Simple Decompression of the Ulnar Nerve for Cubital Tunnel Syndrome

  • Cho, Yong-Jun (Department of Neurosurgery Chunchon Sacred Heart Hospital College of Medicine Hallym University) ;
  • Cho, Sung-Min (Department of Neurosurgery Chunchon Sacred Heart Hospital College of Medicine Hallym University) ;
  • Sheen, Seung-Hoon (Department of Neurosurgery Chunchon Sacred Heart Hospital College of Medicine Hallym University) ;
  • Choi, Jong-Hun (Department of Neurosurgery Chunchon Sacred Heart Hospital College of Medicine Hallym University) ;
  • Huh, Dong-Hwa (Department of Neurosurgery Chunchon Sacred Heart Hospital College of Medicine Hallym University) ;
  • Song, Joon-Ho (Department of Neurosurgery Chunchon Sacred Heart Hospital College of Medicine Hallym University)
  • 발행 : 2007.11.30

초록

Objective : Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper extremity. Although many different operative techniques have been introduced, none of them have been proven superior to others. Simple cubital tunnel decompression has numerous advantages, including simplicity and safety. We present our experience of treating cubital tunnel syndrome with simple decompression in 15 patients. Methods : According to Dellon's criteria, one patient was classified as grade 1, eight as grade 2, and six as grade 3. Preoperative electrodiagnostic studies were performed in all patients and 7 of them were rechecked postoperatively. Five patients of 15 underwent simple decompression using a small skin incision (2 cm or less). Results : Preoperative mean value of motor conduction velocity (MCV) within the segment (above the elbow-below the elbow) was $41.8{\pm}15.2\;m/s$ and this result showed a decrease compared to the result of MCV in the below the elbow-wrist segment ($57.8{\pm}6.9\;m/s$) with statistical significance (p<0.05). Postoperative mean values of MCV were improved in 6 of 7 patients from $39.8{\pm}12.1\;m/s$ to $47.8{\pm}12.1\;m/s$ (p<0.05). After an average follow-up of $4.8{\pm}5.3$ months, 14 patients of 15 (93%) reported good or excellent clinical outcomes according to a modified Bishop scoring system. Five patients who had been treated using a small skin incision achieved good or excellent outcomes. There were no complications, recurrences, or subluxation of the ulnar nerve. Conclusion : Simple decompression of the ulnar nerve is an effective and successful minimally invasive technique for patients with cubital tunnel syndrome.

