Subcutaneous Transposition Of Ulnar Nerve Research Articles

In Situ Neurolysis of Ulnar Nerve for Patients With Failed Anterior Subcutaneous Transposition - A Case Series.

BACKGROUNDVarious surgical techniques have been attempted to treat patients with failed anterior subcutaneous transposition performed for cubital tunnel syndrome.OBJECTIVETo analyze intraoperative findings of failed anterior subcutaneous transposition and to report the outcome of in Situ neurolysis of ulnar nerve.METHODSPatients who, under diagnosis of failed anterior subcutaneous transposition of ulnar nerve, underwent in Situ neurolysis between 2001 and 2018 were included in this study. We excluded patients with follow-up of less than one year, records of traumatic ulnar nerve injury, and concomitant double crush syndrome such as cervical spondylosis causing radicular pain, ulnar tunnel syndrome, or thoracic outlet syndrome. Surgical outcomes were evaluated using visual analog scale (VAS) pain score and Disabilities of the Arm, Shoulder, and Hand (DASH) score, which were assessed before and after surgery. A total of 28 elbows in 27 patients whose average age was 58.5 (range, 31-76) yr were enrolled, and the duration of follow-up was 5.8 (range, 1.0-14.9) yr.RESULTSThe most common pathologic finding identified during operation was severe adhesion of the transposed nerve in all elbows, followed by incomplete decompression of deep flexor-pronator aponeurosis in 26 elbows (93%). The average VAS pain score improved from 4.9 (range, 2-7) to 1.3 (range, 0-5), and the average DASH score from 31.7 (range, 18.1-66.7) to 14.1 (range, 5.0-46.6). Of the 28 elbows, 27 (96.4%) showed improvement of preoperative symptoms.CONCLUSIONIn Situ neurolysis of ulnar nerve for patients with failed anterior subcutaneous transposition resulted in satisfactory outcome.

Reverse End-to-Side Anterior Interosseous Nerve-to-Ulnar Motor Transfer for Severe Ulnar Neuropathy.

Reverse end-to-side anterior interosseous nerve transfer has been reported to enhance treatment of severe, proximal ulnar neuropathy. The authors report on patients with severe neuropathy treated with ulnar nerve transposition and distal reverse end-to-side anterior interosseous nerve transfer. Thirty patients with severe ulnar neuropathy at the elbow were reviewed. Clinical parameters included preoperative and postoperative Medical Research Council muscle strength, clawing, and degree of wasting. Electrodiagnostic data included compound motor action potential and sensory nerve action potential amplitudes. Summary statistics were used for demographic and clinical data. The t test and Wilcoxon signed rank test were used where appropriate. Average follow-up was 18.6 months. Preoperatively, 20 patients had Medical Research Council less than or equal to grade 1 in hand intrinsics, small finger sensory nerve action potentials were absent in all patients except for three, and average compound motor action potentials were severely reduced (absent in nearly 40 percent) confirming severity. All groups had a statistically significant increase in strength. More than three-quarters of patients noted partial or complete resolution of clawing and intrinsic muscle wasting. Seventy-three percent of patients regained Medical Research Council greater than or equal to grade 3 and 47 percent achieved Medical Research Council greater than or equal to grade 4. Mean time to observation of nascent units was 8.5 months, and 77 percent of patients demonstrated an augmentation of motor unit numbers with forearm pronation on needle electromyography CONCLUSION:: Proximal subcutaneous ulnar nerve transposition when combined with reverse end-to-side anterior interosseous nerve-to-ulnar nerve transfer demonstrates significant clinical and electrodiagnostic improvement of intrinsic muscle function. Therapeutic, IV.

Subcutaneous versus submuscular ulnar nerve transposition in cubital tunnel syndrome

Introduction There are different surgical procedures for treatment of cubital tunnel syndrome (CubTS), which can be divided into two types, decompression and transposition procedures. Decompressive procedures include simple decompression with or without medial epicondylectomy without mobilizing the nerve. The transposition procedures mobilize the nerve anteriorly for more protection by subcutaneous, intramuscular, and submuscular methods, depending on the position in which the ulnar nerve is placed. Patients and methods A total of 24 patients with moderate CubTS (according to Dellon’s grading system) between March 2011 and April 2013 were classified according to age and sex into anterior subcutaneous transposition and anterior submuscular transposition groups. The two groups were prospectively followed up for 2 weeks, 6 months, and 12 months postoperatively, and outcome was assessed using the Bishop rating system. Results A total of 24 patients with moderate CubTS were used in this study to compare the operative technique (incision length and operative time), postoperative care (postoperative pain and complications), and the outcome between subcutaneous transposition and submuscular transposition of the ulnar nerve as two surgical modalities in treating moderate CubTS. Final results present that the subcutaneous transposition of the ulnar nerve was associated with shorter incision, shorter operative time, less postoperative pain, less postoperative complication, and better outcome compared with the submuscular transposition. Conclusion Subcutaneous ulnar nerve transposition in the treatment of CubTS, as compared with the submuscular approach, is an easier surgical technique with less operative time and postoperative pain, earlier postoperative mobilization, and better postoperative outcome.

