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Cubital Tunnel Syndrome in Children and Adolescents: Clinical Presentation and Surgical Outcomes
Nathan Chaclas, BS; Scott J. Mahon, BS; Joseph L. Yellin, MD; Christine Goodbody, MD MBE; Apurva S Shah, MD MBA
The Children's Hospital of Philadelphia, Philadelphia, PA
Introduction: Cubital tunnel syndrome (CuTS) is uncommon in children with limited literature on presentation, treatment, and outcomes. With this investigation to describe the clinical course of CuTS in a pediatric cohort, we hypothesized predictable return to asymptomatic baseline function following surgery.Materials and Methods: A retrospective review was conducted of patients treated operatively for CuTS at a single institution from 2012-2023. Patients with acute fracture(s) were excluded. We collected demographics, injury characteristics, management, surgical technique, complications, and outcomes. Descriptive statistics were performed.Results: 56 patients (27 males) with 62 involved elbows underwent 64 operations for CuTS at a mean age of 15.7±3.1 years. 26 (58%) patients experienced symptoms in the dominant arm, including the majority of athletes (14/19, 74%). A history of elbow trauma (29/64), including prior fracture (17/64), and sports overuse (24/64) were the most common etiologies. 17/24 athletes participated in a throwing sport (11 baseball, 5 softball, 1 lacrosse). Eight cases were idiopathic. Common presenting symptoms included pain (78%) and paresthesias (65%). 16 (25%) patients presented with weakness and seven (11%) with clawing. The most common positive exam maneuver was Tinel's sign (39/50). 18 (28%) patients presented without positive exam findings. Electromyography (EMG) and nerve conduction studies were normal in 15/33 (45%) cases; abnormal EMGs included decreased motor unit potentials in 9/11 and 9/14 measured abductor digiti minimi and first dorsal interossei, respectively. There were 22 (34%) in situ decompressions, 35 (55%) subcutaneous transpositions, and 7 (11%) submuscular transpositions. Three cases required centralization or resection of a "snapping” medial triceps. Both patients with cubitus valgus underwent supracondylar osteotomies. Of nine medial epicondyle fracture cases, seven involved fractures initially treated operatively. 58 (90%) cases resulted in full resolution of symptoms, while one case experienced persistent weakness and five experienced residual pain/paresthesias. No surgical complications were reported.Conclusions: CuTS appears primarily pathology-driven, deviating from the idiopathic presentation common in adults. Patients may present with negative exam/diagnostic findings, so suspicion should be exercised in children with fracture history or athletic overuse. Future work should investigate the utility of primary neurolysis with medial epicondyle fixation. While most children return to baseline with standard surgical treatment, surgeons should be mindful that corrective osteotomy or triceps centralization may be necessary for children with cubitus valgus or snapping triceps, respectively. 
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