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Surgical Decision Making for Mild-to-Moderate Cubital Tunnel Syndrome
Ikenna C Onyekwere1, Christian Victoria1, Arin Kim1
1Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY.
Journal of Hand Surgery Global Online
|May 31, 2024
Summary
Predicting surgery for cubital tunnel syndrome (CuTS) is difficult. Electrodiagnostic severity is a key predictor, but patient-reported impairment may further refine surgical decisions for mild to moderate cases.
Area of Science:
- Orthopedic Surgery
- Neurology
- Diagnostic Imaging
Background:
- Ulnar neuropathy management lacks clear guidelines.
- Identifying surgical candidates for mild-to-moderate cubital tunnel syndrome (CuTS) is challenging due to subtle symptoms.
Purpose of the Study:
- To identify predictors of surgical intervention in patients with McGowan mild or moderate CuTS.
- To improve treatment decision-making for CuTS.
Main Methods:
- Retrospective study of 73 patients (103 elbows) with mild/moderate CuTS from March 2016 to July 2022.
- Concurrent electrodiagnostic and ultrasound evaluations were performed.
- Multivariable logistic regression analyzed predictors of surgical treatment.
Main Results:
- Electrodiagnostically severe CuTS cases had 3.7 times higher odds of surgical treatment (aOR=3.7, P=.03).
- Positive electrodiagnostic findings (e.g., motor nerve conduction velocity <50 m/s) were associated with surgery.
- Ultrasound identified CuTS in 29/59 electrodiagnostically normal cases.
Conclusions:
- Objective findings alone have limited ability to predict surgical need in mild/moderate CuTS.
- Patient-reported impairment may help guide surgical decisions.
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