Recurrent Cubital Tunnel Syndrome Caused by Ganglion: A Report of Nine Cases.

Cubital tunnel syndrome (CuTS) is generally treated successfully by surgery and recurrent cases are rare. This study retrospectively investigated the clinical characteristics of recurrent CuTS caused by ganglion. We evaluated nine patients who were surgically treated for recurrent CuTS caused by ganglion. Age distribution at recurrence ranged from 43 to 79 years. The initial surgery for CuTS had been performed using various methods. The asymptomatic period from initial surgery to recurrence ranged from 22 to 252 months. Clinical, diagnostic imaging, and operative findings during the second surgery were analyzed. All patients were treated by anterior subcutaneous ulnar nerve transposition with ganglion resection and later examined directly within a mean of 71 months after the second surgery. The interval from recurrence to consultation was shorter than two months for eight cases. Chief complaints included numbness with or without pain in the ring and little fingers in all patients and resting pain in the medial elbow in five patients. Elbow osteoarthritis was present in all cases. Although four of 10 ganglia were palpable, ultrasonography and magnetic resonance imaging could identify all ganglia preoperatively. The ulnar nerve typically had become entrapped by the ganglion posteriorly and by fascia, scar tissue, and/or muscle anteriorly. Chief complaints and ulnar nerve function were improved in all patients following revision surgery. The acute onset of numbness with or without intolerable pain in the ring and little fingers after a long-term remission period following initial surgery for CuTS in patients with elbow osteoarthritis appears to be the characteristic clinical profile of recurrent CuTS caused by ganglion. As ganglia are often not palpable, ultrasonography and magnetic resonance imaging are recommended for accurate diagnosis.

Anterior subcutaneous transposition versus anterior subfascial transposition of the ulnar nerve in the treatment of cubital tunnel syndrome

Objective To compare the clinical effects of anterior subcutaneous transposition and anterior subfascial transposition of the ulnar nerve in the treatment of cubital tunnel syndrome. Methods A total of 37 patients with cubital tunnel syndrome were retrospectively analyzed. 18 cases were treated with subcutaneous transposition of ulnar nerve, and 19 cases with anterior transposition of ulnar nerve. The scores of sensory deficits in the ulnar nerve innervation area, the intrinsic muscle strength, claw deformity and ulnar nerve conduction velocity were compared between the two groups. Results Postoperative follow-up period ranged from 6 to 18 months. There was no significant difference between anterior subcutaneous and anterior subfascial transposition of the ulnar nerve. The clinical effects of patients with moderate cubital tunnel syndrome treated by the two anterior transposition operations were much better than that of patients with severe cubital tunnel syndrome. Conclusion There was no difference between the two methods of anterior subcutaneous transposition and anterior subfascial transposition. However, the anterior subfascial transposition combines the advantages of anterior subcutaneous transposition and anterior submuscular transposition. Cubital tunnel syndrome should be actively intervened after being definitely diagnosed. Key words: Cubital tunnel syndrome; Treatment outcome; Anterior subcutaneous transposition; Anterior subfascial transposition

Ulnar neuropathy and medial elbow pain in women's fastpitch softball pitchers: a report of 6 cases

Elite-level women's fastpitch softball players place substantial biomechanical strains on the elbow that can result in medial elbow pain and ulnar neuropathic symptoms. There is scant literature reporting the expected outcomes of the treatment of these injuries. This study examined the results of treatment in a series of these patients. We identified 6 female softball pitchers (4 high school and 2 collegiate) with medial elbow pain and ulnar neuropathic symptoms. Trials of conservative care failed in all 6, and they underwent surgical treatment with subcutaneous ulnar nerve transposition. These patients were subsequently monitored postoperatively to determine outcome. All 6 female pitchers had early resolution of elbow pain and neuropathic symptoms after surgical treatment. Long-term follow-up demonstrated that 1 patient quit playing softball because of other injuries but no longer reported elbow pain or paresthesias. One player was able to return to pitching at the high school level but had recurrent forearm pain and neuritis 1 year later while playing a different sport and subsequently stopped playing competitive sports. Four patients continued to play at the collegiate level without further symptoms. Medial elbow pain in women's softball pitchers caused by ulnar neuropathy can be treated effectively with subcutaneous ulnar nerve transposition if nonsurgical options fail. Further study is necessary to examine the role of overuse, proper training techniques, and whether pitching limits may be necessary to avoid these injuries.

