Evaluation of Different Surgical Techniques for Revision Cubital Tunnel Release: A Meta-Analysis of Patient-Reported Symptoms

Shekouhi, Ramin; Taylor, Justin; Chen, Xizhao; Liu, Annika; Hao, Kevin A.; Pomputius, Ariel; Chim, Harvey

doi:10.1016/j.jhsa.2023.11.012

Cited by 2 publications

(4 citation statements)

References 31 publications

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“…It is mandatory to evaluate the pain and its different modality carefully and meticulously in relation to sensory function in patients with nerve injuries, including those with pain in relation to an ulnar nerve entrapment, independently of whether primary or revision surgery is performed or not [ 70 ]. Pain seems to be a prominent feature among the patients with persistent or recurrent ulnar nerve entrapment (meta-analysis; pain 82%, sensory dysfunction 81%, and motor dysfunction 53%) [ 71 ]. Evaluation of pain may include different pain assessment tools, such as Numerical Rating Scale (NRS), pain Visual Analog Scale (VAS), McGill´s Pain Questionnaire (MPQ) and short form MPQ, Pain Disability Index (PDI), Cold Intolerance Symptom Severity (CISS) Scale, Patient-Reported Outcome Measurement Information System (PROMIS) with subsets Pain Intensity, Pain Interference, Pain Behavior, and Neuropathic Pain Quality Scale, as well as the questionnaires Douleur Neuropathique 4 (DN4) and HQ-8 [ 70 , 72 , 73 ].…”

Section: Ulnar Nerve Entrapmentmentioning

confidence: 99%

“…Pain, being present preoperatively or in conjunction with primary and revision surgery for ulnar nerve entrapment, is a symptom not particularly well highlighted or structurally evaluated in the literature, despite included questions about pain in evaluation studies of ulnar nerve entrapment [ 42 , 73 , 80 , 81 ]. Still, pain of different modalities is the most prevalent symptom in many patients [ 71 ]. Interestingly, medial elbow pain can also exist independently from the ulnar nerve entrapment, indicating that medial elbow pain is not a clear diagnostic symptom of ulnar nerve entrapment [ 81 ].…”

Section: Ulnar Nerve Entrapmentmentioning

confidence: 99%

“…Revision surgery may result in complete or partial recovery, but residual problems, such as paresthesia, are the most frequent symptom, and patients with no improvement are common [ 155 , 158 ]. Again, there is a lack of clinical studies with patients suffering from recurrent or persistent ulnar nerve entrapment, despite a recent meta-analysis of the subject indicating that submuscular ulnar nerve transposition is superior to other procedures with respect to improvement of sensory and motor functions [ 71 ]. Still, general recommendations cannot be made regarding diagnostic criteria, indication for surgery, or selection of surgical method in persistent and recurrent ulnar nerve entrapment, although pain and sensory dysfunction seem to be prominent symptoms among such patients [ 71 ].…”

Section: Treatmentmentioning

confidence: 99%

“…Again, there is a lack of clinical studies with patients suffering from recurrent or persistent ulnar nerve entrapment, despite a recent meta-analysis of the subject indicating that submuscular ulnar nerve transposition is superior to other procedures with respect to improvement of sensory and motor functions [ 71 ]. Still, general recommendations cannot be made regarding diagnostic criteria, indication for surgery, or selection of surgical method in persistent and recurrent ulnar nerve entrapment, although pain and sensory dysfunction seem to be prominent symptoms among such patients [ 71 ]. Thereby, it is difficult to generally judge the outcome of revision surgery for ulnar nerve entrapment, and further research is needed [ 137 , 159 ].…”

Section: Treatmentmentioning

confidence: 99%

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The Unpredictable Ulnar Nerve—Ulnar Nerve Entrapment from Anatomical, Pathophysiological, and Biopsychosocial Aspects

Nyman,

Dahlin

2024

Diagnostics

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Peripheral nerves consist of delicate structures, including a rich microvascular system, that protect and nourish axons and associated Schwann cells. Nerves are sensitive to internal and external trauma, such as compression and stretching. Ulnar nerve entrapment, the second most prevalent nerve entrapment disorder after carpal tunnel syndrome, appears frequently at the elbow. Although often idiopathic, known risk factors, including obesity, smoking, diabetes, and vibration exposure, occur. It exists in all adult ages (mean age 40–50 years), but seldom affects individuals in their adolescence or younger. The patient population is heterogeneous with great co-morbidity, including other nerve entrapment disorders. Typical early symptoms are paresthesia and numbness in the ulnar fingers, followed by decreased sensory function and muscle weakness. Pre- and postoperative neuropathic pain is relatively common, independent of other symptom severity, with a risk for serious consequences. A multimodal treatment strategy is necessary. Mild to moderate symptoms are usually treated conservatively, while surgery is an option when conservative treatment fails or in severe cases. The decision to perform surgery might be difficult, and the outcome is unpredictable with the risk of complications. There is no consensus on the choice of surgical method, but simple decompression is relatively effective with a lower complication rate than transposition.

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