title: Clinical results versus subjective improvement with anterior transposition in cubital tunnel syndrome.
abstract: This study was conducted to compare the results of anterior transposition methods and to determine the time needed to attain subjective well-being in patients with cubital tunnel syndrome. A total of 49 cases were retrospectively evaluated. Patients were called for follow-up, completed a questionnaire, and were reexamined. They were assigned to one of 3 groups: subcutaneous transposition (SCT), submuscular transposition (SMT), or intramuscular transposition (IMT). The McGowan classification and Wilson-Krout criteria were used for classification and outcomes assessments. Categorical variables were analyzed with the chi2 test, and metric variables by analysis of variance or through Kruskal-Wallis variance analysis. Improvement of at least 1 McGowan grade was observed in 87.63% of patients. The least responsive group was assigned a McGowan grade of III. The most effective procedure for resolving clawing was SMT. Clinical results were excellent in 26 patients (53.06%), good in 12 (24.48%), fair in 4 (8.16%), and poor in 7 (14.28%). At the latest follow-up, overall grip and pinch strength had improved by 23% and 34%, respectively, compared with the contralateral side. Thirty-six patients exhibited an improvement in grip power and 38 in fine dexterity. Complete resolution of numbness was observed in 32 patients, and complete resolution of pain was noted in 30 patients. The preoperative mean visual analog scale score of 6.82 improved to 3.36 postoperatively. Clawing improved in 4 patients and atrophy in 7. The mean time to subjective improvement was shortest in the SMT group and longest in the IMT group. The greatest pain relief was reported in the IMT group and the least in the SMT group. One case with IMT required reoperation because of recompression of the nerve. The most frequent complication in the SMT and IMT groups was muscular tenderness. In conclusion, SCT offers an alternative to other anterior transposition methods because of its simplicity and quicker recovery time, especially in mild to moderate cases.
authors.affiliation: Department of Orthopaedics and Traumatology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey. kacako@hotmail.com
authors.forename: Kamil Cagri
authors.initials: KC
authors.lastname: Köse
authors.forename: Sinan
authors.initials: S
authors.lastname: Bilgin
authors.forename: Oguz
authors.initials: O
authors.lastname: Cebesoy
authors.forename: Levent
authors.initials: L
authors.lastname: Altinel
authors.forename: Burak
authors.initials: B
authors.lastname: Akan
authors.forename: Dervis
authors.initials: D
authors.lastname: Guner
authors.forename: Beyza
authors.initials: B
authors.lastname: Doganay
authors.forename: Sinan
authors.initials: S
authors.lastname: Adiyaman
authors.forename: Mehmet
authors.initials: M
authors.lastname: Demirtas
mesh_terms: D000328:Adult; D020430:Cubital Tunnel Syndrome / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000601:surgery*