PROGRESS OF TREATMENT OF CUBITAL TUNNEL SYNDROME_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YUShiyang , LIUShen ,  FANCunyi

Department of Orthopedics, Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, 200233, P. R. China;

Corresponding author：

FANCunyi, Email: fancunyi888@hotmail.com

Keywords：

Cubital tunnel syndrome; Peripheral nerve compression; Ulnar nerve; Treatment

DOI：

10.7507/1002-1892.20140227

Video：

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Objective To review the current progress of treatment of cubital tunnel syndrome (CTS). Methods Recent relevant literature on the treatment of CTS was extensively reviewed and summarized. Results CTS is one of the most common peripheral nerve compression diseases.The clinical presentations of CTS consist of numbness and tingling in the ring and small fingers of the hand,pain in the elbow and sensory change following long-time elbow bending.Severe symptoms such as weakness or atrophy of intrinsic muscles of the hand and claw hand deformity may occur.The etiology of CTS is ulnar nerve compression caused by morphological abnormalities and nerve paralysis after elbow trauma.CTS can be treated by nonsurgical methods and surgery.Surgical options include in situ decompression,ulnar nerve transposition,medial epicondylectomy,and endoscopic release. Conclusion There are multiple options to treat CTS,but the indication and effectiveness of each treatment are still controversial.Further studies are required to form a generally accepted treatment system.

Citation： YUShiyang, LIUShen, FANCunyi. PROGRESS OF TREATMENT OF CUBITAL TUNNEL SYNDROME. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(8): 1043-1046. doi: 10.7507/1002-1892.20140227 Copy

1.	Palmer BA,Hughes TB.Cubital tunnel syndrome.J Hand Surg (Am),2010,35(1):153-163.
2.	Wiesler ER,Chloros GD,Cartwright MS,et al.Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel.J Hand Surg (Am),2006,31(7):1088-1093.
3.	贾科锋,丁实,翟丽东,等.肘管与滑车上肘肌的解剖学研究及其临床意义.中国临床解剖学杂志,2011,29(2):140-144.
4.	Iba K,Wada T,Aoki M,et al.Intraoperative measurement of pressure adjacent to the ulnar nerve in patients with cubital tunnel syndrome.J Hand Surg (Am),2006,31(4):553-558.
5.	郑文旭,成伏波,李幼琼,等.肘管综合征的应用解剖学研究.中华手外科杂志,2008,24(3):171-173.
6.	Hariri S,McAdams TR.Nerve injuries about the elbow.Clin Sports Med,2010,29(4):655-675.
7.	Nakamichi K,Tachibana S,Ida M,et al.Patient education for the treatment of ulnar neuropathy at the elbow.Arch Phys Med Rehabil,2009,90(11):1839-1845.
8.	顾玉东.肘管综合征如何治疗.中华手外科杂志,2010,26(2):66.
9.	Shah CM,Calfee RP,Gelberman RH,et al.Outcomes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome.J Hand Surg (Am),2013,38(6):1125-1130.
10.	Svernlöv B,Larsson M,Rehn K,et al.Conservative treatment of the cubital tunnel syndrome.J Hand Surg (Eur Vol),2009,34(2):201-207.
11.	Bartels RH.History of the surgical treatment of ulnar nerve compression at the elbow.Neurosurgery,2001,49(2):391-400.
12.	Waugh RP,Zlotolow DA.In situ decompression of the ulnar nerve at the cubital tunnel.Hand Clin,2007,23(3):319-327.
13.	Gervasio O,Gambardella G,Zaccone C,et al.Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome:a prospective randomized study.Neurosurgery,2005,56(1):108-117.
14.	Nathan PA,Istvan JA,Meadows KD.Intermediate and long-term outcomes following simple decompression of the ulnar nerve at the elbow.Chir Main,2005,24(1):29-34.
15.	Tang P,Nellans KW.Cubital tunnel syndrome-surgical treatment techniques.Operative Techniques in Orthopaedics,2009,19(4):235-242.
