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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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In Idiopathic Cubital Tunnel Syndrome, Ulnar Nerve Length and Instability Can Be Reduced by Repairing Osborne’s Ligament after Simple Decompression

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  • presenting/speaker Sang Ho Kwak - Pusan National University Yangsan Hospital, Yangsan, South Korea
  • Jung Yun Bae - Pusan National University Yangsan Hospital, Yangsan, South Korea

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-825

doi: 10.3205/19ifssh1149, urn:nbn:de:0183-19ifssh11495

Published: February 6, 2020

© 2020 Kwak et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Three approaches are commonly used in the surgical treatment of idiopathic cubital tunnel syndrome (ICTS). In an attempt to reduce the risk of nerve traction and instability after simple decompression, Osborne's modification involves repairing the Osborne's ligament beneath the ulnar nerve after decompression. In this study, we aimed to evaluate the change in ulnar nerve length (UNL) following repair of the Osborne's ligament. Additionally, we aimed to compare Osborne's modified simple decompression (MSD) and conventional simple decompression (CSD) regarding the improvement in ultrasonographic grade of ulnar nerve instability (UNI) and the clinical outcomes.

Methods: 51 patients diagnosed with ICTS underwent surgery for cubital tunnel syndrome. 31 patients underwent MSD and 20 patients underwent CSD. In the MSD group, UNL was measured intraoperatively, in full elbow flexion and extension before and after the repair of Osborne's ligament. UNI during elbow motion was measured using ultrasonography preoperatively and at 12 months postoperatively. The following were recorded preoperatively and at 24 months postoperatively: visual analogue scale (VAS) score; Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) score; grip strength; pinch strength; McGowan grade; and Wilson and Krout criteria.

Results and Conclusions: In patients who received MSD, the UNL in full elbow flexion reduced significantly after repair of the Osborne's ligament (from 12.4±0.79 to 11.7±0.76 cm; p<0.001). At 12 months after surgery, the grade of UNI was lower in the MSD group than in the CSD group (p=0.009). At 24 months postoperatively, the clinical outcomes did not differ significantly between the MSD and CSD groups.

In patients who received MSD, UNL in elbow flexion reduced significantly following repair of the Osborne's ligament, and the grade of UNI was lower than that noted in patients who received CSD, without detrimental effect on clinical outcomes at 24 months postoperatively.