J Korean Orthop Assoc.  2017 Apr;52(2):161-169. 10.4055/jkoa.2017.52.2.161.

The Relationship between Early Improvement of Subjective Symptom and Surgical Outcomes in Moderate to Severe Cubital Tunnel Syndrome

• Bae JY
• Kwak SH
• Kim SH
• Shin WC
• Lee SJ
• Suh KT

• KMID: 2438981
• DOI: http://doi.org/10.4055/jkoa.2017.52.2.161

Abstract

PURPOSE
Moderate to severe cubital tunnel syndrome usually requires surgical treatment. Most surgical outcomes are evaluated 6 months after the procedure; however, subjective symptoms begin to show improvement much earlier. In this study, we explored whether patients who experience early improvement of subjective symptoms have different clinical characteristics and surgical outcomes than those without early improvement.
MATERIALS AND METHODS
Between January 2012 and February 2015, 36 surgical cases of moderate- to severe-stage cubital tunnel syndrome (modified McGowan grade IIA, IIB, or III) were included. Nineteen patients (15 males and 4 females with a mean age of 54.3±12.0 years) reported subjective symptom improvements within 14 days postoperatively. Seventeen patients (15 males and 2 females with a mean age of 53.4±11.9 years) did not report any early symptom improvements. Clinical characteristics"”hand dominance, sex, smoking history, type of surgery, age, symptom duration, elbow range of motion, grip strength, key pinch strength, 2 point discrimination, pain, quick disabilities of the arm, shoulder and hand (DASH) score, and modified McGowan grade"”were analyzed retrospectively using a Mann-Whitney test or chi square test. Surgical outcomes were measured at postoperative 3 and 12 months using repeated-measures ANOVA, and Wilson and Krout criteria were analyzed using a chi-square test.
RESULTS
There was a difference in key pinch strength (p<0.001) between the groups. At postoperative 12 months, Wilson and Krout criteria (p=0.029) were associated with early improvement of subjective symptoms. The subjects' quick DASH scores and grip strengths improved over time, but no difference was observed between the groups.
CONCLUSION
After surgical treatments of moderate to severe cubital tunnel syndrome, patients who presented early improvement of subjective symptoms, compared with those who did not, had significantly higher preoperative key pinch strength and better surgical outcomes at postoperative 12 months.

Keyword

cubital tunnel syndrome; elbow; symptom evaluation; outcomes assessment

MeSH Terms

Arm
Cubital Tunnel Syndrome*
Discrimination (Psychology)
Elbow
Female
Hand
Hand Strength
Humans
Male
Outcome Assessment (Health Care)
Pinch Strength
Range of Motion, Articular
Retrospective Studies
Shoulder
Smoke
Smoking
Symptom Assessment
Smoke

Figure

• 

  Figure 1 Radiologically excluded cases (A, B) and included case (C, D) are presented. (A) An anteroposterior radiograph of a 39-year-old male with post traumatic cubitus varus deformity. (B) In an anteroposterior radiograph of a 55-year-old male, there are medial osteophytes on the humerus and the ulna. (C, D) A small osteophytes are identified at the coronoid process and olecranon of a 62-year-old male. There is no medial osteophyte on the humerus and ulna.

• 

  Figure 2 Quick disabilities of the arm, shoulder and hand (quick DASH) scores (A), grip strength (B), and pinch strength (C) are shown. *p<0.017; error bars=1 standard deviation.

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