Risk factors for revision surgery following isolated ulnar nerve release at the cubital tunnel: a study of 25,977 cases

Camp, Christopher L.; Ryan, Claire; Degen, Ryan M.; Dines, Joshua S.; Altchek, David W.; Werner, Brian C.

doi:10.1016/j.jse.2016.10.028

Cited by 31 publications

(32 citation statements)

References 15 publications

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“…One-third of the present patients were smokers, and they had a significantly increased risk of complications, possibly due to microcirculation disturbances. However, smoking was not a predictive factor for secondary transposition in contrast to the findings reported by Camp et al [23].…”

Section: Discussioncontrasting

confidence: 93%

“…According to Gaspar et al, being younger than 50 years of age is the only significant predictor for revision surgery after simple decompression [21]. Camp et al, in a material of almost 26,000 patients, found young age to be among the most significant risk factors for impaired outcome [23]. e present results show that patients with ulnar nerve compression in need of revision surgery are significantly younger than those who had simple decompression, showing that younger age is a predictor for revision surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, 16% of the cases had revision surgeries with transposition after a simple decompression, which is a higher number than that is seen in some other studies. Goldfarb et al found that only 7% had persistent symptoms after simple decompression and were successfully treated with secondary submuscular transposition [25], and according to Camp et al, just 1.4% needed revision surgery [23]. All current patients were followed up by the surgeon and a physiotherapist at the same centre, which might lead to the identification of more patients with persistent or recurrent symptoms after primary surgery.…”

Section: Discussionmentioning

confidence: 99%

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Patient Characteristics in Ulnar Nerve Compression at the Elbow at a Tertiary Referral Hospital and Predictive Factors for Outcomes of Simple Decompression versus Subcutaneous Transposition of the Ulnar Nerve

Giöstad

Nyman

2019

BioMed Research International

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Patient characteristics and predictive factors for outcomes were analysed in 202 cases undergoing simple decompression, primary subcutaneous transposition, or secondary subcutaneous transposition for ulnar nerve compression at the elbow at a tertiary referral hospital. Data from medical charts and a survey were evaluated. The mean patient age was 49 years with revision surgery cases being significantly younger. Sixty-one percent of cases were female, and 31% were smokers. The comorbidity was extensive, including other nerve compression lesions as well as neck and shoulder problems. Overall, 53% reported being pleased with the result of surgery and 57% of the cases rated function as better or completely recovered after surgery. The median postoperative DASH (Disabilities of the Arm, Shoulder and Hand) score was 26 (IQR 11–49), which is in accordance with unpublished national data. No significant differences in DASH scores were found between surgical groups, but a higher preoperative McGowan grade was significantly associated with a poorer postoperative DASH score. Women scored greater disability postoperatively than men. There was a significantly increased risk of complications, which was doubled for smokers, following primary and secondary transposition compared to simple decompression. Surgical cases with ulnar nerve compression treated at a tertiary referral hospital constitute a heterogeneous group with great comorbidity and frequent concomitant nerve compression lesions. We suggest simple decompression as the procedure of first choice. Transposition can be used in selected cases or when simple decompression fails. All patients should be strongly recommended to stop smoking considering the remarkably increased risk for complications among smokers.

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Section: Discussioncontrasting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Patient Characteristics in Ulnar Nerve Compression at the Elbow at a Tertiary Referral Hospital and Predictive Factors for Outcomes of Simple Decompression versus Subcutaneous Transposition of the Ulnar Nerve

Giöstad

Nyman

2019

BioMed Research International

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“…Muscle atrophy can also appear when range of motion at the elbow is limited over a long period, which would negatively impact the postoperative rehabilitation program, wherein active cycles of flexion-extension and forearm rotation exercises are encouraged and are required to be performed by each patient [ 28 , 29 ]. Patients with symptoms of ulnar nerve motor dysfunction (with or without disability) will be at a higher risk of aggravation of the nerve injury due to ischemia and compression, caused by a constant dysfunctional extension at the elbow, or following continuous pressure from a surrounding HO [ 30 , 31 ]. The articular cartilage also deserves special attention, as it could be damaged and destroyed when the elbow is immobilized, or limited to a small ROM, or hinged acting with an abnormal articular surface or structure (such as trochlea) over a long period [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Determining the effective timing of an open arthrolysis for post-traumatic elbow stiffness: a retrospective cohort study

