Factors Influencing Outcomes after Ulnar Nerve Stability-Based Surgery for Cubital Tunnel Syndrome: A Prospective Cohort Study.
10.3349/ymj.2016.57.2.455
- Author:
Ho Jung KANG
1
;
Won Taek OH
;
Il Hyun KOH
;
Sungmin KIM
;
Yun Rak CHOI
Author Information
1. Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. yrchoi@yuhs.ac
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Cubital tunnel syndrome;
prognostic factor;
ulnar nerve stability-based surgery;
simple decompression;
anterior transposition
- MeSH:
Adult;
Cubital Tunnel Syndrome/*diagnosis/physiopathology/*surgery;
Decompression, Surgical/*methods;
Female;
Follow-Up Studies;
Hand/surgery;
Hand Strength;
Humans;
Male;
Middle Aged;
Neurosurgical Procedures/*methods;
Prospective Studies;
Recovery of Function;
Surveys and Questionnaires;
Treatment Outcome;
Ulnar Nerve/physiopathology/*surgery;
Young Adult
- From:Yonsei Medical Journal
2016;57(2):455-460
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Simple decompression of the ulnar nerve has outcomes similar to anterior transposition for cubital tunnel syndrome; however, there is no consensus on the proper technique for patients with an unstable ulnar nerve. We hypothesized that 1) simple decompression or anterior ulnar nerve transposition, depending on nerve stability, would be effective for cubital tunnel syndrome and that 2) there would be determining factors of the clinical outcome at two years. MATERIALS AND METHODS: Forty-one patients with cubital tunnel syndrome underwent simple decompression (n=30) or anterior transposition (n=11) according to an assessment of intra-operative ulnar nerve stability. Clinical outcome was assessed using grip and pinch strength, two-point discrimination, the mean of the disabilities of arm, shoulder, and hand (DASH) survey, and the modified Bishop Scale. RESULTS: Preoperatively, two patients were rated as mild, another 20 as moderate, and the remaining 19 as severe according to the Dellon Scale. At 2 years after operation, mean grip/pinch strength increased significantly from 19.4/3.2 kg to 31.1/4.1 kg, respectively. Two-point discrimination improved from 6.0 mm to 3.2 mm. The DASH score improved from 31.0 to 14.5. All but one patient scored good or excellent according to the modified Bishop Scale. Correlations were found between the DASH score at two years and age, pre-operative grip strength, and two-point discrimination. CONCLUSION: An ulnar nerve stability-based approach to surgery selection for cubital tunnel syndrome was effective based on 2-year follow-up data. Older age, worse preoperative grip strength, and worse two-point discrimination were associated with worse outcomes at 2 years.
