Objective To produce anatomical theory evidence for treatment of cubital tunnel syndrome with anterior submuscular transposition.Methods Of 32 patients with cubital tunnel syndrome, there were 22 males and 10 females, aged 17-73 years. The distribution of the branches of superior ulnar collateral arteryand the relationship between superior ulnar collateral artery and ulnar nerve were observed; the position, scope and diameter of ulnar nerve lesion were also observed; the volume of new cubit tunnel was measured with dilator. Twenty cubituses of adult cadavers were made the models of anterior subcutaneous transposition and anterior submuscular transposition of ulnar nerve. Length changes of ulnar nerve in different situations were observed.Results Superior ulnar collateral artery could be transposed with ulnar nerve, and new cubit tunnel was wide enough to contain ulnar nerve. In the context of anterior subcutaneous transposition, the ulnar nerve was lengthened by 7.55%±0.52% when compared with that of preoperation in the case of elbow extension, there was significant difference (P＜0.05). In the context of anterior submuscular transposition, there was nosignificant difference in length of the ulnar nerves between preoperation and postoperation(P＞0.05).Conclusion Anterior submuscular transposition can overcome compression and pull of elbow on the ulnar nerve and has sufficient blood supply. New cubital tunnel is wide enough to contain ulnar nerve. Ulnar nerve anterior submuscular transposition is a useful method in treating cubital tunnel syndrome.
ObjectiveTo summarize the clinical research progress of surgical procedures for cubital tunnel syndrome. MethodsThe related literature on surgical procedures for cubital tunnel syndrome was summarized and analyzed. ResultsMultiple surgical procedures have been applied to treat cubital tunnel syndrome, including simple decompression, subcutaneous transposition, submuscular transposition, medial epicondylectomy, intramuscular transposition, and ulnar groove plasty. Each procedure has its own advantages and disadvantages. With the development of minimally invasive surgical technique, endoscope-assisted surgery has been gradually applied to treat cubital tunnel syndrome. ConclusionOptimal surgical procedure remains controversial and individualized treatment decision based on patient's clinical conditions is recommended.
Objective To investigate the clinical therapeutic effect of the ulnar neurolysis and nerve anterior transposition with an immediate range of motionfor the cubital tunnel syndrome in the aged. Methods Forty-three patients (24males and 19 females, aged 60-81 years, averaged 67) admitted for the cubital tunnel syndrome from January 1999 to December 2004 were randomly divided into 2groups: Group A (n=20) and Group B (n=23), with an illness course of 2-10 months. All the patients underwent the ulnar neurolysis and the nerve anterior transposition. After operation the patients’ elbows in group A were immobilized with the plaster slab for an external fixation for 3 weeks; the patients’ elbows in group B did not use the external fixation, but began an immediate range of motion on the 2nd day after operation. The Bishop scoring system was used to evaluate the patients’ functional recovery in the 2 groups. Results The follow-up for 1-5 years showed that the ulnar nerve function of all the patients were improved but no significant differences were found between the 2 groups (P＞0.05). The patients in Group A returned to daily activities or work at 45.2±5.1 days, but the patients in Group B required 15.5±3.8 days, with a significant difference between the 2 groups (P＜0.05). According to Bishop scoring system, the resutls were excellent in 14 cases, good in 4 cases, fair in 1 case and poor in 1 case in Group A, and 16, 4, 2 and 1 respectively in Group B. There was no significant difference between the two groups(P＞0.05). Conclusion The ulnar neurolysis and nerve anterior transposition with an immediate range of motion for the cubital tunnel syndrome can promote the ulnar function recovery of the oldaged patients. They can return to their daily activities or work at a more rapid speed when their elbows are mobilized immediately after operation.
