Back to 2013 Annual Meeting Program
Longterm Outcome of the Ulnar Nerve Decompression and Vascularized Submuscular Transposition for Primary Entrapment at the Elbow
Massachusetts General Hospital, Boston, MA, USA
Jesse B. Jupiter; Massachusetts General Hospital; Juan Del Pino, MD; Santa Cristina University Hospital
Hypothesis: A number of surgical procedures have been proposed for the treatment of primary ulnar nerve compression at the elbow. This retrospective study evaluates the outcome of anterior submuscular ulnar nerve transposition preserving associated vascularity with a minimum follow-up of 6 years. Both physician and patient rated outcome tools were used and the data will support the safety and efficacy of this procedure.
Materials and Methods: From 1992-2010, 110 patients were treated surgically by two surgeons using a standard operative technique. At the time of this abstract, 82 elbows in 76 patients have been followed at an average of 8 yrs 2.9 monts with a minimum of 6 yrs. Thirty-two were male and 44 female with a mean age of 55 yrs. Forty-eight were employed, 15 homemakers, 11 retired, and 2 students. The dominant limb was involved in 49 with the average duration of symptoms being 24 months (range 6-48 mos). Seventy patients complained of paresthesias and 50 hand weakness. A positive elbow flexion test was present in 50 elbows. Intrinsic atrophy was noted in 23. The preoperative Dellon scale (0-III) revealed level II in 48 and level III in 28.
Results: The patients were all evaluated by the treating surgeon. Sixty-three had no pain with 13 noting persistent pain. Eighteen continued to have mild weakness and 6 had a functional problem due to weakness. Using the VAS scale (0-10), the mean patient satisfaction was 8.5. Examination showed the motor rating M5 in 66 limbs, M4 in 15, and M3 in 1. Forty-three patients now normalized the elbow Dellon scale to 0, 28 to I, and 11 to II. The Bishop post surgery scale of 0-9 was an average of 8.2. There were no deep infections nor reoperations.
Conclusions: Surgical decompression of moderately advanced ulnar nerve compression at the elbow using anterior submuscular transposition preserving associated vascularity was associated with and overall satisfaction rate of 93.4% good to excellent with minimal complications.
Back to 2013 Annual Meeting Program