Skip to main content
Top
Published in: Archives of Orthopaedic and Trauma Surgery 12/2010

01-12-2010 | Handsurgery

Objective outcome of partial medial epicondylectomy in cubital tunnel syndrome

Authors: Saskia M. Schnabl, Franziska Kisslinger, Axel Schramm, Adrian Dragu, Ulrich Kneser, Frank Unglaub, Raymund E. Horch

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 12/2010

Login to get access

Abstract

Aim

Goal of the study was to evaluate the clinical outcome in cubital tunnel syndrome (CuTS) after partial medial epicondylectomy (pME) with objective parameters.

Method

A retrospective analysis was performed in 29 (18 male/11 female) patients with CuTS who underwent pME. Mean time follow-up was 41.4 months. Parameters assessed sensibility (two point discrimination (2PD) and Semmes Weinstein Monofilaments (SW)) of the fifth finger and grip and pinch strength. In addition, elbow range of motion, elbow instability, medial elbow pain, Froment sign and Tinel`s sign were evaluated.

Results

Postoperative static 2PD of the fifth finger was 12.6 mm. SW values on the operated side (mean 3.58; 2.44–6.65) were comparable to the non-operated side (mean 3.28; 2.44–4.93). Tinel’s sign over the ulnar sulcus was positive in 13 cases preoperative and in 16 cases postoperatively. Range of motion of the elbow joint achieved normal values in flexion/extension and pronation/supination with no significant difference in comparison to the non-operated side. Froment sign was positive in 2 cases, negative in 23 cases. Grip strength averaged 48.1 kg in man versus 24.4 kg in women. Pinch strength was 8.6 versus 5.3 kg. Grip strength on the operated side reached up to 91.0% values of the opposite arm.

