
Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow.J Manipulative Physiol Ther. 2005;28:345.
Chuang DC, Treciak MA. Subfascial anterior transposition: a modified method for the treatment of cubital tunnel syndrome (CuTS).Tech Hand Up Extrem Surg. 1998;2:178–183.
Filippi R, Farag S, Reisch R, Grunert P, Bocher-Schwarz H. Cubital tunnel syndrome: treatment by decompression without transposition of ulnar nerve.Minim Invasive Neurosurg. 2002;45:164–168.
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;56:108–117.
Leone J, Bhandari M, Thoma A. Anterior intramuscular transposition with ulnar nerve decompression at the elbow.Clin Orthop Relat Res. 2001;387:132–139.
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;30:521–524.
Osterman AL, Davis CA. Subcutaneous transposition of the ulnar nerve for treatment of cubital tunnel syndrome.Hand Clin. 1996;12:421–433.
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;106:327–334.
Posner MA. Compressive neuropathies of the ulnar nerve at the elbow and wrist.Instr Course Lect. 2000;49:305–317.
McGowan AJ. The results of transposition of the ulnar nerve for traumatic ulnar neuritis.J Bone Joint Surg Br. 1950;32:293–301.
Wilson DH, Krout R. Surgery of ulnar neuropathy at the elbow: 16 cases treated by decompression without transposition. Technical note.J Neurosurg. 1973;38:780–785.
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;15:148–157.
Dellon AL, Coert JH. Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow.J Bone Joint Surg Am. 2004;86(suppl 1):169–179.
Kohut GN, Delia Santa DR, Chamay A. Ulnar nerve compression syndrome of the elbow: analysis of 50 operated cases [in French].Ann Chir Main Memb Super. 1996;15:138–147.
Matsuzaki H, Yoshizu T, Maki Y, Tsubokawa N, Yamamoto Y, Toishi S. Long-term clinical and neurologic recovery in the hand after surgery for severe cubital tunnel syndrome.J Hand Surg Am. 2004;29:373–378.
Gervasio O, Gambardella G. Anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: personal experience.J Neurosurg Sci. 2004;48:113–116.
Posner MA. Submuscular transposition for the ulnar nerve at the elbow.Bull Hosp Jt Dis Orthop Inst. 1984;44:406–423.
Kim DH, Han K, Tiel RL, Murovic JA, Kline DG. Surgical outcomes of 654 ulnar nerve lesions.J Neurosurg. 2003;98:993–1004.
Huang JH, Samadani U, Zager EL. Ulnar nerve entrapment neuropathy at the elbow: simple decompression.Neurosurgery. 2004;55:1150–1153.
Pavelka M, Rhomberg M, Estermann D, Loscher WN, Piza-Katzer H. Decompression without anterior transposition: an effective minimally invasive technique for cubital tunnel syndrome.Minim Invasive Neurosurg. 2004;47:119–123.
Hashiguchi H, Ito H, Sawaizumi T. Stabilized subcutaneous transposition of the ulnar nerve.Int Orthop. 2003;27:232–234.
Caputo AE, Watson HK. Subcutaneous anterior transposition of the ulnar nerve for failed decompression of cubital tunnel syndrome.J Hand Surg Am. 2000;25:544–551.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Köse, K.Ç., Bilgin, S., Cebesoy, O. et al. Clinical results versus subjective improvement with anterior transposition in cubital tunnel syndrome. Adv Therapy 24, 996–1005 (2007). https://doi.org/10.1007/BF02877704
Issue Date:
DOI: https://doi.org/10.1007/BF02877704