Surgical Approach to Cubital Tunnel Syndrome in the Symptomatic Osteoarthritic Elbow

Decompression of the ulnar nerve and removal of osteophytes and free bodies to improve function, to relieve symptoms, and to lessen signs of cubital tunnel syndrome through a single incision. Indications Cubital tunnel syndrome secondaryto a progressing osteoarthritis, with chronic pain, impaired function and grade II or III symptoms of an ulnar entrapment neuropathy. Contraindications Neglected cubital tunnel syndrome with advanced muscle atrophy and marked sensory disturbances. Severe osteoarth ritis of elbow joint. Surgical Technique Single posteromedial skin incision with longitudinal splitting of the common tendon of the triceps brachii muscle. To perform these procedures in a combined fashion: medial epicondylectomy; fenestration of the olecranon fossa to debride osteophytes; medial capsulotomy to resect loose bodies or osteophytes. Postoperative Care The elbow is immobilized in 9 °o of flexion in a cast for 2 weeks. After removal of the sutures, hydrotherapy and active and passive range of motion exercises. Results Between 1978 and 1992 , 25 patients (23 men and two women, age range 15-7o years with a mean of 53 years) underwent combined cubital tunnel decompression and surgical debridement of the elbow joint. Follow-up assessments of all patients were completed after an average of 68 (26-17o) months following surgery. Based on the criteria proposed by the British Nerve Injuries Committee, the clinical results were graded as excellent in six patients, good in 14, fair in four, and failure in one patient. The activity- related pain had improved markedly in ten patients, slightly in four, and was unchanged in six patients. Paresthesia improved in 2o patients and remained unchanged in five patients. The average preoperative grip strength was 26.4 kg and improved to an average of 29 kg.