Comparison of Subcutaneous Anterior Transposition and In Situ Decompression Techniques of Ulnar Nerve Surgery in Cubital Tunnel Syndrome

By /
Cite this article Download PDF DOI Email Share
Tayfun Bacaksız, Mehmet Maden

Volume 9 · Issue 1 · pp. 76–80

Received: 20251230  Accepted: 20260222  Published: 20260317

Abstract

Purpose: This study aims to compare two prevalent surgical techniques for cubital tunnel syndrome (CuTS): ulnar nerve in situ decompression (ISD) and subcutaneous anterior transposition (SAT), with an emphasis on clinical outcomes, surgical period, and complications.Material Methods: Sixty-nine patients who underwent surgery for CuTS between 2018 and 2023 and were followed up for a minimum of 12 months were retrospectively evaluated. Patients whose diagnosis was confirmed by electromyography and who had symptoms that persisted despite conservative treatment were included in the study. Patients were divided into two groups based on the surgical technique used: ISD (Group 1, n = 37) and SAT (Group 2, n = 32). The groups were compared in terms of demographic characteristics, preoperative Dellon classification, surgical duration, complications, and clinical outcomes at the last follow-up. Clinical evaluation was performed using the Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Modified Bishop score, and range of motion (ROM) of the elbow.Results: The mean age of the patients was 42.36±12.16 years, and the mean follow-up period was 48.36±24.47 months. No significant differences were found between the groups in terms of age, gender, affected side, dominant extremity distribution, and preoperative Dellon stages (p>0.05). The mean surgical time was significantly shorter in the ISD group compared to the SAT group (34.76±8.65 min vs. 55.41±13.25 min; p0.05 for all). Complication rates were 8.1% in the ISD group and 6.3% in the SAT group, with no significant difference between the groups.Conclusion: In cubital tunnel syndrome surgery, ISD and SAT techniques provide similar results in terms of clinical efficacy. However, ISD stands out as a practical and effective surgical option in the appropriate patient group due to its shorter surgical time and limited surgical dissection requirements. The choice of surgical technique should be individualized according to the patient's specific clinical and anatomical characteristics.Level of Evidence: Level III, Retrospective comperative study

Keywords: Cubital tunnel syndrome; ulnar nerve; in situ decompression; subcutaneous anterior transposition; peripheral nerve surgery

