• Vicente Vanaclocha, Trinidad Blanco, Pedro Ortiz, Javier Lopez-Trigo, Pau Capilla, Vicente Bordes-Garcia, and Leyre Vanaclocha.
• Hospital General Universitario de Valencia, Valencia, Spain. Electronic address: vvanaclo@hotmail.com.
• World Neurosurg. 2017 Nov 1; 107: 908-924.e2.

BackgroundIn situ decompression and transposition are equally effective in cubital tunnel syndrome treatment. Both are traditionally performed in the supine position.ObjectiveTo validate our surgical technique for in situ decompression in the lateral decubitus position, comparing results with other techniques used in our institutions.MethodsA retrospective study was performed from January 2009 to February 2016, of 188 patients with cubital tunnel syndrome 115 males, 73 females; mean age, 53.44 ± 12.12 years standard deviation (range, 18-84 years) treated with in situ decompression in the lateral or supine positions or transposition (subcutaneous or submuscular). The lateral decubitus group received local anesthesia and the remainder received a brachial plexus block. Clinical and electrophysiologic results between these 4 groups were compared.ResultsThere were no statistically significant demographic differences between groups. Results were better in in situ decompression groups compared with transpositions. Mean follow-up was 1511.1 ± 770.57 days standard deviation (range, 310-4203 days). There were no recurrences or residual elbow pain/dysesthesia/anesthetic scar/hyperesthesia/neuroma in the lateral decubitus group. Complication and recurrence rates were in direct correlation to incision size. The worst results were seen in transpositions, particularly in the submuscular group. In situ decompression in the supine position had better results than transpositions but worse than those performed in lateral decubitus. Smaller surgical wound correlates with a reduction in operating time, costs, complication rates, and time out of work.ConclusionsIn situ decompression is equally as effective as ulnar nerve transpositions but with fewer complications and recurrences. In the lateral decubitus position, the retroepicondylar tunnel is more accessible, allowing smaller incisions and better results.Copyright © 2017 Elsevier Inc. All rights reserved.

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