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Susan E. Mackinnon - One of the best experts on this subject based on the ideXlab platform.
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beyond the Cubital Tunnel use of adjunctive procedures in the management of Cubital Tunnel Syndrome
Hand, 2021Co-Authors: Adam G Evans, William M Padovano, Megan J M Patterson, Matthew D Wood, Warangkana Fongsri, Carie R Kennedy, Susan E. MackinnonAbstract:Background:Our management of Cubital Tunnel Syndrome has expanded to involve multiple adjunctive procedures, including supercharged end-to-side anterior interosseous to ulnar nerve transfer, cross-...
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compound muscle action potential amplitude predicts the severity of Cubital Tunnel Syndrome
Journal of Bone and Joint Surgery American Volume, 2019Co-Authors: Hollie A Power, Ketan Sharma, Madi Elhaj, Amy M Moore, Megan M Patterson, Susan E. MackinnonAbstract:BACKGROUND Cubital Tunnel Syndrome has a spectrum of presentations ranging from mild paresthesias to debilitating numbness and intrinsic atrophy. Commonly, the classification of severity relies on clinical symptoms and slowing of conduction velocity across the elbow. However, changes in compound muscle action potential (CMAP) amplitude more accurately reflect axonal loss. We hypothesized that CMAP amplitude would better predict functional impairment than conduction velocity alone. METHODS A retrospective cohort of patients who underwent a surgical procedure for Cubital Tunnel Syndrome over a 5-year period were included in the study. All patients had electrodiagnostic testing performed at our institution. Clinical and electrodiagnostic variables were recorded. The primary outcome was preoperative functional impairment, defined by grip and key pinch strength ratios. Multivariable regression identified which clinical and electrodiagnostic variables predicted preoperative functional impairment. RESULTS Eighty-three patients with a mean age of 57 years (75% male) were included in the study. The majority of patients (88%) had abnormal electrodiagnostic studies. Fifty-four percent had reduced CMAP amplitude, and 79% had slowing of conduction velocity across the elbow (recorded from the first dorsal interosseous). On bivariate analysis, older age and longer symptom duration were significantly associated (p < 0.05) with reduced CMAP amplitude and slowing of conduction velocity across the elbow, whereas body mass index (BMI), laterality, a primary surgical procedure compared with revision surgical procedure, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores, and visual analog scale (VAS) scores for pain were not. Multivariable regression analysis demonstrated that reduced first dorsal interosseous CMAP amplitude independently predicted the loss of preoperative grip and key pinch strength and that slowed conduction velocity across the elbow did not. CONCLUSIONS Reduced first dorsal interosseous amplitude predicted preoperative weakness in grip and key pinch strength, and isolated slowing of conduction velocity across the elbow did not. CMAP amplitude is a sensitive indicator of axonal loss and an important marker of the severity of Cubital Tunnel Syndrome. It should be considered when counseling patients with regard to their prognosis and determining the necessity and timing of operative intervention. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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validity and responsiveness of the dash questionnaire as an outcome measure following ulnar nerve transposition for Cubital Tunnel Syndrome
Plastic and Reconstructive Surgery, 2013Co-Authors: Gregory C Ebersole, Kristen M Davidge, Marci S Damiano, Susan E. MackinnonAbstract:BACKGROUND This study sought to determine the validity and responsiveness of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire in Cubital Tunnel Syndrome. METHODS Consecutive patients with Cubital Tunnel Syndrome treated by anterior ulnar nerve transposition between September of 2009 and December of 2011 were reviewed retrospectively. Questionnaires were completed preoperatively and 1.5, 3, 6, and 12 months postoperatively. The relationship of the questionnaire to measures of pain, health status (Short Form-8), and pinch and grip strength was evaluated using Spearman's correlation coefficients. Responsiveness of the questionnaire was analyzed using Cohen's effect size, and was compared with responsiveness of the physical examination, pain, and Short Form-8 measures. RESULTS The final cohort included 69 patients with isolated Cubital Tunnel Syndrome and 39 with concurrent Cubital and carpal Tunnel Syndrome. Questionnaire scores correlated as expected with other measures. Moderate to strong correlations were observed with pain visual analogue scale and Short Form-8 scores, and weak to moderate correlations were observed with pinch and grip strength. Effect sizes for the DASH questionnaire were small ( 0.8) at all postoperative time points, whereas Short Form-8 and pinch and grip strength were poorly responsive. CONCLUSION The Disabilities of the Arm, Shoulder, and Hand questionnaire is a valid measure in Cubital Tunnel Syndrome, and is moderately responsive to change beyond 3-month follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, II.
