June 10, 2019
1 min read

Ulnar nerve anterior transmuscular transposition yielded favorable results for cubital tunnel syndrome

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Lisa M. Frantz
Bernard F. Hearon

Results showed favorable outcomes in patients who underwent ulnar nerve anterior transmuscular transposition for treatment of cubital tunnel syndrome.

“Ulnar nerve subluxation is more prevalent than previously reported and is a common cause for persistent or recurrent paresthesia after simple decompression for cubital tunnel syndrome,” Lisa M. Frantz, MD, lead author of the study, told Healio.com/Orthopedics. “Surgeons who routinely perform simple decompressions should consider ulnar transmuscular transposition as their primary procedure to decrease intraneural pressure and to reduce the likelihood of revision surgery due to postoperative ulnar nerve subluxation following simple decompression.”

Frantz, Bernard F. Hearon, MD, and colleagues collected demographic and disease-specific data and performed a short-term assessment of 156 patients with cubital tunnel syndrome who underwent primary or revision ulnar nerve anterior transmuscular transposition in the lateral decubitus position. Researchers stratified ulnar neuropathy severity using McGowan grade. Patient outcome surveys were completed by 49 patients with a minimum 2-year follow-up, and researchers noted some patients presented for an ulnar nerve-focused examination to assess long-term outcomes.

Results showed an overall patient satisfaction rate of 92%. Patients had statistically significant improvements in ulnar sensation and intrinsic strength at short- and long-term follow-up. Researchers found better outcomes among patients with lower McGowan grades and who underwent primary ulnar nerve anterior transmuscular transposition compared with patients who had higher McGowan grades and revision cases. Results showed 43% of cases had ulnar nerve instability and 4.3% of patients experienced major complications, all of which were mitigated by contributory patient-related factors. Researchers noted 2.5% of cases required reoperation for recurrent ulnar paresthesia. The lateral decubitus position did not compromise any operations or outcomes in this cohort, according to results.

“There are many indications for ulnar nerve transposition as opposed to simple decompression including prior elbow trauma, elbow arthropathy with contracture, severe ulnar entrapment neuropathy, symptomatic ulnar nerve subluxation or prior failed simple decompression,” Hearon told Healio.com/Orthopedics. “Surgeons who advocate simple decompression for most patients may be overlooking some of these surgical indications, which we believe may be present in about 50% of patients with cubital tunnel syndrome.” – by Casey Tingle


Disclosures: The authors report no relevant financial disclosures.