Early PROMIS Outcomes After Cubital Tunnel Release With and Without Anterior Transposition

BACKGROUND: Cubital tunnel syndrome is the second most common upper extremity neuropathy and is treated surgically with either in situ decompression or anterior transposition of the ulnar nerve. Although both approaches achieve comparable long-term outcomes, variation persists in surgical selection and reported complication rates. Limited data describe how patient characteristics, electrodiagnostic severity, and early patient-reported outcomes differ between techniques. METHODS: Adult patients who underwent cubital tunnel release between 2015 and 2022 at a single institution were retrospectively reviewed. Patients with prior trauma, elbow surgery, or concomitant procedures were excluded. Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity, Physical Function, Pain Interference, and Depression scores were collected preoperatively and at 2-week and 6-week follow-up. Longitudinal mixed-effects regression assessed score changes, adjusted for demographic and clinical covariates. Complications, revisions, and operative characteristics were compared between groups. RESULTS: Of 1892 screened patients, 210 met inclusion criteria (147 in situ, 63 transposition). Demographics and electrodiagnostic severity were comparable, though instability was more frequent in the transposition group. Complication (0.7% vs 3.2%) and revision rates (4.1% vs 1.6%) were low, precluding statistical analysis. At 2 weeks, transposition patients demonstrated greater decline in Physical Function (-6.1) and Upper Extremity (-4.4) and increased Pain Interference (+2.9, below minimal clinically important difference [MCID]) relative to baseline, with convergence of scores between groups by 6 weeks. In situ patients had a modest decrease in pain interference scores from pre-op to six weeks post-operatively (-3.2, below MCID). CONCLUSIONS: Patient-Reported Outcomes Measurement Information System detected transient early differences in recovery between techniques, with slower initial improvement after transposition but comparable outcomes by 6 weeks. These findings highlight PROMIS as a sensitive measure for short-term recovery and a useful tool for postoperative monitoring and patient counseling. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level III.