Endoscopically Assisted Anterior Subcutaneous Transposition of Ulnar Nerve

Ulnar nerve compression at the elbow is the most common neuropathy of the upper extremity. Surgical options include in situ decompression, decompression with anterior transposition of the ulnar nerve, and medial epicondylectomy with or without decompression. With the advancement of endoscopic surgery, techniques of endoscopic in situ decompression of the ulnar nerve and endoscopic anterior transposition of ulnar nerve have been reported. This article describes a technique of endoscopically assisted anterior subcutaneous transposition of ulnar nerve that is composed of an open release and mobilization of the ulnar nerve at and distal to the cubital tunnel and endoscopic release and mobilization of the ulnar nerve proximal to the cubital tunnel.

ANTERIOR SUBCUTANEOUS TRANSPOSITION OF ULNAR NERVE AND HAND INTRINSIC MUSCLES FUNCTION RECONSTRUCTION FOR SEVERE CUBITAL TUNNEL SYNDROME

To study the effectiveness of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle in the treatment of severe cubital tunnel syndrome. Between March 2006 and May 2015, 22 cases (23 hands) of severe cubital tunnel syndrome were treated by use of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle. There were 15 males and 7 females, aged 45-60 years (mean, 55 years). The causes were valgus deformity of elbow joint in 12 cases, ulnar nerve subluxation in 4 cases, and osteoarthritis in 6 cases. The disease duration was 10 months to 3 years (mean, 17 months). According to Akahori classification, 14 cases were rated as type 4 and 9 cases as type 5. The ring/little finger's numbness, hand intrinsic muscle atrophy, recovery of thumb adduction function, and improvement of claw hand deformity were observed after operation. Thumb and index finger's pinch strength was measured by use of pinch device; postoperative hand function was evaluated by the standards of Chinese Medical Society of Hand Surgery of upper limb assessment protocol. All incisions healed well and all cases were successfully followed up 8 to 24 months (mean, 14 months). Numbness of ring/little finger was significantly reduced at 1 day after operation in 10 hands; numbness disappeared completely at 1 month after operation in 12 hands; mild numbness remained at 14 months after operation in 11 hands. At last follow-up, hand intrinsic muscle atrophy partially improved (+++) in 1 hand, no improvement in 22 hands; improvement of claw hand deformity was achieved in 17 hands, no improvement in 6 hands; pinch strength of thumb and index finger was significantly improved to (5.07±1.11) kg from preoperative (2.91±0.63) kg (t=-12.340, P=0.032). At last follow-up, the results were excellent in 11 hands, good in 8 hands, fair in 3 hands, and poor in 1 hand, and the excellent and good rate was 82.6%. Anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle is a simple, effective, and reliable surgical treatment for severe cubital tunnel syndrome.

Anterior subcutaneous transposition of ulnar nerve with fascial flap and complete excision of medial intermuscular septum in cubital tunnel syndrome: A prospective patient cohort

Anterior subcutaneous transposition of ulnar nerve with fascial flap and complete excision of medial intermuscular septum in cubital tunnel syndrome: A prospective patient cohort

Comparative Study of Different Surgical Transposition Methods for Ulnar Nerve Entrapment at the Elbow

This study compared the therapeutic effects of two techniques for surgical decompression treatment for ulnar nerve entrapment at the elbow: subcutaneous transposition and modified submuscular transposition with Z-lengthening of the pronator teres origin. A total of 278 patients with ulnar nerve entrapment (McGowan grades I - III) were randomly assigned to undergo one of these techniques. All patients were followed-up for 2 years. The effects were assessed by preoperative and postoperative cross-sectional area, motor conduction velocity, sensory conduction velocity and nerve action potential. All of these parameters improved after surgery in both groups. For patients with grade I disease, there were no significant differences between the two techniques. For patients with grade II and III disease, modified submuscular transposition was associated with significantly greater improvements compared with subcutaneous transposition. In conclusion, subcutaneous ulnar nerve transposition is recommended for grade I patients and modified submuscular ulnar nerve transposition for grade II and III patients.

