Technical problems with ulnar nerve transposition at the elbow: Findings and results of reoperation

Broudy, Arnold S.; Leffert, Robert D.; Smith, Richard J.

doi:10.1016/s0363-5023(78)80121-x

Cited by 172 publications

(67 citation statements)

References 11 publications

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“…In 92% of our patients, the epicondyle-olecranal ligament appeared to be (partially) intact during ASTAFNUE, which could be a result of secondary fibrosis or incomplete dissection in the primary surgery, as described by others in 1978. 5 Another hypothesis for failure of primary and/or secondary surgery is irreversible damage of the ulnar nerve before surgery; however, this hypothesis is not supported by our findings. In our study, a normal appearance of the ulnar nerve during the transposition was not related to outcome.…”

Section: Surgical Techniquecontrasting

confidence: 80%

Anterior subcutaneous transposition for persistent ulnar neuropathy after neurolysis

Gent¹,

Datema

Groen³

et al. 2017

FOC

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OBJECTIVE Little is known about optimal treatment if neurolysis for ulnar nerve entrapment at the elbow fails. The authors evaluated the clinical outcome of patients who underwent anterior subcutaneous transposition after failure of neurolysis of ulnar nerve entrapment (ASTAFNUE). METHODS A consecutive series of patients who underwent ASTAFNUE performed by a single surgeon between 2009 and 2014 was analyzed retrospectively. Preoperative and postoperative complaints in the following 3 clinical modalities were compared: pain and/or tingling, weakness, and numbness. Six-point satisfaction scores were determined on the basis of data from systematic telephonic surveys. RESULTS Twenty-six patients were included. The median age was 56 years (range 22–79 years). The median duration of complaints before ASTAFNUE was 23 months (range 8–78 months). The median interval between neurolysis and ASTAFNUE was 11 months (range 5–34 months). At presentation, 88% of the patients were experiencing pain and/or tingling, 46% had weakness, and 50% had numbness of the fourth and fifth fingers. Pain and/or tingling improved in 35%, motor function in 23%, and sensory disturbances in 19% of all the patients. Improvement in at least 1 of the 3 clinical modalities was found in 58%. However, a deterioration in 1 of the 3 modalities was noted in 46% of the patients. On the patient-satisfaction scale, 62% reported a good or excellent outcome. Patients with a good/excellent outcome were a median of 11 years younger than patients with a fair/poor outcome. No other factor was significantly related to satisfaction score. CONCLUSIONS A majority of the patients were satisfied after ASTAFNUE, even though their symptoms only partly resolved or even deteriorated. Older age is a risk factor for a poor outcome. Other factors that affect outcome might play a role, but they remain unidentified. One of these factors might be earlier surgical intervention. The modest results of ASTAFNUE should be mentioned when counseling patients after failure of neurolysis of ulnar nerve entrapment to manage their expectations. Patients, especially those who are elderly, might even consider not undergoing a secondary procedure. A randomized trial that includes a conservative treatment group and groups undergoing one of the several possible surgical procedures is needed to find the definitive answer for this clinical problem.

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Section: Surgical Techniquecontrasting

confidence: 80%

Anterior subcutaneous transposition for persistent ulnar neuropathy after neurolysis

Gent¹,

Datema

Groen³

et al. 2017

FOC

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“…This is higher than other studies have reported. [4][5][6][7][10][11][12] However, these studies report clinician-based assessments and compare with our findings of 2.5% poor outcome when using a similar methodology.…”

Section: Discussionsupporting

confidence: 54%

“…4 Few reports deal specifically with recurrent or persistent signs and symptoms after surgery. [3][4][5][6][7][8][9][10][11][12][13][14] Revision techniques which have been described include external neurolysis, 8 decompression, 8 anterior subcutaneous transposition, 7,8 anterior submuscular transposition, 4,5,10,11 repositioning of the nerve, 8 wrapping with a Silastic strip, 6 and wrapping with autogenous saphenous vein. 12,13 Simple decompression is the simplest and least invasive procedure, whereas anterior submuscular transposition is the most extensive.…”

Section: Discussionmentioning

confidence: 99%

“…This is in contrast to the results of our clinical assessment in which 20% were excellent. The reported proportion of excellent results varies between 0% and 37.5% [4][5][6][7][10][11][12] with the majority being less than 5%.…”

Section: Discussionmentioning

confidence: 99%

“…A number of surgical treatments have been reported, 1,2 but the results for recurrent or persistent symptoms after surgery for ulnar nerve compression have been infrequently discussed. [3][4][5][6][7][8][9][10][11][12][13][14] We have reviewed the outcome of re-exploration of the ulnar nerve combined with anterior submuscular transposition in patients with persistent symptoms, using a patient selfassessment questionnaire.…”

mentioning

confidence: 99%

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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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Perioperative Nerve Lesions

Dawson¹,

Krarup²

1989

Archives of Neurology

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Technical problems with ulnar nerve transposition at the elbow: Findings and results of reoperation

Cited by 172 publications

References 11 publications

Anterior subcutaneous transposition for persistent ulnar neuropathy after neurolysis

Anterior subcutaneous transposition for persistent ulnar neuropathy after neurolysis

Anterior submuscular transposition of the ulnar nerve

Perioperative Nerve Lesions

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