Lisa M. Frantz, MD, MPAS, and colleagues present the results of retrospective, single-surgeon case series in which patients with cubital tunnel syndrome were treated with a transmuscular ulnar nerve transposition in the lateral decubitus position. The authors demonstrate the effectiveness and safety of the procedure, which corroborates previously published case series. The authors were able to obtain long-term follow-up via questionnaire for 40 patients who underwent primary ulnar nerve transposition. The patient-reported satisfaction rate was 90%. Of note, 62% of patients did not have complete resolution of symptoms. This is consistent with the literature but provides additional information for perioperative counseling and expectation setting. The authors did not include an assessment of predictors for persistence of symptoms but were likely underpowered to perform this evaluation. The authors discuss the relative merits of ulnar nerve transposition compared to in situ decompression, highlighting the current equipoise in the literature.
The morbidity of ulnar nerve transposition has recently been described by Robert Staples, MD, and colleagues, but the relatively unfavorable results of revision surgery after a prior in situ decompression are worth noting. Additional work is needed to help delineate the appropriate indications for in situ ulnar nerve decompression vs. ulnar nerve transposition, balancing the severity of ulnar neuropathy and the relatively morbidity of each procedure. Detailed examination of motor amplitudes during nerve conduction studies may provide one opportunity to answer this question.
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Christopher J. Dy, MD, MPH, FACS
Washington University Orthopedics
Disclosures: Dy reports no relevant financial disclosures.