The Surgical Treatment of Cubital Tunnel Syndrome: A Decision Analysis

Cubital Tunnel Syndrome is the most common cause of numbness on the ulna aspect of the wrist. Cubital tunnel syndrome arises due to compression of the ulnar nerve at the site of the cubital tunnel on the inner aspect of the elbow.

Authors of this study looked to compare the four most common surgical procedures for cubital tunnel syndrome. These were; simple decompression of the nerve in the cubital tunnel, medial epicondylectomy, anterior subcutaneous transposition and anterior submuscular transposition.

The authors' objective was to use decision analysis to compare these four surgical methods. This allows all possible outcomes to be considered, and the probability that an outcome will occur is estimated from the literature.
The decision analysis was brought about by a PC-based software programme SMLTREE, founded in the USA.

Results of this study show a simple decompression of the cubital tunnel was the preferred method of surgical intervention. Then in decreasing outcomes were subcutaneous transposition, submuscular transposition and medial epicondylectomy providing the least supporting results.

However, although results show simple decompression is the preferred surgical method in moderate to severe cubital tunnel syndrome, if sensory symptoms are not improved submuscular transposition results as the salvage procedure.

Mr Mike Hayton routinely performs simple decompression of the ulnar nerve at the cubital tunnel. However in the rare cases if this surgery fails to help he would consider anterior transposition in agreement with the above.

Brauer. C.A., and Graham. B.
Journal of Hand Surgery (European Volume, 2007) 32E: 6: 654-662