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Introduction Medial skin incision is obligatory for ulnar nerve transposition in cubital tunnel syndrome. However, inadvertent surgical damage to the terminal branches of both the medial antebrachial cutaneous nerve (MACN) and the medial brachial cutaneous nerve (MBCN) has been a concern in the current surgical approach. Hypothesis We hypothesized a modified curved skin incision to avoid the damage to the medial cutaneous nerve. Materials and methods The numbers and locations of MACN and MBCN terminal branches were investigated; also, the location of the posterior branch of MACN in ten fresh frozen cadaveric upper extremities. Using modified incision which is more anterior than classic approach and includes antegrade dissection of the cutaneous branches, same measurement was performed in clinical cases. We described the techniques. Results The average number of MACN posterior terminal branches was 2.6 ± 1.6 and 4.4 ± 2.4 branches in the cadaveric specimens and clinical cases, respectively. The average number of MBCN terminal branches was 2.1 ± 0.87 branches. The MACN posterior terminal branches were located at an average of 19 mm proximal and 45 mm distal from the medial epicondyle. In clinical cases, we could preserve all MBCN terminal branches and posterior terminal branches of MACN using the indexed skin incision. Discussion Our modified medial skin incision technique with antegrade subcutaneous dissection exposed all the terminal branches of MACN and thus, could reduce the risk of inadvertent injury. The medial epicondyle and the basilic vein are reliable anatomical landmarks to identify the posterior branch of the MACN. Level of proof IV, Cadaveric and Therapeutic study.

Introduction: The paper aims to present the advantages and disadvantages related to using the anterior transposition technique for the treatment of the cubital tunnel syndrome. Materials and Methods: The study presents the surgical treatment of a 58 years old woman. The therapeutic protocol included the decompression of the ulnar nerve at the level of the elbow, followed by the anterior transposition, the new position being maintained by anchoring in a fascial sling. Results: The electromyographic evaluation performed 12 months after the surgical intervention indicated that the parameters of motor nerve conduction were within normal limits on all segments, normal sensory velocities from the V finger, orthodromic and from the dorsal branch, sign of a very good postoperative recovery. Conclusions: Anterior transposition of the ulnar nerve may be a firm solution for the treatment of the compressive ulnar neuropathies located at the level of the elbow.

Our aim was to assess the incidence of symptomatic ulnar nerve dislocation and its influence on surgical outcome after primary and revision surgeries in ulnar nerve entrapment at the elbow (ulnar neuropathy at the elbow (UNE) or cubital tunnel syndrome). The influence of pre-or intra-operative ulnar nerve dislocation on postoperative outcome was assessed in 548 surgically treated cases (548 nerves) from two hand surgery departments reporting to the Swedish National Quality Registry for Hand Surgery, using QuickDASH, a patient-reported outcome measure (PROM), before surgery and at 3 and 12 months postoperatively, and a doctor-reported outcome measure (DROM), grading as "cured-improved "or "unchanged-worsened, at a median follow-up of 3.0 months [IQR, 1.5-6.0]. 109 of the 548 cases (20%) showed documented pre-or intra-operative ulnar nerve dislocation; more often found at revision (35/ 75, 47%) than at primary surgery (74/473, 16%) (p < 0.0001). Cases with dislocation presented higher QuickDASH scores at 12 months (p = 0.026). A linear regression model, adjusted for age and gender, predicted higher QuickDASH scores at 12 months postoperatively for cases with dislocation (unstandardized B 11.3 [95% CI 0.4-22.2], p = 0.043). DROM grading as unchanged-worsened at a median 3 months predicted worse QuickDASH scores (p < 0.0001) than in cured-improved cases at 3 (unstandardized B, 18.4 [95% CI 9.4-27.3]) and 12 months (unstandardized B, 18.1 [9.1-27.0]). Primary surgeries had better DROM grading than revision surgeries (p = 0.033; cured-improved, 75% and 63%, respectively), but QuickDASH scores did not differ. Presence of a clinically relevant ulnar nerve dislocation resulted in worse outcome, perhaps due to more extensive surgery with transposition. Nerve dislocation needs attention when treating UNE patients. (C) 2021 SFCM. Published by Elsevier Masson SAS. Notre but était d’évaluer la présence de la luxation symptomatique du nerf ulnaire et son influence sur le résultat après chirurgie de première intention et reprise chirurgicale du syndrome canalaire au coude. L’influence de la luxation pré- ou per-opératoire du nerf ulnaire sur le résultat post-opératoire a été évaluée dans 548 cas (nerfs) traités chirurgicalement à partir des données fournies par deux départements de chirurgie de la main dans un Registre National de Qualité pour la Chirurgie de la Main, mesurant les résultats rapportés par les patients (PROM, QuickDASH, avant la chirurgie, et à 3 et 12 mois postopératoires) et les résultats rapportés par les médecins (DROM, i.e. évaluation à la dernière visite, guéri–amélioré ou inchangé–aggravé, temps médian de suivi de 3,0 mois [EI 1,5–6,0]). Sur l’ensemble des cas, 109/548 (20%) avaient une luxation pré- ou per-opératoire répertoriée du nerf ulnaire, plus fréquemment détectée lors des révisions chirurgicales (35/75, 47%) que lors des chirurgies de première intention (74/473, 16%, p Funding Agencies|Lund University, ALF [0104]; Region Skane (Funds from Skane University Hospital Malmod-Lund); Swedish Diabetes Foundation [DIA2016-117, DIA2020-492]; Sydvadstra Skanes Diabetesfodrening, Sweden; ALF Grants, Region Odstergodtland, Sweden [LIO-823361]

