Transposition Of Ulnar Nerve Research Articles

Open reduction and internal fixation for nonunion of extra-articular distal humeral fractures in patients 70 years and older

The study purpose was to report the clinical and radiologic outcomes of osteosynthesis by open reduction and internal fixation for nonunion of extra-articular distal humeral fractures in patients aged 70 years or older. This retrospective study included 28 patients who received osteosynthesis treatment between March 2010 and December 2015. Primary conservative treatment had failed in all patients. All surgical procedures were performed via the posterior approach without olecranon osteotomy and with the use of double-locking plates for each column. The mean patient age was 72 years, and surgical procedures were performed a mean of 7.6 months after injury. Preoperatively, extension-flexion was 32° to 101° and forearm pronation-supination was 74° to 47°. The mean visual analog scale score was 4; the mean Mayo Elbow Performance Score was 50; and the mean Disabilities of the Arm, Shoulder and Hand score was 58. All cases showed proper union after a mean of 5.2 months. At the final follow-up examination, the extension-flexion and rotation arcs had improved significantly (to 20° to 124° and to 80° to 66°, respectively; both P < .001), and all clinical scores were satisfactory (visual analog scale score, 1; Mayo Elbow Performance Score, 65; and Disabilities of the Arm, Shoulder and Hand score, 24; all P < .001). Ulnar nerve transposition was performed in 7 patients, and no distinct ulnar nerve symptom was observed in any patient at the final follow-up examination. We consider osteosynthesis by open reduction and internal fixation as a recommended option for extra-articular distal humeral fractures in elderly patients aged 70 years or older in whom conservative treatment has failed.

Study of intercondylar fractures of the distal humerus treated with 90-90 plating

Intra articular fractures of the distal humerus cause considerable morbidity to the patients. There are several controversies regarding the approach and fixation of the fracture. AO advocated 90-90 plating of both columns while recent biomechanical studies demonstrated superior mechanical strength with parallel plating. But parallel plating is associated with many complications. We performed bicolumnar perpendicular plating in 15 intraarticular AO type C fractures through transolecranon approach. Ulnar nerve was isolated and carefully protected, but ulnar nerve transposition was not done. We achieved union in all cases with functional range of movement in 13 patients. We had no case of post-operatively developed ulnar nerve neuropathy or heterotopic ossification. The average Mayo Elbow Performance Score was 85 points. We infer that 90-90 plating is effective in intercondylar fractures of distal humerus with minimal complications.

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.

What Are the “Critical Portions” of Carpal Tunnel Release, Ulnar Nerve Transposition, and ORIF Distal Radius?

There is no financial information to disclose. Overlapping surgery is attracting increased scrutiny. The American College of Surgeons (ACS) states that the attending surgeon must be present for all “critical portions” of a surgery; however, critical portions of surgeries are not defined. We hypothesized a Delphi panel process would promote and measure consensus on the critical portion of 3 common hand surgeries. We used a 3-round Delphi process to achieve consensus on the “critical portions” in carpal tunnel release (CTR), ulnar nerve transposition (UNT; subcutaneous/submuscular), and ORIF distal radius. “Critical” was based on the ACS definition. Panelists were 10 hand surgeons (7 fellowship-trained surgeons and 3 fellows). Round 1 (in-person): panel reached consensus on steps of each procedure. Round 2 (online): panelists rated steps from 1 (not critical) to 9 (extremely critical) and provided open-ended comments. Round 3 (online): panelists received summary statistics and open-ended comments from round 2 and re-rated the steps. We operationalized consensus as ≥ 80% rated a step using the same range: 1-3 (not critical), 4-6 (somewhat critical), 7-9 (critical). From round 2 to round 3 the range of scores compressed, indicating greater agreement. Final round results are summarized in Figure 29-1. For CTR, panelists reached consensus that dividing the transverse carpal ligament was critical and wound closure and dressings were non-critical. There was no consensus on skin incision or division of subcutaneous tissue. For UNT, panelists reached consensus that mobilizing the ulnar nerve, preparing the transposition, transposing the nerve, and assessing the transposed nerve were critical and closure and splint/dressings were non-critical. There was no consensus on skin incision, preservation of MABC, and hemostasis. For ORIF distal radius, panelists reached consensus that fracture reduction, skeletal fixation, and fluoroscopic evaluation were critical; fracture exposure and assessment of joint stability was somewhat critical; and hemostasis, closure, and splint/dressings were non-critical. There was no consensus on whether skin incision was critical. •For all procedures, panelists reached a consensus rating for the majority of steps, but not for skin incision.•The project provides proof of concept that a Delphi process is useful in fostering and measuring consensus on the critical portions of surgery.•Further work is needed to address areas of disagreement and the implications of a consensus that a step is “somewhat critical.” A consensus is needed whether such areas should be eliminated through further rounds or leeway in surgical practice is appropriate.•Efforts are underway to repeat this process with additional and more diverse panelists.

