Surgical outcome for severe cubital tunnel syndrome in patients aged >70 years: a mean follow-up of 4.5 years.

BACKGROUND: Surgical outcomes for cubital tunnel syndrome have been reported to be satisfactory, but could be compromised by advanced age and severe nerve compression. We aim to evaluate the prognosis of severe cubital tunnel syndrome in patients aged >70 years. METHODS: This retrospective study included 25 patients (26 extremities, all McGowan grade III, age >70 years); 21 underwent subcutaneous transposition and 5 in situ decompression. Postoperative follow-up lasted >2 years. Demographic data, clinical symptoms, physical examination findings, and the Disabilities of the Shoulder, Arm, and Hand Questionnaire were evaluated preoperatively and at final follow-up. Pain and weakness were evaluated using the visual analog scale and overall functional recovery using the modified Bishop's Score and McGowan Grade. RESULTS: Significant improvements were seen in both sensory and motor function. VAS pain and weakness, 2-PD, key-pinch strength, grip strength, first dorsal interosseous muscle strength, the Wartenberg sign, and claw hand all improved significantly. DASH scores improved from an average of 45.2 points preoperatively to 15.9 points postoperatively. According to the modified Bishop scoring system, 10 extremities were graded excellent; 12, good; 2, fair; and 2, poor. Improvement of at least one McGowan Grade was seen in 18 cases, but only 2 extremities recovered to normal. CONCLUSION: For patients aged >70 years with severe cubital tunnel syndrome, surgical treatment is effective, but complete recovery is unlikely, and the recovery process is long.

Validity and responsiveness of the DASH questionnaire as an outcome measure following ulnar nerve transposition for cubital tunnel syndrome.

BACKGROUND: This study sought to determine the validity and responsiveness of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire in cubital tunnel syndrome. METHODS: Consecutive patients with cubital tunnel syndrome treated by anterior ulnar nerve transposition between September of 2009 and December of 2011 were reviewed retrospectively. Questionnaires were completed preoperatively and 1.5, 3, 6, and 12 months postoperatively. The relationship of the questionnaire to measures of pain, health status (Short Form-8), and pinch and grip strength was evaluated using Spearman's correlation coefficients. Responsiveness of the questionnaire was analyzed using Cohen's effect size, and was compared with responsiveness of the physical examination, pain, and Short Form-8 measures. RESULTS: The final cohort included 69 patients with isolated cubital tunnel syndrome and 39 with concurrent cubital and carpal tunnel syndrome. Questionnaire scores correlated as expected with other measures. Moderate to strong correlations were observed with pain visual analogue scale and Short Form-8 scores, and weak to moderate correlations were observed with pinch and grip strength. Effect sizes for the DASH questionnaire were small (<0.3) at 6 weeks and moderate (0.35 to 0.57) at 3, 6, and 12 months postoperatively in both groups. Pain visual analogue scale scores demonstrated large effect sizes (>0.8) at all postoperative time points, whereas Short Form-8 and pinch and grip strength were poorly responsive. CONCLUSION: The Disabilities of the Arm, Shoulder, and Hand questionnaire is a valid measure in cubital tunnel syndrome, and is moderately responsive to change beyond 3-month follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

A systems change: leading the way to meeting health needs.

Demonstrating the efficacy of our practice requires a paradigm shift. Becoming an effective leader and clinician can facilitate opportunities for program development and clinical research. The use of strategic planning strategies, such as needs assessment and SWOT analysis, can help lead the way to such change. The following illustrates the use of strategic planning to develop The Carpal and Cubital Tunnel Syndrome Program (CCTSP) within a growing orthopedic practice.

Conservative treatment of the cubital tunnel syndrome.

Conservative treatment of the cubital tunnel syndrome was evaluated in a randomised study of 70 patients with mild or moderate symptoms (Dellon, 1989). All patients were informed about the cause of symptoms and allocated to three groups: night splinting, nerve gliding and control. Evaluation consisted of Canadian Occupational Performance Measure, visual analogue pain scales, strength measurements and neurophysiological examination, before treatment and after six months. Fifty-seven patients were followed for six months. Fifty-one (89.5%) were improved at the follow-up. There were no significant differences between the groups in any of the recorded variables. Night splints and nerve gliding exercises did not add favourably. Routine neurophysiological examination seems unnecessary since 76% of the patients with typical symptoms had normal findings and 75% with pathological findings improved. Patients with mild or moderate symptoms have a good prognosis if they are informed of the causes of the condition and how to avoid provocation.

Neurolysis of the ulnar nerve for neuropathy following total elbow replacement.