Anterior subcutaneous transposition of ulnar nerve with fascial flap and complete excision of medial intermuscular septum in cubital tunnel syndrome: A prospective patient cohort

Objective Regarding the frequency of cubital tunnel syndrome, varieties of treatment modalities, and ambiguity of anterior subcutaneous transposition of ulnar nerve method, we aimed to evaluate the efficacy of this procedure in patients with cubital tunnel syndrome referred to Taleghani hospital between 2006 and 2009. Methods This study was a case series including all referred patients with definite diagnosis of cubital tunnel syndrome, treated by anterior subcutaneous transposition. Treatment results were measured according to modified Bishop rating system, and were ranked into excellent, good, fair, and poor. Variables such as gender, age (less/more than 45 years), causation, and initial severity, determined by Dellon criteria preoperatively, were analyzed by Fisher's exact test. Results This study was performed on 26 eligible cases including 29 elbows, 38% males and 62.1% females, with mean age of 44.5 years (ranging 23–72 years). In a 12 months follow-up post-operatively, 62% showed excellent, 20.7% good, and 17.3% fair, with no poor result. In a 1–12 months follow-up post-operatively, results showed improvement, and initial severity and old age were demonstrated to significantly affect treatment results ( P < 0.07). Conclusion Though considered standard of care, the present study suggests that criteria for surgical techniques of ulnar nerve decompression, e.g. simple decompression vs. more extensive repair as in the present cohort, should be revised by controlled prospective studies.

Outcome of Ulnar Collateral Ligament Reconstruction of the Elbow in 1281 Athletes

Background The anterior bundle of the ulnar collateral ligament (UCL) is the primary anatomical structure providing elbow stability in overhead sports, particularly baseball. Injury to the UCL in overhead athletes often leads to symptomatic valgus instability that requires surgical treatment. Hypothesis Ulnar collateral ligament reconstruction with a free tendon graft, known as Tommy John surgery, will allow return to the same competitive level of sports participation in the majority of athletes. Study Design Case series; Level of evidence, 4. Methods Ulnar collateral reconstruction (1266) or repair (15) was performed in 1281 patients over a 19-year period (1988—2006) using a modification of the Jobe technique. Data were collected prospectively and patients were surveyed retrospectively with a telephone questionnaire to determine outcomes and return to performance at a minimum of 2 years after surgery. Results Nine hundred forty-two patients were available for a minimum 2-year follow-up (average, 38.4 months; range, 24-130 months). Seven hundred forty-three patients (79%) were contacted for follow-up evaluation and/or completed a questionnaire at an average of 37 months postoperatively. Six hundred seventeen patients (83%) returned to the previous level of competition or higher, including 610 (83%) after reconstruction. The average time from surgery to the initiation of throwing was 4.4 months (range, 2.8-12 months) and the average time to full competition was 11.6 months (range, 3-72 months) after reconstruction. Complications occurred in 148 patients (20%), including 16% considered minor and 4% considered major. Conclusion Ulnar collateral ligament reconstruction with subcutaneous ulnar nerve transposition was found to be effective in correcting valgus elbow instability in the overhead athlete and allowed most athletes (83%) to return to previous or higher level of competition in less than 1 year.

Is Ulnar Nerve Transposition Beneficial During Open Reduction Internal Fixation of Distal Humerus Fractures?

The purpose of this study was to compare the incidence of ulnar neuritis with and without ulnar nerve transposition during open reduction and internal fixation (ORIF) of distal humerus fractures. Multicenter retrospective cohort series. : Two Level I trauma centers. Two cohorts were identified: 89 patients (mean age, 48.6 years) who had not undergone an ulnar nerve transposition and 48 patients (mean age, 43.2 years) who had undergone a transposition during ORIF of a distal humerus fracture (Orthopaedic Trauma Association 13A or 13C). All patients underwent ORIF of a distal humerus fracture with or without anterior subcutaneous ulnar nerve transposition based on surgeon preference. Presence or absence of ulnar neuritis (ulnar-sided paresthesias, numbness, or intrinsic weakness) or reoperation related to ulnar nerve symptoms. : Average follow up was 9.6 months in the transposition group and 16.0 months in the nontransposition group. Transposition of the ulnar nerve was found to be an independent variable associated with ulnar neuritis (P < 0.001). The incidence of ulnar neuritis was 33% (16 of 48) with transposition and 9% (eight of 89) without transposition (P = 0.0003). Of the patients with ulnar neuritis, one patient in the nontransposition group (1%) and two patients in the transposition group (4%) required additional surgery specifically related to the ulnar nerve. One patient who had undergone transposition developed chronic motor and sensory denervation. Patients who underwent ulnar nerve transposition at the time of ORIF of distal humerus fractures had almost four times the incidence of ulnar neuritis than those without transposition. We do not recommend routine transposition of the ulnar nerve at the time of ORIF of distal humerus fractures.

