Endoscopic versus open in situ decompression for the management of cubital tunnel syndrome

OBJECTIVE: This study aimed to compare the results of endoscopic in situ decompression (EISD) versus open in situ decompression (OISD) in the management of cubital tunnel syndrome (CUTS). METHODS: In this retrospective study, 32 patients who underwent either OISD or EISD for the treatment of CUTS between 2012 and 2019 were identified and divided into one of the two groups: Group I consisted of 13 patients undergoing EISD and group II consisted of 19 patients receiving OISD. Patients were queried regarding the presence of preoperative and postoperative paresthesia. Electromyography (EMG) was performed on all patients preoperatively and at the final control. Preoperative and postoperative pain with palpation were evaluated over the cubital tunnel. The Dellon classification was used for preoperative evaluation of patient symptoms, and the Bishop classification was used for postoperative evaluation. Hand grip strength was measured with a dynamometer. At the preoperative and postoperative final follow-up, the palmar, key, and tip pinches were measured with a pinchmeter. The surgical incision length was measured with a ruler at the end of the operation in all patients. The operation duration was recorded as the time interval between the beginning of the incision and the end of the tourniquet. RESULTS: The overall mean age was 43.8 (range; 22 to 66) years. Nine patients were female, and 23 patients were male. No Dellon I patients were present in either group. Overall, 68.75% of the patients were Dellon II and 31.25% were Dellon III. According to the Bishop score, excellent and good results were obtained in 84.6% of the patients in Group I and 73.7% of the patients in Group II. The final follow-up examination found continued paraesthesia in 6 (18.75%) patients. Comparison of the improvement in the postoperative NCV value showed a statistically significantly superior improvement in Group I compared to Group II. The postoperative palmar pinch and tip pinch tests results were statistically significantly better in group I than in group II. CONCLUSION: Although EISD had better results clinically, no statistically significant difference was found between the two techniques in terms of Bishop scores and complications. Examination of the electrophysiological results suggested a better outcome in patients who underwent EISD. LEVEL OF EVIDENCE: Level III, Therapeutic Study