Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition
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Structured Motor Rehabilitation After Selective Nerve Transfers
Published on: August 15, 2019
Michael Biggs1, Jonathan A Curtis
1Department of Neurosurgery, Royal North Shore Hospital, North Shore Medical Centre, St. Leonards, Sydney, New South Wales, 2065, Australia. biggs@idx.com.au
Objective:
To help clarify the optimal surgical strategy for idiopathic, symptomatic ulnar nerve compression at the elbow in terms of overall outcome and morbidity by using objective criteria.
Methods:
Forty-four surgical candidates were recruited prospectively and were randomized into the neurolysis (n = 23) or transposition (n = 21) arm of the study. Preoperative and postoperative outcomes were assessed symptomatically and by performance on McGowen and Louisiana State University Medical Center grading systems at 1 month, 6 months, and 1 year.
Results:
Both procedures were equally effective in producing objective neurological improvement (61% in the neurolysis group, 67% in the transposition group). Wound complications, however, were more significant in the transposition group. Three of 21 in the transposition group compared with 0 of 23 in the neurolysis group experienced a deep wound infection.
Conclusion:
Idiopathic symptomatic ulnar nerve compression at the elbow is adequately treated by both neurolysis in situ and submuscular transposition. Submuscular transposition was associated with a higher incidence of complications. The authors therefore suggest the simpler procedure of neurolysis in situ as the treatment of choice. Submuscular transposition remains appropriate in certain circumstances.
