Review of treatment results for ulnar nerve entrapment at the elbow

Dellon, A. Lee

doi:10.1016/0363-5023(89)90192-5

Cited by 385 publications

(242 citation statements)

References 40 publications

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“…1,2,17 The prevalence of persistent symptoms varies between 9.9% and 21% with 0.7% to 4.5% being exacerbated by surgery. 2 The number of recurrences is not known.…”

Section: Discussionmentioning

confidence: 99%

Anterior submuscular transposition of the ulnar nerve

Bartels¹,

Grotenhuis²

2004

The Journal of Bone and Joint Surgery. British volume

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Outcome studies of revision surgical treatment for recurrent or persistent neuropathy of the ulnar nerve at the elbow are relatively rare and none involves patient self-assessment. In this study of 40 patients (41 elbows), a clear discrepancy is shown between clinical assessment and the patient's own view. From clinical assessment, 20% of patients had an excellent result, whereas only one (2.5%) patient self-reported a complete cure. More reports using patient self-assessment and validated scores are required.

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“…1,2,17 The prevalence of persistent symptoms varies between 9.9% and 21% with 0.7% to 4.5% being exacerbated by surgery. 2 The number of recurrences is not known.…”

Section: Discussionmentioning

confidence: 99%

Anterior submuscular transposition of the ulnar nerve

Bartels¹,

Grotenhuis²

2004

The Journal of Bone and Joint Surgery. British volume

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“…However, for moderate and severe degrees of compression, anterior submuscular transposition with internal neurolysis yielded the best results with the fewest recurrences. For severe compression, anterior intramuscular transposition yielded the fewest 'excellent' results and most recurrences (7). In Barnes Hospital at the University of Washington School of Medicine, anterior submuscular ulnar transposition is performed when conservative therapy fails.…”

Section: Discussionmentioning

confidence: 99%

Postoperative drainage is recommended in ulnar nerve transposition

Deune

Mackinnon

1998

CAN J PLAST SURG

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C ubital tunnel syndrome, or ulnar nerve compression at the elbow, is the most common entrapment of the ulnar nerve and the second most common compressive nerve lesion of the upper extremity after carpal tunnel syndrome (1). Conservative treatment in early and mild cases consists of anti-inflammatory medications, elbow splinting, and modifications of sleep and work habits and elbow positions. When conservative therapy fails, surgical decompression is indicated.While postoperative hematoma requiring surgical drainage is rare, bruising, induration and swelling are common.These sequelae increase postoperative pain and inhibit elbow mobilization. To decrease these effects of postoperative bleeding around the ulnar nerve and to decrease scarring, it has been our practice to drain the wounds with a silastic catheter that is removed on postoperative day one. This study was undertaken to evaluate the amount of drainage observed and to determine if the amount correlated with any particular patient, anesthetic or surgical parameters. Surgery to transpose the ulnar nerve is a common treatment for cubital tunnel syndrome. Postoperative hematoma is a rare, but well recognized complication of this surgery, whereas postoperative bruising is a common sequela. A retrospective review of 138 cases of anterior submuscular transposition performed between December 1991 and December 1995 was conducted to evaluate the merits of postoperative drainage. Various parameters (patient, surgical, and anesthetic) were compared to determine their effect on drainage. Males had a higher postoperative drainage volume than females (P<0.0001). Other patient, surgical and anesthetic factors did not correlate significantly with the drainage volume. The mean drainage during the first postoperative day was 41.2±2.5 mL (range 3 mL to 190 mL). This volume is significant and warrants drainage with an indwelling catheter when anterior submuscular transposition of the ulnar nerve is performed. MATERIALS AND METHODS Key Words: Anterior submuscular transposition, Cubital tunnel syndrome, Drainage, Hematoma, Ulnar nerve transpositionDrainage post-opératoire recommandé dans la transposition du nerf cubital RÉSUMÉ : La chirurgie pour transposition du nerf cubital est un traitement courant pour le syndrome du nerf cubital. L'hématome post-opératoire est une complication rare, mais bien reconnue de cette chirurgie, alors que l'ecchymose post-opératoire est une séquelle courante. On a procédé à une revue rétrospective de 138 cas de transpostion sous-musculaire antérieure entre décembre 1991 et décembre 1995, afin d'évaluer les mérites du drainage post-opératoire. Divers paramètres (liés aux patients, à la chirurgie ou à l'anesthésie) ont été comparés pour déterminer leur effet sur le drainage. Le drainage a été plus abondant chez les hommes que chez les femmes (P<0,0001). D'autres facteurs, liés au patient, à la chirurgie ou à l'anesthésie n'ont pas été en corrélation significative avec le volume drainé. Le drainage moyen durant le premier jour post-opératoire a été...