Sun

Cui

Liang

et al. 2019

BMC Musculoskelet Disord

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BackgroundFollowing trauma, the elbow is the most susceptible to restricted motion among all joints. Open arthrolysis is often performed for post-traumatic elbow stiffness if that stiffness does not improve with non-operative management. However, the optimal timing for performing an open arthrolysis remains controversial. The purpose of this study was to compare the outcome (elbow motion and function) and the rate of complications among patients who had undergone early, median and late release procedures to establish an optimal time interval following the injury, after which, an effective open arthrolysis can be performed.MethodsIn this retrospective cohort study, we included total 133 patients, who had undergone open arthrolysis for post-traumatic elbow stiffness. The subjects were divided into 3 groups, with 31 patients in the early release group (arthrolysis performed at 6–10 months after injury), 78 patients in the median release group (at 11–20 months), and 24 patients in the late release group (at > 20 months). The release procedure in all patients was performed by the same surgeon, using the same technique. The general data, functional performance, and complications, if any, were retrospectively documented for all patients and statistically analysed.ResultsThe demographic data and disease characteristics of all patients were comparable at baseline. Postoperatively, no significant differences were found among the three groups with respect to the range of motion (p = 0.067), Mayo Elbow Performance Score (p = 0.350) and its ratings (p = 0.329), visual analog scale score for pain (p = 0.227), Dellon classification for ulnar nerve symptoms (p = 0.497), and each discrete complication (all p values > 0.05).ConclusionsAt the final follow-up, our results showed no significant difference in the postoperative elbow motion capacities, functional scores and the rates of complications among patients who had undergone an early, median, and late release. Therefore, we have recommended that an early arthrolysis would be preferable due to its multiple advantages, and the conventionally observed interval of > 1 year after the injury, could be shortened.Level of evidenceLevel III; Retrospective Cohort Design; Therapeutic Study.

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“…A recent US national database review of more than 15,000 patients who underwent ulnar nerve decompression at the cubital tunnel found a low incidence of failure of cubital tunnel release requiring ipsilateral revision, but the presence of DM was an independent risk factor for revision with an adjusted odds ratio of 1.27 [48]. The presence of DM did not increase the risk for infection following cubital tunnel release [49].…”

Section: Treatment Efficacy For Ulnar Compressive Neuropathy At the Ementioning

confidence: 97%

Focal Upper Limb Mononeuropathies in Patients with Diabetes Mellitus

Alon¹,

Bril²

2020

Peripheral Nerve Disorders and Treatment

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In this chapter, we describe the prevalence, diagnostic methods, and treatment efficacy of compressive neuropathies of the median and the ulnar nerves in patients with diabetes mellitus (DM). Median neuropathy at the wrist is found in up to onethird of patients with DM, when demonstrated electrophysiologically, but is symptomatic as carpal tunnel syndrome (CTS) in a smaller proportion of these patients. It is clear that diabetes increases the risk of having clinical CTS. Diagnosis of CTS using nerve conduction studies is difficult in patients with DM and diabetic sensorimotor polyneuropathy (DSP) as median nerve conduction studies are affected predominantly by the diabetes state. We will discuss different electrodiagnostic and ultrasonography techniques for diagnosis and the outcomes of carpal tunnel release decompressive surgery in this special patient population. It is controversial whether DM is a risk factor for cubital tunnel syndrome or ulnar neuropathy at the elbow (UNE) or at the wrist (UNW). In this chapter, we will review the ultrasonographic and electrophysiological diagnostic techniques used in UNE and UNW and the efficacy of cubital tunnel release in DM patients.

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Risk factors for revision surgery following isolated ulnar nerve release at the cubital tunnel: a study of 25,977 cases

Cited by 31 publications

References 15 publications

Patient Characteristics in Ulnar Nerve Compression at the Elbow at a Tertiary Referral Hospital and Predictive Factors for Outcomes of Simple Decompression versus Subcutaneous Transposition of the Ulnar Nerve

Patient Characteristics in Ulnar Nerve Compression at the Elbow at a Tertiary Referral Hospital and Predictive Factors for Outcomes of Simple Decompression versus Subcutaneous Transposition of the Ulnar Nerve

Determining the effective timing of an open arthrolysis for post-traumatic elbow stiffness: a retrospective cohort study

Focal Upper Limb Mononeuropathies in Patients with Diabetes Mellitus

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