Can We Make Simple In Situ Decompression of the Ulnar Nerve at the Elbow Still Easier?

In situ decompression and transposition are equally effective in cubital tunnel syndrome treatment. Both are traditionally performed in the supine position. To validate our surgical technique for in situ decompression in the lateral decubitus position, comparing results with other techniques used in our institutions. A retrospective study was performed from January 2009 to February 2016, of 188 patients with cubital tunnel syndrome 115 males, 73 females; mean age, 53.44 ± 12.12 years standard deviation (range, 18-84 years) treated with in situ decompression in the lateral or supine positions or transposition (subcutaneous or submuscular). The lateral decubitus group received local anesthesia and the remainder received a brachial plexus block. Clinical and electrophysiologic results between these 4 groups were compared. There were no statistically significant demographic differences between groups. Results were better in in situ decompression groups compared with transpositions. Mean follow-up was 1511.1 ± 770.57 days standard deviation (range, 310-4203 days). There were no recurrences or residual elbow pain/dysesthesia/anesthetic scar/hyperesthesia/neuroma in the lateral decubitus group. Complication and recurrence rates were in direct correlation to incision size. The worst results were seen in transpositions, particularly in the submuscular group. In situ decompression in the supine position had better results than transpositions but worse than those performed in lateral decubitus. Smaller surgical wound correlates with a reduction in operating time, costs, complication rates, and time out of work. In situ decompression is equally as effective as ulnar nerve transpositions but with fewer complications and recurrences. In the lateral decubitus position, the retroepicondylar tunnel is more accessible, allowing smaller incisions and better results.

Comparative Study of Outcome of Simple Decompression Versus Anterior Transposition of Ulnar Nerve in the Treatment of Cubital Tunnel Syndrome

Comparative Study of Outcome of Simple Decompression Versus Anterior Transposition of Ulnar Nerve in the Treatment of Cubital Tunnel Syndrome

Submuscular Versus Subcutaneous Ulnar Nerve Transposition: A Cadaveric Model Evaluating Their Role in Primary Ulnar Nerve Repair at the Elbow

To investigate the length gained from subcutaneous and submuscular transposition of the ulnar nerve at the elbow. Specifically, the study aimed to define an expected nerve gap able to be overcome, and to determine if a difference between transposition techniques exists. Eleven cadaveric specimens from the scapula to fingertip were procured. In situ decompression and mobilization of the ulnar nerve at the elbow followed by simulated laceration of the nerve was performed. Nerves were marked 5 mm from the laceration site to facilitate overlap measurement and to simulate nerve end preparation to viable fascicles before primary coaptation. Nerve ends were attached to spring gauges set at 100 g of tension (strain ≤ 10%). Measurements of nerve overlap were obtained in varying degrees of wrist (0°, 30°, 60°) and elbow (0°, 15°, 30°, 45°, 60°, 90°) flexion. Measurements were performed after in situ decompression and mobilization, and then repeated after both subcutaneous and submuscular transposition. Ulnar nerve transposition was found to increase nerve overlap at an elbow flexion of 30° or greater. No difference was seen between subcutaneous and submuscular transpositions at all wrist and elbow positions. In situ decompression and mobilization alone provided an average of 3.5 cm of length gain with the elbow extended. Transposition in conjunction with clinically feasible wrist and elbow flexion (30° and 60°, respectively) provided 5.2 cm of length gain. Controlling for mobilization, a statistically significant increase in overlap of approximately 2 cm was gained from transposition. Although mobilization combined with wrist and elbow flexion may afford substantial gap reduction and should be used initially when approaching proximal ulnar nerve lacerations, transposition should be considered when faced with a large nerve gap greater than 3 cm at the elbow. No difference was seen between submuscular and subcutaneous transposition techniques. This study defines the extent an ulnar nerve gap at the elbow can be overcome by in situ mobilization, joint positioning, and transposition. It additionally compares theefficacy of submuscular and subcutaneous transposition techniques in closing this gap.

