Paper presented April 3, 2007 at the Annual Meeting of the American Association for Hand Surgery
Institution where the work was prepared: Orthopaedic Specialists, Davenport, IA, USA
TYSON Cobb, MD; Patrick T Sterbank, PA-C; ORTHOPAEDIC SPECIALISTS, P.C
Endoscopic Cubital Tunnel Release (ECTR) is an emerging technique with speculated advantage of a smaller incision and earlier return to activity. Several earlier studies have demonstrated clinical efficacy of ECTR but early return to activity has not been clearly documented. The purpose of the study was to compare the return to work time for patients undergoing ECTR versus Anterior Subcutaneous Transposition of the Ulnar Nerve (ASTUN).
Methods A retrospective review of 30 consecutive cases was used to determine the time from surgery to return to work. Follow-up time averaged one year for both groups. All patients had electrical studies prior to surgery. All patients had positive Tinel’s and Elbow Flexion test. Severity of symptoms was rated preoperatively using Dellon’s classification. Postoperative results were graded using Bishop 12 point rating system.
The ECTR study group consisted of 15 patients, 6 females and 9 males, 11 workmen’s compensation and 4 group insurance; average age was 49 years, range 28 to 69. Dominant side surgery occurred in 8 cases (54%). Average length of preoperative symptoms was 26 months. 10 (68%) patients had a positive electrical study for Cubital Tunnel. Preoperative symptoms based on Dellon’s classification were 10% Mild, 60% Moderate and 30% Severe.
The ASTUN group consisted of 5 males and 10 females, 12 involved workmen’s compensation and 3 private insurance, average age was 44 years, range 23 to 57. Dominant side surgery occurred in 9 cases (60%). The average length of preoperative symptoms was 28 months. 9 (60%) patients had positive electrical studies for Cubital Tunnel. Preoperative symptoms based on Dellon’s classification was 7% Mild, 63% Moderate and 30% Severe.
Results The ECTR results were 10 (68%) Excellent, 3 (20%) Good, 1 (6%) Fair and 1(6%) Poor utilizing the Bishop12 point rating system. The average return to modified work was 2 days (range 1 to 3) and to regular work 7 days (range 5 to 9).
The ASTUN group average return to modified work was 17 days (range 12 to 22) and for full duty 70 days (range 60 to 80). Results based on the Bishop 12 point rating system was 10% Excellent, 62% Good, 22% Fair and 6% Poor.All patients returned to their usual preoperative activities.
Conclusion Endoscopic Cubital tunnel release provides good to excellent symptom relief in most patients with an earlier return to activity compared to ASTUN. The differences in recurrence, complications, and long-term outcome require additional study.