This protocol applies to patients with cubital tunnel syndrome who present with intermittent paresthesias in the ulnar nerve distribution — without first dorsal interosseous muscle weakness, without intrinsic hand muscle atrophy, and without axonal loss on electrodiagnostic studies — and in whom a full course of conservative management has failed to resolve symptoms at three months.
Intermittent sensory symptoms in the ulnar nerve distribution, with an otherwise intact neurological examination: no motor deficit, no muscle wasting, and no axonal loss on electrodiagnostic testing. Patients meeting this profile are candidates for an initial non-operative approach; escalation to the present protocol occurs when that approach does not achieve symptom resolution.
A structured conservative programme — comprising elbow extension night splinting, elbow pads, activity modification with avoidance of provocative elbow flexion and triceps exercises, nonsteroidal anti-inflammatory drugs, physical therapy, pulsed signal therapy, postural and behavioural modification, ergonomics education, and corticosteroid injection at the cubital tunnel — did not achieve resolution of intermittent paresthesias in the ulnar nerve distribution by three months.
When the conservative programme fails, a surgical intervention at the elbow is indicated. The choice of technique is guided by intraoperative findings and individual patient factors, rather than a single fixed approach for all cases.
DOI: 10.1016/j.jhsg.2022.07.008
Patients with intermittent symptoms and clinical examination consistent with CuTS without evidence of axon loss, weakness, or atrophy are candidates for nonoperative treatment.
The procedure involves releasing the points of compression from the ulnar nerve without mobilizing it anterior to the medial epicondyle and performing a soft tissue stabilization procedure.
Currently, history or examination consistent with ulnar nerve instability, recurrent disease, and muscle atrophy are the most common indicators for transposition.
Current indications for medial epicondylectomy include patients with hypermobile nerves, pre-existing vascular disease where transposition could potentially worsen ischemia, and thin patients.
View source ↗