Revision Arthroscopic Contracture Release in the Elbow Resulting in an Ulnar Nerve Transection

The indications for elbow arthroscopy have expanded over the past several years. Currently, it is used for removal of loose bodies, treatment of lateral epicondylitis, synovectomy, contracture release, and management of osteochondritis dissecans1-4. Although elbow arthroscopy is a relatively safe procedure, the reported complication rate is as high as 10%, which is higher than that seen with knee and shoulder arthroscopy3,5,6. The rate of neurovascular complications is reported to range from 0% to 14%5,6. In a review of a large series of patients treated with elbow arthroscopy, Kelly et al.5 reported a 2.5% rate of neurovascular complication, all of which were transient neurapraxias. In the literature, there are only a few reports of complete nerve transection occurring during elbow arthroscopy7-10. In the present report, we describe a patient who presented, following an arthroscopic release of an elbow contracture, with a complete transection of a previously transposed ulnar nerve. The patient was informed that data concerning the case would be submitted for publication, and he consented. Institutional review board approval was obtained. A forty-five-year-old left-hand-dominant construction worker fell and sustained a small avulsion fracture of the coronoid process of the right ulna without an elbow dislocation. The elbow was immobilized in a posterior splint for four weeks. On removal of the splint, there was a restricted range of motion of the elbow. Intensive physical therapy was initiated with the aid of a turnbuckle-type splint to improve flexion. At four months after the injury, the active and passive ranges of motion were still limited (10° of extension to 70° of flexion, with full forearm rotation). The patient underwent an open release of the contracture and a subcutaneous ulnar nerve transposition with postoperative radiation …

Elbow arthrolysis in severely stiff elbows

This study involves the results of open elbow arthrolysis performed on a series of patients having fixed joint contracture. Eighteen patients were treated with open arthrolysis. Eleven patients had very severely stiff elbows (flexion arc less than 30 degrees ), five patients had severely stiff elbows (31 degrees -60 degrees ) and two patients had moderately stiff elbows (60 degrees -90 degrees ). Fixed flexion deformity was observed in nine patients preoperatively.The mean interval between the trauma and arthrolysis was 14.8 months. The mean age was 27 years. After radiological examination, lateral kocher incision was used on 13 patients, medial and lateral incision on 3 patients, transolecranon approach on 1 patient and anterior and posterior approach on 1 patient. External fixator was applied on four patients. Fasia lata interposition was performed in three patients. Additional procedures were as follows, bone fixation in five patients, bone grafting in two patients, nerve grafting in one patient, subcutaneous ulnar nerve transposition in three patients. The average follow-up time was 47 months. At the final evaluation, the mean extension deficit had improved from 55 degrees to 32 degrees . The mean end flexion increased from 81 degrees to 124 degrees postoperatively. The flexion arc of three patients in whom heterotopic ossification was excised had increased to 65 degrees . Infection was diagnosed in two patients (11%). The importance of this study is that the patients have fixed deformities and a long follow-up time. Severely stiff elbow is one of the main indications of open arthrolysis in the patients without muscle atrophy. We suggest sequential arthrolysis as an effective way to obtain good range of motion especially in severe stiff elbows as well as to maintain the ligamantous stability of the elbow joint.

Comparative study between minimal medial epicondylectomy and anterior subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome

The purpose of this study was to review the results of 2 surgical methods for treating cubital tunnel syndrome. From 1994 to 2001, minimal medial epicondylectomy was performed on 22 elbows, and anterior subcutaneous transposition of the ulnar nerve was done on 34 elbows. In the group treated by medial epicondylectomy, 9 of the results (41%) were excellent, 10 (45%) were good, 2 (9%) were fair, and 1 result (5%) was poor. In the group treated by anterior subcutaneous transposition of ulnar nerve, 14 of the results (41%) were excellent, 13 (38%) were good, 6 (18%) were fair, and 1 result (3%) was poor. No significant difference was found between the 2 groups (P < .05). Both methods can be used for the treatment of cubital tunnel syndrome with a high rate of satisfaction.