ObjectiveTo review the current progress of treatment of cubital tunnel syndrome (CTS). MethodsRecent relevant literature on the treatment of CTS was extensively reviewed and summarized. ResultsCTS is one of the most common peripheral nerve compression diseases.The clinical presentations of CTS consist of numbness and tingling in the ring and small fingers of the hand,pain in the elbow and sensory change following long-time elbow bending.Severe symptoms such as weakness or atrophy of intrinsic muscles of the hand and claw hand deformity may occur.The etiology of CTS is ulnar nerve compression caused by morphological abnormalities and nerve paralysis after elbow trauma.CTS can be treated by nonsurgical methods and surgery.Surgical options include in situ decompression,ulnar nerve transposition,medial epicondylectomy,and endoscopic release. ConclusionThere are multiple options to treat CTS,but the indication and effectiveness of each treatment are still controversial.Further studies are required to form a generally accepted treatment system.
Objective To evaluate the surgical method and the results of endoscopic decompression and anterior transposition of the ulnar nerve for treatment of cubital tunnel syndrome. Methods Between May 2008 and August 2009, 13 cases of cubital tunnel syndrome were treated with endoscopic decompression and anterior transposition of the ulnar nerve. There were 4 males and 9 females with an average age of 47.5 years (range, 32-60 years). The injury was caused by fractures of the humeral medial condyle in 1 case, by long working in elbow flexion position with no obvious injury in 10 cases, and subluxafion of ulnar nerve in 2 cases. The locations were the left side in 6 cases and the right side in 7 cases. The disease duration was 4-30 months. The time from onset to operation was 3-20 months (mean, 8.5 months). Ten patients compl icated by intrinsic muscle atrophy. Results The operation was successfully performed in 13 cases, and the operation time was 45-60 minutes. All the wounds gained primary heal ing. All patients were followed up 12-18 months (mean, 14 months). The numbness of ring finger, l ittle finger, and the ulnar side of hand were decreased obviously on the first day after operation. The examination of electromyogram showed that the ulnar nerve conduction increased at 2 weeks, the ampl itude was improved, and recruitment of the intrinsic muscles of hand enhanced. In 10 cases compl icated by intrinsic muscle atrophy, myodynamia was recovered to the normal in 7 cases and was mostly recovered in 3 cases at 3 months after operation. The symptom of cubital tunnel syndrome disappeared and gained a normal function at 12 months after operation. According to the assessment of Chinese Medical Association and Lascar et al. grading criteria, the cl inical results were excellent in 10 cases and good in 3; the excellent and good rate was 100%. Patients recovered to work 12-16 days (mean, 14 days) after operation. No recurrence occurred during followup. Conclusion The surgical method of endoscope and microscope assisted three small incisions for treatment cubital tunnel syndrome has less invasion with small incision and complete decompression. Patients can recover to work early. It is a convenient and efficient procedure for treating cubital tunnel syndrome.
Objective To compare the effectiveness of anterior subcutaneous transposition and anterior submuscular transposition of the ulnar nerve in the treatment of cubital tunnel syndrome. Methods Between June 2006 and October 2008, 39 patients with cubital tunnel syndrome were treated separately by anterior subcutaneous transposition (anterior subcutaneous transposition group, n=20) and anterior submuscular transposition (anterior submuscular transposition group, n=19). There was no significant difference in gender, age, duration, and cl inical classification between 2 groups (P gt; 0.05). Results All incisions healed by first intention in 2 groups. In anterior submuscular transposition group, 17 patients (89.5%) had abruptly deteriorated symptoms after the symptom of ulnar nerve compression was abated, and 1 patient (5.3%) had cicatrix at elbow; in the anterior subcutaneous transposition group, 10 patients (50.0%) had disesthesia at cubital anterointernal skin after operation; and there was significant difference in the complication between 2 groups (χ2=9.632, P=0.002). The patients were followed up 24 to 36 months, 28 months on average. There was no significant difference in grip strength, pinch power of thumb-to-ring finger and thumb-to-little finger, or two-point discrimination of distal l ittle fingers between 2 groups (P gt; 0.05), but significant differences were found between before operation and after operation in 2 groups (P lt; 0.05). According to the Chinese Medical Society of Hand Surgery Trial upper part of the standard evaluation function assessment, the results were excellent in 5 cases, good in 12 cases, fair in 1 case, and poor in 2 cases in the anterior subcutaneous transposition group; the results were excellent in 6 cases, good in 10 cases, fair in 2 cases, and poor in 1 case in the anterior submuscular transposition group; and there was no significant difference between 2 groups (u=0.346, P=0.734). According to disabil ity of arm-shoulder-hand (DASH) questionnaires, the score was 22 ± 7 in anterior subcutaneous transposition group and was 19 ± 6 in anterior submuscular transposition group, showing no significant difference (t=1.434, P=0.161). Conclusion Both anterior subcutaneous transposition and anterior submuscular transposition have good effectiveness in treating cubital tunnel syndrome; and anterior submuscular transposition has less complication than that of submuscular transposition.
