Outcomes of ulnar nerve anterior transmuscular transposition and significance of ulnar nerve instability in cubital tunnel syndrome

Modern Treatment of Cubital Tunnel Syndrome: Evidence and Controversy

Cubital tunnel syndrome is the second most common peripheral mononeuropathy in the upper extremity. However, the diagnosis and treatment of cubital tunnel syndrome remains controversial without a standard algorithm. Although diagnosis can often be made from the patient's history and physical examination alone, electrodiagnostic studies, ultrasound, computed tomography (CT), and magnetic resonance image (MRI) can also be useful in diagnosing the disease and selecting the most appropriate treatment option. Treatment options include conservative nonoperative techniques as well as various surgical options, including in situ decompression with or without transposition, medial epicondylectomy, and nerve transfer in advanced disease. The purpose of this review is to summarize the most up-to-date literature regarding cubital tunnel syndrome and propose a treatment algorithm to provide clarity about the challenges of treating this complex patient population.

Management of cubital tunnel syndrome by anterior trans-muscular transposition of the ulnar nerve

Background

Various surgical options are used for the treatment of ulnar nerve entrapment at the elbow. In this study, anterior trans-muscular transposition of the ulnar nerve was used for the treatment of cubital tunnel syndrome.

Objectives

To evaluate the surgical results of anterior trans-muscular transposition technique for the treatment of cubital tunnel syndrome with particular emphasis on clinical outcome.

Methods

Forty patients with cubital tunnel syndrome were operated using anterior trans-muscular transposition technique. Patients were classified into post-operative clinical outcome grades according to the Wilson & Krout criteria, and they were followed up by visual analog scale (VAS), the Disability of Arm Shoulder and Hand (DASH) questionnaire, electrophysiological study, and post-operative clinical evaluation.

Results

Forty patients with cubital tunnel syndrome who underwent anterior trans-muscular transposition of the ulnar nerve show a significant clinical improvement at 24 months post-surgery regarding visual analog scale (VAS), the Disability of Arm Shoulder and Hand (DASH) questionnaire, electrophysiological study, and the Wilson & Krout grading as 87.5% of the patients recorded excellent and good outcome.

Conclusion

Anterior transmuscular transposition of the ulnar nerve is a safe and effective treatment for ulnar nerve entrapment at the elbow.