Article

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: 4.31). 01/2008; 89(12):2591-8. DOI: 10.2106/JBJS.G.00183
Source: PubMed

ABSTRACT 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.

2 Followers
 · 
119 Views
  • The Journal Of Hand Surgery 09/2014; 39(9):e29-e30. DOI:10.1016/j.jhsa.2014.06.069 · 1.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Fragestellung Ziel der Studie war es, die Ergebnisse nach endoskopischer Dekompression des N. ulnaris zu evaluieren. Sind die Ergebnisse mit dem offenen Verfahren vergleichbar? Methode Vierundzwanzig Patienten mit einem klinisch und elektrophysiologisch nachgewiesenem Kubitaltunnelsyndrom wurden einer endoskopischen Dekompression zugeführt. Über eine etwa 2 cm breite Inzision über dem N. ulnaris wird dieser im Sulcus aufgesucht. Die weitere Dekompression nach distal (bis etwa 15 cm distal des Ellbogens) und nach proximal (ca. 10 cm) erfolgt endoskopisch. Eine Verlagerung des Nervs war in keinem Fall erforderlich. Die Patienten wurden prospektiv nach 3, 6 und 12 Monaten klinisch und elektrophysiologisch nachuntersucht. Eine Bewertung erfolgte nach der Klassifikation von Dellon, der postoperative Verlauf wurde anhand der modifizierten Bishop-Klassifikation sowie der Patientenzufriedenheit gewertet. Ergebnisse Zweiundzwanzig Patienten konnten vollständig erfasst werden. Alle Patienten zeigten klinisch eine Besserung der präoperativen Beschwerdesymptomatik. Der modifizierte Bishop-Score ergab beim letzten Follow-up 14 sehr gute, 7 gute und 1 zufriedenstellendes Ergebnis. Ein oberflächliches Hämatom war zu verzeichnen. Einundzwanzig Patienten waren mit dem Operationsergebnis zufrieden und würden die Operation erneut durchführen lassen. Diskussion Die endoskopische Dekompression des N. ulnaris beim Kubitaltunnelsyndrom ist eine minimal-invasive Methode mit hoher Patientenakzeptanz und hoher Operationssicherheit. Sie stellt eine sinnvolle Alternative zur offenen Dekompression dar.
    Obere Extremität 12/2012; 7(4):216-220. DOI:10.1007/s11678-012-0183-z
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study was performed to identify factors associated with the need for revision surgery after in situ decompression of the ulnar nerve for cubital tunnel syndrome. This case-control investigation examined all patients treated at one institution with open in situ decompression for cubital tunnel syndrome between 2006 and 2011. The case patients were 44 failed decompressions that required revision, and the controls were 79 randomly selected patients treated with a single operation. Demographic data and disease-specific data were extracted from the medical records. The rate of revision surgery after in situ decompression was determined from our 5-year experience. A multivariate logistic regression model was used based on univariate testing to determine predictors of revision cubital tunnel surgery. Revision surgery was required in 19% (44 of 231) of all in situ decompressions performed during the study period. Predictors of revision surgery included a history of elbow fracture or dislocation (odds ratio [OR], 7.1) and McGowan stage I disease (OR, 3.2). Concurrent surgery with in situ decompression was protective against revision surgery (OR, 0.19). The rate of revision cubital tunnel surgery after in situ nerve decompression should be weighed against the benefits of a less invasive procedure compared with transposition. When considering in situ ulnar nerve decompression, prior elbow fracture as well as patients requesting surgery for mild clinically graded disease should be viewed as risk factors for revision surgery. Patient factors often considered relevant to surgical outcomes, including age, sex, body mass index, tobacco use, and diabetes status, were not associated with a greater likelihood of revision cubital tunnel surgery. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 02/2015; DOI:10.1016/j.jse.2014.12.015 · 2.37 Impact Factor

Full-text

Download
25 Downloads
Available from
Sep 24, 2014