Ulnar nerve transposition using a mini-invasive approach: case series of 30 patients

Abstract

The treatment of ulnar nerve compression at the elbow remains controversial. No single technique has yet proven its superiority. We describe a technique combining the advantages of the mini-invasive approach with those of transposition. We present the results of 30 patients, of mean age 52 years, who underwent anterior subcutaneous transposition of the ulnar nerve using a mini-invasive approach with a follow-up of more than six months. The incision measures 3 cm. The results were evaluated by measuring pain intensity, quick disabilities of the arm shoulder and hand (DASH), grip strength and pinch, and McGowan score, pre- and post-operatively. All parameters were improved post-operative. The mean pain score went from 5.5 to 4, the quick DASH from 48 to 38, mean grip strength from 28 to 31 kg, and mean pinch strength from 4.7 to 6.4 kg. The McGowan score was also improved; pre-operatively, there were 16 patients at stage III, seven patients stage II, seven patients stage I, and post-operatively there was one patient stage III, three patients stage II, 16 patients stage I, and 10 patients stage 0. Analysis of our series shows that a 3 cm incision without endoscopy allows subcutanous transposition, with results at least as good as those with other techniques. The advantages of our technique are that it is easy, has a limited approach, preserves blood supply, allows placement of the nerve in a favourable environment, and decreases nerve stretching during elbow flexion.

Comparative Study of Outcome of Simple Decompression Versus Anterior Transposition of Ulnar Nerve in the Treatment of Cubital Tunnel Syndrome

“…This is in agreement with the results given by Thomsen et al [29] and Vanderpool et al [30]. On the other hand, few similar studies have reported a male predominance [31].…”

“…This relation was found to have no statistically significant difference between both modalities. This is in accordance with several series which found a significant improvement in the postoperative transelbow NCVs studies compared to the preoperative values; however there was no significant difference between both types of surgery [25,31]. They concluded that electrophysiological values help predict the functional outcome of surgery.…”

Endoscopic decompression of the ulnar nerve in the cubital tunnel yields similar outcomes but a lower complication rate than open decompression: a systematic review and meta-analysis

“…However, as the elbow flexes, the cross-sectional area of the cubital tunnel decreases and the intraneural pressure exceeds the extraneural pressure in the cubital tunnel indicating a possible tension component to cubital tunnel syndrome and the need for anterior transposition of the ulnar nerve 25. Recent randomised control trials and meta-analyses have demonstrated similar outcomes between these techniques leading to the investigation of more minimally invasive and endoscopic decompression of the ulnar nerve in the cubital tunnel 5–12 26…”

Ultrasound Diagnosis after Anterior Subcutaneous Transposition of the Ulnar Nerve

“…Этот же способ используют также при лечении рецидивирующего вывиха-подвывиха локтевого нерва и для устранения значительного диастаза при сшивании поврежденного локтевого нерва. С целью предупреждения вывихивания после передней подкожной транспозиции локтевой нерв фиксируют в перемещенном положении адипозными, фасциальными лоскутами-блоками [3,7,9]. Мы разработали и используем способ фиксации перемещенного нерва [8].…”

“…Для того, чтобы локтевой нерв после подкожной передней транспозиции не вывихивался в область локтевой борозды, его фиксируют различными способами [6,7]. Нами предложен и используется способ фиксации локтевого нерва, который заключается в создании кожно-подкожно-фасциального бло-ка-рубца [8].…”