Epicondylectomy combined with local fat flap versus anterior nerve transposition in surgical treatment of cubital tunnel
Tarik Mujadzic, MD1, Charles Gober, MD2, Mirza M Mujadzic, MD3, Abdelaziz Atwez, MD4, Elliot Chen, M.D.1 and Mirsad Mujadzic, MD1, (1)University of South Carolina, Columbia, SC, (2)Augusta University, Augusta,, GA, (3)Saint Louis University School of Medicine, St. Louis, MO, (4)Prisma Health, Columbia, SC
Compression neuropathy of the ulnar nerve at the elbow is the second most common entrapment neuropathy of the upper extremity. Surgical treatment options include simple decompression, decompression with medial epicondylectomy, anterior transposition to a subcutaneous position, and anterior transposition to a submuscular or subfascial position. However, the literature is unable to elucidate the superiority of one procedure over another. The purpose of this study is to use a retrospective chart review to compare two techniques, medial epicondylectomy combined with local fat flap versus ulnar nerve anterior transposition, to evaluate the outcomes regarding the potential for neurological recovery, localized tenderness, and recurrence. Patients who underwent medial epicondylectomy (n=32) were classified into mild (3.1%), moderate (15.6%) and severe (81.3%) categories. For this group, the complete resolution of symptoms occurred <6 weeks (12.5%), 6 weeks-3 months (3.13%), and >3 months (18.75%). Incomplete resolution was documented as improved (65.6%), unchanged (0%), or worse (0%). Scar discomfort was documented as lasting >4 weeks (9.4%) and unresolved (0%). The recurrence rate (3.1%) and the need for a second surgery (3.1%) were also recorded. Patients who underwent subcutaneous anterior transposition (n=33) were classified into mild (3.0%), moderate (48.5%), and severe (48.5%) categories. For this group, the complete resolution of symptoms occurred <6 weeks (12.1%), 6 weeks-3 months (12.1%), and >3 months (21.2%). The incomplete resolution was documented as improved (36.4%), unchanged (12.1%), or worse (6.1%). Scar discomfort was documented as lasting >4 weeks (33.3%), unresolved (24.2%). The recurrence rate (15.2%) and the need for a second surgery (39.4%) were also recorded. We concluded that medial epicondylectomy provides less tenderness at the site and less recurrence. There was no significant difference in the potential for neurological recovery.
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