Comparative Clinical Outcomes of Submuscular and Subcutaneous Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome
Purpose 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, ag...
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| Veröffentlicht in: | The Journal of hand surgery (American ed.) 2009-05, Vol.34 (5), p.866-874 |
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| creator | Charles, Yann Philippe, MD Coulet, Bertrand, MD, PhD Rouzaud, Jean-Claude Daures, Jean-Pierre, MD, PhD Chammas, Michel, MD, PhD |
| description | Purpose 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. Methods 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. Results 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 discrimination |
| doi_str_mv | 10.1016/j.jhsa.2009.01.008 |
| format | Article |
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Methods 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. Results 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 discrimination <6 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. Conclusions 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. Type of study/level of evidence Therapeutic III.</description><identifier>ISSN: 0363-5023</identifier><identifier>EISSN: 1531-6564</identifier><identifier>DOI: 10.1016/j.jhsa.2009.01.008</identifier><identifier>PMID: 19410989</identifier><identifier>CODEN: JHSUDV</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction ; Cubital tunnel syndrome ; Cubital Tunnel Syndrome - etiology ; Cubital Tunnel Syndrome - physiopathology ; Cubital Tunnel Syndrome - surgery ; Decompression, Surgical - methods ; Diseases of the osteoarticular system ; Female ; Fingers - innervation ; Follow-Up Studies ; Humans ; Male ; Mechanoreceptors - physiology ; Medical sciences ; Microsurgery - methods ; Middle Aged ; Motor Neurons - physiology ; Muscle, Skeletal - surgery ; Nervous system (semeiology, syndromes) ; Neurology ; Orthopedics ; Outcome and Process Assessment (Health Care) ; prognostic factors ; Sensory Thresholds - physiology ; Subcutaneous Tissue - surgery ; subcutaneous transposition ; submuscular transposition ; Suture Techniques ; Touch - physiology ; ulnar nerve ; Ulnar Nerve - physiopathology ; Ulnar Nerve - surgery</subject><ispartof>The Journal of hand surgery (American ed.), 2009-05, Vol.34 (5), p.866-874</ispartof><rights>American Society for Surgery of the Hand</rights><rights>2009 American Society for Surgery of the Hand</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-a67aeb5683e0436240884d6c29f48bd05525d08ecc1c448318b426863fca707b3</citedby><cites>FETCH-LOGICAL-c439t-a67aeb5683e0436240884d6c29f48bd05525d08ecc1c448318b426863fca707b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jhsa.2009.01.008$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21465326$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19410989$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Charles, Yann Philippe, MD</creatorcontrib><creatorcontrib>Coulet, Bertrand, MD, PhD</creatorcontrib><creatorcontrib>Rouzaud, Jean-Claude</creatorcontrib><creatorcontrib>Daures, Jean-Pierre, MD, PhD</creatorcontrib><creatorcontrib>Chammas, Michel, MD, PhD</creatorcontrib><title>Comparative Clinical Outcomes of Submuscular and Subcutaneous Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome</title><title>The Journal of hand surgery (American ed.)</title><addtitle>J Hand Surg Am</addtitle><description>Purpose 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. Methods 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. Results 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 discrimination <6 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. Conclusions 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. Type of study/level of evidence Therapeutic III.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction</subject><subject>Cubital tunnel syndrome</subject><subject>Cubital Tunnel Syndrome - etiology</subject><subject>Cubital Tunnel Syndrome - physiopathology</subject><subject>Cubital Tunnel Syndrome - surgery</subject><subject>Decompression, Surgical - methods</subject><subject>Diseases of the osteoarticular system</subject><subject>Female</subject><subject>Fingers - innervation</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Mechanoreceptors - physiology</subject><subject>Medical sciences</subject><subject>Microsurgery - methods</subject><subject>Middle Aged</subject><subject>Motor Neurons - physiology</subject><subject>Muscle, Skeletal - surgery</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Orthopedics</subject><subject>Outcome and Process Assessment (Health Care)</subject><subject>prognostic factors</subject><subject>Sensory Thresholds - physiology</subject><subject>Subcutaneous Tissue - surgery</subject><subject>subcutaneous transposition</subject><subject>submuscular transposition</subject><subject>Suture Techniques</subject><subject>Touch - physiology</subject><subject>ulnar nerve</subject><subject>Ulnar Nerve - physiopathology</subject><subject>Ulnar Nerve - surgery</subject><issn>0363-5023</issn><issn>1531-6564</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kk2L1TAUhosoznX0D7iQbnTXevLRtAURhuIXDM7i3lmHND1lUnuTa9IMXH-9KbcouHAVAs_7kjznZNlrAiUBIt5P5fQQVEkB2hJICdA8yXakYqQQleBPsx0wwYoKKLvKXoQwAaQUq55nV6TlBNqm3WW_Onc8Ka8W84h5NxtrtJrzu7hod8SQuzHfx_4Yg46z8rmyw3rXcVEWXQz5wSsbTi6YxTi70ssD5vezTex39KlydD7vYm-W1HqI1uKc78928Kn9ZfZsVHPAV9t5nd1__nTovha3d1--dTe3heasXQolaoV9JRqGwJmgHJqGD0LTduRNP0BV0WqABrUmmvOGkabnVDSCjVrVUPfsOnt36T159zNiWOTRBI3zfPmDFDVpa1rRBNILqL0LweMoT94clT9LAnI1Lie5GpercQlEJuMp9GZrT55w-BvZFCfg7QaokNyOyZg24Q9HCRcVoyJxHy4cJhePBr0M2qDVOBiPepGDM_9_x8d_4nqb5g88Y5hc9DZZlkQGKkHu191YVwPatBbQcvYboU202A</recordid><startdate>20090501</startdate><enddate>20090501</enddate><creator>Charles, Yann Philippe, MD</creator><creator>Coulet, Bertrand, MD, PhD</creator><creator>Rouzaud, Jean-Claude</creator><creator>Daures, Jean-Pierre, MD, PhD</creator><creator>Chammas, Michel, MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20090501</creationdate><title>Comparative Clinical Outcomes of Submuscular and Subcutaneous Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome</title><author>Charles, Yann Philippe, MD ; Coulet, Bertrand, MD, PhD ; Rouzaud, Jean-Claude ; Daures, Jean-Pierre, MD, PhD ; Chammas, Michel, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-a67aeb5683e0436240884d6c29f48bd05525d08ecc1c448318b426863fca707b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction</topic><topic>Cubital tunnel syndrome</topic><topic>Cubital Tunnel Syndrome - etiology</topic><topic>Cubital Tunnel Syndrome - physiopathology</topic><topic>Cubital Tunnel Syndrome - surgery</topic><topic>Decompression, Surgical - methods</topic><topic>Diseases of the osteoarticular system</topic><topic>Female</topic><topic>Fingers - innervation</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Mechanoreceptors - physiology</topic><topic>Medical sciences</topic><topic>Microsurgery - methods</topic><topic>Middle Aged</topic><topic>Motor Neurons - physiology</topic><topic>Muscle, Skeletal - surgery</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Orthopedics</topic><topic>Outcome and Process Assessment (Health Care)</topic><topic>prognostic factors</topic><topic>Sensory Thresholds - physiology</topic><topic>Subcutaneous Tissue - surgery</topic><topic>subcutaneous transposition</topic><topic>submuscular transposition</topic><topic>Suture Techniques</topic><topic>Touch - physiology</topic><topic>ulnar nerve</topic><topic>Ulnar Nerve - physiopathology</topic><topic>Ulnar Nerve - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Charles, Yann Philippe, MD</creatorcontrib><creatorcontrib>Coulet, Bertrand, MD, PhD</creatorcontrib><creatorcontrib>Rouzaud, Jean-Claude</creatorcontrib><creatorcontrib>Daures, Jean-Pierre, MD, PhD</creatorcontrib><creatorcontrib>Chammas, Michel, MD, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of hand surgery (American ed.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Charles, Yann Philippe, MD</au><au>Coulet, Bertrand, MD, PhD</au><au>Rouzaud, Jean-Claude</au><au>Daures, Jean-Pierre, MD, PhD</au><au>Chammas, Michel, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparative Clinical Outcomes of Submuscular and Subcutaneous Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome</atitle><jtitle>The Journal of hand surgery (American ed.)</jtitle><addtitle>J Hand Surg Am</addtitle><date>2009-05-01</date><risdate>2009</risdate><volume>34</volume><issue>5</issue><spage>866</spage><epage>874</epage><pages>866-874</pages><issn>0363-5023</issn><eissn>1531-6564</eissn><coden>JHSUDV</coden><abstract>Purpose 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. Methods 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. Results 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 discrimination <6 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. Conclusions 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. Type of study/level of evidence Therapeutic III.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>19410989</pmid><doi>10.1016/j.jhsa.2009.01.008</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Aged Biological and medical sciences Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction Cubital tunnel syndrome Cubital Tunnel Syndrome - etiology Cubital Tunnel Syndrome - physiopathology Cubital Tunnel Syndrome - surgery Decompression, Surgical - methods Diseases of the osteoarticular system Female Fingers - innervation Follow-Up Studies Humans Male Mechanoreceptors - physiology Medical sciences Microsurgery - methods Middle Aged Motor Neurons - physiology Muscle, Skeletal - surgery Nervous system (semeiology, syndromes) Neurology Orthopedics Outcome and Process Assessment (Health Care) prognostic factors Sensory Thresholds - physiology Subcutaneous Tissue - surgery subcutaneous transposition submuscular transposition Suture Techniques Touch - physiology ulnar nerve Ulnar Nerve - physiopathology Ulnar Nerve - surgery |
| title | Comparative Clinical Outcomes of Submuscular and Subcutaneous Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome |
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