Cases We present 3 patients who underwent ulnar nerve transposition and wrapping of the nerve with human amniotic membrane (HAM). All 3 patients subsequently required a reoperation for the original pathologic condition (not for ulnar nerve symptoms), necessitating the exploration and dissection of the transposed ulnar nerve. We demonstrate the lack of scar formation and ease of separation between nerve and surrounding tissue, as well as histology in one case taken from the perineural tissues (previous amniotic membrane), demonstrating no inflammatory cells or absence of scar tissue formation. Conclusion Exploration and dissection of a previously transposed ulnar nerve can be facilitated by wrapping the nerve with HAM to prevent scarring and perineural fibrosis.

Objectives/Interrogation: There is a wide variation in outcome after surgery for cubital tunnel syndrome. Chronic pain is a well known and relatively common complication with severe consequences for the individual patient. In this study, we aimed to evaluate possible predictive factors for severe[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

Ulnar nerve is often trapped in cubital tunnel at elbow level, this being the second most common place of entrapment of the peripheral nerves in the upper limb.3 The most commonly associated etiology is the anatomic alteration of the cubital tunnel.12 There are three mechanisms described: compression, traction, and friction. The symptoms exhibited are hypoesthesia, pain, and weakness, which increase with the bending of the elbow at an angle greater than 90°, and according to nerve involvement we can classify the clinical status using the modified McGowan score.13 In this article, an unusual extrinsic compression mechanism to cubital tunnel is shown, caused by free intra-articular body, and its surgical management.

Introduction Cubital tunnel syndrome (CTS) is responsible for one of the types of ulnar nerve neuropathy and is the second cause of compressive neuropathy of the upper limb, only surpassed by carpal tunnel syndrome. Objective To describe the epidemiological data of the ulnar nerve transposition surgical code in the treatment of CTS by the United Health System (SUS) from 2005 to 2015. Methodology This is a descriptive epidemiological study, in which data were obtained through consultation of the DATASUS database. Results/Discussion During this period, 774 procedures were performed and, despite the addition of 20.3 million people to the Brazilian population, the incidence was 0.33/1,000,000. National and international epidemiology point to a slightly higher prevalence of the procedure between men, in the fourth and fifth decades of life. Low permanence rate, as well as the absence of hospital deaths related to the procedure, infer that the procedure is safe, with low morbidity and mortality rates. Conclusion The annual incidence of the cubital syndrome submitted to surgical treatment at SUS in the Brazilian population was 1/7,670,833 in 2005 and ½,174,468 in 2015. The cost of each surgical procedure during the same period ranged from R$ 318.88 to R$ 539.74. The mean hospitalization time for CTS surgery was 1.85 days.