Ulnar neuropathy presents as a complication in 5% to 10% of total elbow replacements, but subsequent ulnar neurolysis is rarely performed. Little information is available on the surgical management of persistent ulnar neuropathy after elbow replacement. We describe our experience with the surgical management of this problem. Of 1607 total elbow replacements performed at our institution between January 1969 and December 2004, eight patients (0.5%) had a further operation for persistent or progressive ulnar neuropathy. At a mean follow-up of 9.2 years (3.1 to 21.7) six were clinically improved and satisfied with their outcome, although, only four had complete recovery. When transposition was performed on a previously untransposed nerve the rate of recovery was 75%, but this was reduced to 25% if the nerve had been transposed at the time of the replacement.

Comparison of range-of-motion constraints provided by splints used in the treatment of cubital tunnel syndrome--a pilot study.

Nocturnal splinting of the elbow is commonly used to treat cubital tunnel syndrome (CBTS). Rationales are based on several studies, which suggest that proper nocturnal positioning of the elbow during sleep contributes to decreased cubital tunnel symptoms. Currently there is limited scientific evidence supporting the rationale for specific splinting protocols. Splints may be custom or prefabricated. The purpose of this article is to assess the range-of-motion constraints of five nighttime elbow orthoses commonly used in the treatment of CBTS. This preliminary study was conducted using a cadaveric model, using three arms to represent three human arm sizes, and compared five different splints, and no splint. Range-of-motion testing was performed using gravity alone and then testing was repeated using gravity plus a 1-pound weight in a standardized fashion. Results showed that all splints restricted elbow flexion significantly more than the unsplinted extremity. Of the five splints, the AliMed splint allowed the most elbow flexion both in the gravity assisted, and gravity plus a 1-pound weight assisted conditions. The only splint that restricted elbow extension was the Hely & Weber splint. The Pil-O-Splint Elbow Support with stay, Hely & Weber and the Folded Towel all restricted elbow flexion to less than 90 degrees under all study conditions. The information provided may be helpful in making clinical decisions regarding splinting for CBTS.

[Therapeutic effect evaluation of ulnar neurolysis and nerve anterior transposition with an immediate range of motion in the aged].

OBJECTIVE: To investigate the clinical therapeutic effect of the ulnar neurolysis and nerve anterior transposition with an immediate range of motion for the cubital tunnel syndrome in the aged. METHODS: Forty-three patients (24 males and 19 females, aged 60-81 years, averaged 67) admitted for the cubital tunnel syndrome from January 1999 to December 2004 were randomly divided into 2 groups: Group A (n=20) and Group B (n=23), with an illness course of 2-10 months. All the patients underwent the ulnar neurolysis and the nerve anterior transposition. After operation the patients' elbows in group A were immobilized with the plaster slab for an external fixation for 3 weeks; the patients' elbows in group B did not use the external fixation, but began an immediate range of motion on the 2nd day after operation. The Bishop scoring system was used to evaluate the patients' functional recovery in the 2 groups. RESULTS: The follow-up for 1-5 years showed that the ulnar nerve function of all the patients were improved but no significant differences were found between the 2 groups (P > 0.05). The patients in Group A returned to daily activities or work at 45.2 +/- 5.1 days, but the patients in Group B required 15.5 +/- 3.8 days, with a significant difference between the 2 groups (P < 0.05). According to Bishop scoring system, the results were excellent in 14 cases, good in 4 cases, fair in 1 case and poor in 1 case in Group A, and 16, 4, 2 and 1 respectively in Group B. There was no significant difference between the two groups (P > 0.05). CONCLUSION: The ulnar neurolysis and nerve anterior transposition with an immediate range of motion for the cubital tunnel syndrome can promote the ulnar function recovery of the old-aged patients. They can return to their daily activities or work at a more rapid speed when their elbows are mobilized immediately after operation.

Treatment of cubital tunnel syndrome by frontal partial medial epicondylectomy. A retrospective series of 55 cases.

The outcomes of 55 cases of cubital tunnel syndrome treated by a partial frontal epicondylectomy are presented at a mean follow-up of 38 months follow-up. According to McGowan classification, 25 cases were grade I (45%), 12 grade II (22%) and 18 grade III (33%). The results (Wilson and Krout classification) were excellent or good in 41 patients (75%), fair in nine patients and unchanged in five, without any worsening or recurrence. Total relief was reported in 80% of grade I, 75% of grade II and 66% of grade III patients. Seven painful scars and one persistent 15( composite function) elbow extension deficit were the only complications. The satisfaction rate was 93%. This technique preserves bony protection, the blood supply and gliding tissues for the nerve and nerve recovery were comparable to other surgical procedures. Residual pain at the osteotomy site was not a serious problem.

Revision anterior submuscular transposition of the ulnar nerve for failed subcutaneous transposition.

We evaluated the results of revision surgery for persistent cubital tunnel syndrome after failed surgical treatment. Eighteen patients were evaluated with an average age of 44 years. The majority of the primary procedures were subcutaneous transpositions (15 patients). The average follow-up time was 34 months. All patients were treated with a submuscular transposition of the ulnar nerve and Z-lengthening of the flexor-pronator origin. The most common operative findings were perineural scarring (16), retained medial intermuscular septum (10) and common flexor aponeurosis (9). Pre-operative and post-operative data were compared. The majority of patients improved their postoperative grade and their ability to do daily activities or work and stated that the surgery met some or all of their expectations. Most patients had partial relief of their pain and the satisfaction rate was 78%. Our study suggests that although these results are less favorable than those for the primary procedure, submuscular transposition is a useful technique for revision of failed cubital tunnel syndrome surgery.

