Syed I Khalid1, Adam Carlton1, Ryan Kelly2, Jonathan Citow1,3. 1. Chicago Medical School, North Chicago, IL, USA. 2. Georgetown University School of Medicine, Washington, D.C., USA. 3. Department of Neurosurgery, Condell Medical Center, Libertyville, IL USA.
Abstract
BACKGROUND: Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper extremity in the United States. Most cases are idiopathic and symptoms consist of a combination of weakness, pain, and sensory disturbances ranging from paresthesias and dysesthesias to numbness or complete anesthesia. The purpose of this study is to report results of a novel, minimally invasive surgical procedure for cubital tunnel syndrome with comparison to existing interventions including full open or endoscopic approaches. METHODS: A total of 41 consecutive patients underwent the procedure, their ages ranged from ages 36 to 81 with an average age of 60.52±12.18 years. The procedure consists of a 1.0-2.0-cm incision with decompression of the ulnar nerve under direct visualization proximally with Metzenbaum scissors as a dilator for distal decompression. Patients were evaluated for improvements in pain, numbness, paresthesias, weakness, and muscle atrophy and was measured utilizing the Gabel/Amadio scale. RESULTS: Fifty-three point two percent (n=25) of patients were found to have excellent outcomes, 36.2% (n=17) had good outcomes, 8.5% (n=4) had fair outcomes, and 2.1% (n=1) had poor outcomes as determined by the Gabel/Amadio scale. The greatest improvement in all patients was the reduction in sensory symptoms: pain, numbness, and paresthesia. There were no operative or postoperative complications. CONCLUSIONS: This novel procedure provided symptom relief comparable to the most effective existing techniques without significant complications, and with rapid recovery and minimal scar formation. The authors assert that this technique demonstrates optimal results for patients with relative ease of adoption for surgeons.
BACKGROUND: Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper extremity in the United States. Most cases are idiopathic and symptoms consist of a combination of weakness, pain, and sensory disturbances ranging from paresthesias and dysesthesias to numbness or complete anesthesia. The purpose of this study is to report results of a novel, minimally invasive surgical procedure for cubital tunnel syndrome with comparison to existing interventions including full open or endoscopic approaches. METHODS: A total of 41 consecutive patients underwent the procedure, their ages ranged from ages 36 to 81 with an average age of 60.52±12.18 years. The procedure consists of a 1.0-2.0-cm incision with decompression of the ulnar nerve under direct visualization proximally with Metzenbaum scissors as a dilator for distal decompression. Patients were evaluated for improvements in pain, numbness, paresthesias, weakness, and muscle atrophy and was measured utilizing the Gabel/Amadio scale. RESULTS: Fifty-three point two percent (n=25) of patients were found to have excellent outcomes, 36.2% (n=17) had good outcomes, 8.5% (n=4) had fair outcomes, and 2.1% (n=1) had poor outcomes as determined by the Gabel/Amadio scale. The greatest improvement in all patients was the reduction in sensory symptoms: pain, numbness, and paresthesia. There were no operative or postoperative complications. CONCLUSIONS: This novel procedure provided symptom relief comparable to the most effective existing techniques without significant complications, and with rapid recovery and minimal scar formation. The authors assert that this technique demonstrates optimal results for patients with relative ease of adoption for surgeons.
Authors: Ronald H M A Bartels; Wim I M Verhagen; Gert Jan van der Wilt; Jan Meulstee; Leo G M van Rossum; J André Grotenhuis Journal: Neurosurgery Date: 2005-03 Impact factor: 4.654