Anterior transposition for cubital tunnel syndrome consists of the surgical decompression of the ulnar nerve followed by movement of the nerve anterior to its native retrocondylar location relative to the medial epicondyle. Three different types of anterior transposition have been described, including subcutaneous, intramuscular, and submuscular transpositions. These procedures were developed to not only decompress the ulnar nerve but also to reduce nerve traction during elbow flexion that is not addressed by in situ ulnar nerve decompression alone. However, transposition procedures may pose a greater risk of complications (Macadam SA, Gandhi R, Bezuhly M, Lefaivre KA, J Hand Surg Am 33:1314.e1–12, 2008; Zlowodzki M, Chan S, Bhandari M, Kalliainen L, Schubert W, J Bone Joint Surg Am 89:2591–2598, 2007; Staples R, London DA, Dardas AZ, Goldfarb CA, Calfee RP, J Hand Surg Am 43:207–213, 2018; Zhang D, Earp BE, Blazar P, J Hand Surg Am 42:294.e1–294.e5, 2017). Evidence for the superiority of in situ decompression vs transposition and the type of transposition is lacking. Rather, surgeons may choose to perform an ulnar nerve transposition based on specific clinical settings or simply surgical preference. The goals of this chapter are to define various indications for anterior transposition, to outline controversies regarding in situ ulnar nerve decompression vs anterior transposition, to describe operative techniques, and to report outcomes comparing transposition procedures and in situ decompression.

Purpose Simple decompression of the ulnar nerve has outcomes similar to anterior transposition for cubital tunnel syndrome; however, there is no consensus on the proper technique for patients with an unstable ulnar nerve. We hypothesized that 1) simple decompression or anterior ulnar nerve transposition, depending on nerve stability, would be effective for cubital tunnel syndrome and that 2) there would be determining factors of the clinical outcome at two years. Materials and Methods Forty-one patients with cubital tunnel syndrome underwent simple decompression (n=30) or anterior transposition (n=11) according to an assessment of intra-operative ulnar nerve stability. Clinical outcome was assessed using grip and pinch strength, two-point discrimination, the mean of the disabilities of arm, shoulder, and hand (DASH) survey, and the modified Bishop Scale. Results Preoperatively, two patients were rated as mild, another 20 as moderate, and the remaining 19 as severe according to the Dellon Scale. At 2 years after operation, mean grip/pinch strength increased significantly from 19.4/3.2 kg to 31.1/4.1 kg, respectively. Two-point discrimination improved from 6.0 mm to 3.2 mm. The DASH score improved from 31.0 to 14.5. All but one patient scored good or excellent according to the modified Bishop Scale. Correlations were found between the DASH score at two years and age, pre-operative grip strength, and two-point discrimination. Conclusion An ulnar nerve stability-based approach to surgery selection for cubital tunnel syndrome was effective based on 2-year follow-up data. Older age, worse preoperative grip strength, and worse two-point discrimination were associated with worse outcomes at 2 years.

Introduction Medial skin incision is obligatory for ulnar nerve transposition in cubital tunnel syndrome. However, inadvertent surgical damage to the terminal branches of both the medial antebrachial cutaneous nerve (MACN) and the medial brachial cutaneous nerve (MBCN) has been a concern in the current surgical approach. Hypothesis We hypothesized a modified curved skin incision to avoid the damage to the medial cutaneous nerve. Materials and methods The numbers and locations of MACN and MBCN terminal branches were investigated; also, the location of the posterior branch of MACN in ten fresh frozen cadaveric upper extremities. Using modified incision which is more anterior than classic approach and includes antegrade dissection of the cutaneous branches, same measurement was performed in clinical cases. We described the techniques. Results The average number of MACN posterior terminal branches was 2.6 ± 1.6 and 4.4 ± 2.4 branches in the cadaveric specimens and clinical cases, respectively. The average number of MBCN terminal branches was 2.1 ± 0.87 branches. The MACN posterior terminal branches were located at an average of 19 mm proximal and 45 mm distal from the medial epicondyle. In clinical cases, we could preserve all MBCN terminal branches and posterior terminal branches of MACN using the indexed skin incision. Discussion Our modified medial skin incision technique with antegrade subcutaneous dissection exposed all the terminal branches of MACN and, thus, could reduce the risk of inadvertent injury. The medial epicondyle and the basilic vein are reliable anatomical landmarks to identify the posterior branch of the MACN. Level of proof IV, cadaveric and therapeutic study.