Conclusion

Good postoperative objective results were reached by pME. pME is an adequate treatment option in CuTS.
Literature
1.
go back to reference Amako M, Nemoto K, Kawaguchi M, Kato N, Arino H, Fujikawa K (2000) Comparison between partial and minimal medial epicondylectomy combined with decompression for the treatment of cubital tunnel syndrome. J Hand Surg Am 25(6):1043–1050PubMed Amako M, Nemoto K, Kawaguchi M, Kato N, Arino H, Fujikawa K (2000) Comparison between partial and minimal medial epicondylectomy combined with decompression for the treatment of cubital tunnel syndrome. J Hand Surg Am 25(6):1043–1050PubMed
2.
go back to reference Amirfeyz R, Clark D, Parsons B, Melotti R, Bhatia R, Leslie I, Bannister G (2010) Clinical tests for carpal tunnel syndrome in contemporary practice. Arch Orthop Trauma Surg [Epub ahead of print] Amirfeyz R, Clark D, Parsons B, Melotti R, Bhatia R, Leslie I, Bannister G (2010) Clinical tests for carpal tunnel syndrome in contemporary practice. Arch Orthop Trauma Surg [Epub ahead of print]
3.
go back to reference Assmus H (2009) From sulcus ulnaris to cubital tunnel syndrome–a new/old concept. Handchir Mikrochir Plast Chir 41(1):1CrossRefPubMed Assmus H (2009) From sulcus ulnaris to cubital tunnel syndrome–a new/old concept. Handchir Mikrochir Plast Chir 41(1):1CrossRefPubMed
4.
go back to reference Assmus H, Antoniadis G, Bischoff C et al (2009) Diagnosis and therapy of cubital tunnel syndrome—state of the art. Handchir Mikrochir Plast Chir 41(1):2–12CrossRefPubMed Assmus H, Antoniadis G, Bischoff C et al (2009) Diagnosis and therapy of cubital tunnel syndrome—state of the art. Handchir Mikrochir Plast Chir 41(1):2–12CrossRefPubMed
5.
go back to reference Bartels RH, Menovsky T, Van Overbeeke JJ, Verhagen WI (1998) Surgical management of ulnar nerve compression at the elbow: an analysis of the literature. J Neurosurg 89(5):722–727CrossRefPubMed Bartels RH, Menovsky T, Van Overbeeke JJ, Verhagen WI (1998) Surgical management of ulnar nerve compression at the elbow: an analysis of the literature. J Neurosurg 89(5):722–727CrossRefPubMed
6.
go back to reference Bartels RH, Verhagen WI, van der Wilt GJ, Meulstee J, van Rossum LG, Grotenhuis JA (2005) Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: Part 1. Neurosurgery 56(3):522–530 (discussion 522–530)CrossRefPubMed Bartels RH, Verhagen WI, van der Wilt GJ, Meulstee J, van Rossum LG, Grotenhuis JA (2005) Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: Part 1. Neurosurgery 56(3):522–530 (discussion 522–530)CrossRefPubMed
7.
go back to reference Bednar MS, Blair SJ, Light TR (1994) Complications of the treatment of cubital tunnel syndrome. Hand Clin 10(1):83–92PubMed Bednar MS, Blair SJ, Light TR (1994) Complications of the treatment of cubital tunnel syndrome. Hand Clin 10(1):83–92PubMed
8.
go back to reference Bell-Krotoski J, Tomancik E (1987) The repeatability of testing with Semmes–Weinstein monofilaments. J Hand Surg Am 12(1):155–161PubMed Bell-Krotoski J, Tomancik E (1987) The repeatability of testing with Semmes–Weinstein monofilaments. J Hand Surg Am 12(1):155–161PubMed
9.
go back to reference Bultmann C, Hoffmann R (2009) Endoscopic decompression of the ulnar nerve in cubital tunnel syndrome. Oper Orthop Traumatol 21(2):193–205CrossRefPubMed Bultmann C, Hoffmann R (2009) Endoscopic decompression of the ulnar nerve in cubital tunnel syndrome. Oper Orthop Traumatol 21(2):193–205CrossRefPubMed
11.
go back to reference Caputo AE, Watson HK (2000) Subcutaneous anterior transposition of the ulnar nerve for failed decompression of cubital tunnel syndrome. J Hand Surg Am 25(3):544–551CrossRefPubMed Caputo AE, Watson HK (2000) Subcutaneous anterior transposition of the ulnar nerve for failed decompression of cubital tunnel syndrome. J Hand Surg Am 25(3):544–551CrossRefPubMed
12.
go back to reference Charles YP, Coulet B, Rouzaud JC, Daures JP, Chammas M (2009) Comparative clinical outcomes of submuscular and subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg Am 34(5):866–874CrossRefPubMed Charles YP, Coulet B, Rouzaud JC, Daures JP, Chammas M (2009) Comparative clinical outcomes of submuscular and subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg Am 34(5):866–874CrossRefPubMed
13.
go back to reference Craven PR Jr, Green DP (1980) Cubital tunnel syndrome. Treatment by medial epicondylectomy. J Bone Jt Surg Am 62(6):986–989 Craven PR Jr, Green DP (1980) Cubital tunnel syndrome. Treatment by medial epicondylectomy. J Bone Jt Surg Am 62(6):986–989