키워드

참고문헌

  1. Bednar MS, Blair SJ, Light TR: Complications of the treatment of cubital tunnel syndrome. Hand Clin 10 : 83-92, 1994
  2. Bimmler D, Meyer VE : Surgical treatment of the ulnar nerve entrapment neuropathy: sub muscular anterior transposition or simple decompression of the ulnar nerve? Long-term results in 79 cases. Ann Chir Main Memb Super 15: 148-157, 1996 https://doi.org/10.1016/S0753-9053(96)80004-4
  3. Butters K, Singer K : Nerve lesions of the arm and elbow, in DeLee J, Drez D (eds) : Orthopaedic sports medicine, principles and practice. Philadelphia: Saunders, 1994, Vol 1, pp 802-811
  4. Campbell WW, Pridgeon RM, Sahni KS : Short segment incremental studies in the evaluation of ulnar neuropathy at the elbow. Muscle Nerve 15 : 1050-1054, 1992 https://doi.org/10.1002/mus.880150910
  5. Chan RC, Paine KW, Varughese G : Ulnar neuropathy at the elbow: comparison of simple decompression and anterior transposition. Neurosurgery 7 : 545-550, 1980 https://doi.org/10.1227/00006123-198012000-00001
  6. 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 61 : 929-934, 1991 https://doi.org/10.1111/j.1445-2197.1991.tb00011.x
  7. Dellon AL : Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg Am 14 : 688-700, 1989 https://doi.org/10.1016/0363-5023(89)90192-5
  8. Feindel W, Stratford J : Cubital tunnel compression in tardy ulnar palsy. Can Med Assoc J 78: 351-353, 1958
  9. Fernandez E, Pallini R, Lauretti L, Scogna A, La Marca F : Neurosurgery of the peripheral nervous system : cubital tunnel syndrome. Surg Neurol 50 : 83-85, 1998 https://doi.org/10.1016/S0090-3019(97)00231-0
  10. 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 45: 164-168, 2002 https://doi.org/10.1055/s-2002-34394
  11. Gabel GT, Amadio PC : Reoperation for failed decompression of the ulnar nerve in the region of the elbow. J Bone Joint Surg Am 72: 213-219, 1990 https://doi.org/10.2106/00004623-199072020-00008
  12. Gervasio O, Gambardella G : Anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome. Personal experience. J Neurosurg Sci 48 : 113-116, 2004
  13. 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 56 : 108-117; discussion 117, 2005
  14. Heithoff SJ : Cubital tunnel syndrome does not require transposition of the ulnar nerve. J Hand Surg Am 24: 898-905, 1999 https://doi.org/10.1053/jhsu.1999.0898
  15. Hoffmann R, Siemionow M : The endoscopic management of cubital tunnel syndrome. J Hand Surg Br 31 : 23-29, 2006
  16. Kanakamedala RV, Simons DG, Potter RW, Zucker RS : Ulnar nerve entrapment at the elbow localized by short segment stimulation. Arch Phys Med Rehabil 69 : 959-963, 1988
  17. Kim DH, Han K, Tiel RL, Murovic JA, Kline DG : Surgical outcomes of 654 ulnar nerve lesions. J Neurosurg 98 : 993-1004, 2003 https://doi.org/10.3171/jns.2003.98.5.0993
  18. Kim JG, Lee KY, Yoo YR, Kim KN, Chung HY : Medial epicondylectomy for tardy ulnar palsy. J Korean Neurosurg Soc 3 : 101-103, 1974
  19. Kleinman WB, Bishop AT: Anterior intramuscular transposition of the ulnar nerve. J Hand Surg Am 14: 972-979, 1989 https://doi.org/10.1016/S0363-5023(89)80046-2
  20. Lascar T, Laulan J : Cubital tunnel syndrome: a retrospective review of 53 anterior subcutaneous transpositions. J Hand Surg Br 25 : 453-456, 2000 https://doi.org/10.1016/S0266-7681(00)80011-X
  21. Leffert RD : Anterior submuscular transposition of the ulnar nerves by the Learmonth technique. J Hand Surg Am 7 : 147-155, 1982 https://doi.org/10.1016/S0363-5023(82)80079-8
  22. 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 106 : 327-334, 2000 https://doi.org/10.1097/00006534-200008000-00014
  23. Muermans S, De Smet L : Partial medial epicondylectomy for cubital tunnel syndrome: Outcome and complications. J Shoulder Elbow Surg 11 : 248-252, 2002 https://doi.org/10.1067/mse.2002.123901
  24. 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 30 : 521-524, 2005 https://doi.org/10.1016/j.jhsb.2005.05.011
  25. Nathan PA, Istvan JA, Meadows KD : Intermediate and long-term outcomes following simple decompression of the ulnar nerve at the elbow. Chir Main 24 : 29-34, 2005 https://doi.org/10.1016/j.main.2004.11.004
  26. 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 Br 20 : 628-637, 1995 https://doi.org/10.1016/S0363-5023(05)80280-1
  27. Nouhan R, Kleinert JM : Ulnar nerve decompression by transposing the nerve and Z-lengthening the flexor-pronator mass: clinical outcome. J Hand Surg Am 22: 127-131, 1997 https://doi.org/10.1016/S0363-5023(05)80192-3
  28. Olney RK, Miller RG : Conduction block in compression neuropathy: recognition and quantification. Muscle Nerve 7: 662-667, 1984 https://doi.org/10.1002/mus.880070812
  29. Raynor EM, Shefner JM, Preston DC, Logigian EL : Sensory and mixed nerve conduction studies in the evaluation of ulnar neuropathy at the elbow. Muscle Nerve 17: 785-792, 1994 https://doi.org/10.1002/mus.880170714
  30. Robertson C, Saratsiotis J : A review of compressive ulnar neuropathy at the elbow. J Manipulative Physiol Ther 28 : 345, 2005 https://doi.org/10.1016/j.jmpt.2005.04.005
  31. Taniguchi Y, Takami M, Takami T, Yoshida M : Simple decompression with small skin incision for cubital tunnel syndrome. J Hand Surg Br 27: 559-562, 2002 https://doi.org/10.1054/jhsb.2002.0821
  32. Tomaino MM, Brach PJ, Vansickle DP : The rationale for and efficacy of surgical intervention for electrodiagnostic-negative cubital tunnel syndrome. J Hand Surg Am 26 : 1077-1081, 2001 https://doi.org/10.1053/jhsu.2001.26327