Objective To evaluate and compare the efficacy of anterior subcutaneous and submuscular transposition of the ulnar nerve in treating cubital tunnel syndrome. Methods From August 2006 to August 2008, 66 patients with cubital tunnel syndrome were treated with anterior subcutaneous transposition (subcutaneous group, 24 cases) and with anterior submuscular transposition (submuscular group, 42 cases). According to McGowan stages, all patients were at Stage2 or 3 entrapment neuropathy with paresthesia in the ring and small fingers. Respectively, 3 cases and 8 cases compl icated by interosseous muscle atrophy in subcutaneous group and in submuscular group. No significant difference was found in gender, age, duration of the disease, and compl ication between two groups (P lt; 0.05). The surgical features, distribution of Bishop rates, two-point discrimination test, muscular strength, and compl ications were recorded. Results The operation time was (28.4 ± 5.2) minutes in subcutaneous group and (43.8 ± 5.6) minutes in submuscular group, showing significant difference (P lt; 0.01). The incision length was (12.2 ± 2.5) cm in subcutaneous group and (13.6 ± 2.8) cm in submuscular group, showing significant difference (P lt; 0.05). All patients were followed up 1-3 years. According to Bishop scoring system, the results were excellent in 18 cases, good in 4 cases, and poor in 2 cases in subcutaneous group; excellent in 36 cases, good in 3 cases, and poor in 3 cases in submuscular group; and showing no significant difference between two groups (P gt; 0.05). At 6 months postoperatively, twopoint discrimination and grip strength were improved when compared with that of preoperation (P lt; 0.05), but there was no significant difference between two groups (P gt; 0.05). Pain and dysesthesia of the scar were noted in 1 patient of the subcutaneous group and 3 patients of the submuscular group. No infection or hematoma was found and no patient needed reoperation. Conclusion Both operative methods are effective alternative for treating cubital tunnel syndrome. The anterior ubcutaneous anterior transposition of the ulnar nerve has fewer traumas, and it is a better choice for some old patients.
Objective To investigate the methods and outcome of endoscopic ulnar neurolysis and minimal medial epicondylectomy in treatment of cubital tunnel syndrome with ulnar nerve subluxation. Methods Between June 2004 and June 2009, 11 cases of cubital tunnel syndrome with ulnar nerve subluxation were treated with endoscopic ulnar neurolysis andminimal medial epicondylectomy. There were 7 males and 4 females with an average age of 36 years (range, 18-47 years). All cases had numbness in l ittle finger and ring finger. The disease duration varied from 3 to 18 months (7 months on average). Nine cases had atrophy in the first dorsal interosseous muscle and hypothenar muscles. The preoperative electromyography showed that the ulnar nerve conduction velocity (NCV) were slowed down at elbow, which was (27.0 ± 1.5) m/s. Results All incisions healed by first intention, and no compl ication occurred. Eleven cases were followed up 6-37 months (19 months on average). All cases had normal sensation after 1 month of operation. The muscle strength was obviously improved in 11 cases after 3 months postoperatively (grade 4 in 7 cases and grade 3-4 in 4 cases). The postoperative electromyography showed that the NCV was obviously improved, which was (43.5 ± 9.5) m/s, showing significant difference when compared with preoperative one (P lt; 0.05). According to Amadio’ efficacy appraisal standard, the results were excellent in 7 cases and good in 4 cases. Conclusion The method of endoscopic ulnar neurolysis and minimal medial epicondylectomy has the advantages of safety, convenient manipulation, small incision, and early recovery for cubital tunnel syndrome with ulnar nerve subluxation.
