Background:The measurement of cross-sectional area (CSA) is a diagnostic tool to detect entrapments syndrome. The aim of this study was to compare the clinical outcome in elbows undergoing endoscopic and “in situ” open cubital tunnel release for cubital tunnel syndrome (CuTS) using ultrasound-related changes in the largest CSA of the ulnar nerve. The purpose is to determine the association between clinical outcome and CSA. Methods: From May 2011 to April 2016, 60 patients with CuTS were prospectively followed and not randomly divided in two groups: 30 patients undergoing an endoscopic release (ER) and 30 patients with “in situ” open neurolysis (OR). A sonographic examination was performed by the senior authors at baseline and 3, 6, and 12 months after surgical decompression. Results: CSA values were statistically significantly lower in the ER. Hand grip strength difference with Jamar test was not statistically significant a 12 months (39 kg vs 27 kg). Static-2 point discrimination test difference was only statistically significant lower in the endoscopic group at 3, 6 and 12 months but not clinically relevant (5 mm vs 6 mm). The American Shoulder and Elbow Surgeons—Elbow questionnaire (ASES-e) function score, ASES-e Pain score, and ASES-e Satisfaction score were not statistically significant different between the two groups at 3, 6, and 12 months post operatively. Conclusions: The study confirms that in spite of lower values of CSA in the ER, there is not a statistically significant difference between the two techniques in terms of subjective outcomes. Ultrasound (US) measurements seem to have a limited value in clinical results of patients treated for entrapment neuropathy of the ulnar nerve.
LatinovicRGullifordMCHughesRA. Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry. 2006;77(2):263-265.
2.
MondelliMGianniniFBalleriniM, et al. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci. 2005;234(1-2):5-10.
3.
ChildressH. Recurrent ulnar-nerve dislocation at the elbow. J Bone Joint Surg. 1956;38-A(5):978-984.
4.
RempelDDahlinLLundborgG. Pathophysiology of nerve compression syndromes: response of peripheral nerves to loading. J Bone Joint Surg Am. 1999;81(11):1600-1610.
5.
StruthersSJ. On some points in the abnormal anatomy of the arm. Br Foreign Med Chir Rev. 1854;12:523-533.
6.
OsborneGV. Compression neuritis of the ulnar nerve at the elbow. Hand. 1970;2(1):10-13.
7.
AmadioPCBeckenbaughRD. Entrapment of the ulnar nerve by the deep flexor-pronator aponeurosis. J Hand Surg Am. 1986;11(1):83-87.
8.
SzaboRMKwakC. Natural history and conservative management of cubital tunnel syndrome. Hand Clin. 2007;23(3):311-318, v-vi.
9.
TsaiTMChenICMajdME, et al. Cubital tunnel release with endoscopic assistance: results of a new technique. J Hand Surg Am. 1999 Jan;24(1):21-29.
10.
WattsACBainGI. Patient-rated outcome of ulnar nerve decompression: a comparison of endoscopic and open in situ decompression. J Hand Surg Am. 2009;34(8):1492-1498.
11.
BolsterMAZöphelOTvan den HeuvelER, et al. Cubital tunnel syndrome: a comparison of an endoscopic technique with a minimal invasive open technique. J Hand Surg Eur. 2014;39(6):621-625.
12.
HoffmannRSiemionowM. The endoscopic management of cubital tunnel syndrome. J Hand Surg Br. 2006;31(1):23-29.
13.
MartinoliCBianchiSDerchiLE. Ultrasonography of peripheral nerves. Semin Ultrasound CT MR. 2000;21(3):205-213.
14.
ChiouHJChouYHChengSP, et al. Cubital tunnel syndrome: diagnosis by high-resolution ultrasonography. J Ultrasound Med. 1998;17(10):643-648.
15.
WieslerERChlorosGDCartwrightMS, et al. Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel. J Hand Surg Am. 2006;31(7):1088-1093.
16.
YoonJSWalkerFOCartwrightMS. Ultrasonographic swelling ratio in the diagnosis of ulnar neuropathy at the elbow. Muscle Nerve. 2008;38(4):1231-1235.
17.
JacobDCreteurVCourthaliacC, et al. Sonoanatomy of the ulnar nerve in the cubital tunnel: a multicentre study by the GEL. Eur Radiol. 2004;14(10):1770-1773.
18.
