Medial Epicondylectomy With Adipofascial Flap Versus Anterior Subcutaneous Transposition in Surgical Treatment of Cubital Tunnel Syndrome.

Abstract

Cubital tunnel syndrome, the second most common compression neuropathy of the upper extremity, has several surgical treatment options including simple (in situ) decompression, decompression with medial epicondylectomy (ME), or anterior transposition to a subcutaneous, submuscular, or subfascial position. The existing literature does not clearly establish the superiority of one procedure over the other. This study aims to compare two techniques, ME combined with an adipofascial flap versus anterior subcutaneous transposition, in terms of outcomes including resolution of neurological deficits, surgical site discomfort, recurrence, and reoperation. This was an IRB-approved retrospective chart analysis on patients who had primary ulnar nerve decompression via either ME or subcutaneous anterior transposition. Outcomes recorded were tenderness at operative site, resolution of neurological deficits, recurrence rate, and need for secondary surgery. Patients undergoing ME (n = 48) were classified into mild (n = 1, 2%), moderate (n = 11, 23%), and severe (n = 36, 75%) categories. For this group, complete resolution of neurological symptoms was recorded as <6 weeks (n = 10, 21%), 6 weeks to 3 months (n = 8, 16.6%), and >3 months (n = 13, 27%). Incomplete resolution was documented as improved (n = 15, 31.2%), unchanged (n = 2, 4.1%), or worse (0%). Surgical site discomfort was documented as lasting <3 weeks (n = 30, 62.5%), 3 to 6 weeks (n = 15, 37.5%), and 6 weeks to 3 months (n = 3, 6.3%), and there were no patients who had unresolved pain. The recurrence rate was 2/48 (4.1%). The secondary surgery rate was 1/48 (2%).Patients undergoing subcutaneous anterior transposition (n = 54) were classified into mild (n = 6, 11%), moderate (n = 26, 48%), and severe (n = 22, 41%) categories. For this group, complete resolution of symptoms was recorded as <6 weeks in (n = 13, 24%), 6 weeks to 3 months (n = 10, 18.5%), and >3 months (n = 12, 22.2%). Incomplete resolution was documented as improved (n = 13, 24.1%), unchanged (n = 4, 7.4%), or worse (n = 2, 3.7%). Surgical site discomfort was documented as lasting <3 weeks (n = 41, 76%), 3 to 6 weeks (n = 2, 4%), and 6 weeks to 3 months (n = 1, 2%), and 10 patients (18%) had unresolved pain. The recurrence rate (n = 13, 24%) and need for a second surgery (n = 19, 18.5%) were also recorded. Medial epicondylectomy with adipofascial flap is effective in treating cubital tunnel syndrome and has a lower potential for persistent surgical site pain and recurrence than subcutaneous transposition.