14.
go back to reference Dellon AL (1989) Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg Am 14(4):688–700CrossRefPubMed Dellon AL (1989) Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg Am 14(4):688–700CrossRefPubMed
15.
go back to reference Dellon AL, Coert JH (2004) Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow. J Bone Jt Surg Am 86-A Suppl 1(Pt 2):169–179 Dellon AL, Coert JH (2004) Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow. J Bone Jt Surg Am 86-A Suppl 1(Pt 2):169–179
16.
go back to reference Dinh PT, Gupta R (2005) Subtotal medial epicondylectomy as a surgical option for treatment of cubital tunnel syndrome. Tech Hand Up Extrem Surg 9(1):52–59CrossRefPubMed Dinh PT, Gupta R (2005) Subtotal medial epicondylectomy as a surgical option for treatment of cubital tunnel syndrome. Tech Hand Up Extrem Surg 9(1):52–59CrossRefPubMed
17.
go back to reference Eaton RG, Crowe JF, Parkes JC 3rd (1980) Anterior transposition of the ulnar nerve using a non-compressing fasciodermal sling. J Bone Jt Surg Am 62(5):820–825 Eaton RG, Crowe JF, Parkes JC 3rd (1980) Anterior transposition of the ulnar nerve using a non-compressing fasciodermal sling. J Bone Jt Surg Am 62(5):820–825
18.
go back to reference Efstathopoulos DG, Themistocleous GS, Papagelopoulos PJ, Chloros GD, Gerostathopoulos NE, Soucacos PN (2006) Outcome of partial medial epicondylectomy for cubital tunnel syndrome. Clin Orthop Relat Res 444:134–139CrossRefPubMed Efstathopoulos DG, Themistocleous GS, Papagelopoulos PJ, Chloros GD, Gerostathopoulos NE, Soucacos PN (2006) Outcome of partial medial epicondylectomy for cubital tunnel syndrome. Clin Orthop Relat Res 444:134–139CrossRefPubMed
19.
go back to reference Froimson AI, Anouchi YS, Seitz WH Jr, Winsberg DD (1991) Ulnar nerve decompression with medial epicondylectomy for neuropathy at the elbow. Clin Orthop Relat Res (265):200–206 Froimson AI, Anouchi YS, Seitz WH Jr, Winsberg DD (1991) Ulnar nerve decompression with medial epicondylectomy for neuropathy at the elbow. Clin Orthop Relat Res (265):200–206
20.
go back to reference Geutjens GG, Langstaff RJ, Smith NJ, Jefferson D, Howell CJ, Barton NJ (1996) Medial epicondylectomy or ulnar-nerve transposition for ulnar neuropathy at the elbow? J Bone Jt Surg Br 78(5):777–779 Geutjens GG, Langstaff RJ, Smith NJ, Jefferson D, Howell CJ, Barton NJ (1996) Medial epicondylectomy or ulnar-nerve transposition for ulnar neuropathy at the elbow? J Bone Jt Surg Br 78(5):777–779
21.
go back to reference Gobel F, Musgrave DS, Vardakas DG, Vogt MT, Sotereanos DG (2001) Minimal medial epicondylectomy and decompression for cubital tunnel syndrome. Clin Orthop Relat Res (393):228–236 Gobel F, Musgrave DS, Vardakas DG, Vogt MT, Sotereanos DG (2001) Minimal medial epicondylectomy and decompression for cubital tunnel syndrome. Clin Orthop Relat Res (393):228–236
22.
go back to reference Goldberg BJ, Light TR, Blair SJ (1989) Ulnar neuropathy at the elbow: results of medial epicondylectomy. J Hand Surg Am 14(2 Pt 1):182–188CrossRefPubMed Goldberg BJ, Light TR, Blair SJ (1989) Ulnar neuropathy at the elbow: results of medial epicondylectomy. J Hand Surg Am 14(2 Pt 1):182–188CrossRefPubMed
23.
go back to reference Heithoff SJ (1999) Cubital tunnel syndrome does not require transposition of the ulnar nerve. J Hand Surg Am 24(5):898–905CrossRefPubMed Heithoff SJ (1999) Cubital tunnel syndrome does not require transposition of the ulnar nerve. J Hand Surg Am 24(5):898–905CrossRefPubMed
24.
go back to reference Heithoff SJ, Millender LH, Nalebuff EA, Petruska AJ Jr (1990) Medial epicondylectomy for the treatment of ulnar nerve compression at the elbow. J Hand Surg Am 15(1):22–29CrossRefPubMed Heithoff SJ, Millender LH, Nalebuff EA, Petruska AJ Jr (1990) Medial epicondylectomy for the treatment of ulnar nerve compression at the elbow. J Hand Surg Am 15(1):22–29CrossRefPubMed
25.
go back to reference Hoffmann R, Siemionow M (2006) The endoscopic management of cubital tunnel syndrome. J Hand Surg Br 31(1):23–29CrossRefPubMed Hoffmann R, Siemionow M (2006) The endoscopic management of cubital tunnel syndrome. J Hand Surg Br 31(1):23–29CrossRefPubMed
26.
