Treatment Options for Cubital Tunnel Syndrome

Compression of the ulnar nerve can occur at multiple sites at the level of the elbow, and it is the second most common compressive neuropathy after carpal tunnel syndrome. At this time, the evidence does not suggest that there is a superior procedure for treatment of ulnar nerve decompression. It is largely dependent on surgeon preference and comfort level. In situ decompression is the simplest procedure, with the least disruption of the normal anatomy and similar results to the more extensive anterior transposition or medial epicondylectomy. The more recent use of endoscopic techniques may further minimize the postoperative recovery time and duration of pain symptoms beyond what is seen with in situ decompression. These procedures are commonly performed and well described in the literature, and the techniques for each procedure are summarized here. The authors suggest a surgical algorithm of in situ decompression as the primary option for ulnar nerve decompression with anterior transposition may best be reserved for revision cases refractory to in situ decompression or cases in which the ulnar nerve is found to subluxate anterior to the medial epicondyle when observed through a full range of motion after in situ decompression.