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Introduction: Cubital Tunnel Syndrome (CuTS) is a common compression neuropathy affecting the upper extremity. Treatment options for CuTS vary, but there is considerable debate over which procedure should be performed for varying degrees of severity. The purpose of our study was to determine, based upon survey responses, how physicians are treating patients with CuTS. We then integrated the results with current literature.
Methods: We surveyed physicians from the American Society of Surgery of the Hand (ASSH). They were presented with six hypothetical cases and asked to choose their preferred treatment from the following options: open in situ decompression, endoscopic decompression, submuscular transposition, subcutaneous transposition, medial epicondylectomy, and conservative management. This was assessed independently and anonymously through an online survey (SurveyMonkey).
Results: The survey invitation was e-mailed to members of ASSH and 135 responded. When asked about occasional paresthesias presenting for greater than 6 months with a normal EMG/NCV, 64% of the respondents said they would continue conservative management. In the case of paresthesias, weakness of intrinsics, and EMG/NCV reports of mild-moderate ulnar nerve entrapment, 63.4% said their preferred treatment would be open in situ decompression. When asked about sensory loss of two-point discrimination of less than 5mm in addition to the presentation above, 67% of respondents picked open in situ in decompression, 24% picked subcutaneous transposition and 21% picked submuscular transposition as their preferred treatment. There was no difference in responses if co-morbidities such as CAD, CKD or uncontrolled DM were present. If symptoms of numbness and weakness were present for more than 1 year, sensory loss of two-point discrimination of more than 10mm and EMG/NCV reports of severe ulnar nerve entrapment, 44.6% of the respondents picked in situ decompression, 21.5% picked subcutaneous transposition and 18.5% picked submuscular transposition. In addition to the above case, if co-morbidities were present, 43.4% picked open in situ decompression and 20% picked conservative management. 74% of the respondents said their treatment algorithm would change with ulnar nerve subluxation.
Conclusion: This is the first study to survey hand surgeons on their preferred treatment for CuTS. Our survey results indicate that open in situ decompression is the preferred operative procedure amongst hand surgeons for CuTS regardless of severity.