Rates of Complications and Secondary Surgeries After In Situ Cubital Tunnel Release Compared With Ulnar Nerve Transposition: A Retrospective Review

The purpose of this study was to contrast the rate and types of complications and secondary surgeries for in situ cubital tunnel release and ulnar nerve transposition. A retrospective cohort study was performed by query of hospital billing records for all patients who underwent cubital tunnel surgery from August 2008 to July 2013, yielding 421 patients. Exclusion criteria were acute trauma, revision surgery, neoplasm, age younger than 18 years, incomplete records, and postoperative follow-up less than 3 months. Of the remaining 234 patients, 147 patients underwent 157 in situ cubital tunnel releases and 87 patients underwent 90 ulnar nerve transpositions. In 157 in situ cubital tunnel releases, there were 6 complications (3.8%), including 3 cases (1.9%) of ulnar nerve instability, 2 cases (1.3%) of postoperative infection, and 1 case (0.6%) of a postoperative seroma. In 90 ulnar nerve transpositions, there were 2 complications (2.2%), including 1 case (1.1%) of postoperative infection and 1 case (1.1%) of medial antebrachial cutaneous nerve injury. The secondary surgery rate was 5.7% overall, 2.5% for insitu cubital tunnel release, and 11.1% for ulnar nerve transposition. Chronic kidney disease was associated with complication after cubital tunnel surgery. Prior trauma to the elbow and ulnar nerve transposition were associated with secondary surgery. The short-term complication rates of cubital tunnel surgery are low (3.2%), but higher for patients with chronic kidney disease. The secondary surgery rate after cubital tunnel surgery was 5.7% overall, but higher for patients with prior elbow trauma and for patients undergoing ulnar nerve transposition. Therapeutic IV.

A minimally invasive approach for cubital tunnel release and ulnar nerve transposition

ABSTRACTObjectives: The aim of the study is to introduce a new minimally invasive technique for ulnar nerve release and transposition.Methods: From January 2010 to May 2011, 51 patients with cubital tunnel syndrome were treated through a 1.5 to 2 cm incision. Limb functional recovery, scar esthetics, sensitivity of scar, numbness of the operating area, and patient satisfaction were assessed.Results: No wound hematoma nor infection was observed in the group. The time of operation was 36 ± 17.2 minutes. At the final follow-up of 63 ± 7.3 months, 2-point discrimination of the small finger was improved from 6.3 ± 2.2 mm to 5.2 ± 2.4 mm. Grip and pinch strength of the hand were improved from 14.2 ± 7.7 kg and 3.7 ± 2.4 kg to 35.2 ± 12.7 kg and 4.1 ± 2.8 kg, respectively. The motor nerve conduction velocity was improved from 36.5 ± 11.2 to 44.6 ± 6.7 (m/sec). The Disabilities of the Shoulder, Arm, and Hand questionnaire score was improved from 37.2 ± 23.8 to 10.5 ± 9.6. No patients reported scar pain, sensitivity of scar, or numbness of the operating area. No revision surgery was needed. Michigan Hand Outcome score for aesthetics was 94.6%±5.1 and satisfaction was 92 ± 8, respectively. We obtained 33 excellent, 12 good, 5 fair, and 1 poor result.Conclusion: Ulnar nerve decompression with anterior transposition can be safely and effectively accomplished through the small incision. It can be an alternative technique producing good appearance.