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scratch collapse test localizes osborne s band as the point of maximal nerve compression in Cubital Tunnel Syndrome
Hand, 2010Co-Authors: Justin Brown, David B Mokhtee, Maristella S Evangelista, Susan E. MackinnonAbstract:The objective of this study is to demonstrate the utility of the scratch collapse test (SCT) in localizing the point of maximal compression in Cubital Tunnel Syndrome. From January 1, 2004 to December 1, 2005, 64 adult patients with Cubital Tunnel Syndrome were evaluated by a single surgeon. Cubital Tunnel Syndrome was diagnosed based upon symptoms of numbness, tingling, and/or pain in the ulnar nerve distribution or by the presence of weakness or wasting of the ulnar-innervated intrinsic hand muscles. All diagnoses were confirmed with electrodiagnostic studies. As part of the physical examination, the SCT was performed along three subdivided segments in the region of the Cubital Tunnel. Results of the SCT were recorded and correlated with intraoperative findings. Of the 64 patients evaluated, 44 had a positive SCT that was either more profound or solely present a few centimeters distal to the medial epicondyle in the region of Osborne’s band. All of these patients subsequently underwent anterior submuscular transposition and were found to have a tight compression point at Osborne’s band corresponding to their preoperative SCT. This study suggests that the scratch collapse test may be a reliable physical examination technique for localizing the point of maximal nerve compression in patients with Cubital Tunnel Syndrome. That point, in this series, corresponded with Osborne’s band.
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scratch collapse test for evaluation of carpal and Cubital Tunnel Syndrome
Journal of Hand Surgery (European Volume), 2008Co-Authors: Christine J Cheng, Brendan Mackinnonpatterson, John L Beck, Susan E. MackinnonAbstract:Purpose The purpose of this study was to evaluate the clinical usefulness of a new test, the scratch collapse test , for the diagnosis of carpal Tunnel Syndrome and Cubital Tunnel Syndrome. Methods The scratch collapse test was prospectively compared with Tinel's sign and flexion/nerve compression in 169 patients and 109 controls. One hundred nineteen patients were diagnosed with carpal Tunnel Syndrome and 70 patients were diagnosed with Cubital Tunnel Syndrome based on history, examination, and positive electrodiagnostic test. For the new test, the patient resisted bilateral shoulder external rotation with elbows flexed. The area of suspected nerve compression was lightly "scratched," and then resisted shoulder external rotation was immediately repeated. Momentary loss of shoulder external rotation resistance on the affected side was considered a positive test. The sensitivity, specificity, and predictive values were calculated. Results For carpal Tunnel Syndrome, sensitivities were 64%, 32%, and 44% for the scratch collapse test, Tinel's test, and wrist flexion/compression test, respectively. For Cubital Tunnel Syndrome, sensitivities were 69%, 54%, and 46% for the scratch collapse test, Tinel test, and elbow flexion/compression test, respectively. The scratch collapse test had the highest negative predictive value (73%) for carpal Tunnel Syndrome. Tinel's test had the highest negative predictive value (98%) for Cubital Tunnel Syndrome. Specificity and positive predictive values were high for all of the tests. Conclusions The scratch collapse test had significantly higher sensitivity than Tinel's test and the flexion/nerve compression test for carpal Tunnel and Cubital Tunnel Syndromes. Accuracy for this test was 82% for carpal Tunnel Syndrome and 89% for Cubital Tunnel Syndrome. This novel test provides a useful addition to existing clinical maneuvers in the diagnosis of these common nerve compression Syndromes. Type of study/level of evidence Diagnostic II.
