Return to play rates after ulnar nerve transposition and decompression surgery: a retrospective analysis

Abstract

Background Medial elbow pain is a common complaint in overhead throwing athletes. The throwing motion places repetitive tensile and compressive forces on the elbow resulting in significant stress across the ulnohumeral joint. This stress can result in soft-tissue, ligamentous, and ulnar nerve injury. The purpose of this study was to retrospectively investigate the clinical findings and outcomes, including return to play rates, of patients who underwent ulnar nerve transposition surgery for isolated ulnar neuritis. Methods Throwing athletes who underwent isolated, primary ulnar nerve transposition surgery over an eight-year period, 2009 to 2017, were identified and included in our analysis. Nonthrowing athletes, those who underwent revision ulnar nerve transposition surgery, and those who underwent concomitant ulnar collateral ligament reconstruction or repair were excluded. Patients were contacted to complete the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score as well as a return to play rate questionnaire. The minimum follow-up was 2 years. Results Fifteen patients met the inclusion criteria: 13 (86.7%) men and 2 (13.3%) women. The average age at the time of surgery was 19.2 years old (range, 15.6-28.0). Preoperatively, 13 (86.7%) patients played baseball and 2 (13.3%) patients played softball. Two patients (13.3%) underwent a previous ulnar collateral ligament reconstruction. There were no complications. The average final follow-up was 65.26 (range, 24.44-113.29) months with an average Kerlan-Jobe Orthopaedic Clinic Score of 64.51 (range, 28.60-100.00). Thirteen (86.7%) patients were able to return to their preinjury sport, 2 to a higher level of competition, 8 to the same level, and 3 to a lower level. Seven of the 13 (53.8%) patients sustained a postoperative ipsilateral shoulder or elbow injury at an average of 19.57 (range, 7.00-36.00) months postoperatively. All patients reported sustaining the injury as a result of throwing. Conclusion The results of our study indicate that ulnar nerve transposition surgery in throwing athletes allows athletes to return to throwing with low reoperation rates. However, more than half of the athletes in our analysis sustained a subsequent ipsilateral shoulder or elbow injury. Further investigation regarding outcomes in throwing athletes after ulnar nerve transposition surgery is warranted.

Cubital tunnel syndrome: A retrospective analysis of surgical management

“…One study showed that decompression and transposition not only relieve symptoms but also allows athletes to go back to their sports. 12 Another study also suggested that SDAT is helpful in case of subluxated nerve at elbow. 13 Studies have shown that ulnar nerve becomes more vulnerable to compression during flexion movement due to traction.…”

Ulnar Nerve Decompression With Subcutaneous Transposition

“…3 This is predominantly due to high valgus stress and repetitive flexion that the elbow experiences during the throwing motion. 3,5 As with most overuse injuries, the initial treatment of cubital tunnel syndrome is nonoperative in the form of rest, therapy, and functional training. However, when conservative measures fail, surgical decompression may be a viable treatment option.…”

“…[1][2][3]7 In the overhead or throwing athlete, decompression with subcutaneous transposition is the preferred surgical technique as this relieves tension placed on the nerve and minimizes the risk of recurrent instability. 1,5 It also allows preservation of the flexor pronator musculature which is critical for performance in the throwing athlete. 2,3 The patient is positioned supine with the arm out on an armboard.…”

Return to Activity Following Isolated Ulnar Nerve Surgery: A Systematic Review

“…Additionally, non-English and non-original studies were excluded from our analysis. Following full-text screening, 12 studies met inclusion criteria and were included in our analysis [ 3 - 14 ].To assess the quality of each article included, the Methodological Index for Non-Randomized Studies (MINORS) criteria was used [ 15 ]. This quality assessment tool is composed of 12 questions, with three of them addressing comparative studies.…”

“…Two patients were unable to return due to preexisting neuropathy (chronic diabetic neuropathy and McGowan grade 3 neuropathy). Two additional patients were unable to return to sport due to reinjury or other injuries and one patient did not return due to a loss of interest [ 3 , 5 ].…”