The rationale for and efficacy of surgical intervention for electrodiagnostic-negative cubital tunnel syndrome

Because conservative management of McGowan grade 1 cubital tunnel syndrome (symptoms only) may be successful in a high percentage of patients, normal electrodiagnostic studies and the absence of intrinsic muscle weakness or decreased sensation or both may be viewed as contraindications to operative intervention. Because the results of surgery are known to be inferior once objective motor weakness and abnormal 2-point sensory discrimination (McGowan grades 2 and 3) develop, however, we advocate surgical intervention for patients with symptoms only, even when electrodiagnostic studies are normal. We enrolled 16 patients (18 elbows) with McGowan I cubital syndrome who underwent in situ ulnar nerve release and medial epicondylectomy. Paresthesias resolved in all cases, and both elbow range of motion and grip strength returned to normal in 17 of 18 elbows. The elbow flexion test resolved in all cases, and a Tinel's sign was present at final review in 5 elbows (28%). One patient required another operation to address a neuroma of a posterior branch of the medial antebrachial cutaneous nerve, but additional morbidity was not identified after objective review and patient self-assessment.