James R Sanger - One of the best experts on this subject based on the ideXlab platform.
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anconeus epitrochlearis muscle associated with Cubital Tunnel Syndrome a case series
Hand, 2019Co-Authors: Nicholas Kim, Ryan Stehr, Hani S Matloub, James R SangerAbstract:Background: Cubital Tunnel Syndrome is a common compressive neuropathy of the upper extremity. The anconeus epitrochlearis muscle is an unusual but occasional contributor. We review our experience with this anomalous muscle in elbows with Cubital Tunnel Syndrome. Methods: We retrospectively reviewed charts of 13 patients noted to have an anconeus epitrochlearis muscle associated with Cubital Tunnel Syndrome. Results: Ten patients had unilateral ulnar neuropathy supported by nerve conduction studies. Three had bilateral Cubital Tunnel Syndrome symptoms with 1 of those having normal nerve conduction studies for both elbows. Eight elbows were treated with myotomy of the anconeus epitrochlearis muscle and submuscular transposition of the ulnar nerve. The other 8 elbows were treated with myotomy of the anconeus epitrochlearis muscle and in situ decompression of the ulnar nerve only. All but 1 patient had either clinical resolution or improvement of symptoms at follow-up ranging from 2 weeks to 1 year after surgery. The 1 patient who had persistent symptoms had received myotomy and in situ decompression of the ulnar nerve only. Conclusions: An anomalous anconeus epitrochlearis occasionally results in compression of the ulnar nerve but is usually an incidental finding. Its contribution to compression neuropathy can be tested intraoperatively by passively ranging the elbow while observing the change in vector and tension of its muscle fibers over the ulnar nerve. Regardless of findings, we recommend myotomy of the muscle and in situ decompression of the ulnar nerve. Submuscular transposition of the ulnar nerve may be necessary if there is subluxation.
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anconeus epitrochlearis muscle associated with Cubital Tunnel Syndrome a case series
Hand, 2019Co-Authors: Ryan Stehr, Hani S Matloub, James R SangerAbstract:Background: Cubital Tunnel Syndrome is a common compressive neuropathy of the upper extremity. The anconeus epitrochlearis muscle is an unusual but occasional contributor. We review our experience ...
Kelly A. Lefaivre - One of the best experts on this subject based on the ideXlab platform.
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outcomes measures used to assess results after surgery for Cubital Tunnel Syndrome a systematic review of the literature
Journal of Hand Surgery (European Volume), 2009Co-Authors: Sheina A Macadam, Michael Bezuhly, Kelly A. LefaivreAbstract:Purpose The primary objective of this systematic review was to identify and analyze the outcomes measures that have been used to evaluate postoperative results following surgery for Cubital Tunnel Syndrome. The secondary objective was to compare the postoperative results among patients evaluated using patient-satisfaction instruments to those evaluated using surgeon-reported scales. Methods Computerized database searches of MEDLINE, EMBASE, and MEDLINE In-Process were performed. Studies involving adults with Cubital Tunnel Syndrome in whom the surgical intervention was simple decompression, anterior transposition (subcutaneous, submuscular or intramuscular), endoscopic decompression, or medial epicondylectomy were included. A systematic review was performed that included randomized controlled trials, comparative observational studies, noncomparative observational studies, and case series. Results This systematic review of the literature identified 42 studies that satisfied the inclusion criteria. The authors identified 21 health outcomes measures used in Cubital Tunnel studies. These consisted of 2 generic instruments; 10 symptom-specific, author-reported instruments; 3 symptom-specific, patient-reported instruments; and 6 patient questionnaires. No measure demonstrated adequate development or validation for use in its target population. Available data revealed a consistently high level of patient satisfaction following simple decompression or submuscular transposition (65% to 92%). The results of the author-reported, symptom-specific scales varied widely and showed no obvious association with patient satisfaction. The variation in reporting of results prevented statistical comparisons between author-reported results and patient-reported results. Conclusions To the best of our knowledge, this is the first systematic review to delineate the outcomes measures used to evaluate the treatment of Cubital Tunnel Syndrome. Our results show that reliable, reproducible, and valid outcomes measures are lacking from the surgical literature. A standardized assessment protocol for ulnar neuropathy is required for future comparison trials. Type of study/level of evidence Therapeutic III.
