Medical Science
| Open Access |
DOI: Comparison Of Endoscopic and Open Decompression of The Ulnar Nerve in Cubital Tunnel Syndrome: A Systematic Review with Meta-Analysis
Diego Figueirêdo Macêdo Secundo , Médico Residente de Ortopedia e Traumatologia pelo Hospital Universitário da Universidade Federal do Vale do São Francisco, Petrolina, PE Luis Fernando Warpechowski Krammer , Médico Residente de Ortopedia e Traumatologia pelo Hospital Nossa Senhora das Graças, Canoas, RS Caio Rodrigues Coelho Mendes , Médico Residente de Ortopedia e Traumatologia pelo Hospital Aroldo Tourinho, Montes Claros, MG Gustavo Petracco , Médico Ortopedista e Traumatologista pelo Hospital Nossa Senhora das Graças, Canoas, RS Melissa Alves Aires Marques , Acadêmica de Medicina da Universidade Iguaçu, Itaperuna, RJAbstract
Cubital tunnel syndrome (CTS) is the second most common compressive neuropathy of the upper limb, associated with symptoms of pain, paresthesia and hand weakness, with a significant impact on patients' quality of life.1 The primary surgical treatment is decompression of the ulnar nerve using the open in situ technique, with good scientific evidence and a low complication rate. 2
Minimally invasive techniques, such as endoscopic in situ decompression (EISD), have emerged as an alternative, promising smaller scars, less postoperative pain and faster functional return. Doubts remain about the safety, efficacy and complication profile of these techniques when compared to open in situ decompression (OISD).2
Randomized clinical trials, such as those by Elwenspoek et al. in 2014-2017 with 45 patients, showed equivalence in clinical outcomes (Bishop's excellent/optimal score between 90-96%), but with less chronic scar pain and better aesthetic satisfaction in the endoscopic group, albeit with a longer operative time. Another randomized double-blind study (2008-2011, 56 cases) corroborated the similarity of functional results, observing a higher incidence of hematomas in the endoscopic group. 2,3
Two contemporary meta-analyses consolidate this perception: The meta-analysis of 686 cases revealed endoscopic decompression with longer surgical duration, increased risk of hematoma and acute pain, but less postoperative paresthesia and better grip strength. And a previous meta-analysis comparing eight studies (582 patients) confirmed equivalent efficacy, highlighting less painful scar sensitivity in the endoscopic group .3
To this end, despite equivalence in functional and clinical outcomes, EISD offers advantages in terms of scar, chronic pain and grip strength, at the cost of longer surgical time and risk of hematoma, more robust and standardized studies are needed. This systematic review with meta-analysis aims to rigorously compare efficacy, safety and technical quality between endoscopic and open decompression of the ulnar nerve in CTS, with a focus on clinical impact and decision-making guidelines for orthopaedic practice.
Keywords
References
Smeraglia F, Del Buono A, Maffulli N. Endoscopic cubital tunnel release: a systematic review. Br Med Bull. 2015;116:155-163. doi:10.1093/bmb/ldv049
Byvaltsev VA, Stepanov IA, Kerimbayev TT. A systematic review and meta-analysis comparing open versus endoscopic in situ decompression for the treatment of cubital tunnel syndrome. Acta Neurol Belg. 2020;120(1):1-8. doi:10.1007/s13760-019-01149-9
Krejčí T, Večeřa Z, Krejčí O, Šalounová D, Houdek M, Lipina R. Comparing endoscopic and open decompression of the ulnar nerve in cubital tunnel syndrome: a prospective randomized study. Acta Neurochir (Wien). 2018;160(10):2011-2017. doi:10.1007/s00701-018-3647-0
Schmidt S, Kleist Welch-Guerra W, Matthes M, Baldauf J, Schminke U, Schroeder HW. Endoscopic vs Open Decompression of the Ulnar Nerve in Cubital Tunnel Syndrome: A Prospective Randomized Double-Blind Study. Neurosurgery. 2015 Dec;77(6):960-70; discussion 970-1. doi: 10.1227/NEU.0000000000000981. PMID: 26595347.
Dützmann S, Martin KD, Sobottka S, Marquardt G, Schackert G, Seifert V, Krishnan KG. Open vs retractor-endoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome: a retrospective cohort study. Neurosurgery. 2013 Apr;72(4):605-16; discussion 614-6. doi: 10.1227/NEU.0b013e3182846dbd. PMID: 23277372.