go back to reference Inaparthy PK, Anwar F, Botchu R, Jahnich H, Katchburian MV (2008) Compression of the deep branch of the ulnar nerve in Guyon’s canal by a ganglion: two cases. Arch Orthop Trauma Surg 128(7):641–643CrossRefPubMed Inaparthy PK, Anwar F, Botchu R, Jahnich H, Katchburian MV (2008) Compression of the deep branch of the ulnar nerve in Guyon’s canal by a ganglion: two cases. Arch Orthop Trauma Surg 128(7):641–643CrossRefPubMed
27.
go back to reference Jones RE, Gauntt C (1979) Medial epicondylectomy for ulnar nerve compression syndrome at the elbow. Clin Orthop Relat Res (139):174–178 Jones RE, Gauntt C (1979) Medial epicondylectomy for ulnar nerve compression syndrome at the elbow. Clin Orthop Relat Res (139):174–178
28.
go back to reference Kaempffe FA, Farbach J (1998) A modified surgical procedure for cubital tunnel syndrome: partial medial epicondylectomy. J Hand Surg Am 23(3):492–499CrossRefPubMed Kaempffe FA, Farbach J (1998) A modified surgical procedure for cubital tunnel syndrome: partial medial epicondylectomy. J Hand Surg Am 23(3):492–499CrossRefPubMed
29.
go back to reference King T, Morgan FP (1959) Late results of removing the medial humeral epicondyle for traumatic ulnar neuritis. J Bone Jt Surg Br 41-B(1):51–55 King T, Morgan FP (1959) Late results of removing the medial humeral epicondyle for traumatic ulnar neuritis. J Bone Jt Surg Br 41-B(1):51–55
30.
go back to reference Kleinman WB, Bishop AT (1989) Anterior intramuscular transposition of the ulnar nerve. J Hand Surg Am 14(6):972–979CrossRefPubMed Kleinman WB, Bishop AT (1989) Anterior intramuscular transposition of the ulnar nerve. J Hand Surg Am 14(6):972–979CrossRefPubMed
31.
go back to reference Levin S, Pearsall G, Ruderman RJ (1978) Von Frey’s method of measuring pressure sensibility in the hand: an engineering analysis of the Weinstein–Semmes pressure aesthesiometer. J Hand Surg Am 3(3):211–216PubMed Levin S, Pearsall G, Ruderman RJ (1978) Von Frey’s method of measuring pressure sensibility in the hand: an engineering analysis of the Weinstein–Semmes pressure aesthesiometer. J Hand Surg Am 3(3):211–216PubMed
32.
go back to reference Louahem DM, Bourelle S, Buscayret F et al (2009) Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases. Arch Orthop Trauma Surg 130(5):649–655CrossRefPubMed Louahem DM, Bourelle S, Buscayret F et al (2009) Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases. Arch Orthop Trauma Surg 130(5):649–655CrossRefPubMed
33.
go back to reference Macadam SA, Gandhi R, Bezuhly M, Lefaivre KA (2008) Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a meta-analysis. J Hand Surg Am 33(8):1314 e1311–e1312 Macadam SA, Gandhi R, Bezuhly M, Lefaivre KA (2008) Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a meta-analysis. J Hand Surg Am 33(8):1314 e1311–e1312
34.
go back to reference Manske PR, Johnston R, Pruitt DL, Strecker WB (1992) Ulnar nerve decompression at the cubital tunnel. Clin Orthop Relat Res (274):231–237 Manske PR, Johnston R, Pruitt DL, Strecker WB (1992) Ulnar nerve decompression at the cubital tunnel. Clin Orthop Relat Res (274):231–237
35.
go back to reference Mowlavi A, Andrews K, Lille S, Verhulst S, Zook EG, Milner S (2000) The management of cubital tunnel syndrome: a meta-analysis of clinical studies. Plast Reconstr Surg 106(2):327–334CrossRefPubMed Mowlavi A, Andrews K, Lille S, Verhulst S, Zook EG, Milner S (2000) The management of cubital tunnel syndrome: a meta-analysis of clinical studies. Plast Reconstr Surg 106(2):327–334CrossRefPubMed
36.
go back to reference Muermans S, De Smet L (2002) Partial medial epicondylectomy for cubital tunnel syndrome: outcome and complications. J Shoulder Elbow Surg 11(3):248–252CrossRefPubMed Muermans S, De Smet L (2002) Partial medial epicondylectomy for cubital tunnel syndrome: outcome and complications. J Shoulder Elbow Surg 11(3):248–252CrossRefPubMed
37.
38.
go back to reference Novak CB, Mackinnon SE (2009) Selection of operative procedures for cubital tunnel syndrome. Hand (N Y) 4(1):50–54 Novak CB, Mackinnon SE (2009) Selection of operative procedures for cubital tunnel syndrome. Hand (N Y) 4(1):50–54
39.
go back to reference O’Driscoll SW, Horii E, Carmichael SW, Morrey BF (1991) The cubital tunnel and ulnar neuropathy. J Bone Jt Surg Br 73(4):613–617 O’Driscoll SW, Horii E, Carmichael SW, Morrey BF (1991) The cubital tunnel and ulnar neuropathy. J Bone Jt Surg Br 73(4):613–617
42.
