Surgical management of ulnar nerve compression at the elbow: an analysis of the literature

Bartels, Ronald H. M. A.; Menovsky, Tomas; Overbeeke, J.J. van; Verhagen, W. I. M.

doi:10.3171/jns.1998.89.5.0722

Cited by 183 publications

(111 citation statements)

References 52 publications

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“…8 This is in contrast to primary ulnar nerve compression and the explanation is unclear. 2 The other demographics are within the ranges of primary ulnar nerve compression. 2 In the Netherlands, the majority of neurosurgeons perform either simple decompression or anterior subcutaneous transposition.…”

Section: Discussionmentioning

confidence: 99%

“…2 The other demographics are within the ranges of primary ulnar nerve compression. 2 In the Netherlands, the majority of neurosurgeons perform either simple decompression or anterior subcutaneous transposition. Medial epicondylectomy is seldom performed.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,17 The prevalence of persistent symptoms varies between 9.9% and 21% with 0.7% to 4.5% being exacerbated by surgery. 2 The number of recurrences is not known. 4 Few reports deal specifically with recurrent or persistent signs and symptoms after surgery.…”

Section: Discussionmentioning

confidence: 99%

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Anterior submuscular transposition of the ulnar nerve

Bartels¹,

Grotenhuis²

2004

The Journal of Bone and Joint Surgery. British volume

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Outcome studies of revision surgical treatment for recurrent or persistent neuropathy of the ulnar nerve at the elbow are relatively rare and none involves patient self-assessment. In this study of 40 patients (41 elbows), a clear discrepancy is shown between clinical assessment and the patient's own view. From clinical assessment, 20% of patients had an excellent result, whereas only one (2.5%) patient self-reported a complete cure. More reports using patient self-assessment and validated scores are required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Anterior submuscular transposition of the ulnar nerve

Bartels¹,

Grotenhuis²

2004

The Journal of Bone and Joint Surgery. British volume

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“…Among 165], collagen gel tubes [166], bioartificial nerve graft seeded with Schwann cells [167], Schwann cells modified to over-express specific growth factors [168][169][170], conduits of synthetic materials [147,153,171,172], the infusion of antibodies [173], gradients of factors within tubes [174], allographs [175], factors that induce inflammation [149,176], pseudo nerves [177], alginate gel [178], biodegradable polymer tubes [179], tubes filled with platelet-rich plasma [180][181][182], and arteries, veins and muscle tubes [160, 183,184]. None of these techniques induces more effective axon regeneration than autologous sensory nerve grafts [20,31,[185][186][187][188].…”

Section: Alternative Tested Techniques For Bridging Nerve Gapsmentioning

confidence: 99%

Promoting Axon Regeneration and Neurological Recovery Following Traumatic Peripheral Nerve Injuries

Kuffler¹

2015

Int J Neurorehabilitation Eng

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Repairing Peripheral Nerves following Traumas Nerve crushWithin several days of crushing a peripheral nerve, the injured axons begin to regenerate through their distal pathway until they reach their original targets with which they restore neurological function. The larger the number of axons that regenerate through the distal nerve, the greater the extent of neurological recovery [1][2][3]. The number of axons that regenerate, and thus neurological recovery, is influenced by the physiological state of the distal denervated nerve pathway [4][5][6][7].Following a peripheral nerve crush, the injured axons begin to regenerate within 2 days of injury [8]. They may regenerate to their targets through their original pathway in association with and promoted by its Schwann cells, the neurotrophic factors they release, and the Schwann cell extracellular matrix [1,4,[9][10][11][12][13][14]. Thus, the distal nerve provides a simple means for promoting and directing the regenerating axons to their original targets [15][16][17][18]. However, when a nerve has a gap, the gap must be bridged with a material that is permissive to and promotes axon regeneration across the entire gap to reach the distal nerve stump, through which the axons must then be able to regenerate.The Schwann cells in the denervated distal nerve release neurotrophic factors that promote axon regeneration, but also release extracellular matrix components that promote and inhibit axon regeneration [19][20][21][22][23][24][25][26]. Thus, regeneration through the distal nerve is a balance of the influences of factors that both promote and inhibit regeneration. If the Schwann cells are present, such as after a simple nerve crush, virtually 100% of the axons regenerate and they innervate all the denervated synaptic sites. If the Schwann cells within the distal nerve pathway are killed, leaving only the extracellular matrix intact, the number of axons that regenerates to their targets decreases by 94%. This is because the factors required to trigger the regenerating axons to branch at extracellular matrix branch points are missing, axons do not branch, and therefore each axon reinnervates only a single denervated muscle fiber. Thus, Schwann cells along the distal nerve pathway and a AbstractFollowing a peripheral nerve crush, or when a peripheral the nerve is transected and the nerve stumps anastomosed, neurological recovery is generally excellent. This is because the axons merely have to regenerate through the distal portion of the nerve through the existing extracellular matrix of the denervated Schwann cells that direct and promote them to their distant denervated motor and sensory targets. However, when a length of a peripheral nerve is destroyed, and anastomosis is not possible, the standard surgical repair technique is to graft a length/s of autologous sensory nerve into the gap. Neurological recovery is generally good if the nerve gap is <2 cm in length, the repair is performed <4 months post trauma, and the patients are <25 years of age. Because the nerve ...

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“…With each operative procedure, there have been reports of excellent patient outcome as well as postoperative complications [10,11,18,28]. While some surgeons have advocated particular surgical procedures dependent upon the severity of nerve compression, the overall selection of the operative procedure for primary surgery appears to be dependent upon surgeon preference and a number of non-specific patient factors [5,8,20].…”

Section: Introductionmentioning

confidence: 99%

Selection of Operative Procedures for Cubital Tunnel Syndrome

Novak

Mackinnon²

2008

Hand (New York, N,Y.)

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The purpose of this study was to investigate the primary operative procedures that are performed by hand surgeons for cubital tunnel syndrome and their reported satisfaction with these procedures. The survey consisted of 22 questions regarding primary operative treatment of cubital tunnel syndrome and demographics and was sent by email to the 459 active members of the American Association for Hand Surgery. One hundred sixty-four surgeons completed the survey (36% response rate). The total sample included 154 hand surgeons (143 males, 11 females) who operated on cubital tunnel syndrome and the majority of surgeons were in private practice (n=100) followed by academic practice (n=50). The most prevalent factors that influence the decision to operate include evidence of muscle atrophy (84%), abnormal nerve conduction studies (51%), and failed non-operative treatment (49%). Most surgeons (n=133) reported using more than one operative procedure for their patients with cubital tunnel syndrome. Factors that influenced the operative procedure selected included the degree of nerve compression (60%), medical comorbidities (30%), patient's occupation (28%), and obesity (22%). Following carpal tunnel surgery, 88% of the surgeons were "very satisfied" with their patient outcome and following surgery for cubital tunnel syndrome, only 44% were "very satisfied" with their patient outcome. Most surgeons use more than one operative procedure in their treatment of patients with cubital tunnel syndrome and the selection of the operative procedure is influenced by patient factors and surgeon preference.

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Surgical management of ulnar nerve compression at the elbow: an analysis of the literature

Cited by 183 publications

References 52 publications

Anterior submuscular transposition of the ulnar nerve

Anterior submuscular transposition of the ulnar nerve

Promoting Axon Regeneration and Neurological Recovery Following Traumatic Peripheral Nerve Injuries

Selection of Operative Procedures for Cubital Tunnel Syndrome

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