Objective To investigate the blood supply of the ulnar nerve in the elbow region and to design the procedure of anterior transposition of ulnar nerve accompanied with arteries for cubital tunnel syndrome.Methods The vascularity of the ulnar nerve was observed and measured in20adult cadaver upper limb specimens. And the clinical surgical procedure was imitated in 3 adult cadaver upper limb specimens. Results There were three major arteries to supply the ulnar nerve at the elbow region: the superior ulnar collateral artery, the inferior ulnar collateral artery and the posterior ulnar recurrent artery. The distances from arterial origin to the medial epicondyle were 14.2±0.9, 4.2±0.6 and 4.8±1.1 cm respectively. And the total length of the vessels travelling alone with the ulnar nerve were 15.0±1.3,5.1±0.3 and 5.6±0.9 cm. The external diameter of the arteries at the beginning spot were 1.5±0.5, 1.2±0.3 and 1.4±0.5 mm respectively. The perpendicular distance of the three arteries were 1.2±0.5,2.7±0.9 and 1.3±0.5 cm respectively.Conclusion It is feasible to perform anterior transposition of the ulnar nerve accompanied with arteries for cubital tunnel syndrome. And the procedure preserves the blood supply of the ulnar nerve following transposition.
Objective To discuss the curative effect of expanding ulnar nerve groove and interfascicular neurolysis under microscope in treating severe cubital tunnel syndrome (Cub Ts), and to compare with that of the forward moving of ulnar nerve and interfascicular neurolysis under microscope to find out the best way to treat severe Cub Ts. Methods From December 2002 to January 2007, 22 severe Cub Ts cases were treated with expansion of ulnar nerve groove and interfascicular neurolysis under microscope (treatment group), and other 22 cases were treated with forward moving of ulnar nerve and interfascicular neurolysis under microscope (control group). In treatment group, there were 17 males and 5 females, aged 21-66 years (mean 43.8 years). Pathogenic causes were elbow arthritis in 17 cases, ulnar nerve dislocation in 3 cases and elbow ectroption in 2 cases. The locations were left elbow in 8 cases and right elbow in 14 cases. Thecourse of disease was 6-69 months. In control group, there were 18 males and 4 females, aged 20-64 years (mean 42.1 years). Pathogenic causes were elbow in arthritis 16 cases, ulnar nerve dislocation in 3 cases, elbow ectroption in 1 case and narrowing and shallowing of ulnar nerve groove caused by abnormal heal ing of medial condyle fracture in 1 case. The locations were left elbow in 7 cases and right elbow in 15 cases. The course of disease was 5-67 months. Results For all patients of both groups, the wound healed by first intention, and all were followed up for 12-45 months. In treatment group, the numbness in l ittle finger was obviously rel ieved, or disappeared in 22 cases 1 day after operation. In control group, the numbness in l ittle finger was obviously rel ieved or disappeared in 22 cases 3-5 days after operation. EMG showed that conduction speed of ulnar nerve was normal. Evaluated by upper l imbs function standard of China Medical Association, Surgery Association and Lascar grades, the results were excellent in 21 cases and good in 1 case in treatment group; whilet excellent in 19 cases, good in 2 cases and fair in 1 case in control group. There was significant difference between treatment group and control group (P lt; 0.01). Conclusion Either expansion of ulnar nerve groove and interfascicular neurolysis or forward moving of ulnar nerve and interfascicular neurolysis is an effective method to treat severe Cub Ts, but the former is better than the latter.