51 patients (55 elbows) who had a frontal partial medial epicondylectomy and ulnar nerve decompression as treatment for cubital tunnel syndrome were retrospectively reviewed at an average of 38 months postoperatively. According to the McGowan-grading system, 25 cases were grade 1, 12 grade 2, and 18 grade 3 preoperatively. Total relief of symptoms was reported in 80% of grade 1, 75% of grade 2, and 66% of grade 3 patients, with an overall patient satisfaction rating of 93%. Complications were limited to 7 mildly tender scars and 1 persistent 15 degrees elbow flexion contracture.
There are numerous published reports of the use of medial epicondylectomy for the treatment of cubital tunnel syndrome with reasonably good results. The main theoretical advantage of this technique over ulnar nerve transposition entails preservation of the nerve blood supply. Potential disadvantages include injury to the ulnar collateral ligament of the elbow, tenderness over the osteotomy site, joint contracture, and ulnar nerve subluxation. The authors’ technique limits the osteotomy to the frontal plane, preserving the origin of the ulnar collateral ligament and the stability of the ulnar nerve in the cubital tunnel. It is clearly a viable option for the surgical treatment of cubital tunnel syndrome. While there are many descriptions of what to do with the ulnar nerve following surgical decompression, with proponents of each sometimes to the level of religious conviction, the most important aspect of the operation probably involves a proper and thorough release of the nerve in the first place in the patient with appropriate preoperative indications.
J Hand Surg