Submuscular Versus Subcutaneous Anterior Ulnar Nerve Transposition: A Rat Histologic Study

Lee, Steve K.; Sharma, Shobhona; Silver, Benjamin; Kleinman, George; Hausman, Michael R.

doi:10.1016/j.jhsa.2009.08.007

Cited by 9 publications

(5 citation statements)

References 45 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, the preoperative data of neurophysiological parameters and of cross-sectional area were very similar between comparison groups, which is statistically improbable and a potentially methodological problem. A similar comparison conducted by Lee 39 demonstrated that submuscular transposition comparing to subcutaneous transposition displayed less perineural scar tissue and healthier axons. But we did not include this study because it was based on the histological study using the rat model.…”

Section: Discussionmentioning

confidence: 74%

Subcutaneous Versus Submuscular Anterior Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome

Chun-hua

et al. 2015

Medicine

View full text Add to dashboard Cite

Subcutaneous and submuscular anterior ulnar nerve transposition have been widely used in patients with cubital tunnel syndrome. However, the reliable evidence in favor of 1 of 2 surgical options on clinical improvement remains controversial.To maximize the value of the available literature, we performed a systematic review and meta-analysis to compare subcutaneous versus submuscular anterior ulnar nerve transposition in patients with ulnar neuropathy at the elbow.PubMed, Cochrane Library, and EMBASE databases were searched for randomized and observational studies that compared subcutaneous transposition with submuscular transposition of ulnar nerve for cubital tunnel syndrome. The primary outcome was clinically relevant improvement in function compared to the baseline. Randomized and observational studies were separately analyzed with relative risks (RRs) and 95% confidence intervals (CIs).Two randomized controlled trials (RCTs) and 7 observational studies, involving 605 patients, were included. Our meta-analysis suggested that no significant differences in the primary outcomes were observed between comparison groups, both in RCT (RR, 1.16; 95% CI 0.68–1.98; P = 0.60; I2 = 81%) and observational studies (RR, 1.01; 95% CI 0.95–1.08; P = 0.69; I2 = 0%). These findings were also consistent with all subgroup analyses for observational studies. In the secondary outcomes, the incidence of adverse events was significantly lower in subcutaneous group than in submuscular group (RR, 0.54; 95% CI 0.33–0.87; P = 0.01; I2 = 0%), whereas subcutaneous transposition failed to reveal more superiority than submuscular transposition in static two-point discrimination (MD, 0.04; 95% CI −0.18–0.25; P = 0.74; I2 = 0%).The available evidence is not adequately powered to identify the best anterior ulnar nerve transposition technique for cubital tunnel syndrome on the basis of clinical outcomes, that is, suggests that subcutaneous and submuscular anterior transposition might be equally effective in terms of postoperative clinical improvement. However, differences in clinical outcomes metrics should be noted, and these findings largely rely on the outcomes data from observational studies that are potentially subject to a high risk of selection bias. Therefore, more high-quality and adequately powered RCTs with standardized clinical outcomes metrics are necessary for proper comparison of these techniques.

show abstract

Section: Discussionmentioning

confidence: 74%

Subcutaneous Versus Submuscular Anterior Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome

Chun-hua

et al. 2015

Medicine

View full text Add to dashboard Cite

show abstract

“…During flexion, the traction suffered by the nerve causes a 30-40% reduction in its cross-sectional area and alters the intraneural microcirculation [16]. In this sense, only the transposition could eliminate all pathophysiological phenomena of ulnar neuropathy [17], and the submuscular would be the most appropriate when housing the nerve in a well-vascularized bed, protected from trauma and less susceptible to perineural scar tissue [18].…”

Section: Discussionmentioning

confidence: 99%

Submuscular Anterior Transposition for Treatment of Ulnar Nerve Syndrome: Outcomes and Final Satisfaction

