Cubital tunnel syndrome: comparative results of a multicenter study of 4 surgical techniques with a mean follow-up of 92 months.
BACKGROUND
Cubital tunnel syndrome is the second most frequent entrapment syndrome. Physiopathology is mixed, and treatment options are multiple, none having yet proved superior efficacy.


OBJECTIVE
The present retrospective multicenter study compared results and rates of complications and recurrence between the 4 main cubital tunnel syndrome treatments, to identify trends and optimize outcome.


METHODS
Patients presenting with primary clinical cubital tunnel syndrome diagnosed on electroneuromyography were included and operated on using 1 of the following 4 techniques: open or endoscopic in situ decompression, or subcutaneous or submuscular anterior transposition. Four specialized upper-limb surgery centers participated, each systematically performing 1 of the above procedures. Subjective and objective results and rates of complications and recurrence were compared at end of follow-up.


RESULTS
Five hundred and two patients were included and 375 followed up for a mean 92 months (range, 9-144 months); 103 were lost to follow-up and 24 died. Whichever the procedure, more than 90% of patients were cured or showed improvement. There was a single case of scar pain at end of follow-up, managed by endoscopic decompression; there were no other long-term complications. None of the 4 techniques aggravated symptoms. There were 6 recurrences by end of follow-up: 1 associated with open in situ decompression and 5 with submuscular transposition.


CONCLUSIONS
Surgery was effective in treating cubital tunnel syndrome. Submuscular anterior transposition was associated with recurrence. In contrast to literature reports, subcutaneous anterior transposition, which is a reliable and valid technique, was not associated with a higher complication rate than in situ decompression.


METHODS
Level IV. Multicenter retrospective.
Service de Chirurgie Orthopédique 1 et 2, Unité de Chirurgie de la Main, Hôpital Trousseau, CHRU de Tours, 37044 Tours cedex, France. Electronic address: bacle.guillaume@wanadoo.fr.
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G
Bacle
Service de Chirurgie Orthopédique 1 et 2, Unité de Chirurgie de la Main, Hôpital Trousseau, CHRU de Tours, 37044 Tours cedex, France.
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E
Marteau
Service de Chirurgie Orthopédique, CHU de Poitiers, 2, rue de la Milèterie, 86021 Poitiers, France.
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M
Freslon
Service de Chirurgie Orthopédique, CH de Versailles, 78157 Le Chesnay cedex, France.
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Desmoineaux
Centre de la Main, Angers Assistance Main, 49100 Angers, France.
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Y
Saint-Cast
Centre de la Main, Angers Assistance Main, 49100 Angers, France.
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R
Lancigu
Clinique Jeanne-d'Arc, Nantes Assistance Main, 44000 Nantes, France.
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Y
Kerjean
Clinique Jeanne-d'Arc, Nantes Assistance Main, 44000 Nantes, France.
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Vernet
Service de Chirurgie Orthopédique 1 et 2, Unité de Chirurgie de la Main, Hôpital Trousseau, CHRU de Tours, 37044 Tours cedex, France.
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Fournier
Service d'Électroneuromyographie, Hôpital Trousseau, CHRU de Tours, 37044 Tours cedex, France.
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Corcia
Service de Chirurgie Orthopédique, Hôpital de la Cavale-Blanche, CHU de Brest, 29200 Brest, France.
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Le Nen
Centre de la Main, Angers Assistance Main, 49100 Angers, France.
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F
Rabarin
Service de Chirurgie Orthopédique 1 et 2, Unité de Chirurgie de la Main, Hôpital Trousseau, CHRU de Tours, 37044 Tours cedex, France.
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J
Laulan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020430:Cubital Tunnel Syndrome / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010146:Pain / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000601:surgery*
Anterior transposition; Cubital tunnel syndrome; Endoscopic release; In situ decompression; McGowan grading system