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simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for Cubital Tunnel Syndrome a meta analysis
Journal of Hand Surgery (European Volume), 2008Co-Authors: Sheina A Macadam, Michael Bezuhly, Rajiv Gandhi, Kelly A. LefaivreAbstract:Purpose Optimal surgical management of Cubital Tunnel Syndrome remains uncertain despite the publication of numerous case series, observational studies, systematic reviews, and, in recent years, randomized controlled studies. The purpose of this meta-analysis was to compare simple decompression to anterior transposition of the ulnar nerve for the treatment of this condition, using comparative trials and randomized controlled trials. Methods Computerized database searches of MEDLINE, EMBASE, Cochrane Central, and all relevant surgical archives were performed. Studies involving adults with Cubital Tunnel Syndrome in whom surgical intervention was simple decompression or anterior transposition (subcutaneous or submuscular) were included. Analysis was limited to randomized controlled trials and comparative observational studies. Included studies were assessed for quality, heterogeneity, and publication bias. Odds ratios of clinical improvement comparing simple decompression to anterior transposition (submuscular or subcutaneous) were calculated for each study. Results Ten studies involving a total of 449 simple decompressions, 342 subcutaneous transpositions, and 115 submuscular transpositions were included. There was little evidence of publication bias or statistical study heterogeneity. Odds of improvement with simple decompression versus anterior transposition were 0.751, 95% confidence interval (0.542, 1.040). Subanalyses on the basis of transposition technique (subcutaneous or submuscular) and study quality did not render a statistically significant result. Conclusions This report represents the best cumulative evidence to date examining the surgical management of Cubital Tunnel Syndrome. In this study, we found no statistically significant difference, but rather a trend toward an improved clinical outcome with transposition of the ulnar nerve as opposed to simple decompression. Additional prospective, randomized studies that use reproducible preoperative and postoperative objective measures might add statistical power to this finding. Type of study/level of evidence Therapeutic II.
Ryan P. Calfee - One of the best experts on this subject based on the ideXlab platform.
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Cubital Tunnel Syndrome: Current Concepts.
The Journal of the American Academy of Orthopaedic Surgeons, 2017Co-Authors: Jonathan Robert Staples, Ryan P. CalfeeAbstract:Cubital Tunnel Syndrome is the second most common upper extremity compressive neuropathy. In recent years, rates of surgical treatment have increased, and the popularity of in situ decompression has grown. Nonsurgical treatment, aiming to decrease both compression and traction on the ulnar nerve about the elbow, is successful in most patients with mild nerve dysfunction. Recent randomized controlled trials assessing rates of symptom resolution and ultimate success have failed to identify a preferred surgical procedure. Revision Cubital Tunnel surgery, most often consisting of submuscular transposition, may improve symptoms. However, ulnar nerve recovery after revision Cubital Tunnel surgery is less consistent than that after primary Cubital Tunnel surgery.
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the management of Cubital Tunnel Syndrome
Journal of Hand Surgery (European Volume), 2015Co-Authors: Sean Boone, Richard H Gelberman, Ryan P. CalfeeAbstract:Symptomatic Cubital Tunnel Syndrome is a condition that frequently prompts patients to seek hand surgical care. Although Cubital Tunnel Syndrome is readily diagnosed, achieving complete symptom resolution remains challenging. This article reviews related anatomy, clinical presentation, and current management options for Cubital Tunnel Syndrome with an emphasis on contemporary outcomes research.