Epidemiology and Estimated Cost of Surgery for Cubital Tunnel Syndrome Conducted by the Unified Health System in Brazil (2005–2015)

Introduction Cubital tunnel syndrome (CTS) is responsible for one of the types of ulnar nerve neuropathy and is the second cause of compressive neuropathy of the upper limb, only surpassed by carpal tunnel syndrome. Objective To describe the epidemiological data of the ulnar nerve transposition surgical code in the treatment of CTS by the United Health System (SUS) from 2005 to 2015. Methodology This is a descriptive epidemiological study, in which data were obtained through consultation of the DATASUS database. Results/Discussion During this period, 774 procedures were performed and, despite the addition of 20.3 million people to the Brazilian population, the incidence was 0.33/1,000,000. National and international epidemiology point to a slightly higher prevalence of the procedure between men, in the fourth and fifth decades of life. Low permanence rate, as well as the absence of hospital deaths related to the procedure, infer that the procedure is safe, with low morbidity and mortality rates. Conclusion The annual incidence of the cubital syndrome submitted to surgical treatment at SUS in the Brazilian population was 1/7,670,833 in 2005 and ½,174,468 in 2015. The cost of each surgical procedure during the same period ranged from R$ 318.88 to R$ 539.74. The mean hospitalization time for CTS surgery was 1.85 days.

Current Trends in Ulnar Collateral Ligament Reconstruction Surgery Among Newly Trained Orthopaedic Surgeons.

Ulnar collateral ligament (UCL) reconstructions are being performed with an increasing annual incidence. The purpose of this study was to evaluate trends in UCL surgery among recently trained orthopaedic surgeons. The American Board of Orthopaedic Surgeons (ABOS) database was used to identify all UCL reconstructions from 2004 to 2013. Procedures were identified by Current Procedural Terminology (CPT) codes and verified by International Classification of Disease, Ninth Revision (ICD-9) codes. Data on surgeon fellowship, practice location, concomitant surgical procedures, and complications were collected. One hundred sixty-four UCL reconstructions were performed by 133 ABOS Part II candidates. The annual incidence increased from 1.52 to 3.46 cases per 10,000 (P = 0.042). Reconstructions were most commonly performed by surgeons with fellowship training in sports medicine (65.9%), hand and upper extremity (18.9%), and shoulder and elbow (9.1%). Most reconstructions were performed in isolation (57.3%), or with ulnar nerve transposition (32.9%) or elbow arthroscopy (9.8%). Concomitant elbow arthroscopy rates decreased significantly (P = 0.022). Complications occurred in 9.8% of cases, although the rates did not significantly change (P = 0.466). UCL reconstructions are being performed with increasing frequency. Concomitant procedure rates remained the same, although arthroscopy was less commonly performed. Complication rates did not change considerably over the observed period. Further study of the surgical trends and associated long-term outcomes is warranted. Level IV.

A modified approach for elbow arthroscopy using an adjustable arm holder

BackgroundPosition shifting from elbow arthroscopy to open surgery could complicate the surgical procedures; patient safety and risks of contamination are of concern. The aim of this study is to retrospectively assess the safety and efficacy of elbow arthroscopy in 32 elbows of 32 patients using a modified arm holder to facilitate subsequent open surgery in supine position.MethodsWe performed a retrospective study in arthroscopy of the elbow performed with patients in the supine position under general or regional anesthesia. Arthroscopic indications were intraarticular lesions with or without second disorders. The operated arm was securely supported using an adjustable arm holder, which allowed a second surgical procedure without repositioning the patient. We recorded arthroscopic findings, clinical outcome, and complications for all patients. The average duration of follow-up was 17.1 months. Functional assessment was based on the Mayo Elbow Performance Score.ResultsAll patients had either good or excellent results with a mean Mayo Elbow Performance Score of 89.2 ± 7.2. Final motion arc averaged 113.3 ± 11.8; residual motion limitation was noted in 2 patients with preoperative ankylosis. No complications were observed immediately after surgery or during follow-up except transient paresthesia along medial cutaneous nerve in 2 patients. A total of 17 patients (53.1%) underwent other surgeries (19 procedures) after arthroscopy; 16 of these surgeries were open elbow procedures including ligament repair (7), ligament reconstruction (5), and ulnar nerve transposition (4). The average time for arthroscopy was 45.2 min; the time interval between the end of arthroscopy and the start of the second surgery procedure averaged 6.5 min.ConclusionsArthroscopy of the elbow using an adjustable arm holder with the patients in the supine position was safe and efficacious. This procedure eliminates the need for repositioning the patient and thus may facilitate subsequent concomitant surgical procedures.