go back to reference Popa M, Dubert T (2004) Treatment of cubital tunnel syndrome by frontal partial medial epicondylectomy. A retrospective series of 55 cases. J Hand Surg Br 29(6):563–567CrossRefPubMed Popa M, Dubert T (2004) Treatment of cubital tunnel syndrome by frontal partial medial epicondylectomy. A retrospective series of 55 cases. J Hand Surg Br 29(6):563–567CrossRefPubMed
43.
go back to reference Porcellini G, Paladini P, Campi F, Merolla G (2005) Arthroscopic neurolysis of the ulnar nerve at the elbow. Chir Organi Mov 90(2):191–200PubMed Porcellini G, Paladini P, Campi F, Merolla G (2005) Arthroscopic neurolysis of the ulnar nerve at the elbow. Chir Organi Mov 90(2):191–200PubMed
44.
go back to reference Rogers MR, Bergfield TG, Aulicino PL (1991) The failed ulnar nerve transposition. Etiology and treatment. Clin Orthop Relat Res (269):193–200 Rogers MR, Bergfield TG, Aulicino PL (1991) The failed ulnar nerve transposition. Etiology and treatment. Clin Orthop Relat Res (269):193–200
45.
go back to reference Seradge H, Owen W (1998) Cubital tunnel release with medial epicondylectomy factors influencing the outcome. J Hand Surg Am 23(3):483–491CrossRefPubMed Seradge H, Owen W (1998) Cubital tunnel release with medial epicondylectomy factors influencing the outcome. J Hand Surg Am 23(3):483–491CrossRefPubMed
46.
go back to reference Simmen BR, Angst F, Schwyzer HK et al (2009) A concept for comprehensively measuring health, function and quality of life following orthopaedic interventions of the upper extremity. Arch Orthop Trauma Surg 129(1):113–118CrossRefPubMed Simmen BR, Angst F, Schwyzer HK et al (2009) A concept for comprehensively measuring health, function and quality of life following orthopaedic interventions of the upper extremity. Arch Orthop Trauma Surg 129(1):113–118CrossRefPubMed
47.
go back to reference Tsai TM, Bonczar M, Tsuruta T, Syed SA (1995) A new operative technique: cubital tunnel decompression with endoscopic assistance. Hand Clin 11(1):71–80PubMed Tsai TM, Bonczar M, Tsuruta T, Syed SA (1995) A new operative technique: cubital tunnel decompression with endoscopic assistance. Hand Clin 11(1):71–80PubMed
48.
go back to reference Tsai TM, Chen IC, Majd ME, Lim BH (1999) Cubital tunnel release with endoscopic assistance: results of a new technique. J Hand Surg Am 24(1):21–29CrossRefPubMed Tsai TM, Chen IC, Majd ME, Lim BH (1999) Cubital tunnel release with endoscopic assistance: results of a new technique. J Hand Surg Am 24(1):21–29CrossRefPubMed
49.
go back to reference Unglaub F, Wolf E, Goldbach C, Hahn P, Kroeber MW (2008) Subjective and functional outcome after revision surgery in carpal tunnel syndrome. Arch Orthop Trauma Surg 128(9):931–936CrossRefPubMed Unglaub F, Wolf E, Goldbach C, Hahn P, Kroeber MW (2008) Subjective and functional outcome after revision surgery in carpal tunnel syndrome. Arch Orthop Trauma Surg 128(9):931–936CrossRefPubMed
50.
go back to reference Vogel RB, Nossaman BC, Rayan GM (2004) Revision anterior submuscular transposition of the ulnar nerve for failed subcutaneous transposition. Br J Plast Surg 57(4):311–316CrossRefPubMed Vogel RB, Nossaman BC, Rayan GM (2004) Revision anterior submuscular transposition of the ulnar nerve for failed subcutaneous transposition. Br J Plast Surg 57(4):311–316CrossRefPubMed
51.
go back to reference Wolf MB, Kroeber MW, Reiter A et al (2010) Ulnar shortening after TFCC suture repair of Palmer type 1B lesions. Arch Orthop Trauma Surg 130(3):301–306CrossRefPubMed Wolf MB, Kroeber MW, Reiter A et al (2010) Ulnar shortening after TFCC suture repair of Palmer type 1B lesions. Arch Orthop Trauma Surg 130(3):301–306CrossRefPubMed
52.
go back to reference Zlowodzki M, Chan S, Bhandari M, Kalliainen L, Schubert W (2007) Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome. A meta-analysis of randomized, controlled trials. J Bone Jt Surg Am 89(12):2591–2598CrossRef Zlowodzki M, Chan S, Bhandari M, Kalliainen L, Schubert W (2007) Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome. A meta-analysis of randomized, controlled trials. J Bone Jt Surg Am 89(12):2591–2598CrossRef
Metadata
Title
Objective outcome of partial medial epicondylectomy in cubital tunnel syndrome
Authors
Saskia M. Schnabl
Franziska Kisslinger
Axel Schramm
Adrian Dragu
Ulrich Kneser
Frank Unglaub
Raymund E. Horch
Publication date
01-12-2010
Publisher
Springer-Verlag
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 12/2010
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-010-1160-x

Other articles of this Issue 12/2010

Archives of Orthopaedic and Trauma Surgery 12/2010 Go to the issue