Anterior Transposition Compared with Simple Decompression for Treatment of Cubital Tunnel Syndrome. A Meta-Analysis of Randomized, Controlled Trials

Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Room 200, Minneapolis, MN 55454, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 01/2008; 89(12):2591-8. DOI: 10.2106/JBJS.G.00183
Source: PubMed


There is currently no consensus on the optimal operative treatment for cubital tunnel syndrome. The objective of this meta-analysis of randomized, controlled trials was to evaluate the efficacy of simple decompression compared with that of anterior transposition of the ulnar nerve in the treatment of this condition.
Multiple databases were searched for randomized, controlled trials on the outcome of operative treatment of cubital tunnel syndrome in patients who had not previously sustained trauma or undergone a surgical procedure involving the elbow. Two reviewers abstracted baseline characteristics, clinical scores, and motor nerve-conduction velocities independently. Data were pooled across studies, standard mean differences in effect sizes weighted by study sample size were calculated, and heterogeneity across studies was assessed.
We identified four randomized, controlled trials comparing simple decompression with anterior ulnar nerve transposition (two submuscular and two subcutaneous). In three studies that included a total of 261 patients, a clinical scoring system was used as the primary clinical outcome. There were no significant differences between simple decompression and anterior transposition in terms of the clinical scores in those studies (standard mean difference in effect size = -0.04 [95% confidence interval = -0.36 to 0.28], p = 0.81). We did not find significant heterogeneity across these studies (I(2) = 34.2%, p = 0.22). Two reports, on a total of 100 patients, presented postoperative motor nerve-conduction velocities; they showed no significant differences between the procedures (standard mean difference in effect size = 0.24 [95% confidence interval -0.15 to 0.63] in favor of simple decompression, p = 0.23; I(2) = 0%, p = 0.9).
The results of this meta-analysis suggest that there is no difference in motor nerve-conduction velocities or clinical outcome scores between simple decompression and ulnar nerve transposition for the treatment of ulnar nerve compression at the elbow in patients with no prior traumatic injuries or surgical procedures involving the affected elbow. Confidence intervals around the points of estimate were narrow, which probably exclude the possibility of clinically meaningful differences. These data suggest that simple decompression of the ulnar nerve is a reasonable alternative to anterior transposition for the surgical management of ulnar nerve compression at the elbow.

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Available from: Loree K Kalliainen, Sep 24, 2014
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    • "Macadam et al. [14] studied in a recent meta-analysis randomized controlled trials and observational studies comparing simple decompression of the ulnar nerve to anterior transposition (subcutaneous or submuscular) and found no statistically significant difference but rather a trend toward an improved clinical outcome with nerve transposition compared to simple decompression. This finding has encouraged researchers to recommend the simple decompression as the CubTS surgical treatment of choice because it is less invasive [15, 16]. "
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    ABSTRACT: The surgical treatment of Cubital tunnel syndrome (CubTS) is still a matter of debate. No consensus exists about the necessity of anterior transposition of the ulnar nerve after decompression. However, this technique is fairly common in clinical practice. In the present study we compared the operative technique (incision length, operative time), postoperative care (postoperative pain and complications) and the outcome between subcutaneous transposition and submuscular transposition of the ulnar nerve as two surgical modalities in treating moderate CubTS. Between March 2004 and March 2007, twenty six patients with moderate CubTS (according to Dellon's grading system) were stratified according to age and gender into these two surgical techniques. The two groups were prospectively followed up 2 weeks, 6 months and 12 months postoperatively by the same observer and the operation outcome was assessed using the Bishop rating system. We found that the subcutaneous transposition of the ulnar nerve was associated with shorter incision, shorter operative time, less postoperative pain, less postoperative complication and better outcome compared with the submuscular transposition. The authors recommend the subcutaneous technique when considering anterior transposition of the ulnar nerve in treating moderate CubTS.
    The Open Orthopaedics Journal 09/2009; 3(1):78-82. DOI:10.2174/1874325000903010078
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    • "There have been two recent meta-analyses comparing decompression and transposition The first evaluated four randomised controlled investigations of simple decompression compared to anterior transposition and concluded that in patients without prior surgery or injury to the elbow, there was no significant difference in clinical outcomes or postoperative nerve conduction tests between the treatment groups. They favoured, therefore, the decompression procedure because of its simplicity and faster recovery (Zlowodzki et al., 2007). The other investigation (Macadam et al., 2008) evaluated ten comparative studies of decompression and transposition. "
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    ABSTRACT: The purpose of this investigation was to determine the failure rate of in situ decompression for cubital tunnel syndrome as determined by the need for additional surgery. We performed a comprehensive chart review of 56 adult patients who had undergone in situ decompression for cubital tunnel syndrome in 69 extremities with more than 1 year follow-up. The patients completed a comprehensive questionnaire concerning preoperative and postoperative pain, numbness, and weakness. After decompression, symptoms were improved substantially or resolved. Five limbs (7%) with persistent symptoms postoperatively were treated successfully with anterior submuscular transposition. These data suggest that in situ decompression of the ulnar nerve is a reliable treatment for cubital tunnel syndrome and has a low failure rate. The uncommon patient with continued symptoms after decompression can be treated effectively with transposition of the ulnar nerve.
    04/2009; 34(3):379-83. DOI:10.1177/1753193408101467
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    • "Trend toward an improved clinical outcome with transposition of the ulnar nerve Zlowodzki et al. 2007 Meta-analysis AT vs. SD "
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    ABSTRACT: The decision-making process in the diagnosis and treatment of an ulnar nerve entrapment (UNE) at the elbow is presented from the viewpoint of the patient and from that of a physician who in this case, were the same individual. The problems of diagnosis and the selection of the appropriate therapy-conservative or surgical and the choice of a particular surgical approach are discussed in the light of recent evidence-based medicine (EMB) literature.
    Hand 03/2009; 4(4):350-6. DOI:10.1007/s11552-009-9176-9
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