Team Approach: Elbow Contracture Due to Heterotopic Ossification

➢ The elbow is prone to the formation of heterotopic ossification after trauma. Elbow contracture due to heterotopic ossification leads to compromised range of motion and disabilities in performing daily activities.➢ The treatment of elbow contracture is challenging and requires a multidisciplinary assessment.➢ Nonoperative treatment is appropriate for patients within 6 months after the injury to counter the progressive loss of motion during the maturation of heterotopic bone.➢ Operative intervention is indicated if the functional arc of motion cannot be maintained.➢ Open arthrolysis combined with heterotopic excision, ulnar nerve decompression and transposition, and application of a hinged external fixator are effective interventions for improving elbow function.➢ A prolonged and rigorous rehabilitation protocol after elbow release is important for preserving the arc of motion achieved during surgery.

Open Surgical Release of Posttraumatic Elbow Contracture in Children and Adolescents.

Posttraumatic elbow contractures in children and adolescents are challenging to manage, and studies investigating surgical treatment are limited by the rarity of this condition. Small case series have shown variable gains in immediate and long-term elbow arc of motion after open surgical release. We reviewed our experience with open surgical release of posttraumatic elbow contracture in patients <21 years old at 2 institutions. A retrospective chart review identified patients who underwent posttraumatic open elbow contracture release by 2 surgeons at 2 institutions between 2006 and 2013. Nontraumatic contractures and arthroscopic releases were excluded. Twenty-six patients were included in this study. Mean age at the time of injury was 12 years (5 to 19 y) and at the time of surgery was 14 years (7 to 20 y). Capsulotomy, osteoplasty, removal of hardware, ulnar nerve release or transposition, and ligament reconstruction were performed through medial and lateral approaches as indicated by the pathology. Ten patients had ligament repair or stabilization, and 16 patients used a continuous passive motion (CPM) postoperatively. Outcomes included active range of motion and complications. Mean time from injury to surgical release was 29 months. Mean postoperative follow-up was 42 months. Elbow active flexion-extension and forearm rotation arcs both increased significantly by a mean of 49 and 70 degrees, respectively, at final follow-up. A mean 85% of intraoperative flexion-extension arc was maintained at final follow-up. Ligament repair or reconstruction and the use of a postoperative CPM did not significantly change these outcomes. Outcomes were not significantly different if our contracture release was performed within a year from injury. Patients who had surgery before our contracture release had decreased restoration of forearm rotation after release. Complications included 2 recurrent contractures (1 used a CPM and 1 did not), and 2 postoperative ulnar neuropathies (1 used a CPM and 1 did not). Open contracture release for posttraumatic elbow contracture in an adolescent population can significantly improve active range of motion. Level 3-therapeutic.

Subjective ulnar nerve dysfunction commonly following open reduction, internal fixation (ORIF) of distal humeral fractures and in situ decompression of the ulnar nerve

The aim of this retrospective study was to investigate the frequency of persistent ulnar affection in patients who underwent open reduction and internal fixation (ORIF) of distal humeral fractures without ulnar nerve transposition or mobilisation. Eighty-two patients (53 women), mean age 62 years, were, at a mean of 48 months, reviewed through medical records and a subjective evaluation form concerning ulnar nerve problems. Ulnar nerve affliction, in most cases regarded as mild, was experienced by 22 patients (27%; 14 women) and significantly associated with multiple surgeries. Three patients had been operated with late neurolysis and one with transposition without reported improvement. The proportion of ulnar nerve dysfunction was equally common regardless of medial or lateral plating. ORIF with plate fixation and without ulnar nerve transposition seems to be an acceptable option for patients with distal humeral fractures. The frequency of ulnar nerve affection in our series does not appear higher than previously reported. Subjective ulnar nerve symptoms were, however, relatively common and appear related to the trauma itself, the surgery, or the post-operative management which highlights the need for further analysis of these factors.

