Bartels ulnar nerve decompression vs transposition

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

For idiopathic cubital tunnel syndrome, is simple decompression as effective as anterior subcutaneous transposition?

Design

Prospective randomised controlled trial in the Netherlands.

Patients

Adults with idiopathic ulnar neuropathy at the elbow.

Intervention

Simple in situ decompression

Comparison

Anterior subcutaneous transposition

Primary outcome

Clinical outcome score at 1 year

Key result

Outcomes were similar, but transposition had significantly more complications.

Limitations

Single-centre trial with a relatively subjective clinical outcome grading at only one year.

Impact on practice

Simple decompression is the usual first-line operation for idiopathic cubital tunnel syndrome because it is simpler and has fewer complications than transposition; the authors favoured it even when the nerve subluxed.