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Nonoperative management of cubital tunnel syndrome

An 8-year prospective study

Division of Plastic Surgery and Department of Neurological Surgery (Dr. Dellon), Johns Hopkins Hospital, Baltimore, MD; Erasmus University School of Medicine (Dr. Hament), Rotterdam, Holland; and the Department of Biostatisties (Dr. Gittelshon), School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD.

This study reports the results of a prospective trial of nonoperative management of the cubital tunnel syndrome in 128 patients. Forty-three of the patients had bilateral ulnar nerve compression. At study's end, information was available on 94% of patients and 164 managed extremities, at a mean of 58.6 months of follow-up. We scored the degree of severity of cubital tunnel syndrome numerically, based on concepts of the pathophysiology of chronic nerve compression. For statistical purposes, a successful outcome of the nonoperative regimen was not having an operation. Life-table analysis demonstrated that 89% of patients with symptoms only, 67% of patients with abnormal sensorimotor thresholds, and 38% of patients with abnormal sensorimotor innervated density did not have surgery. These differences were significant (p < 0.001) by both parametric and nonparametric analysis. A history of elbow injury significantly worsened outcome (p < 0.02), but the results of the pretreatment electrodiagnosis did not. We conclude that a strict nonoperative regimen be supervised in the initial management of the cubital tunnel syndrome.

Address correspondence and reprint requests to Dr. A. Lee Dellon, Suite 104, 3901 Greenspring Avenue, Baltimore, MD 21211.

Received October 29, 1992. Accepted for publication in final form January 15, 1993.

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