16.	Guinet V,Cordier-Fuzeau C,Auquit-Auckbur I.Cubital tunnel syndrome:a retrospective review of 55 subcutaneous transpositions with minimum 3-year follow-up.Chir Main,2013,32(5):292-298.
17.	Leone J,Bhandari M,Thoma A.Anterior intramuscular transposition with ulnar nerve decompression at the elbow.Clin Orthop Relat Res,2001,(387):132-139.
18.	Dellon AL,Coert JH.Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow.J Bone Joint Surg (Am),2004,86-A Suppl 1(Pt 2):169-179.
19.	Fitzgerald BT,Dao KD,Shin AY.Functional outcomes in young,active duty,military personnel after submuscular ulnar nerve transposition.J Hand Surg (Am),2004,29(4):619-624.
20.	Cirpar M,Turker M,Yalcinozan M,et al.Effect of partial,distal epicondylectomy on reduction of ulnar nerve strain:a cadaver study.J Hand Surg (Am),2013,38(4):666-671.
21.	Osei DA,Padegimas EM,Calfee RP,et al.Outcomes following modified oblique medial epicondylectomy for treatment of cubital tunnel syndrome.J Hand Surg (Am),2013,38(2):336-343.
22.	Kim KW,Lee HJ,Rhee SH,et al.Minimal epicondylectomy improves neurologic deficits in moderate to severe cubital tunnel syndrome.Clin Orthop Relat Res,2012,470(5):1405-1413.
23.	Oertel J,Keiner D,Gaab MR.Endoscopic decompression of the ulnar nerve at the elbow.Neurosurgery,2010,66(4):817-824.
24.	Cobb TK.Endoscopic cubital tunnel release.J Hand Surg (Am),2010,35(10):1690-1697.
25.	Dützmann S,Martin KD,Sobottka S,et al.Open vs retractor-endoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome:a retrospective cohort study.Neurosurgery,2013,72(4):605-616.
26.	Jiang S,Xu W,Shen Y,et al.Endoscopy-assisted cubital tunnel release under carbon dioxide insufflation and anterior transposition.Ann Plast Surg,2012,68(1):62-66.
27.	Martin K,Dützmann S,Sobottka SB,et al.Retractor-endoscopic nerve decompression in carpal and cubital tunnel syndromes:outcomes in a small series.World Neurosurg,2013.[Epub ahead of print].
28.	Stutz CM,Calfee RP,Steffen JA,et al.Surgical and nonsurgical treatment of cubital tunnel syndrome in pediatric and adolescent patients.J Hand Surg (Am),2012,37(4):657-662.
29.	Zarezadeh A,Shemshaki H,Nourbakhsh M,et al.Comparison of anterior subcutaneous and submuscular transposition of ulnar nerve in treatment of cubital tunnel syndrome:A prospective randomized trial.J Res Med Sci,2012,17(8):745-749.
30.	Zhong W,Zhang W,Zheng X,et al.Comparative study of different surgical transposition methods for ulnar nerve entrapment at the elbow.J Int Med Res,2011,39(5):1766-1772.
31.	Capo JT,Jacob G,Maurer RJ,et al.Subcutaneous anterior transposition versus decompression and medial epicondylectomy for the treatment of cubital tunnel syndrome.Orthopedics,2011,34(11):e713-717.
32.	Sur YJ,Lee JS,Song SW.Comparison of the effects of subcutaneous anterior transposition and in situ decompression on the histologic and electrophysiologic properties of the ulnar nerve:an experimental study in a rabbit model.J Hand Surg (Am),2013,38(4):660-665.
33.	Caliandro P,La Torre G,Padua R,et al.Treatment for ulnar neuropathy at the elbow.Cochrane Database Syst Rev,2012,doi:10.1002/14651858.CD006839.pub3.
34.	Zlowodzki M,Chan S,Bhandari M,et al.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.
35.	Macadam SA,Gandhi R,Bezuhly M,et al.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-e12.
36.	Soltani AM,Best MJ,Francis CS,et al.Trends in the surgical treatment of cubital tunnel syndrome:an analysis of the national survey of ambulatory surgery database.J Hand Surg (Am),2013,38(8):1551-1556.
37.	Ochi K,Horiuchi Y,Nakamura T,et al.Ulnar nerve strain at the elbow in patients with cubital tunnel syndrome:effect of simple decompression.J Hand Surg (Eur),2013,38(5):474-480.