References

  1. Boone S, Gelberman RH, Calfee RP. The Management of Cubital Tunnel Syndrome. J Hand Surg Am. 2015;40(9):1897-1904. Crossref
  2. Mallette P, Zhao M, Zurakowski D, Ring D. Muscle Atrophy at Diagnosis of Carpal and Cubital Tunnel Syndrome. J Hand Surg Am. 2007;32(6):855-858. Crossref
  3. Drake ML, Hensley DT, Chen WC, Taylor KF. Muscle Atrophy at Presentation of Cubital Tunnel Syndrome: Demographics and Duration of Symptoms. Hand (N Y). 2017;12(1):64-67. Crossref
  4. Graf A, Ahmed AS, Roundy R, Gottschalk MB, Dempsey A. Modern Treatment of Cubital Tunnel Syndrome: Evidence and Controversy. J Hand Surg Glob Online. 2023;5(4):547-560. Crossref
  5. Shah CM, Calfee RP, Gelberman RH, Goldfarb CA. Outcomes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome. J Hand Surg Am. 2013;38(6):1125-1130.e1. Crossref
  6. Kessler RB, Thompson RG, Lourie GM. Cubital tunnel syndrome: a surgical modification to in situ decompression to improve results. JSES Int. 2020;4(1):15-20. Crossref
  7. Gaspar MP, Kane PM, Putthiwara D, Jacoby SM, Osterman AL. Predicting Revision Following in Situ Ulnar Nerve Decompression for Patients with Idiopathic Cubital Tunnel Syndrome. J Hand Surg Am. 2016;41(3):427-435. Crossref
  8. Zhang D, Earp BE, Blazar P. Rates of Complications and Secondary Surgeries After In Situ Cubital Tunnel Release Compared With Ulnar Nerve Transposition: A Retrospective Review. J Hand Surg Am. 2017;42(4):294.e1-294.e5. Crossref
  9. Sousa M, Aido R, Trigueiros M, Lemos R, Silva C. Cubital compressive neuropathy in the elbow: in situ neurolysis versus anterior transposition - comparative study. Rev Bras Ortop (Engl Ed). 2014;49(6):647-652. Crossref
  10. Nakamura K, Uchiyama S, Ido Y, Itsubo T, Hayashi M, Murakami H, et al. The effect of vascular pedicle preservation on blood flow and clinical outcome following ulnar nerve transposition. J Hand Surg Am. 2014;39(2):291-302. Crossref
  11. Dellon AL, Chang E, Coert JH, Campbell KR. Intraneural ulnar nerve pressure changes related to operative techniques for cubital tunnel decompression. J Hand Surg Am. 1994;19(6):923-930. Crossref
  12. Foran I, Vaz K, Sikora-Klak J, Ward SR, Hentzen ER, Shah SB. Regional Ulnar Nerve Strain Following Decompression and Anterior Subcutaneous Transposition in Patients With Cubital Tunnel Syndrome. J Hand Surg Am. 2016;41(10):e343-e350. Crossref
  13. Lundborg G, Rydevik B. Effects of stretching the tibial nerve of the rabbit. A preliminary study of the intraneural circulation and the barrier function of the perineurium. J Bone Joint Surg Br. 1973;55(2):390-401. Crossref
  14. Mitchell J, Dunn JC, Kusnezov N, Bader J, Ipsen DF, Forthman CL, et al. The effect of operative technique on ulnar nerve strain following surgery for cubital tunnel syndrome. Hand (N Y). 2015;10(4):707-711. Crossref
  15. Eberlin KR, Marjoua Y, Jupiter JB. Compressive Neuropathy of the Ulnar Nerve: A Perspective on History and Current Controversies. J Hand Surg Am. 2017;42(6):464-469. Crossref
  16. Zlowodzki M, Chan S, Bhandari M, Kalliainen L, Schubert W. Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome: A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 2007;89(12):2591-2598. Crossref
  17. Said J, Van Nest D, Foltz C, Ilyas AM. Ulnar Nerve In Situ Decompression versus Transposition for Idiopathic Cubital Tunnel Syndrome: An Updated Meta-Analysis. J Hand Microsurg. 2019;11(1):18-27. Crossref
  18. Macadam SA, Gandhi R, Bezuhly M, Lefaivre KA. Simple Decompression Versus Anterior Subcutaneous and Submuscular Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome: A Meta-Analysis. J Hand Surg Am. 2008;33(8):1314.e1-1314.e12. Crossref
  19. Dellon AL. Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg Am. 1989;14(4):688-700. Crossref
  20. Bartels RHMA, Menovsky T, Van Overbeeke JJ, Verhagen WIM. Surgical management of ulnar nerve compression at the elbow: An analysis of the literature. J Neurosurg. 1998;89(5):722-727. Crossref
  21. Bartels RHMA, Verhagen WIM, Van Der Wilt GJ, Meulstee J, Van Rossum LGM, Grotenhuis JA. Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: Part 1. Neurosurgery. 2005;56(3):522-529. Crossref
  22. Biggs M, Curtis JA. Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition. Neurosurgery. 2006;58(2):296-303. Crossref
  23. Abouzeid W, Almamoun M, Niazy T, Abbas M, Abdeltawab M. Ulnar Nerve in Situ Decompression versus Transposition for Idiopathic Cubital Tunnel Syndrome: Long-term clinical outcome: Multicenteric retrospective study. Pan Arab J Neurosurg. 2022;17(1):71-79. Crossref
  24. Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2016;2016(11):CD006839. Crossref
  25. Mowlavi A, Andrews K, Lille S, Verhulst S, Zook EG, Milner S. The management of cubital tunnel syndrome: A meta-analysis of clinical studies. Plast Reconstr Surg. 2000;106(2):327-334. Crossref
  26. Hutchinson DT, Sullivan R, Sinclair MK. Long-term Reoperation Rate for Cubital Tunnel Syndrome: Subcutaneous Transposition Versus In Situ Decompression. Hand (N Y). 2021;16(4):447-452. Crossref
  27. Carlton A, Khalid SI. Surgical Approaches and Their Outcomes in the Treatment of Cubital Tunnel Syndrome. Front Surg. 2018;5:48. Crossref
  28. Gervasio O, Gambardella G. Anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: Personal experience. J Neurosurg Sci. 2004;48(3):113-116.

Cite this article

Tayfun Bacaksız, Mehmet Maden. Comparison of Subcutaneous Anterior Transposition and In Situ Decompression Techniques of Ulnar Nerve Surgery in Cubital Tunnel Syndrome. Journal of Cukurova Anesthesia and Surgical Sciences. 9(1):76-80. https://doi.org/10.36516/jocass.1851971

Scroll to Top