2020

Arch Orthop

View full text Add to dashboard Cite

Objective: Despite being the second most common neuropathy in the upper limb, surgical treatment of ulnar syndrome remains controversial, in part because the published studies are heterogeneous in terms of surgical technique and variables studied. This study aims to assess the poor satisfaction prognostic factors in several patients treated by the same surgeon and the same surgical technique. Material and methods:We reviewed retrospectively all patients who underwent a submuscular anterior transposition of the ulnar nerve between 2011 to 2017. The duration of symptoms, grade of neuropathy (McGowan score and electromyographic scale study) pain, paresthesia and motor alterations were recorded before surgery and at present. Satisfaction was evaluated according to the modified Bishop score.Results: A total of 43 cases in 42 patients were reviewed. with an average follow-up of 34.9 months. There was an improvement in pain in 75% of patients, paresthesia's in 64% and motor alterations in 67%. According to the modified Bishop score, 82% of patients reported good or excellent results. Low satisfaction was associated with residuals postoperative symptoms (p<0.001), low postoperative McGowan grade (p<0.001), reinterventions cases (p=0.03) and with the duration of symptoms before surgery (p=0.003). No relationship between satisfaction and age, preoperative symptoms, preoperative grade of neuropathy or preoperative electromyographic alteration was found. Conclusion:Submuscular transposition is a safe and effective technique for ulnar neuropathy. Overall, good and excellent satisfaction were archived in 82% of patients. The duration of preoperative symptoms are the main prognostic factors, so surgical treatment should be advised as soon as possible. On the other hand, periprosthetic fractures represent an independent risk factor for non-union.

show abstract

“…Those who advocate for anterior submuscular transposition are concerned with the new location of ulnar nerve that has a healthy vascular bed and is well protected by soft tissue [ 7 – 9 ]. Moreover, submuscular transposition, based on the histological study using the rat model, displayed less perineural scar tissue and healthier axons when compared to subcutaneous transposition [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Anterior Subcutaneous versus Submuscular Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome: A Systematic Review and Meta-Analysis

Liu

Chang-xian

et al. 2015

PLoS ONE

View full text Add to dashboard Cite

ObjectiveTo pool reliable evidences for the optimum anterior transposition technique in the treatment of cubital tunnel syndrome by comparing the clinical efficacy of subcutaneous and submuscular anterior ulnar nerve transposition.MethodsA comprehensive search was conducted in PubMed MEDLINE, Cochrane Library, EMBASE, Web of Science, OVID AMED, EBSCO and potentially relevant surgical archives. Risk of bias of each included studies was evaluated according to Cochrane Handbook for Systematic Reviews of Interventions. The risk ratio (RR) and 95% confidence intervals (CI) were calculated for the clinical improvement in function compared to baseline. Heterogeneity was assessed across studies, and subgroup analysis was also performed based on the study type and follow-up duration.ResultsThree studies with a total of 352 participants were identified, and the clinically relevant improvement was used as the primary outcomes. Our meta-analysis revealed that no significant difference was observed between two comparison groups in terms of postoperative clinical improvement in those studies (RR 1.04, 95% CI 0.86 to 1.25, P = 0.72). Meanwhile, subgroup analyses by study type and follow-up duration revealed the consistent results with the overall estimate. Additionally, the pre- and postoperative motor nerve conduction velocities were reported in two studies with a total of 326 patients, but we could not perform a meta-analysis because of the lack of concrete numerical value in one study. The quality of evidence for clinical improvement was ‘low’ or ‘moderate’ on the basis of GRADE approach.ConclusionsBased on small numbers of studies with relatively poor methodological quality, the limited evidence is insufficient to identify the optimum anterior transposition technique in the treatment of cubital tunnel syndrome. The results of the present study suggest that anterior subcutaneous and submuscular transposition might be equally effective in patients with ulnar neuropathy at the elbow. Therefore, more high-quality randomized controlled trials with standardized clinical improvement metrics are required to further clarify this topic and to provide reproducible pre- and postoperative objective outcomes.

show abstract

Submuscular Versus Subcutaneous Anterior Ulnar Nerve Transposition: A Rat Histologic Study

Cited by 9 publications

References 45 publications

Subcutaneous Versus Submuscular Anterior Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome

Subcutaneous Versus Submuscular Anterior Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome

Submuscular Anterior Transposition for Treatment of Ulnar Nerve Syndrome: Outcomes and Final Satisfaction

Anterior Subcutaneous versus Submuscular Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About