Poster Presentation NZ Association of Plastic Surgeons & NZ Society for Surgery of the Hand

A comparison of outcomes of medial epicondylectomy in primary and revision cubital tunnel syndrome (1541)

Andrew D Sanders 1 2 , Abdus Burahee 2 , Francesca Susini 2 , Saskia Millard 2 , Dominic Power 2 3
  1. CMDHB, Auckland, AUCKLAND, New Zealand
  2. Peripheral Nerve Injury Service, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  3. HaPPeN Research Group, Institute of Translational Medicine, Birmingham, UK

Simple decompression (SD) is the most commonly performed operation for treatment of cubital tunnel syndrome (CuTS). In cases of ulnar nerve instability, persistent compression or recurrence, the addition of medial epicondylectomy (ME) or anterior transposition (AT) is often considered. This study compares the treatment response when ME is utilised in primary compared to revision CuTS in a regional peripheral nerve surgery unit in the UK.

Methods: Patient records were reviewed for an eight-year period from 2013 to 2020, and screened to identify cases where a ME was performed for compressive neuropathy. Disease severity, motor function, sensory function, duration of follow up and complications were. Response to treatment was scored using the Wilson-Krout system (WK) for assessment of progression.

Results: 185 CuTS operations met the inclusion criteria. There were 107 men (116 nerves) and 62 women (69 nerves). Median age was 52.2 years (range 17.5–81.1 years). 155 were primary and 30 were revision cases. Disease severity in the primary v revision cohorts were grade 1 - 46 v 6, grade 2 – 80 v 21, and grade 3 – 29 v 3. At final review, 80% of patients with primary CuTS and 87% of the recurrent CuTS cohort achieved a WK outcome of good or excellent. At 24 months follow up, only 9 patients had recurrence of symptoms of whom 3 required reoperation.

Discussion: The optimal treatment for CuTS has not been defined in the literature. In a recent systematic review, SD or SD + ME was shown to have a lower complication rate that AT. This study supports the finding that ME is a useful addition SD for both primary and revision CuTS with low complication rates.

Conclusion: The addition of medial epicondylectomy to an in situ cubital tunnel decompression is a safe and effective treatment for cubital tunnel syndrome.