Cubital tunnel syndrome is the second most common peripheral nerve compression seen by hand surgeons. A thorough understanding of the ulnar nerve anatomy and common sites of compression are required to determine the cause of the neuropathy and proper treatment. Recognizing the various clinical presentations of ulnar nerve compression can guide the surgeon to choose examination tests that aid in localizing the site of compression. Diagnostic studies such as radiographs and electromyography can aid in diagnosis. Conservative management with bracing is typically trialed first. Surgical decompression with or without ulnar nerve transposition is the mainstay of surgical treatment. This article provides a review of the ulnar nerve anatomy, clinical presentation, diagnostic studies, and treatment options for management of cubital tunnel syndrome.

Cubital tunnel syndrome is a common neuropathy of the upper extremity. Patient symptoms typically consist of numbness in the ulnar side of the side and hand intrinsic muscle weakness. Physical examination and EMG/NCV are usually adequate to establish a diagnosis. Nonoperative management works approximately 50% of the time and consists of rest and splinting. Operative management can help the symptoms and prevent progression of disease. During surgical decompression, all sites of potential compression should be evaluated to give the patient the best chance for a successful outcome.

The aim of the study is to introduce a new minimally invasive technique for ulnar nerve release and transposition.From January 2010 to May 2011, 51 patients with cubital tunnel syndrome were treated through a 1.5 to 2 cm incision. Limb functional recovery, scar esthetics, sensitivity of scar, numbness of the operating area, and patient satisfaction were assessed.No wound hematoma nor infection was observed in the group. The time of operation was 36 ± 17.2 minutes. At the final follow-up of 63 ± 7.3 months, 2-point discrimination of the small finger was improved from 6.3 ± 2.2 mm to 5.2 ± 2.4 mm. Grip and pinch strength of the hand were improved from 14.2 ± 7.7 kg and 3.7 ± 2.4 kg to 35.2 ± 12.7 kg and 4.1 ± 2.8 kg, respectively. The motor nerve conduction velocity was improved from 36.5 ± 11.2 to 44.6 ± 6.7 (m/sec). The Disabilities of the Shoulder, Arm, and Hand questionnaire score was improved from 37.2 ± 23.8 to 10.5 ± 9.6. No patients reported scar pain, sensitivity of scar, or numbness of the operating area. No revision surgery was needed. Michigan Hand Outcome score for aesthetics was 94.6%±5.1 and satisfaction was 92 ± 8, respectively. We obtained 33 excellent, 12 good, 5 fair, and 1 poor result.Ulnar nerve decompression with anterior transposition can be safely and effectively accomplished through the small incision. It can be an alternative technique producing good appearance.

The most common site of ulnar nerve compression is within the cubital tunnel. Surgery has historically involved an open cubital tunnel release with or without transposition of the nerve. A comparative study has demonstrated that endoscopic decompression is as effective as open decompression and has the advantages of being less invasive, utilizing a smaller incision, producing less local symptoms, causing less vascular insult to the nerve, and resulting in faster recovery for the patient. Ulnar nerve transposition is indicated with symptomatic ulnar nerve instability or if the ulnar nerve is located in a "hostile bed" (eg, osteophytes, scarring, ganglions, etc.). Transposition has previously been performed as an open procedure. The authors describe a technique of endoscopic ulnar nerve release and transposition. Extra portals are used to allow retractors to be inserted, the medial intermuscular septum to be excised, cautery to be used, and a tape to control the position of the nerve. In our experience this minimally invasive technique provides good early outcomes. This report details the indications, contraindications, surgical technique, and rehabilitation of the endoscopic ulnar nerve release and transposition.