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outcomes of rigid night splinting and activity modification in the treatment of Cubital Tunnel Syndrome
Journal of Hand Surgery (European Volume), 2013Co-Authors: Chirag M Shah, Ryan P. Calfee, Richard H Gelberman, Charles A GoldfarbAbstract:Purpose To prospectively analyze, using validated outcome measures, symptom improvement in patients with mild to moderate Cubital Tunnel Syndrome treated with rigid night splinting and activity modifications. Methods Nineteen patients (25 extremities) were enrolled prospectively between August 2009 and January 2011 following a diagnosis of idiopathic Cubital Tunnel Syndrome. Patients were treated with activity modifications as well as a 3-month course of rigid night splinting maintaining 45° of elbow flexion. Treatment failure was defined as progression to operative management. Outcome measures included patient-reported splinting compliance as well as the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and the Short Form-12. Follow-up included a standardized physical examination. Subgroup analysis included an examination of the association between splinting success and ulnar nerve hypermobility. Results Twenty-four of 25 extremities were available at mean follow-up of 2 years (range, 15–32 mo). Twenty-one of 24 (88%) extremities were successfully treated without surgery. We observed a high compliance rate with the splinting protocol during the 3-month treatment period. Quick Disabilities of the Arm, Shoulder, and Hand scores improved significantly from 29 to 11, Short Form-12 physical component summary score improved significantly from 45 to 54, and Short Form-12 mental component summary score improved significantly from 54 to 62. Average grip strength increased significantly from 32 kg to 35 kg, and ulnar nerve provocative testing resolved in 82% of patients available for follow-up examination. Conclusions Rigid night splinting when combined with activity modification appears to be a successful, well-tolerated, and durable treatment modality in the management of Cubital Tunnel Syndrome. We recommend that patients presenting with mild to moderate symptoms consider initial treatment with activity modification and rigid night splinting for 3 months based on a high likelihood of avoiding surgical intervention. Type of study/level of evidence Therapeutic II.
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outcomes following modified oblique medial epicondylectomy for treatment of Cubital Tunnel Syndrome
Journal of Hand Surgery (European Volume), 2013Co-Authors: Daniel A Osei, Ryan P. Calfee, Eric M Padegimas, Richard H GelbermanAbstract:Purpose To quantify and define objective and patient-rated outcomes after our modification of medial epicondylectomy for the treatment of Cubital Tunnel Syndrome. Although medial epicondylectomy has been previously studied, data are lacking regarding elbow-specific outcomes after our technique that aims to minimize complications historically associated with medical epicondylectomy. Methods A total of 27 subjects with clinical and electrodiagnostic evidence of Cubital Tunnel Syndrome underwent a modified oblique medial epicondylectomy that was designed to minimize bony resection and preserve the origin of the ulnar collateral ligament of the elbow. Average age was 57 years, mean duration of symptoms was 24 months, and mean postoperative follow-up was 29 months. Eight patients had McGowan stage I disease, 14 had stage II, and 5 had stage III. Preoperatively, we measured intrinsic hand strength, 2-point discrimination, and residual medial elbow pain, and assessed for continuing signs and symptoms of nerve compression. Postoperatively, we added to the clinical examination elbow stability testing, elbow range of motion, and assessment of medial antebrachial cutaneous nerve injury. We collected patient-reported outcomes, including Quick Disabilities of the Shoulder, Arm, and Hand; Levine-Katz Severity Score; and Patient-Rated Elbow Evaluation. Results We noted improvement of at least 1 McGowan grade in 20 of 27 patients (74%). Three of the 7 patients who had no change in McGowan grade still reported excellent patient-rated outcomes. Good to excellent results were achieved in 25 of 27 patients (93%). One patient had long-term severe medial elbow pain. Three patients had postoperative medial elbow pain that resolved with a single corticosteroid injection. One patient had a 30° flexion contracture; preoperative motion was not available for comparison. No patients had signs of elbow instability or numbness in the medial antebrachial cutaneous nerve distribution. Conclusions Modified oblique medial epicondylectomy was effective in improving symptoms in Cubital Tunnel Syndrome. This medial collateral ligament sparing technique minimized complications previously associated with the original technique. Type of study/level of evidence Therapeutic IV.
