Abstract
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Dear Sir,
Two recent Journal articles describe modifications to anterior transposition and decompression, (Taniguchi et al. (2003); Teoh et al. (2002)), and both merit further comparative review by surgeons who treat cubital tunnel syndrome (CubTS).
The traditional surgical approach for CubTS has been anterior transposition involving detachment of the flexor/pronator muscle group. This procedure is significantly invasive and permanently alters the normal forearm anatomy. It is also known to be associated with an elevated level of morbidity, prolonged postoperative immobilization and delayed resumption of the activities of daily living. The technique of modified subfascial transposition used by Teoh et al. (2002) in a small series of patients offers a less disruptive approach as it avoids detaching the flexor/pronator muscle group. The authors state that this protects against scarring, recurrence and elbow contracture, all common problems after anterior transposition. Return to activity was more rapid following modified subfascial transposition when compared to a traditional type of anterior transposition.
Taniguchi et al. (2003) achieved similar results in a small series of patients with an uncomplicated simple decompression procedure with an extremely short (1.5–1.9 cm) incision. The decompression procedure is less invasive than even modified subfascial transposition, and it retains the normal anatomy of the ulnar nerve at the elbow. The authors referenced our 1995 study (Nathan et al., 1995) of 164 patients treated by simple decompression through a short (3 cm) surgical incision. They confirmed our finding that a less invasive decompression procedure, without transposition, is appropriate for treating CubTS.
We encourage those who prefer transposition to consider simple decompression as a viable option for achieving satisfactory results for mild, moderate or severe CubTS. It does not disrupt the normal anatomy, has few postoperative complications and causes only a minimal delay in resumption of normal activities.