TY - JOUR
T1 - Comparative Morbidity of Cubital Tunnel Surgeries
T2 - A Prospective Cohort Study
AU - Staples, Robert
AU - London, Daniel A.
AU - Dardas, Agnes Z.
AU - Goldfarb, Charles A.
AU - Calfee, Ryan P.
N1 - Funding Information:
Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR000448, sub-award TL1TR000449, from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH), and Siteman Comprehensive Cancer Center and National Cancer Institute (NCI) Cancer Center Support Grant P30 CA091842, which supported the maintenance and use of REDCap electronic data capture tools, hosted in the Biostatistics Division of Washington University School of Medicine. The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. This funding did not play a direct role in this investigation.
Publisher Copyright:
© 2018 American Society for Surgery of the Hand
PY - 2018/3
Y1 - 2018/3
N2 - Purpose: Randomized controlled trials have not identified a superior surgical approach to cubital tunnel syndrome surgery. This study evaluates the early morbidity of open in situ decompression and transposition. Methods: This prospective cohort study enrolled 125 adult patients indicated for cubital tunnel surgery at a tertiary institution. Exclusion criteria included preoperative use of narcotics and concurrent elbow procedures. In situ decompressions (n = 47) and ulnar nerve transpositions (n = 78) were performed. Data were collected by independent clinicians at 3 postoperative intervals: 1 to 3 weeks, 4 to 8 weeks, and longer than 8 weeks. Postoperative data quantified surgical morbidity: visual analog scale (0–10) surgical site pain, narcotic consumption, patient-reported disability (Levine-Katz, Patient-Reported Elbow Evaluation [PREE] scores). Olecranon paresthesia and wound complications (hematoma, drainage, infection) were recorded. Results: No preoperative differences in age, sex, or the presence of pain existed between the surgical groups. Surgical site pain was not significantly different at any time. Following transposition, a significantly greater percentage of patients were using narcotics at 4 to 8 weeks after surgery and the average total morphine equivalents consumed per patient was significantly greater. Both Levine-Katz and PREE scores indicated greater disability at 1 to 3 and 4 to 8 weeks after transposition, but this significant difference resolved by final follow-up. Olecranon paresthesias occurred after both procedures but were significantly less frequent at 4 to 8 weeks and longer than 8 weeks after decompression. Twelve hematomas occurred following transposition (15%) with 1 requiring operative debridement and 5 hematomas resolved with nonsurgical treatment after in situ decompression (11%). Conclusions: Ulnar nerve transposition imparts greater surgical morbidity than decompression with greater narcotic consumption, more patient-reported disability up to 8 weeks after surgery, and more persistent olecranon paresthesia. However, most differences in surgical morbidity are transient with resolution after 8 weeks following surgery. Type of study/level of evidence: Therapeutic II.
AB - Purpose: Randomized controlled trials have not identified a superior surgical approach to cubital tunnel syndrome surgery. This study evaluates the early morbidity of open in situ decompression and transposition. Methods: This prospective cohort study enrolled 125 adult patients indicated for cubital tunnel surgery at a tertiary institution. Exclusion criteria included preoperative use of narcotics and concurrent elbow procedures. In situ decompressions (n = 47) and ulnar nerve transpositions (n = 78) were performed. Data were collected by independent clinicians at 3 postoperative intervals: 1 to 3 weeks, 4 to 8 weeks, and longer than 8 weeks. Postoperative data quantified surgical morbidity: visual analog scale (0–10) surgical site pain, narcotic consumption, patient-reported disability (Levine-Katz, Patient-Reported Elbow Evaluation [PREE] scores). Olecranon paresthesia and wound complications (hematoma, drainage, infection) were recorded. Results: No preoperative differences in age, sex, or the presence of pain existed between the surgical groups. Surgical site pain was not significantly different at any time. Following transposition, a significantly greater percentage of patients were using narcotics at 4 to 8 weeks after surgery and the average total morphine equivalents consumed per patient was significantly greater. Both Levine-Katz and PREE scores indicated greater disability at 1 to 3 and 4 to 8 weeks after transposition, but this significant difference resolved by final follow-up. Olecranon paresthesias occurred after both procedures but were significantly less frequent at 4 to 8 weeks and longer than 8 weeks after decompression. Twelve hematomas occurred following transposition (15%) with 1 requiring operative debridement and 5 hematomas resolved with nonsurgical treatment after in situ decompression (11%). Conclusions: Ulnar nerve transposition imparts greater surgical morbidity than decompression with greater narcotic consumption, more patient-reported disability up to 8 weeks after surgery, and more persistent olecranon paresthesia. However, most differences in surgical morbidity are transient with resolution after 8 weeks following surgery. Type of study/level of evidence: Therapeutic II.
KW - Cubital tunnel
KW - in situ decompression
KW - morbidity
KW - transposition
UR - http://www.scopus.com/inward/record.url?scp=85042747478&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2017.10.033
DO - 10.1016/j.jhsa.2017.10.033
M3 - Article
C2 - 29223632
AN - SCOPUS:85042747478
SN - 0363-5023
VL - 43
SP - 207
EP - 213
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 3
ER -