Elsevier

The Journal of Hand Surgery

Volume 34, Issue 8, October 2009, Pages 1492-1498
The Journal of Hand Surgery

Scientific article
Patient-Rated Outcome of Ulnar Nerve Decompression: A Comparison of Endoscopic and Open In Situ Decompression

https://doi.org/10.1016/j.jhsa.2009.05.014Get rights and content

Purpose

To report patient-rated outcomes after ulnar nerve decompression at the elbow and to compare the outcome after open in situ decompression with that after endoscopic in situ decompression.

Methods

Patients having ulnar nerve decompression were evaluated using patient-rated outcome measures. Fifty-five patients were recruited; 3 were lost to follow-up, and 18 were excluded because they had anterior transposition. Of the thirty-four patients followed up for 12 months, 19 had endoscopic decompression and 15 had open in situ decompression. Patient demographics, presenting symptoms, range of elbow movement, grip and pinch strength, and sensation were recorded preoperatively and at 12 months by an independent observer. Postoperative patient satisfaction, pain, and ongoing paresthesia were recorded using visual analog scales. Subgroup analysis was performed to compare the outcome of open in situ decompression with that of endoscopic in situ decompression.

Results

At 12 months after surgery, the proportion of patients satisfied with the outcome was 9 of 15 (60%) for open in situ surgery and 15 of 19 (79%) for endoscopic in situ surgery. The postoperative complication rate was significantly higher after open in situ decompression than that after endoscopic in situ decompression surgery (10%). Preoperative function scores were predictive of patient-rated satisfaction and were related to McGowan grade.

Conclusions

The patient-reported outcome of surgical treatment of cubital tunnel syndrome is good but is affected by preoperative symptom severity. Outcomes after open and endoscopic in situ decompression, including the proportion of patients reporting satisfaction and functional improvement, are equivalent, but more patients reported complications after open decompression.

Type of study/level of evidence

Therapeutic III.

Section snippets

Materials and Methods

With local ethics committee approval, data were collected on all consenting patients having ulnar nerve surgery either as an endoscopic or open procedure under the care of a single surgeon between May 1997 and March 2006. The diagnosis of ulnar nerve entrapment at the elbow was made based on a history including paresthesia or numbness in the ulnar nerve distribution, weakness or wasting of the small muscles of the hand, and a positive elbow flexion provocation test. Nerve conduction studies

Results of subjective assessment

A greater proportion of patients in the endoscopic group (15 of 19; 79%) reported that they were satisfied with the outcome of the procedure at 12 months than that in the open in situ decompression group (9 of 15; 60%) but the difference was not statistically significant (p = .229) (Table 3).

The degree of self-reported patient satisfaction measured on a VAS was a median of 90 for the endoscopic decompression group and 60 for the open in situ group. The difference between the scores for the

Discussion

The optimal treatment for cubital tunnel syndrome is widely debated. Some authors argue that the primary problem is nerve compression by overlying structures11 and that the syndrome is best treated by decompression of the nerve without removing it from its bed, therefore causing minimal disruption to the vascular supply. Others argue in favor of ulnar nerve transposition or medial epicondylectomy,12, 13, 14 citing evidence that the nerve is under tension with elbow flexion15 that can only be

References (29)

Cited by (0)

The authors would like to acknowledge the important contribution made to this study by Ron Heptinstall, Enid Buckton, and Rob Maurmo.

No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.

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