Surgical management of ulnar nerve compression at the elbow: an analysis of the literature

Object. Surgical treatment for cubital ulnar nerve compresson includes medi al epicondylectomy, simple decompression, or anterior transposition (subcut aneous. intramuscular. or submuscular). There is a dearth of prospective ra ndomized studies on which to base guidelines for choosing one operative tre atment over another. The authors review the literature on this subject and present their findings. Methods. The authors reviewed the literature from January 1970 to July 1997 . Two authors decided independently whether an article should be included f or review based on previously formulated inclusion and exclusion criteria. In addition to demographic information, data concerning preoperative status and outcome were extracted. For statistical analyses chi-square and Kruska l-Wallis tests win performed. Irrespective of their preoperative status, patients with simple decompressi on had the best outcome. whereas those with anterior subcutaneous and submu scular transposition had the worst. If outcome was related to the patient's preoperative status, a significant difference was not found among the vari ous groups for those patients with a preoperative McGowan Grade 2. However, for those with McGowan Grade 3 (severe) symptoms. patients with anterior i ntramuscular transposition had the best outcome followed by those with simp le decompression and anterior submuscular transposition. Statistical analys is was not possible for patients with Mc Gowan Grade 1 because of the small numbers of patients in several treatment modality groups. Conclusions. Formulating a uniform guideline for operative treatment is not possible bused on the results of this study. However, the authors believe that support is given to their policy, which is primarily to perform a simp le decompression. Its surgical simplicity with preservation of the anatomy, especially the vascularization, and the possibility of rapid postoperative rehabilitation are also taken into consideration. If subluxation is found intraoperatively, anterior transposition is proposed.