주관 증후군에 대한 척골 신경 전방 피하 전위술

Purpose: To evaluate the clinical results of anterior subcutaneous ulnar nerve transposition operation and the factors that influence the results for cubital tunnel syndrome. Materials and Methods: Seventeen cases of cubital tunnel syndrome were treated by anterior subcutaneous transposition between March 2001 and December 2003. The mean age was 56 years and mean follow up period was 20.4 months. All patients were reviewed retrospectively. The preoperative evaluation was done by Dellon`s classification and the clinical results were evaluated by Messina’s classification. We analyzed the effect of the operation and the relations between the results and the preoperative factors, for example, duration of symptom, age, cause of illness, present of association with diabetes mellitus or preoperative flexion contracture of the elbow were analyzed. Results: The results according to Messina`s classification were 4 cases of excellent, 9 cases of good, 3 cases of fair, and 1 case of poor. The preoperative factors like duration of symptom, age, cause of illness and flexion contracture of the elbow didn`t show any statistical difference in the result of operation, but the cases which have diabetes mellitus were unsatisfactory with statistical difference (p

Stabilized Subcutaneous Ulnar Nerve Transposition with Immediate Range of Motion

Anterior transposition of the ulnar nerve at the elbow produces generally good results regardless of whether the nerve is transposed subcutaneously, intramuscularly, or submuscularly. The eventual recovery of nerve function is related less to the specific surgical technique than to the severity of the intrinsic nerve pathology. A primary variable in surgical management is the duration of postoperative elbow immobilization. The purpose of this study was to review the longterm results of a specific technique of subcutaneous anterior transposition of the ulnar nerve that utilizes a stabilizing fasciodermal sling. The study compared the results of immediate and late institution of a range of motion postoperatively. Forty-seven patients with fifty-one elbows were reexamined, by an investigator who had not been involved in their treatment, at a minimum of two years (range, twenty-four months to fourteen years) after an anterior transposition. Of the fifty-one elbows, twenty-one were immobilized for two to three weeks whereas thirty were managed with an immediate range of motion. At the latest follow-up evaluation, there were occasional, mild paresthesias in 16 percent of the limbs and there was still subjective weakness of 19 percent. Both pinch and grip strength had increased substantially. No patient had lost elbow motion. A positive Tinel sign persisted in 31 percent of the limbs, but it was mildly positive in most of them. The elbow flexion test was uniformly negative. The results for 92 percent of the limbs were satisfactory to the patients, who stated that they would undergo the same procedure again if necessary. Overall, 73 percent of the limbs had an excellent result; 18 percent, a good result; 4 percent, a fair result; and 6 percent, a poor result. With the numbers available, no significant difference could be detected, with regard to these outcomes, between the group managed with elbow immobilization and that managed with immediate elbow mobilization. However, patients treated with a postoperative cast returned to work at an average of thirty days after surgery whereas the group treated with immediate motion of the elbow returned to work at an average of ten days. This technique of stabilized subcutaneous anterior transposition of the ulnar nerve yielded predictably good results for a wide spectrum of patients. Patients returned to their occupation sooner when the elbow had been mobilized immediately.

Operative treatment of ulnar collateral ligament injuries of the elbow in athletes.

Over a 6-year period, the senior author (JRA) performed 91 ulnar collateral ligament reconstructions (N = 78) or repairs (N = 13). All patients were male and between the ages of 15 and 39 years (average, 21.6). Thirty-seven patients (41%) were professional baseball players, 41 (45%) were collegiate baseball players, and 7 (7.7%) were high school or recreational players. Subcutaneous ulnar nerve transposition with stabilization of the nerve with fascial slings of the flexor pronator mass was performed in all patients, and additional procedures were performed in 27 patients (29.7%), including 22 excisions of posteromedial olecranon osteophytes. Average follow-up was 35.4 months. Ten patients had preoperative ulnar nerve symptoms, nine of whom had complete resolution of symptoms after surgery. Complications occurred in eight patients. The average time from surgery to initiation of the interval throwing program was 3.4 months, and the average time to return to competitive throwing was 9.8 months. Sixty-seven patients (74%) were available for follow-up; of these, 53 (79%) had returned to their previous levels of competition or to a higher level. Reconstruction of the ulnar collateral ligament, with transposition and stabilization of the ulnar nerve and appropriate rehabilitation, was found to be effective in correcting medial instability of the elbow and allowed most athletes to return to previous levels of play in less than 1 year.