Purpose The purpose of this study was to contrast the rate and types of complications and secondary surgeries for in situ cubital tunnel release and ulnar nerve transposition. Methods A retrospective cohort study was performed by query of hospital billing records for all patients who underwent cubital tunnel surgery from August 2008 to July 2013, yielding 421 patients. Exclusion criteria were acute trauma, revision surgery, neoplasm, age younger than 18 years, incomplete records, and postoperative follow-up less than 3 months. Of the remaining 234 patients, 147 patients underwent 157 in situ cubital tunnel releases and 87 patients underwent 90 ulnar nerve transpositions. Results In 157 in situ cubital tunnel releases, there were 6 complications (3.8%), including 3 cases (1.9%) of ulnar nerve instability, 2 cases (1.3%) of postoperative infection, and 1 case (0.6%) of a postoperative seroma. In 90 ulnar nerve transpositions, there were 2 complications (2.2%), including 1 case (1.1%) of postoperative infection and 1 case (1.1%) of medial antebrachial cutaneous nerve injury. The secondary surgery rate was 5.7% overall, 2.5% for in situ cubital tunnel release, and 11.1% for ulnar nerve transposition. Chronic kidney disease was associated with complication after cubital tunnel surgery. Prior trauma to the elbow and ulnar nerve transposition were associated with secondary surgery. Conclusions The short-term complication rates of cubital tunnel surgery are low (3.2%), but higher for patients with chronic kidney disease. The secondary surgery rate after cubital tunnel surgery was 5.7% overall, but higher for patients with prior elbow trauma and for patients undergoing ulnar nerve transposition. Type of study/level of evidence Therapeutic IV.

Purpose The 2 most common methods of ulnar nerve anterior transposition are submuscular and subcutaneous. Controversy exists as to which technique yields superior results. The purpose of this study was to examine the histologic differences between the 2 methods in a rat model. Methods Twenty forelimbs in 10 adult Sprague-Dawley rats had bilateral ulnar nerve transpositions; one side with the submuscular method, and the other side with the subcutaneous method. Animals were killed 6 weeks after the index surgery and the forelimbs were examined for histologic evidence of the health of the axons and perineural scar formation. Results Nerve health was assessed using a 4-part classification in which 4=normal nerve, 3=abnormal axons in one-third cross-sectional area (CSA), 2=abnormal axons in two-thirds CSA, and 1=abnormal axons in 100% CSA. Perineural scar formation was assessed using a 3-part classification in which 3=scar completely encasing nerve, 2=scar formation partially surrounding nerve, and 1=no scar. The submuscular method displayed healthier ulnar nerve axons. In addition, the submuscular method displayed less perineural scar tissue. Conclusions On this basis of this rat model, the submuscular method of ulnar nerve anterior transposition displayed histologically healthier axons and less perineural scar tissue when compared to the subcutaneous method.

Background:The surgical treatment of Cubital tunnel syndrome (CubTS) is still a matter of debate. No consensus exists about the necessity of anterior transposition of the ulnar nerve after decompression. However, this technique is fairly common in clinical practice.Material and Methodology:In the present study we compared the operative technique (incision length, operative time), postoperative care (postoperative pain and complications) and the outcome between subcutaneous transposition and submuscular transposition of the ulnar nerve as two surgical modalities in treating moderate CubTS.Between March 2004 and March 2007, twenty six patients with moderate CubTS (according to Dellon’s grading system) were stratified according to age and gender into these two surgical techniques. The two groups were prospectively followed up 2 weeks, 6 months and 12 months postoperatively by the same observer and the operation outcome was assessed using the Bishop rating system.Results:We found that the subcutaneous transposition of the ulnar nerve was associated with shorter incision, shorter operative time, less postoperative pain, less postoperative complication and better outcome compared with the submuscular transposition.Conclusion:The authors recommend the subcutaneous technique when considering anterior transposition of the ulnar nerve in treating moderate CubTS.