Carpal tunnel syndrome and cubital tunnel syndrome: work-related musculoskeletal disorders in four symptomatic radiologists.

OBJECTIVE: This report describes work-related upper extremity musculoskeletal disorders in four radiologists and identifies risk factors and preventive measures for these syndromes. SUBJECTS AND METHODS: Four radiologists with complaints of upper extremity pain, numbness, and weakness or a combination of symptoms were examined by an occupational therapist. The work activities and duties of all 12 staff radiologists in our filmless department were subsequently evaluated. Time working as staff, workday hours, and academic activities were recorded. Nonoccupational activities were also noted. An industrial hygienist evaluated the department work areas and staff offices. RESULTS: One radiologist had bilateral carpal tunnel syndrome, and all four radiologists had cubital tunnel syndrome (two [50%] unilateral, two [50%] bilateral). The four spent 3.4 +/- 0.3 years (mean +/- standard error of the mean) as staff radiologists in our filmless department, performing computer keyboard and mouse or trackball image manipulation and work list navigation, typing preliminary reports and telephone notifications, and editing electronically and approving dictated final reports. All four are academically active and had significantly greater workday hours (p < 0.05) and performed more research (p < 0.003) than the asymptomatic radiologists. Three (75%) of four radiologists routinely performed sonography. The industrial hygienist identified hazardous working conditions, especially related to ergonomics, in the reviewing areas and staff offices. CONCLUSION: Current technology renders staff radiologists at risk for work-related, upper extremity musculoskeletal disorders, including carpal and cubital tunnel syndromes. Proper equipment, ergonomics, and professional consultation should be used in all radiology departments.

The Cubital Tunnel syndrome: a case report and discussion.

Cubital Tunnel Syndrome is the second most common peripheral neuropathy of the upper extremity. It presents as elbow, forearm, or hand pain in the ulnar nerve sensory distribution and it is the result of overuse, trauma, or entrapment of the ulnar nerve at the elbow. Proper physical diagnosis can localize the site of ulnar nerve entrapment to the elbow or wrist. Both conservative and operative modalities exist to treat the Cubital Tunnel Syndrome; optimal management is still unclear.

[The influence of patient age and duration time of symptoms on the long-term outcome of surgical treatment]. / Wplyw wieku chorych i czasu trwania neuropatii na odlegle wyniki operacyjnego leczenia zespolu rowka nerwu lokciowego.

The paper presents the influence of patient age and duration time of symptoms on the long-term outcome of surgical treatment of cubital tunnel syndrome. The material consisted of 57 patients treated at the Department of Hand Surgery between 1971 and 1997. Evaluation of the material revealed that there is no significant correlation between the age of onset of the symptoms and the result of treatment. Significantly better results were observed in post operative assessment in patients who have had the neuropathy for a shorter time. Patients over 40 years of age should be operated earlier. Results were better when assessed in a subjective score system, compared to an objective one.

[Ulnar nerve tunnel syndrome of the elbow and an occupational disorder. Analysis of socio-professional and physical parameters]. / Syndrome du nerf ulnaire au coude et maladie professionnelle. Analyse des paramètres socioprofessionnels et physiques.

PURPOSE: The ulnar nerve tunnel syndrome at the elbow is the second frequently tunnel syndrome, registered as an occupational disorder. The musculoskeletal troubles of the upper limb are now a public health challenge. These disorders allow manifold risk factors related to the work state, extrinsic to the patient, and related to individual factors, or intrinsic. MATERIAL AND METHOD: In the same venture, 25 patients with a UNTS, declared as an occupational disorder, have been compared to 48 individuals (T). Intrinsic (physical and psychological) and extrinsic parameters have been evaluated by a questionnaire, physical examination completed by an investigation in the venture. The Nottingham Health Profile was performed by all the individuals. RESULTS: All the cases of UNTS were observed after an increase of the production and a change in the work organization. Only 50% of the declared UNTS have a typical topography of the pain. No UNTS patient had neurological objective motor and sensitive deficit. 52% of the UNTS patients had diffused physical disorders comparatively to 17% of the T population. Stress events were observed more frequently in the UNTS population than in the T population: in the living area, in respectively 96% and 52% of the cases, at the work place in 12% and 2%. 50% of the UNTS population was distress comparatively to 17% of the T population. The NHP score was significantly higher in the UNTS population than the T population. CONCLUSION: These data confirm the mutual influences of individual factors, physical and psychological, and of workplace factors in the occurrence of painful disorders related to an occupational activity. The therapeutic approach of these patients must be done with a physical, psychological and social evaluation.