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An Individualized Operative Approach To Cubital Tunnel Syndrome Provides Excellent Postoperative Results
Jerrod Keith MD, Ronit Wollstein MD
University of Pittsburgh Medical Center
2010-03-30
Presenter: Jerrod Keith, MD
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: Hand
Cubital tunnel syndrome (CTS) is the second most common entrapment neuropathy. This syndrome represents a heterogeneous group of pathologies and thus was treated with a tailored approach, performing the treatment according to the pathology found at surgery. This is a retrospective review of 63 patients treated surgically for CTS from 2004 to 2009. In situ neurolysis was performed, and then the intraoperative stability of the nerve was assessed. Unstable nerves were transposed; anconeus epitrochlearis muscles were excised as necessary. Statistical analysis included paired t-test and logistic regression analysis. The average age was 63.0 years, follow-up 13 months. The average time from onset to surgery was 14.5 months, with both motor and sensory deficits occurring most frequently. At surgery, 35 patients (55.6%) were found to have nerve impingement due to fibrosis, in 13 (20.6%) there was an anconeus epitrochlearis, in 9 (14.3%) the nerve was unstable with the cubital tunnel, and in 6 (9.5%) there was a large medial head of the triceps. Overall, the nerve was transposed in 14.3%. Postoperatively, 90% of patients reported an overall improvement of function as evidenced by an average DASH score of 23.5. Sensation improved in 71% of patients, with 9 patients (14.2%) regaining normal sensation. The average 2-pt discrimination post-op was .66mm. Postoperative grip strength was measured as 94.8% of the uninvolved hand, and first dorsal interosseous strength improved from 4.40 to 1.46; p < .0001. Our results support an individualized surgical approach to treating CTS based upon intraoperative findings.