To determine retrospectively whether the technique of ulnar nerve transposition (subcutaneous versus submuscular) is associated with clinical sensory and motor recovery in cubital tunnel syndrome, and whether recovery is influenced by prognostic factors such as preoperative McGowan stage, age, and duration of symptoms.Twenty-five patients (average age, 53 years; follow-up, 7 years) with cubital tunnel syndrome had submuscular transposition, and 24 patients (average age, 46 years; follow-up, 3 years) were treated by subcutaneous transposition. There were 11 McGowan stage II and 14 stage III patients in the submuscular group and 14 stage II and 10 stage III patients in the subcutaneous group. Preoperatively, all patients presented with diminished 2-point discrimination. Postoperative sensory and motor recovery was evaluated clinically.There was no significant difference between subjective results in the submuscular and subcutaneous groups: 20 of 25 patients in the submuscular group versus 17 of 24 patients in the subcutaneous group were clearly improved, and 3 of 25 patients in the submuscular group versus 6 of 24 patients in the subcutaneous group partially improved. The logistic multivariate regression analysis indicated that sensory and motor function were both significantly improved following both surgical techniques. Sensory function recovered (2-point discrimination6 mm) in 17 of 25 patients in the submuscular group and in 17 of 24 patients in the subcutaneous group, and motor function recovered (intrinsic strength grade 5) in 19 of 25 patients in the submuscular group and in 19 of 24 patients in the subcutaneous group. Symptoms lasting more than 6 months were associated with a poor prognosis.Sensory and motor recovery for patients with McGowan stages II and III of cubital tunnel syndrome were similar following submuscular and subcutaneous transposition techniques, and patients with symptoms lasting longer than 6 months had a worse prognosis regardless of surgical technique.

Purpose: To evaluate the clinical results of anterior subcutaneous ulnar nerve transposition operation and the factors that influence the results for cubital tunnel syndrome. Materials and Methods: Seventeen cases of cubital tunnel syndrome were treated by anterior subcutaneous transposition between March 2001 and December 2003. The mean age was 56 years and mean follow up period was 20.4 months. All patients were reviewed retrospectively. The preoperative evaluation was done by Dellon`s classification and the clinical results were evaluated by Messina’s classification. We analyzed the effect of the operation and the relations between the results and the preoperative factors, for example, duration of symptom, age, cause of illness, present of association with diabetes mellitus or preoperative flexion contracture of the elbow were analyzed. Results: The results according to Messina`s classification were 4 cases of excellent, 9 cases of good, 3 cases of fair, and 1 case of poor. The preoperative factors like duration of symptom, age, cause of illness and flexion contracture of the elbow didn`t show any statistical difference in the result of operation, but the cases which have diabetes mellitus were unsatisfactory with statistical difference (p

Subjective outcome was assessed in 100 patients with cubital tunnel syndrome at least 2 years after anterior transmuscular transposition of the ulnar nerve. The mean time from surgery was 37 months (standard deviation, 10 months). The patient sample of 119 operated cases included 81 unilateral procedures and 19 patients had bilateral procedures. The mean time between surgeries was 7 months. Sixty-one patients who underwent unilateral procedures reported improvement, and there was no difference in 13 unilateral cases. Thirteen patients who underwent bilateral procedures reported improvement in both arms. Postoperatively symptoms were significantly less than those preoperatively: pain, p = 0.001; cold sensitivity, p = 0.001; tingling, p = 0.05; and numbness p = 0.08. In 51 cases, patients reported normal sensation and in 45 cases patients reported normal strength. Reported outcome was significantly better in nonsmokers than in smokers (p = 0.02) but was not significantly different in patients with workers' compensation/litigation (p = 0.51), obesity (p = 0.16), abnormal preoperative nerve conduction studies (p = 0.21), concomitant carpal tunnel syndrome (p = 0.95), or brachial plexus nerve compression (p = 0.35).