1. Palmer BA,Hughes TB.Cubital tunnel syndrome.J Hand Surg (Am),2010,35(1):153-163.
2. Wiesler ER,Chloros GD,Cartwright MS,et al.Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel.J Hand Surg (Am),2006,31(7):1088-1093.
3. 贾科锋,丁实,翟丽东,等.肘管与滑车上肘肌的解剖学研究及其临床意义.中国临床解剖学杂志,2011,29(2):140-144.
4. Iba K,Wada T,Aoki M,et al.Intraoperative measurement of pressure adjacent to the ulnar nerve in patients with cubital tunnel syndrome.J Hand Surg (Am),2006,31(4):553-558.
5. 郑文旭,成伏波,李幼琼,等.肘管综合征的应用解剖学研究.中华手外科杂志,2008,24(3):171-173.
6. Hariri S,McAdams TR.Nerve injuries about the elbow.Clin Sports Med,2010,29(4):655-675.
7. Nakamichi K,Tachibana S,Ida M,et al.Patient education for the treatment of ulnar neuropathy at the elbow.Arch Phys Med Rehabil,2009,90(11):1839-1845.
8. 顾玉东.肘管综合征如何治疗.中华手外科杂志,2010,26(2):66.
9. Shah CM,Calfee RP,Gelberman RH,et al.Outcomes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome.J Hand Surg (Am),2013,38(6):1125-1130.
10. Svernlöv B,Larsson M,Rehn K,et al.Conservative treatment of the cubital tunnel syndrome.J Hand Surg (Eur Vol),2009,34(2):201-207.
11. Bartels RH.History of the surgical treatment of ulnar nerve compression at the elbow.Neurosurgery,2001,49(2):391-400.
12. Waugh RP,Zlotolow DA.In situ decompression of the ulnar nerve at the cubital tunnel.Hand Clin,2007,23(3):319-327.
13. Gervasio O,Gambardella G,Zaccone C,et al.Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome:a prospective randomized study.Neurosurgery,2005,56(1):108-117.
14. Nathan PA,Istvan JA,Meadows KD.Intermediate and long-term outcomes following simple decompression of the ulnar nerve at the elbow.Chir Main,2005,24(1):29-34.
15. Tang P,Nellans KW.Cubital tunnel syndrome-surgical treatment techniques.Operative Techniques in Orthopaedics,2009,19(4):235-242.
16. Guinet V,Cordier-Fuzeau C,Auquit-Auckbur I.Cubital tunnel syndrome:a retrospective review of 55 subcutaneous transpositions with minimum 3-year follow-up.Chir Main,2013,32(5):292-298.
17. Leone J,Bhandari M,Thoma A.Anterior intramuscular transposition with ulnar nerve decompression at the elbow.Clin Orthop Relat Res,2001,(387):132-139.
18. Dellon AL,Coert JH.Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow.J Bone Joint Surg (Am),2004,86-A Suppl 1(Pt 2):169-179.
19. Fitzgerald BT,Dao KD,Shin AY.Functional outcomes in young,active duty,military personnel after submuscular ulnar nerve transposition.J Hand Surg (Am),2004,29(4):619-624.
20. Cirpar M,Turker M,Yalcinozan M,et al.Effect of partial,distal epicondylectomy on reduction of ulnar nerve strain:a cadaver study.J Hand Surg (Am),2013,38(4):666-671.
21. Osei DA,Padegimas EM,Calfee RP,et al.Outcomes following modified oblique medial epicondylectomy for treatment of cubital tunnel syndrome.J Hand Surg (Am),2013,38(2):336-343.
22. Kim KW,Lee HJ,Rhee SH,et al.Minimal epicondylectomy improves neurologic deficits in moderate to severe cubital tunnel syndrome.Clin Orthop Relat Res,2012,470(5):1405-1413.
23. Oertel J,Keiner D,Gaab MR.Endoscopic decompression of the ulnar nerve at the elbow.Neurosurgery,2010,66(4):817-824.
24. Cobb TK.Endoscopic cubital tunnel release.J Hand Surg (Am),2010,35(10):1690-1697.
25. Dützmann S,Martin KD,Sobottka S,et al.Open vs retractor-endoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome:a retrospective cohort study.Neurosurgery,2013,72(4):605-616.
26. Jiang S,Xu W,Shen Y,et al.Endoscopy-assisted cubital tunnel release under carbon dioxide insufflation and anterior transposition.Ann Plast Surg,2012,68(1):62-66.
27. Martin K,Dützmann S,Sobottka SB,et al.Retractor-endoscopic nerve decompression in carpal and cubital tunnel syndromes:outcomes in a small series.World Neurosurg,2013.[Epub ahead of print].
28. Stutz CM,Calfee RP,Steffen JA,et al.Surgical and nonsurgical treatment of cubital tunnel syndrome in pediatric and adolescent patients.J Hand Surg (Am),2012,37(4):657-662.
29. Zarezadeh A,Shemshaki H,Nourbakhsh M,et al.Comparison of anterior subcutaneous and submuscular transposition of ulnar nerve in treatment of cubital tunnel syndrome:A prospective randomized trial.J Res Med Sci,2012,17(8):745-749.
30. Zhong W,Zhang W,Zheng X,et al.Comparative study of different surgical transposition methods for ulnar nerve entrapment at the elbow.J Int Med Res,2011,39(5):1766-1772.
31. Capo JT,Jacob G,Maurer RJ,et al.Subcutaneous anterior transposition versus decompression and medial epicondylectomy for the treatment of cubital tunnel syndrome.Orthopedics,2011,34(11):e713-717.
32. Sur YJ,Lee JS,Song SW.Comparison of the effects of subcutaneous anterior transposition and in situ decompression on the histologic and electrophysiologic properties of the ulnar nerve:an experimental study in a rabbit model.J Hand Surg (Am),2013,38(4):660-665.
33. Caliandro P,La Torre G,Padua R,et al.Treatment for ulnar neuropathy at the elbow.Cochrane Database Syst Rev,2012,doi:10.1002/14651858.CD006839.pub3.
34. Zlowodzki M,Chan S,Bhandari M,et al.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.
35. Macadam SA,Gandhi R,Bezuhly M,et al.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-e12.
36. Soltani AM,Best MJ,Francis CS,et al.Trends in the surgical treatment of cubital tunnel syndrome:an analysis of the national survey of ambulatory surgery database.J Hand Surg (Am),2013,38(8):1551-1556.
37. Ochi K,Horiuchi Y,Nakamura T,et al.Ulnar nerve strain at the elbow in patients with cubital tunnel syndrome:effect of simple decompression.J Hand Surg (Eur),2013,38(5):474-480.

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PROGRESS OF TREATMENT OF CUBITAL TUNNEL SYNDROME

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