BayrakAOBayrakIKTurkerH, et al. Ultrasonography in patients with ulnar neuropathy at the elbow: comparison of cross-sectional area and swelling ratio with electrophysiological severity. Muscle Nerve. 2010;41(5):661-666.
19.
PatelPNorburyJWFangX. Sonographic measurements of the ulnar nerve at the elbow with different degrees of elbow flexion. PM R. 2014;6(5):395-399.
20.
LikertR. Technique for the measure of attitudes. Arch Psycho. 1932;22(140):5-55.
21.
KingGJRichardsRRZuckermanJD, et al. A standardized method for assessment of elbow function. Research Committee, American Shoulder and Elbow Surgeons. J Shoulder Elbow Surg. 1999;8(4):351-354.
22.
KruskalWHWallisA. Use of ranks in one-criterion variance analysis. J Am Stat Assoc. 1952;47(260):583-621.
23.
FisherRA. On the interpretation of χ2 from contingency tables, and the calculation of P. J R Stat Soc. 1922;85(1):87-94.
24.
GelbermanRHYamaguchiKHollstienSB, et al. Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow. An experimental study in human cadavera. J Bone Joint Surg Am. 1998;80(4):492-501.
25.
HeinemeyerOReimersCD. Ultrasound of radial, ulnar, median, and sciatic nerves in healthy subjects and patients with hereditary motor and sensory neuropathies. Ultrasound Med Biol. 1999;25(3):481-485.
26.
RichardsonJKGreenDFJamiesonSC, et al. Gender, body mass and age as risk factor for ulnar mononeuropathy at the elbow. Muscle Nerve. 2001;24(4):551-554.
27.
QrimliMEbadiHBreinerA, et al. Reference values for ultrasonograpy of peripheral nerves. Muscle Nerve. 2016;53(4):538-544.
28.
CartwrightMSShinHWPassmoreLV, et al. Ultrasonographic findings of the normal ulnar nerve in adults. Arch Phys Med Rehabil. 2007;88(3):394-396.
29.
KutlayMColakASimşekH, et al. Use of ultrasonography in ulnar nerve entrapment surgery: a prospective study. Neurosurg Rev. 2009;32(2):225-232.
30.
SchertzMMutschlerCMasmejeanE, et al. High-resolution ultrasound in etiological evaluation of ulnar neuropathy at the elbow. Eur J Radiol. 2017;95:111-117.
31.
ThoirsKWilliamsMAPhillipsM. Ultrasonographic measurements of the ulnar nerve at the elbow: role of confounders. J Ultrasound Med. 2008;27(5):737-743.
32.
BeekmanRWokkeJHSchoemakerMC, et al. Ulnar neuropathy at the elbow: follow-up and prognostic factors determining outcome. Neurology. 2004;63(9):1675-1680.
33.
DuetzmannSKrishnanKGStaubF, et al. Cross-sectional area of the ulnar nerve after decompression at the cubital tunnel. J Hand Surg Eur Vol. 2016;41(8):838-842.
34.
AbicalafCAde BarrosNSernikRA, et al. Ultrasound evaluation of patients with carpal tunnel syndrome before and after endoscopic release of the transverse carpal ligament. Clin Radiol. 2007;62(9):891-894.
35.
VögelinENüeschEJüniP, et al. Sonographic follow-up of patients with carpal tunnel syndrome undergoing surgical or nonsurgical treatment: prospective cohort study. J Hand Surg Am. 2010;35(9):1401-1409.
36.
TasSStaub DombertTMarquardtG, et al. Sonographic short-term follow-up after surgical decompression of the median nerve at the carpal tunnel: a single-center prospective observational study. Neurosurg Focus. 2015;39(3):E6.
37.
RenYMZhouXHQiaoHY, et al. Open versus endoscopic in situ decompression in cubital tunnel syndrome: a systematic review and meta-analysis. Int J Surg. 2016;35:104-110.
38.
AldekhayelSGovshievichALeeJ, et al. Endoscopic versus open cubital tunnel release: a systematic review and meta-analysis. Hand (N Y). 2016;11(1):36-44.
39.
BuchananPJChiengLOHubbardZS, et al. Endoscopic versus open in situ cubital tunnel release: a systematic review of the literature and meta-analysis of 655 patients. Plast Reconstr Surg. 2018;141(3):679-684.