Krejčí T, Večeřa Z, Krejčí O, Šalounová D, Houdek M, Lipina R. Comparing endoscopic and open decompression of the ulnar nerve in cubital tunnel syndrome: a prospective randomized study. Acta Neurochir (Wien). 2018 Oct;160(10):2011-2017. doi: 10.1007/s00701-018-3647-0. Epub 2018 Aug 15. PMID: 30112716.
Schwarm FP, Nagl J, Graf K, Reinges MHT, Uhl E, Krishnan KG, Kolodziej MA. A prospective randomized study comparing retractor-endoscopic vs. open release of carpal tunnel and cubital tunnel syndromes. Clin Neurol Neurosurg. 2022 Nov;222:107437. doi: 10.1016/j.clineuro.2022.107437. Epub 2022 Sep 19. PMID: 36182782.
Bultmann C, Hoffmann R. Die endoskopische Dekompression des Nervus ulnaris bei Kubitaltunnelsyndrom [Endoscopic decompression of the ulnar nerve in cubital tunnel syndrome]. Oper Orthop Traumatol. 2009;21(2):193-205. doi:10.1007/s00064-009-1707-6
Watts AC, Bain GI. Patient-rated outcome of ulnar nerve decompression: a comparison of endoscopic and open in situ decompression. J Hand Surg Am. 2009;34(8):1492-1498. doi:10.1016/j.jhsa.2009.05.014
Sprangers PN, van der Heijden EPA. Protocol for Endoscopic Versus Open Cubital tunnel release (EVOCU): an open randomized controlled trial : EVOCU trial: Endoscopic Versus Open Cubital tunnel release. BMC Musculoskelet Disord. 2023;24(1):137. Published 2023 Feb 22. doi:10.1186/s12891-023-06234-y
Carlton A, Khalid SI. Surgical Approaches and Their Outcomes in the Treatment of Cubital Tunnel Syndrome. Front Surg. 2018;5:48. Published 2018 Jul 26. doi:10.3389/fsurg.2018.00048
Öztürk T, Zengin EÇ, Şener U, Şener M. Endoscopic versus open in situ decompression for the management of cubital tunnel syndrome. Acta Orthop Traumatol Turc. 2022;56(2):125-130. doi:10.5152/j.aott.2022.21143
Lucchina S, Fusetti C, Guidi M. Sonographic Follow-Up of Patients With Cubital Tunnel Syndrome Undergoing in Situ Open Neurolysis or Endoscopic Release: The SPECTRE Study. Hand (N Y). 2021;16(3):385-390. doi:10.1177/1558944719857816
Spies CK, Schäfer M, Langer MF, Bruckner T, Müller LP, Unglaub F. Functional outcome after endoscopic assisted release of the ulnar nerve for cubital tunnel syndrome: mid-to-long term results. Int Orthop. 2018;42(6):1331-1337. doi:10.1007/s00264-018-3760-y
Graesser EA, Dy CJ, Brogan DM. Future Considerations in the Diagnosis and Treatment of Compressive Neuropathies of the Upper Extremity. J Hand Surg Glob Online. 2022;5(4):536-546. Published 2022 Nov 30. doi:10.1016/j.jhsg.2022.10.009
Sprangers PN, van der Heijden EPA. Protocol for Endoscopic Versus Open Cubital tunnel release (EVOCU): an open randomized controlled trial : EVOCU trial: Endoscopic Versus Open Cubital tunnel release. BMC Musculoskelet Disord. 2023;24(1):137. Published 2023 Feb 22. doi:10.1186/s12891-023-06234-y
Article Statistics
Downloads
Copyright License
Copyright (c) 2025 Diego Figueirêdo Macêdo Secundo, Luis Fernando Warpechowski Krammer, Caio Rodrigues Coelho Mendes, Gustavo Petracco, Melissa Alves Aires Marques
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain the copyright of their manuscripts, and all Open Access articles are disseminated under the terms of the Creative Commons Attribution License 4.0 (CC-BY), which licenses unrestricted use, distribution, and reproduction in any medium, provided that the original work is appropriately cited. The use of general descriptive names, trade names, trademarks, and so forth in this publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations.