There is no general agreement on the best surgical procedure for treatment of cubital tunnel syndrome. Each technique has its own advocate. Comparison between the various procedures is further complicated by lack of consensus in patient selection and outcome measurement.

This study compares the results of cubital tunnel decompression after in-situ decompression, endoscopic assisted release and anterior transposition and provide guidelines in the selection of treatment procedure based on clinical criteria.

196 patients (208 elbows) with cubital tunnel syndrome were included in the study. 78 patients (n=80 elbows) underwent in-situ decompression, 76 patients (n=85 elbows) underwent endoscopic assisted release decompression and 42 patients (n=43 elbows) underwent anterior transposition. Of the latter, 18 patients (n=18 elbows) had anterior subcutaneous transposition and 24 patients (n=25 elbows) had anterior submuscular transposition. Exclusion criteria were follow up for less than a year; associated pathology around the elbow or recurrent cubital tunnel syndrome. Patients were graded in severity using Dellon’s classification. There were 24 (30%) mild, 33 (41%) moderate and 23 (29%) severe elbows in the in-situ decompression group and 33 (39%) mild, 35 (41%) moderate and 17 (20%) severe elbows in the endoscopic assisted release group and 11 ( 26%) mild, 9 ( 21%) moderate and 23 ( 53%) severe elbows in the anterior transposition group. Results of surgery were assessed using a modified Bishop’s rating system. In the in-situ decompression group, there were 44% excellent, 41% good, 9% fair and 6% poor results. In the endoscopic assisted release group there were 42% excellent, 45% good, 11% fair and 2% poor results. In the anterior transposition group there were 51% excellent, 35% good, 7% fair and 7% poor results. Return to work was significantly faster in the endoscopic assisted release group. Complications were highest in the in-situ decompression group.

All three procedures are effective in the treatment of mild and moderate cubital tunnel syndrome.