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surgical and nonsurgical treatment of Cubital Tunnel Syndrome in pediatric and adolescent patients
Journal of Hand Surgery (European Volume), 2012Co-Authors: Christopher M Stutz, Ryan P. Calfee, Jennifer A Steffen, Charles A GoldfarbAbstract:Purpose Few studies have investigated the presence or treatment of Cubital Tunnel Syndrome in pediatric or adolescent patients. We conducted this retrospective investigation to quantify success rates of nonsurgical care and to assess patient outcomes after surgical intervention. Methods We identified 39 extremities treated for Cubital Tunnel Syndrome between 2000 and 2009 at one institution. We documented patient demographic data, precipitating events, symptomatology, physical examination findings, and treatment for all patients. We assessed patient-rated outcomes with validated measures including the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the visual analog scale (VAS). Results Subjective complaints at the time of presentation included 16 extremities with ulnar nerve instability at the elbow, 21 extremities with pain at the elbow, and 15 extremities with numbness and tingling in the ring and small fingers. Physical examination revealed 33 extremities with a positive Tinel sign and 20 extremities with a positive elbow flexion–compression test. In the nonsurgical group (9), pretreatment DASH scores averaged 32 and posttreatment DASH scores averaged 11. Pretreatment recall VAS pain scores had a median of 7, and were similar to posttreatment scores, which had a median of 3. In the surgical group (30), DASH scores averaged 46 before surgery and improved to 7 at final follow-up. The VAS pain scores improved from a median of 8 before surgery to 2 after surgery. A total of 30 patients (from both groups) were treated with a trial of nonsurgical care without symptom resolution. Conclusions Cubital Tunnel Syndrome in pediatric or adolescent patients is rare. It can be treated successfully with surgical intervention. Although nonsurgical treatment is unlikely to relieve symptoms in this patient population, a trial of nighttime splinting, activity modification, and anti-inflammatory medications remains appropriate for most patients. Surgical intervention is effective for symptom relief if nonsurgical care fails. Type of study/level of evidence Therapeutic III.
Nicholas Kim - One of the best experts on this subject based on the ideXlab platform.
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anconeus epitrochlearis muscle associated with Cubital Tunnel Syndrome a case series
Hand, 2019Co-Authors: Nicholas Kim, Ryan Stehr, Hani S Matloub, James R SangerAbstract:Background: Cubital Tunnel Syndrome is a common compressive neuropathy of the upper extremity. The anconeus epitrochlearis muscle is an unusual but occasional contributor. We review our experience with this anomalous muscle in elbows with Cubital Tunnel Syndrome. Methods: We retrospectively reviewed charts of 13 patients noted to have an anconeus epitrochlearis muscle associated with Cubital Tunnel Syndrome. Results: Ten patients had unilateral ulnar neuropathy supported by nerve conduction studies. Three had bilateral Cubital Tunnel Syndrome symptoms with 1 of those having normal nerve conduction studies for both elbows. Eight elbows were treated with myotomy of the anconeus epitrochlearis muscle and submuscular transposition of the ulnar nerve. The other 8 elbows were treated with myotomy of the anconeus epitrochlearis muscle and in situ decompression of the ulnar nerve only. All but 1 patient had either clinical resolution or improvement of symptoms at follow-up ranging from 2 weeks to 1 year after surgery. The 1 patient who had persistent symptoms had received myotomy and in situ decompression of the ulnar nerve only. Conclusions: An anomalous anconeus epitrochlearis occasionally results in compression of the ulnar nerve but is usually an incidental finding. Its contribution to compression neuropathy can be tested intraoperatively by passively ranging the elbow while observing the change in vector and tension of its muscle fibers over the ulnar nerve. Regardless of findings, we recommend myotomy of the muscle and in situ decompression of the ulnar nerve. Submuscular transposition of the ulnar nerve may be necessary if there is subluxation.