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AAHS 2014: Simple open vs. endoscopic decompression for cubital tunnel syndrome
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December 2013
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CONFERENCE ACE REPORTS
This ACE Report is a summary of a conference presentation or abstract. The information provided has limited the ability to provide an accurate assessment of the risk of bias or the overall quality. Please interpret the results with caution as trials may be in progress and select results may have been presented.
Synopsis
18 studies (level II evidence and below) investigating the use of open simple or endoscopic release of idiopathic cubital tunnel syndrome were included in this systematic review to compare the clinical outcome and complication rates between these procedures. The results of the study demonstrated that open simple decompression and endoscopic decompression are both effective treatments for cubical tunnel syndrome. Assessments of complications did show that hematoma occurred in more patients receiving endoscopic treatment, but these cases were mostly managed conservatively. Contrastingly, endoscopic treatment was found to reduce medial antebrachial cutaneous (MABC) nerve injury and scar sensitivity when compared to open treatment. Further research is required using randomized controlled trials before definitive conclusion can be made regarding the comparative efficacy of these treatments
Why was this study needed now?
While several techniques currently exist for the treatment of cubital tunnel syndrome, there is no clear consensus on which one is the most effective. Recent studies have shown that endoscopic release may provide promising results for patients with cubital tunnel syndrome when compared to other possible treatments, and so this study aimed to compare the outcomes and complications of open simple decompression and endoscopic decompression of the ulnar nerve.
What was the principal research question?
How do the outcomes and complications of endoscopic decompression compare to open simple decompression, for the treatment of cubital tunnel syndrome?
Study Characteristics
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Data Source:
The electronic databases PubMed, MEDLINE, OVID EMBASE, and SCOPUS were searched from 1975 to 2013.
Index Terms:
"cubital tunnel", "ulnar neuropathy", ulnar neuritis", "ulnar nerve entrapment", "open decompression", "in situ decompression", "endoscopic decompression", "arthroscopic decompression"
Study Selection:
Studies that contained adults with idiopathic cubital tunnel syndrome who were treated by either open simple or endoscopic release were included (18 studies).
Data Extraction:
Outcomes of interest were postoperative grade, complications, number of re-operations and the need for intra-operative conversion to another technique.
Data Synthesis:
N/A
What were the important findings?
- 18 studies met inclusion criteria. 471 open simple releases were described in 9 studies and 413 endoscopic releases reported in the other 9 (6 studies in each group were level 2 evidence, the remaining studies were level 4).
- In the open simple release group, 84.1% of patients experienced “good” or “excellent” results, compared to 85.9% in the endoscopic group.
- Overall complication rate was 4.2% in the open group; including hematoma (1 case), medial antebrachial cutaneous (MABC) nerve injury (14 cases), sensitive scar (4 cases), and infection (1 case). Overall complication rate in the endoscopic group was 6.5%; including hematoma (16 cases), numbness (4 cases), MABC nerve injury (1 case), ulnar nerve subluxation (5 cases), and infection (1 case).
- Re-operation rate was 2.3% in the open group, due to persistent symptoms, and 2.4% in the endoscopic group, due to persistent symptoms (4 cases), hematoma (2 cases) nerve subluxation (2 cases), and infection (1 case).
- 2 cases in the endoscopic group required conversion to open decompression due to ganglion surrounding the nerve and nerve subluxation.
What should I remember most?
Both treatments resulted in patients experiencing good or excellent results. Complications were similar between the treatment methods, but it should be noted that a larger amount of patients in the endoscopic group experienced hematoma. Re-operation was also comparable between the groups.
How will this affect the care of my patients?
Open simple decompression and endoscopic decompression are both effective treatments for cubical tunnel syndrome when looking at clinical outcomes and re-operation rates. Further investigations using RCTs are required before definitive conclusions can be drawn regarding the comparative efficacy of these treatment options.
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