Minimal Medial Epicondylectomy and Decompression for Cubital Tunnel Syndrome

Author(s): Goebel F, Musgrave DS, Vardakas DG, Vogt MT, Sotereanos DG

Source: Clinical Orthopaedics and Related Research, 393: 228-236, 2001

Summary:

This study is a retrospective review of one surgeon’s experience with minimal medial epicondylectomy and in situ decompression of the ulnar nerve for cubital tunnel syndrome.  The minimal epicondylectomy was defined as “the smallest bony resection of the medial epicondyle to enable undisturbed gliding of the ulnar nerve.”  Ulnar nerve decompression was carried out  8 cm proximal and distal to the epicondyle.  Patients were classified according to the McGowan stages, with 15% grade I, 67% grade II, and 18% grade III.  At a mean of 27 months follow-up, findings revealed 79% good or excellent results, 15% fair, and 6% poor results.  There were no major complications from the medial epicondylectomy.  However, 52% reported minor pain at 6 months and 30% at 1-year following the procedure.  There was no incidence of ulnar nerve palsy, snapping, or medial elbow instability.  One patient had a 5 degree flexion contracture and one had a superficial wound breakdown treated locally.  The outcome did not appear to correlate with duration of symptoms, electrodiagnostic findings, work-related status, or the McGowan grading system.

This article adds to the growing body of literature reporting the success of one treatment option for cubital tunnel syndrome without a comparison group.  Interestingly, the results of this study did not correlate with the severity of the McGowan stage.  Possibly the numbers were not great enough to support the findings of  Mowlavi et. al., who in a meta-analysis of 30 articles, suggested that McGowan stage III patients did less well with medial epicondyectomy than other forms of  treatment. 

These authors suggest that medial epicondylectomy and in situ decompression is a viable option for cubital tunnel syndrome, achieving approximately 80% good to excellent results.   It is doubtful that the findings will lead to any change in the current procedure of choice for a given surgeon, which is more likely based on training, experience and personal preference.  Hopefully, we will one day all acknowledge that there are many successful surgical options for cubital tunnel syndrome that all involve release and decompression of the ulnar nerve.  The continuing debate on which one is “best” may simply not be relevant.

 


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