OBJECTIVES The purpose of this study was to test the hypothesis that symptomatic transposed ulnar nerves have a larger average cross-sectional area (CSA) than symptomatic in situ ulnar nerves. METHODS We conducted a retrospective review of the charts and sonograms of 68 patients who had failed ulnar nerve transposition compared to 48 patients with cubital tunnel syndrome who had not undergone surgical management. In addition, postoperative sonograms were compared with preoperative studies when available. Failure was defined as persistence or recurrence of symptoms of ulnar neuropathy postoperatively. The cross-sectional area of the nerve, subjective echogenicity, and residual sites of compression were recorded. Groups were subsequently compared by t tests. RESULTS The failed ulnar nerve transposition group showed a mean cross-sectional area ± SD of 17.26 ± 9.93 mm(2), whereas the control group showed a mean cross-sectional area of 13.45 ± 7.33 mm(2). This difference was statistically significant (P= .018). Nontransposed nerves were more likely to have identifiable sites of compression (P< .05). There was a trend toward postoperative enlargement in the 6 patients with available preoperative imaging (P = .17). No difference in subjective echogenicity was found in this analysis. CONCLUSIONS Patients with failed ulnar nerve transposition show a significantly enlarged cross-sectional area when compared to symptomatic nerves in situ. Although a specific etiology for this difference cannot be determined, the data suggest that the reference ranges for the cross-sectional area of the ulnar nerve may need to be revised for those who have undergone surgery.

This study sought to determine the validity and responsiveness of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire in cubital tunnel syndrome.Consecutive patients with cubital tunnel syndrome treated by anterior ulnar nerve transposition between September of 2009 and December of 2011 were reviewed retrospectively. Questionnaires were completed preoperatively and 1.5, 3, 6, and 12 months postoperatively. The relationship of the questionnaire to measures of pain, health status (Short Form-8), and pinch and grip strength was evaluated using Spearman's correlation coefficients. Responsiveness of the questionnaire was analyzed using Cohen's effect size, and was compared with responsiveness of the physical examination, pain, and Short Form-8 measures.The final cohort included 69 patients with isolated cubital tunnel syndrome and 39 with concurrent cubital and carpal tunnel syndrome. Questionnaire scores correlated as expected with other measures. Moderate to strong correlations were observed with pain visual analogue scale and Short Form-8 scores, and weak to moderate correlations were observed with pinch and grip strength. Effect sizes for the DASH questionnaire were small (0.3) at 6 weeks and moderate (0.35 to 0.57) at 3, 6, and 12 months postoperatively in both groups. Pain visual analogue scale scores demonstrated large effect sizes (0.8) at all postoperative time points, whereas Short Form-8 and pinch and grip strength were poorly responsive.The Disabilities of the Arm, Shoulder, and Hand questionnaire is a valid measure in cubital tunnel syndrome, and is moderately responsive to change beyond 3-month follow-up.Diagnostic, II.

Subcutaneous anterior ulnar nerve transposition has been advocated by many surgeons as simple and effective. Techniques to maintain the nerve anterior to the medial epicondyle include subcutaneous pocket, subcutaneous-fascia tunnel, and fascial and fasciodermal sling. We describe a modified technique that uses the medial intermuscular septum as a sling to allow a more gentle transition of the ulnar nerve as it enters into the flexor carpi ulnaris muscle belly.

Controversy remains regarding the surgical treatment of cubital tunnel syndrome. Similar outcomes with ulnar nerve transposition, both subcutaneous and submuscular, and simple decompression have recently been reported. We describe an endoscopically assisted cubital tunnel release through a 2-cm incision using readily available standard equipment. Seventeen of 21 procedures successfully alleviated symptoms of cubital tunnel syndrome in these patients. Four patients who developed ulnar nerve subluxation intraoperatively who were treated with medial epicondylectomy failed to experience relief of symptoms and were successfully treated with anterior submuscular transposition. Patients with more profound motor weakness and/or electrodiagnostic studies had less complete relief of symptoms.

Anterior, subcutaneous ulnar nerve transposition decompresses the ulnar nerve and, by transposing anterior to the medial epicondyle, eliminates longitudinal traction forces applied to the nerve during elbow flexion. This article reviews the indications and contraindications of the technique and describes the surgical technique in detail.