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Effect of Preoperative Ulnar Nerve Subluxation on Outcome Following Endoscopic Cubital Tunnel Release
Tyson Cobb, MD1; Peter Merrell, PA-C2; Jon Lemke, PhD3
1Director of Hand Surgery, Orthopaedic Specialists, PC, Davenport, IA; 2Orthopaedic Specialists, Davenport, IA; 3Biostatistics, Genesis Medical Center, Davenport, IA

Purpose of Study: Ulnar nerve subluxation at the elbow is considered by many surgeons as a contraindication for simple decompression for patients with cubital tunnel syndrome. We hypothesize that there are no differences between patients with and without ulnar nerve subluxation who undergo simple endoscopic decompression of the ulnar nerve with respect to patient satisfaction, pain and modified bishop rating.

Methodology/Design: We reviewed 170 cases of endoscopic ulnar nerve decompression in 149 patients. There were 56 females (5 bilateral) and 93 males (16 bilateral). Surgical indication included persistent numbness and tingling in the ulnar nerve distribution despite conservative treatment. Contraindications included revision surgery, concomitant severe elbow contracture release, mass compressing the ulnar nerve, malunion of the distal humerus with valgus deformity, and ulnar nerve neuritis. Preoperatively 17 patients (11.4%) (2 bilateral) with 19 (11.1%) procedures had ulnar nerve subluxation by preoperative examination. In the subluxing group, the Dellonís grade was mild in 6.7%, moderate in 53.3%, and severe in 40.0%. In the non-subluxing group, the Dellonís grade was mild in 9.0%, moderate in 38.9%, and severe in 52.1%. There was no difference in the Dellonís grade between the study groups (p=0.677).  Postoperatively, patients rated their satisfaction on a 5 point scale and reported presence or absence of elbow pain. Modified Bishop was calculated on patients. Scale data were compared using exact permutation tests for ordered multinomial distributions.

Results: The Bishop rating for the subluxation group was excellent in 76.5%, good in 17.6%, fair in 5.9% with no poor.  For the non-subluxation group, 66.2% had excellent results, 21.6% had good results, 6.8% had fair results, and 5.4% had poor results. There was no difference in the Bishopís rating for the two groups (p=0.440). Postoperatively 87.5% of the subluxators reported no elbow pain compared to 86.7% of the non-subluxators (p=0.931). Satisfaction was rated as completely or mostly satisfied in 88.4% of those with subluxation compared to 76.5% for those with no subluxation (p=0.792).

Conclusions: Preoperative ulnar nerve subluxation in the absence of ulnar nerve neuritis does not affect the outcome after endoscopic cubital tunnel release with respect to patient satisfaction, pain or modified Bishop rating.

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