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“…We have found no other prospective study comparing these two methods of treatment (Dellon 1989;Lundborg 1992), and this is the first study which assessed the elbow postoperatively. This is important since removal of the medial epicondyle may weaken the flexor muscles which arise from it, and perhaps also lead to instability of the joint.…”

Section: Discussionmentioning

confidence: 99%

Medial Epicondylectomy or Ulnar-Nerve Transposition for Ulnar Neuropathy at the Elbow?

Geutjens

Langstaff

Smith

et al. 1996

The Journal of Bone and Joint Surgery. British volume

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W e carried out a prospective randomised study comparing medial epicondylectomy with anterior transposition for the treatment of ulnar neuropathy at the elbow. The mean follow-up period was 4.5 years and we assessed the patients neurologically and orthopaedically.Neither procedure appeared to have a significant effect on elbow function. Our study showed better results after medial epicondylectomy; in particular patient satisfaction was higher than after ulnar nerve transposition. There were no significant differences in motor power or nerve-conduction rates and sensory fibres appeared to be more vulnerable to devascularisation. [Br] 1996;78-B:777-9. Received 15 August 1995; Accepted after revision 6 February 1996 The place of surgery in the treatment of lesions of the ulnar nerve at the elbow is uncertain: a variety of procedures has been recommended. There have been several reports of good results for medial epicondylectomy (King and Morgan 1959;Craven and Green 1980;Froimson and Zahwari 1980;Robinson, Aghasi and Halperin 1992), but none of these includes comparison with other operations, such as the commonly performed anterior transposition of the nerve (Macnicol 1979;Adelaar, Foster and McDowell 1984;Lundborg 1992). J Bone Joint SurgWe have performed a prospective randomised study of medial epicondylectomy and anterior transposition for the treatment of lesions of the ulnar nerve at the elbow. PATIENTS AND METHODSFrom 1985 to 1992, a total of 52 patients had operations for ulnar neuropathy and were entered into the study. Nine were lost to follow-up of whom two had died, records were untraceable in four, and three had moved away and could not be contacted. This left 43 patients, four of whom had bilateral operations, giving 47 cases. The mean age at operation was 58 years (36 to 85). Seven patients had preexisting osteoarthritis of the elbow, but there was no apparent cause in 36. For entry into the study, patients had to fulfil the following criteria: 1) clinical evidence of a lesion of the ulnar nerve at the elbow; 2) demonstrable slowing of conduction of the ulnar nerve at the elbow; 3) persistent symptoms for at least three months; 4) no rheumatoid disease at the elbow; and 5) no valgus deformity, defined as a carrying angle of more than 5° greater than the opposite elbow.All patients had a detailed neurological assessment (DJ) and nerve-conduction studies (NJS) before operation and at 12 months. They were randomly allocated to one of the two operations by the use of sealed envelopes which were only opened in the operating theratre just before the procedure. All surgery was performed by one of two surgeons (NJB or CJH), so that both procedures were performed by both surgeons, thus avoiding any technical bias.Neurological assessments, made before operation and at follow-up, included muscle strength rated on a scale of 0 to 5, muscle atrophy and sensation evaluated by light touch and static two-point discrimination. Pain in the hand was scored from 5 for severe nocturnal pain to zero. Follow-up review w...

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Review of treatment results for ulnar nerve entrapment at the elbow

Cited by 385 publications

References 40 publications

Anterior submuscular transposition of the ulnar nerve

Anterior submuscular transposition of the ulnar nerve

Postoperative drainage is recommended in ulnar nerve transposition

Medial Epicondylectomy or Ulnar-Nerve Transposition for Ulnar Neuropathy at the Elbow?

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