Management of chronic neglected lateral condyle elbow non-union in adults: functional results of a cohort study and a proposed treatment algorithm.

To evaluate surgical treatment of symptomatic non-union of lateral condylar elbow fractures in adults. In this retrospective cohort study, 11 consecutive adult patients were surgically treated for symptomatic non-union of the lateral humeral condyle. Milch type I fracture non-unions (n = 3) were treated with medial closing wedge osteotomy and ulnar nerve transposition, while type II equivalents (n = 8) were treated with non-union fixation and bone grafting. Age at injury, age at referral, pre-operative symptoms, and pre-operative functional data (Modified An and Morrey functional rating index) were collected. Eleven patients (average age 20years old) with varying symptoms attributable to non-union were surgically treated at a mean of 15.8years following the initial fracture. Post-operative complications included one superficial infection and 17one radial nerve temporary neuropraxia. Pain, ulnar neuritis, and functional outcomes (Modified An and Morrey, mean 7.1 point improvement) improved significantly. However, the combined range of motion decreased by a mean of 11.4°. Our treatment algorithm for adults with chronic neglected and symptomatic non-union of the lateral humeral condyle improved functional outcomes in this cohort.

Complication Rates of Cubital Tunnel Surgery: In situ Cubital Tunnel Release Compared with Ulnar Nerve Transposition: Level 3 Evidence

There is no financial information to disclose. The purposes of this study are to determine the rate and types of complications of in situ cubital tunnel release compared with ulnar nerve transposition. Our null hypothesis is that complication rates are the same after in situ cubital tunnel release and ulnar nerve transposition. An IRB-approved retrospective cohort study was performed over a 5-year period at a single institution. The hospital medical records database was queried using Common Procedural Terminology code for all patients who underwent open cubital tunnel release from August 2008 to July 2013, yielding 426 patients who underwent cubital tunnel surgery. Application of exclusion criteria of acute trauma, revision surgery, neoplasm, age less than 18, misdated procedure, miscoded procedure, insufficient records, and non-study surgeon resulted in 340 patients who underwent cubital tunnel decompression, including 225 in situ cubital tunnel releases and 115 ulnar nerve transpositions. Computerized medical records were analyzed for surgical complications. Of 340 cubital tunnel surgeries performed, 19 were noted to have a complication by final follow-up (5.6%). There were 8 complications out of 225 in situ cubital tunnel releases (3.6%), including 3 cases of ulnar nerve instability (1.3%), 2 cases of persistent or recurrent cubital tunnel syndrome (0.9%) treated with ulnar nerve transposition, 2 cases of postoperative infection (0.9%) treated with antibiotics and wound care, and 1 case of a postoperative seroma (0.4%) not requiring reoperation. There were 11 complications out of 115 ulnar nerve transpositions (9.6%), including 9 cases of persistent or recurrent cubital tunnel syndrome (7.8%), 8 of which were treated with revision ulnar nerve transposition, 1 case of postoperative infection (0.9%) treated with surgical debridement, and 1 case of MACN injury (0.9%) repaired intraoperatively. The revision surgery rate was 4.7% overall, 1.8% for in situ cubital tunnel release and 7.8% for ulnar nerve transposition. Ulnar nerve transposition was associated with increased rates of complication (P = 0.02) and revision surgery (P = 0.01). •The short-term complication rates of cubital tunnel surgery are low (5.6%), but higher for ulnar nerve transposition (9.6%) than in situ cubital tunnel release (3.6%), P = 0.02.•The revision surgery rate after cubital tunnel surgery was 4.7% overall, but higher for ulnar nerve transposition (7.8%) than in situ cubital tunnel release (1.8%), P = 0.01.•The most common complications following in situ cubital tunnel release are ulnar nerve instability (1.3%), persistent or recurrent cubital tunnel syndrome (0.9%), and infection (0.9%).•The most common complication following ulnar nerve transposition is persistent or recurrent cubital tunnel syndrome (7.8%).

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.

Ультрасонографическое исследование после передней подкожной транспозиции локтевого нерва

Ультрасонографическое исследование после передней подкожной транспозиции локтевого нерва

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.