title: Surgical and nonsurgical treatment of cubital tunnel syndrome in pediatric and adolescent patients.
abstract: OBJECTIVE
  Few studies have investigated the presence or treatment of cubital tunnel syndrome in pediatric or adolescent patients. We conducted this retrospective investigation to quantify success rates of nonsurgical care and to assess patient outcomes after surgical intervention.
  
  
  METHODS
  We identified 39 extremities treated for cubital tunnel syndrome between 2000 and 2009 at one institution. We documented patient demographic data, precipitating events, symptomatology, physical examination findings, and treatment for all patients. We assessed patient-rated outcomes with validated measures including the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the visual analog scale (VAS).
  
  
  RESULTS
  Subjective complaints at the time of presentation included 16 extremities with ulnar nerve instability at the elbow, 21 extremities with pain at the elbow, and 15 extremities with numbness and tingling in the ring and small fingers. Physical examination revealed 33 extremities with a positive Tinel sign and 20 extremities with a positive elbow flexion-compression test. In the nonsurgical group (9), pretreatment DASH scores averaged 32 and posttreatment DASH scores averaged 11. Pretreatment recall VAS pain scores had a median of 7, and were similar to posttreatment scores, which had a median of 3. In the surgical group (30), DASH scores averaged 46 before surgery and improved to 7 at final follow-up. The VAS pain scores improved from a median of 8 before surgery to 2 after surgery. A total of 30 patients (from both groups) were treated with a trial of nonsurgical care without symptom resolution.
  
  
  CONCLUSIONS
  Cubital tunnel syndrome in pediatric or adolescent patients is rare. It can be treated successfully with surgical intervention. Although nonsurgical treatment is unlikely to relieve symptoms in this patient population, a trial of nighttime splinting, activity modification, and anti-inflammatory medications remains appropriate for most patients. Surgical intervention is effective for symptom relief if nonsurgical care fails.
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Shriners Hospital for Children and St. Louis Children's Hospital at Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, MO, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Stutz
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Calfee
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Steffen
authors.forename: Charles A
authors.initials: CA
authors.lastname: Goldfarb
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002648:Child; D020430:Cubital Tunnel Syndrome / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D012189:Retrospective Studies; D013165:Splints; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal