PURPOSE: Cubital tunnel syndrome is a consequence of the ulnar nerve being compressed at the elbow. It is unknown whether early mobilization after cubital tunnel decompression improves functional outcomes without increasing complication risk. The objective of this systematic review is to evaluate the benefits and harms of early mobilization compared to delayed mobilization of the elbow after operative management of cubital tunnel syndrome.
METHODS: We conducted a systematic review of studies using Embase, MEDLINE, and The Cochrane Central Register of Controlled Trials from database inception to January 2020. Randomized controlled trial (RCT) and non-RCT were selected based on meeting the inclusion criterion of being a comparative study of adult patients who underwent either early mobilization (defined as mobilizing within 3 days postoperation) or late mobilization (after 3 days postoperation). When appropriate outcome data were pooled and analyzed with meta-analysis.
RESULTS: Of the 1,932 studies identified and screened, 5 studies (2 RCT and 3 observational design) totalling 224 patients (232 elbows) were included for review. Two studies included patients who underwent anterior subcutaneous transpositions, whereas patients in the other 2 studies underwent cubital tunnel release with medial epicondylectomy. The evidence from 2 RCTs (100 patients) suggest that early mobilization may result in a large reduction in the amount of time need to return to work (mean difference, 40.1 days; 95% CI, 63.6 days to 16 days earlier; I2, 85%, low-certainty evidence). Pooled results from 3 observational studies found similar findings (very low-certainty evidence). Pooled results from RCT evidence (100 patients) demonstrated that early mobilization may results in little to no difference in grip strength (0 kg; 95% CI, −0.17 to 0.17; I2 = 0%, low-certainty evidence). Furthermore, the evidence suggests that the mobilization strategy employed (early versus late) may have little to no differences in adverse events or range of motion (very-low to low-certainty evidence). Outcomes such as upper extremity quality of life measures were not evaluated in the included studies.
CONCLUSION: While there is considerable uncertainty around the effect estimates, immobilizing patients for periods longer than 3 days does appear to delay patients’ return to work with no appreciable clinical benefit. There is a lack of robust evidence to guide plastic surgeons on the postoperative management of cubital tunnel syndrome patients. There is a need for high-quality, well-reported, randomized controlled trials evaluating the potential effects and harms associated with early mobilization. Future trials should measure patient-reported outcomes related to upper limb-related quality of life. Considering the low-certainty evidence, plastic surgeons should engage in a shared decision-making process with patients when deciding to immobilize them postcubital tunnel release.