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Anterior Subcutaneous Transposition for persistent Ulnar Neuropathy after Neurolysis
Justus L Groen, MD PhD1; Jort Van Gent, MD1; Miriam Datema, MD1; Job Eekhof, MD PhD2, Willem Pondaag, MD; PhD1; Martijn Malessy, MD; PhD1
1Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands, 2Alrijne Leiden Hospital, Leiden, Netherlands
Introduction: The standard for surgical treatment of ulnar neuropathy at the elbow is neurolysis. Success rates of this procedure vary between 75 and 90%. Little is known about optimal treatment if neurolysis fails. Anterior subcutaneous transposition is than one of the treatment options.
Materials & Methods: A consecutive series of 26 patients treated by a single surgeon between 2009-2014 was retrospectively analysed. All patients had anterior subcutaneous transposition to treat persistent ulnaropathy after neurolysis. Pre- and postoperative differences in three clinical modalities were compared: pain and tingling, weakness and numbness. A 6-point satisfaction score was obtained using a telephonic systematic survey.
Results: At presentation, 88% of patients experienced pain and tingling, 46% had weakness and 50% had numbness of the forth and fifth finger. The mean age was 55 years (range 28-79). The mean duration of complaints until transposition was 32 months (range 4-49) with a mean interval of 12 months between the two surgeries. After transposition, pain and tingling improved in 35%, motor function in 23% and sensory disturbances in 19% of all patients. Improvement in at least one of the three clinical modalities was found in 58% of patients of which two symptoms improved in 15%. However, a deterioration in one of the three modalities was noted in 46% of patients. On the patient satisfaction scale, 61% reported good or excellent outcome. Patient satisfaction was correlated with pain (Pearson correlation coefficient 0.62), more than weakness (0.40) or numbness (0.22). Patients with good/excellent outcome were on average 10.3 years younger than patients with a poor outcome. No other factors were significantly related to satisfaction score.
Conclusions: Symptoms that persist after neurolysis employed to treat sulcus ulnaropathy are difficult to treat. Subcutaneous transposition is a viable surgical option. The majority of patient is satisfied after this second surgery, however, only part of the initial symptoms resolve. In some patients, symptoms even deteriorate. The reason why some patients do not fair well remains unknown. The total outcome of treatment of all patients that present with ulnar neuropathy can still be improved. Patient selection, timing of intervention and choice of surgical technique need to be considered.
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