Artikel
Patient characteristics in cubital tunnel syndrome at a referral centre and predictive factors for outcome of simple decompression versus subcutaneous transposition of the ulnar nerve
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Autoren
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Erika Nyman
- Dept of Clin and Exp med, Linköping University, Division of Hand Surg and Plastic Surg, Linköping University, Linköping, Sweden
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Alice Giöstad
- Dept of Clin and Exp med, Linköping University, Division of Hand Surg and Plastic Surg, Linköping University, Linköping, Sweden
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: The objectives were to study characteristics of patients with cubital tunnel syndrome at a referral centre and to analyse predictive factors for outcome of simple decompression versus ulnar nerve transposition.
Methods: A retrospective observational study was performed on patients with cubital tunnel syndrome operated 2011 - 2014. Data were obtained from patient charts from, a specially designed form, and a DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire. Patient characteristics and predictive factors for surgical outcome were analysed in 202 cases (173 patients; each arm evaluated as a separate entity).
Results and Conclusions: The mean age was 51 years, 61% of the cases were females, 31% were smokers, and mean BMI was 27. Fifty-four percent suffered from another nerve compression lesion in the same arm, 35% from another nerve compression lesion in the opposite arm, 23% had neck problems, 17% had shoulder problems and 12% had diabetes. Fifty-six percent (n=114) of the cases had simple decompression, 28% (n=56) had primary, and 16% (n=32) had secondary subcutaneous transposition. Patients with secondary transposition were significantly younger than patients treated with simple decompression.
Overall, 55% of the patients were satisfied with the surgical result (56% after simple decompression, 48% after primary and 64% after secondary transposition), but only 8% stated that they would not go through the surgery again. The mean DASH score was 31 (SD 25) with no significant difference in DASH scores between surgical groups, or between patients with positive or negative electrophysiological tests; nor was there any association between results from the tests and type of surgery. There was a significantly increased risk of complications, following primary and secondary transposition compared to simple decompression, and the complication rate was doubled in smokers.
We conclude that surgically treated cases with cubital tunnel syndrome at a referral centre constitute a heterogeneous group with great comorbidity and often other nerve compression lesions with a wide variation in symptoms and surgical outcome. We recommend simple decompression as surgical procedure of first choice. Anterior transposition should only be used in selected cases or when simple decompression fails. All patients should be strongly recommended to stop smoking considering the remarkably increased risk for complications among smokers.
