Diagnosing and Treating Cubital Tunnel Syndrome in Adolescents

Surgery leads to improved outcomes in pediatric patients with symptoms of cubital tunnel syndrome, even when electrodiagnostic studies are negative.

In a new study, researchers from Nationwide Children’s Hospital demonstrate that pediatric patients who underwent surgical decompression for cubital tunnel syndrome achieved good resolution of their symptoms, regardless of whether their electrodiagnostic findings were positive or negative.

To diagnose cubital tunnel syndrome, clinicians often use electrodiagnostic studies, such as nerve conduction studies and electromyography, in combination with physical examination. The sensitivities of these tests can range from 37% to 86% in adults and could be even less for children.

A team from Nationwide Children’s conducted a retrospective review of adolescent patients with symptomatic ulnar neuropathy at the elbow who underwent electrodiagnostic testing followed by ulnar nerve decompression between 2009 and 2019. Electrodiagnostic findings were positive in eight cases and negative in 12.

“We found that even the kids that had totally normal electrodiagnostic findings experienced improvement in symptoms after surgery,” says Julie Samora, MD, PhD, MPH, an orthopaedic hand surgeon at Nationwide Children’s and senior author of the study. “This indicates that they did have cubital tunnel syndrome, even if we did not see it based on the electrodiagnostic study.”

Although this is a small sample, it suggests that sensitivity of electrodiagnostic testing for this population of pediatric patients is low. For adult patients, ultrasonography is being used more often to make the diagnosis of cubital tunnel syndrome. Unlike electrodiagnostic testing, ultrasound is minimally invasive, can assess nerve diameter and cross-sectional area, and can provide information regarding nerve subluxation (which was found in the majority of cases in this study). Dr. Samora and colleagues see a growing role for ultrasound in diagnosing pediatric patients, possibly in addition to electrodiagnostic studies.

According to the researchers, the results suggest that negative electrodiagnostic findings should not preclude surgical intervention for pediatric patients presenting with symptoms of cubital tunnel syndrome. However, Dr. Samora says she still orders these studies — to help inform clinical diagnosis and to serve as a baseline for potential comparisons if problems arise in the future.

“If we order electrodiagnostic testing and it’s negative, but the patient has classic symptoms of cubital tunnel syndrome, surgery is one of the tools in the toolbox that I’ll offer them to help improve or relieve symptoms if conservative management was unsuccessful,” says Dr. Samora.

“If you think that it’s cubital tunnel syndrome, it probably is. And even if their electrodiagnostic testing doesn’t confirm it, surgery is a reasonable option.”

Reference:

Lin JS, Gelfius CD, Balch Samora J. Diagnostic accuracy and surgical outcomes in adolescent patients with cubital tunnel syndrome. J Hand Surg Eur Vol. 2023 Jul;48(7):672-674. doi: 10.1177/17531934231157581. Epub 2023 Feb 22.