title: Minimal epicondylectomy improves neurologic deficits in moderate to severe cubital tunnel syndrome.
abstract: BACKGROUND
  Previous studies of minimal medial epicondylectomy for cubital tunnel syndrome included patients with mild disease, making it difficult to determine how much this procedure improved sensory and motor impairments in patients with moderate to severe disease.
  
  
  OBJECTIVE
  We asked if minimal epicondylectomy improved sensory and motor impairments in patients with moderate to severe cubital tunnel syndrome.
  
  
  METHODS
  We retrospectively reviewed 25 patients treated with minimal medial epicondylectomy for advanced cubital tunnel syndrome involving motor weakness between January 2003 and February 2009. Preoperatively, five patients had Medical Research Council (MRC) Grade 4 motor strength without atrophy (McGowan Grade IIA), nine had MRC Grade 3 motor strength with detectable atrophy (McGowan Grade IIB), and 11 had MRC Grade 3 or less motor strength with severe atrophy (McGowan Grade III). Postoperatively we obtained DASH scores and evaluated improvement of sensory impairment and motor impairment: excellent with minimal sensory deficit and motor deficit, good with mild deficits, fair with improved but persistent deficit(s), and poor with no improvement. The minimum followup was 13 months (mean, 46 months; range, 13-86 months).
  
  
  RESULTS
  The mean DASH score was 14 points (range, 2-47 points). Of the 25 patients, sensory improvement and motor improvement were excellent in 16 patients, good in five, fair in two, and poor in two. Twenty-three of the 25 patients improved at least one McGowan grade. There were no complications, such as medial elbow instability.
  
  
  CONCLUSIONS
  Minimal medial epicondylectomy can improve sensory and motor impairments for patients with moderate to severe cubital tunnel syndrome.
  
  
  METHODS
  Level IV, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, SM Christianity Hospital, Pohang, Korea.
authors.forename: Kang Wook
authors.initials: KW
authors.lastname: Kim
authors.forename: Hyuk Jin
authors.initials: HJ
authors.lastname: Lee
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Rhee
authors.forename: Goo Hyun
authors.initials: GH
authors.lastname: Baek
mesh_terms: D000328:Adult; D000368:Aged; D020430:Cubital Tunnel Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery; D004576:Electromyography; D004838:Epiphyses / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D018908:Muscle Weakness / Q000503:physiopathology / Q000601:surgery; D009422:Nervous System Diseases / Q000503:physiopathology / Q000601:surgery*; D009431:Neural Conduction / Q000502:physiology*; D019637:Orthopedic Procedures; D010292:Paresthesia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D014459:Ulnar Nerve / Q000503:physiopathology