Anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome. Personal experience.
OBJECTIVE
The authors report the results of anterior submuscular transposition, on a clinical series of selected patients with severe cubital tunnel syndrome. In these patients, the degree of ulnar nerve compression was valued using a grading system that includes measurements of motor and sensitive function. In this series, a technique of flexor-pronator mass Z-lengthening was adopted.


METHODS
From 1998 to 2002, 18 patients were surgically treated with anterior deep submuscular transposition for cubital tunnel syndrome. The preoperative status was determined using Dellon's classification. Fifteen out of 18 patients were graded as Dellon's grade 3 (severe syndrome). The mean duration of follow-up after surgery was 27.6 months.


RESULTS
Postoperative outcome was assessed in all the 15 patients according to a modified Bishop scoring system. Based on this score, 6 patients (40%) were graded as excellent, 7 (47%) were graded as good and 2 (13%) were graded as fair. The complete recovery occurred about 6 months after surgery. None complication was observed.


CONCLUSIONS
Treatment of severe cubital syndrome by means of a technique of flexor-pronator mass Z-lengthening was linked to 87% rate of good to excellent results. The present study demonstrate the feasibility of this technique with restitutio ad integrum in spite of the severity of the syndrome. None failure nor recurrence was present in this series.
Gervasio
O
O
Department of Neurosurgery, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy. olgage@tin.it
Gambardella
G
G
D000328:Adult; D000368:Aged; D020430:Cubital Tunnel Syndrome / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D004550:Elbow / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008022:Ligaments / Q000033:anatomy & histology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery; D010523:Peripheral Nervous System Diseases / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000033:anatomy & histology / Q000601:surgery; D014459:Ulnar Nerve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*