Endoscopic approach to cubital tunnel syndrome

Friday, September 4 ASSH Scientific Session 1 Room: 3000-3012 (Moscone West) 9:20 - 10:05 AM

Symposium 05 Cubital Tunnel Syndrome – An Endoscopic Approach

Moderator: John D. Lubahn, MD, FACS Faculty: Tyson K. Cobb, MD Reimer Hoffmann, MD

2009 Combined Meeting of the ASSH & ASHT Bridges: Connecting the Past and the Future

Cubital Tunnel Syndrome: An Endoscopic Approach Symposium 5 Tyson Cobb, M.D. ASSH * September 4, 2009 Endoscopic cubital tunnel release is clearly a better choice • Minimally invasive o 2 cm incision • Rapid recovery o 1 week • Safe and reliable o efficacy and failures=open • Simple and fast o 11 minutes

The ulnar nerve does not need to be transposed for idiopathic cubital tunnel syndrome.

Evidence: • •

Prospective Comparison of Simple Decompression vs. Anterior Transposition 152 patients o Relief of Symptoms: Same Complications 23 Anterior transpositions (14 superficial nerves) 7 Simple

(1) Bartels, et al Neurosurgery 2005: 56(3): 522-30

Randomized Study: Simple Decompression vs. Anterior Transposition • 66 patients o No difference in outcomes o Recommended simple decompression because it is less invasive (2) Nabhan, et al JHS (br) 2005; 30(5): 521-4

Prospective Randomized: Simple Decompression vs. Submuscular Transposition 44 patients o No difference in outcomes o Higher complication rate submuscular transposition

Notes

Cubital Tunnel Syndrome: An Endoscopic Approach Symposium 5 Tyson Cobb, M.D. ASSH * September 4, 2009 Studies supporting safety and efficacy of endoscopic cubital tunnel release. 85 Cases Endoscopic Cubital Tunnel Release • • • • • •

Excellent 42% Good 45% Fair 11% Poor 2% Complications: Hematoma in 4 cases Conclusion: safe and reliable

(4) TSAI, et al JHS 1999; 24A:21-29

76 Cases Endoscopic Cubital Tunnel Release • • • • •

Excellent 61% Good 33% Fair 5% Poor 1% Complications o Hematoma: 4 cases o CRPS: 1 case o ABCN Abnormality: 9 cases

(5) Hoffman and Siemionow, JHS B 2006 31B:1:23-29

36 Cases Endoscopic Cubital Tunnel Release • • • • • •

Excellent 58% Good 33% Fair 8% Complications o Hematoma: 1 case 32 patients returned to full duty/activity by 3 weeks 100% satisfied and would have surgery again

(6) Ahcan and Zorman JHS 2007:32A:1171-1176

Notes

Cubital Tunnel Syndrome: An Endoscopic Approach Symposium 5 Tyson Cobb, M.D. ASSH * September 4, 2009 Notes

Author’s own experience with endoscopic cubital tunnel release Endoscopic Cubital Tunnel Release 140 Cases • Dellons: Pre-Op o 8% mild, 43% Moderate, 49% Severe • Bishops: Post Op o 74% Excellent, 22% Good, 4% Fair or poor • Satisfaction: o 59% very satisfied, 23% mostly satisfied, 7% uncertain, 7% mildly dissatisfied, 5% very dissatisfied • Re-operation: 4 cases

Return to Work

Number of Days

80

70

60 Open ECTR

40 20

17 2

7

0 Modifed Work

Regular Work

(7) Cobb TK and Sterbank P: Comparison of Return to Work: Endoscopic Cubital Tunnel. HAND. June 2007: 2(2):73.

•

Resolution of preoperative paresthesias 113 Cases Endoscopic=Literature control open procedures

(8) Cobb TK, Tyler J, Sterbank P and Lemke J: Efficacy of Endoscopic Cubital Tunnel Release. HAND 2008; 3(2):191.

Cubital Tunnel Syndrome: An Endoscopic Approach Symposium 5 Tyson Cobb, M.D. ASSH * September 4, 2009 Results: Resolution of Symptoms Dellon’s Classification Mild Moderate Severe

Endoscopic 100% 80% 66%

Simple Control 91% 60% 33%

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