Journal List > Korean J Neurotrauma > v.8(1) > 1058894

Comparative Study between the Conventional Method and Small Skin Incision Method for Simple Decompression of Cubital Tunnel Syndrome

Abstract

Objective:

The purpose of this study is to review the results of two surgical methods of simple decompression for treatment of cubital tunnel syndrome.

Methods:

Surgical procedure of simple decompression of the ulnar nerve using the conventional method requires a relatively long incision of 6-8 cm. Later with accumulating experience, we performed simple decompression using a skin incision of 2 cm or less. Between November 2005 and July 2010, simple decompression using the conventional method was performed in 10 elbows (Group 1), and simple decompression using the small skin incision method was performed in 10 elbows (Group 2). The surgical outcome was evaluated and the two groups were compared using a modified Bishop scoring system. We also compared the operation time and hospital stay between the two groups.

Results:

There were no significant differences in the outcomes between the two groups using the modified Bishop scoring system (p>0.05). Also, there were no significant differences in the postoperative electrodiagnostic study results between the two groups (p>0.05). However, the operation time and hospital stay were significantly shorter in Group 2 (p <0.01).

Conclusion:

Both the methods can be recommended for the treatment of cubital tunnel syndrome due to their advantages including simplicity and safety of the method. However, the small skin incision method is superior to the conventional method due to the shorter operation time and hospital stay.

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FIGURE 1.
Intraoperative finding of simple decompression in left elbow using a long incision shows decompression at the entrapment site.
kjn-8-37f1.tif
FIGURE 2.
A: Skin marking at right elbow for simple decompression of ulnar nerve using a small incision. A 2 cm skin incision made between the medial epicondyle (E) and olecranon (O). B: Intraoperative photograph demonstrating the ulnar nerve and overlying fascial membranes within the cubital tunnel.
kjn-8-37f2.tif
TABLE 1.
Dellon's classification of cubital tunnel syndrome
  Mild (I) Moderate (II) Severe (III)
Sensory Intermittent paresthesia Intermittent paresthesia Permanent paresthesia
Motor Subjective weakness Measurable weakness Palsy
No. of patients in group 1 0 6 4
No. of patients in group 2 1 4 5
TABLE 2.
Modified Bishop's scoring system
  Points
Satisfaction
Satisfied 2
Satisfied with reservation 1
Dissatisfied 0
Improvement
Better 2
Unchanged 1
Worse 0
Severity of residual symptoms
Asymptomatic 3
Mild, occasional 2
Moderate 1
Severe 0
Work status
Working or able to work at previous job 1
Not working because of ulnar neuropathy 0
Leisure activity
Unlimited 1
Limited 0
Strength
Intrinsic muscle strength normal (M5)∗ 2
Intrinsic muscle strength reduced to M4 1
Intrinsic muscle strength less than or equal to M3 0
Sensibility (static two point discrimination)
Normal (≤6 mm) 1
Abnormal (≥6 mm) 0
Total 12

∗medical council grading

TABLE 3.
Clinical summary of the two groups that underwent simple decompression using conventional and small skin incision methods n
Factor Group 1 (conventional method) Group 2 (small skin incision) p value
No. of patients Total 10 10  
Men 6 4  
Women 4 6  
Age of patients (years) 46.3 (39-65) 43.4 (18-79) 0.853
Symptom duration (months) 6.6±7.3 (1-24) 5.0±6.5 (1-21) 0.393
Follow up (months) 8.8±8.6 (2-26) 5.9±5.0 (1-15) 0.529
Preoperative MCV      
Above the elbow-below the elbow (m/s) 35.6±7.4 35.5±16.2 0.853
Below the elbow-wrist (m/s) 56.9±6.7 59.3±5.9 0.393
TABLE 4.
Mean value of motor conduction velocity of the ulnar nerve in the segment above the elbow-below the elbow
  Preoperative (m/s) Postoperative (m/s) p value
Group 1 (n=5) 35.8±8.3 44.6±12.1 <0.001
Group 2 (n=6) 37.1±13.2 51.9±7.3 <0.001
TABLE 5.
Surgical results
    Group 1 (n=10) Group 2 (n=10) p value
Outcome (bishop rate) Excellent 7 7 >0.05
Good 2 3 >0.05
Fair 1 0 >0.05
Poor 0 0 >0.05
Operation time (minute)   58.5±17.3 36.0±4.4 <0.001
Hospital stay (day)   4.4±0.8 2.1±0.32 <0.001
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