Abstract
Background
Entrapment neuropathy of the ulnar nerve at the level of the elbow is the shared domain of multiple surgical specialties. A wide variety of operative methods for its surgical management have been reported. Our hospital utilizes neurolysis (NL) and subcutaneous transposition (AST). The aim of this paper was to compare the clinical outcomes in patients treated by ulnar nerve transposition versus neurolysis over a 20-year period.
Methods
We included patients who underwent either neurolysis or an ulnar nerve transposition. A retrospective analysis was performed which included 480 patients at our institution between January 1992 and December 2012. In total, physical and electronic records for 480 patients were reviewed. Three-hundred and one underwent ulnar nerve transposition and 179 underwent ulnar nerve neurolysis .
Results
In the AST group 201/301 patients suffered from parasthesiae pre-operatively and 156/301 had pain at and around the cubital tunnel. Paresis of the ulnar nerve innervated muscles was present in 99/301 patients. At the 3-month follow-up appointment, 187/201 patients with parasthesiae and 113/156 patients with local pain had resolution of their symptoms. In the NL group 151/179 patients had parasthesiae pre-operatively and 126/179 had pain at and around the cubital tunnel. Paresis of the ulnar nerve innervated muscles was present in 56/179 patients. At the 3-month follow-up appointment, 141/151 patients with parasthesiae and 117/126 patients with local pain had resolution of their symptoms.
Conclusions
In cases of ulnar nerve compression at the cubital tunnel, both neurolysis and transposition are effective in improving clinical outcome. The only statistically significant advantage of neurolysis over transposition seems to be relief of localized elbow pain. We recommend neurolysis as the preferred procedure.
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References
Bartels RMH (2001) History of the surgical treatment of ulnar nerve compression at the elbow. Neurosurgery 49:391–400
Biggs M, Curtis JA (2006) Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition. Neurosurgery 58:296–304
Hagstrom P (1977) Ulnar nerve compression at the elbow: results of surgery in 85 cases. Scand J Plast Reconst Surg 11:59–62
Bartels RH, Verhagen WI, van der Wilt GJ, Meulstee J, van Rossum LG, Grotenhuis JA (2005) Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: part 1. Neurosurgery 56:522–530
Bartels RHMA, Menovsky T, van Overbeeke JJ, Verhagen WIM (1998) Surgical management of ulnar nerve compression at the elbow: an analysis of the literature. J Neurosurg 89:722–727
Bimmler D, Meyer VE (1996) Surgical treatement of the ulnar nerve entrapment neuropathy: submuscular anterior transposition or simple decompression of the ulnar nerve? Long-term results in 79 cases. Ann Chir Main Memb Super 15:148–157
Davis GA, Bulluss KJ (2005) Submuscular transposition of the ulnar nerve: review of safety, efficacy and correlation with neurophysiological outcome. J Clin Neurosci 12(5):524–528
Dellon AL, Hament W, Gittelshon A (1993) Nonoperative management of cubital tunnel syndrome: an 8-year prospective study. Neurology 43:1673–1677
Filippi R, Farag S, Reisch R, Grunert P, Bocher-Schwarz II (2002) Cubital tunnel syndrome. Treatment by decompression without transposition of ulnar nerve. Minin Invas Neurosurg 45:164–168
Feindel W, Stratford J (1958) Cubital tunnel compression in tardy ulnar palsy. Can Med J 78(351):353
Froimson AI, Anouchi YS, Seitz WH, Winsberg DD (1991) Ulnar nerve decompression with medial epicondylectomy for neuropathy at the elbow. Clin Orthop Rel Res 265:200–206
Stuffer M, Jungwirth W, Hussl H, Schmutzhardt E (1992) Subcutaneous or submuscular anterior transposition of the ulnar nerve? J Hand Surg (Br) 17B:2
Osborne GV (1957) The surgical treatment of tardy ulnar neuritis. J Bone Joint Surg 39B:782
Davies MA, Vonau M, Blum PW (1991) Results of ulnar neuropathy at the elbow treated by decompression or anterior transposition. Aust NZ J Surg 61:929–934
Willis BK (1992) Cubital tunnel syndrome. In: Benzel EC (ed) Practical approaches to peripheral nerve surgery., pp 77–93
Huang JH, Samadani U, Zager EL (2004) Ulnar nerve entrapment neuropathy at the elbow: simple decompression. Neurosurgery 55:1150–1153
Kleinman WB (1999) Cubital tunnel syndrome: anterior transposition as a logical approach to complete nerve decompression. J Hand Surg [Am] 24(5):886–897
Le Roux PD, Todd DE, Burchiel KJ (1990) Surgical decompression without transposition for ulnar neuropathy: factors determining outcome. Neurosurgery 27:709–714
Asami A, Morisawa K, Tsuruta T (1998) Functional outcome of anterior transposition of the vascularised ulnar nerve for cubital tunnel syndrome. J Hand Surg (Br) 23:613–616
Barone CM, Jiminez DF, Frempog-Bodeau A (1992) Blood flow measurements of injured peripheral nerves by laser Doppler flowmetry. J Reconstr Microsurg 8:319–323
Mitsionis GI, Manoudis GN, Paschos NK, Korompilias AV, Beris AE (2010) Comparative study of surgical treatment of ulnar nerve compression at the elbow. J Shoulder Elbow Surg 19(4):513–519
Lim BH, Toh CL, Wong HP, Pho RW (1992) Cadaveric study on the vascular anatomy of the ulnar nerve at the elbow – a basis for anterior transposition? Ann Acad Med Singapore 21:689–693
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Kamat, A.S., Jay, S.M., Benoiton, L.A. et al. Comparative outcomes of ulnar nerve transposition versus neurolysis in patients with entrapment neuropathy at the cubital tunnel: a 20-year analysis. Acta Neurochir 156, 153–157 (2014). https://doi.org/10.1007/s00701-013-1962-z
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DOI: https://doi.org/10.1007/s00701-013-1962-z