Bartels cubital tunnel RCT

Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: Part 1.

Bartels RH, Verhagen WI, van der Wilt GJ, et al. Neurosurgery 2005 · PMID 15730578 · doi:10.1227/01.neu.0000154131.01167.03

Question

Is anterior subcutaneous transposition better than simple in situ decompression for idiopathic ulnar neuropathy at the elbow?

Design

Prospective randomised controlled trial at a single Dutch referral centre with 1-year follow-up.

Patients

Adults with idiopathic cubital tunnel syndrome (ulnar neuropathy at the elbow).

Intervention

Anterior subcutaneous transposition of the ulnar nerve

Comparison

Simple decompression in situ

Primary outcome

Clinical outcome (excellent/good versus fair/poor) at 1 year

Key result

Clinical outcomes did not differ significantly between the two operations, but complications were significantly more frequent after transposition.

Limitations

Single-centre trial of modest size with only 1-year follow-up; outcome rating was not blinded to the procedure.

Impact on practice

Supports simple in situ decompression as the first-line operation for idiopathic cubital tunnel syndrome, as it is simpler and safer; the authors favoured it even when the nerve subluxed.