Return to Play Rates Following Ulnar Nerve Transposition and Decompression Surgery

Background: Injury to the ulnar collateral ligament (UCL) leading to medial elbow instability and possible ulnar neuritis is common in overhead-throwing athletes. Treatment may require UCL reconstruction (UCLR) and concomitant ulnar nerve transposition (UNT) for those with preoperative ulnar neuritis. Purpose: To evaluate the return-to-play (RTP) rates, clinical outcomes, and rates of persistent ulnar neuritis after concomitant UCLR and UNT in a cohort of baseball players with confirmed preoperative ulnar neuritis. Study Design: Case series; Level of evidence, 4. Methods: Eligible patients were those who underwent concomitant UCLR and UNT at a single institution between January 2008 and June 2018 and who had a minimum of 2 years of follow-up. Additional inclusion criteria were athletes who identified as baseball players and who had a confirmed history of ulnar neuritis. Patients were contacted at a minimum of 2 years from surgery and assessed with the Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score, Andrew-Timmerman (A-T) Elbow Score, Mayo Elbow Performance Score (MEPS), Single Assessment Numeric Evaluation (SANE) score, and a custom RTP questionnaire. Results: Included were 22 male baseball players with a mean age of 18.9 ± 2.1 years (range, 16-25 years). The mean follow-up was 6.1 ± 2.4 years (range, 2.5-11.7 years). Preoperatively, all 22 patients reported ulnar nerve sensory symptoms, while 4 (18.2%) patients reported ulnar nerve motor symptoms. At the final follow-up, 7 (31.8%) patients reported persistent ulnar nerve sensory symptoms, while none of the patients reported persistent ulnar nerve motor symptoms. Overall, 16 (72.7%) players were able to return to competitive play at an average of 11.2 months. The mean postoperative patient-reported outcome scores for the KJOC Shoulder and Elbow Score, MEPS, A-T Elbow Score, and SANE score were 77.9 ± 20.9 (range, 14-100), 92.7 ± 12.7 (range, 45-100), 86.1 ± 17.1 (range, 30-100), and 85.5 ± 14.8 (range, 50-100), respectively. Conclusion: This study demonstrated that after concomitant UCLR and UNT for UCL insufficiency and associated ulnar neuritis, baseball players can expect reasonably high RTP rates and subjective outcomes; however, rates of persistent sensory ulnar neuritis can be as high as 30%.

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Return to Play Rates and Clinical Outcomes of Baseball Players Following Concomitant Ulnar Collateral Ligament Reconstruction and Indicated Ulnar Nerve Transposition (130)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00273 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0027

Author(s):

Somnath Rao ◽

Donald Willier ◽

Richard Gawel ◽

Robert Jack ◽

Taylor D’Amore ◽

...

Keyword(s):

Ulnar Nerve ◽

Ulnar Collateral Ligament ◽

Patient Reported Outcome ◽

Ulnar Neuropathy ◽

Return To Play ◽

Baseball Players ◽

Ulnar Nerve Transposition ◽

Patient Reported ◽

Nerve Transposition

Objectives: Injury to the ulnar collateral ligament (UCL)—leading to medial elbow instability and concomitant ulnar neuropathy symptoms—is common in the overhead throwing athlete secondary to the repetitive stress that these individuals place on the elbow during the throwing motion. Treatment customarily involves UCL reconstruction (UCLR) and for those with preoperative ulnar neuropathy symptoms, concomitant ulnar nerve transposition (UNT) may also be warranted. The purpose of this study was to evaluate the return to play rates, clinical outcomes and more specifically rates of persistent ulnar nerve symptoms after concomitant UCLR and UNT in a cohort of baseball players with confirmed preoperative ulnar neuropathy symptoms. Methods: Patients who underwent concomitant UCLR and UNT from January 2008 to June 2018 were identified at one institution with a minimum of 2 years of follow-up. Additional inclusion criteria included athletes who identified as baseball players with a confirmed history of ulnar neuropathy symptoms. Exclusion criteria included patients who had any other concomitant open procedures at the time of surgery. After identifying the cohort, patients were contacted via phone to complete a Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Score (KJOC), Andrews-Timmerman (AT) Elbow Score, Mayo Elbow Performance Score (MEPS), Single Assessment Numeric Evaluation (SANE) score and a custom return to play questionnaire. Evidence for preoperative and postoperative ulnar nerve symptoms was elicited within the custom survey and corroborated with the provider’s clinical notes. Sensory ulnar nerve symptoms were defined as having numbness and/or tingling sensations in the 5th and ulnar half of the 4th fingers. Motor ulnar nerve symptoms were defined as either exhibiting 1st dorsal interosseous muscle weakness by inability to maintain finger abduction resistance, ulnar-sided hand grip weakness of inability to control precise movement of the 5th digit. Results: During this time period, a total of 22 male baseball players underwent concomitant UCLR and UNT at a mean age of 18.9+/-2.1 years (range, 16-25). The mean follow-up was 6.1+/-2.4 years (range, 2.5-11.7 years). The cohort consisted of 15 pitchers and 7 position players. In total, 7 players competed in high school and 15 competed in college. Preoperatively, all 22 patients reported ulnar nerve sensory symptoms while only 4 (18.2%) patients reported ulnar nerve motor symptoms. Overall, 16 (72.3%) players were able to return to competitive play at an average of 11.2 months. Of the 6 that failed to return to play after surgery, 3 reported that persistent elbow symptoms were the reason for not returning to play while the other 3 reported losing the desire to return to play. At final follow-up, 7 (31.8%) patients reported of persistent sensory ulnar nerve sensory symptoms while 1 (4.5%) of these patients additionally reported persistent ulnar nerve motor symptoms. The mean postoperative patient reported outcome scores were as follows: KJOC: 77.9+/-20.9 (range, 14-100); MEPS: 92.7+/-12.7 (range, 45-100); AT Elbow Score: 86.1+/-17.1 (range, 30-100); SANE score: 85.5+/-14.8 (range, 50-100). Conclusions: While patient-reported outcome scores and return to play rates are reasonably high, this study demonstrates that following concomitant UCL reconstruction and ulnar nerve transposition for UCL insufficiency and associated ulnar neuropathy, rates of persistent ulnar neuropathy symptoms are persistently present in over 30% of patients. Currently, handling of the ulnar nerve in the setting of UCL insufficiency is debated and thus further investigation is warranted to optimize outcomes for this group of patients.

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Performance and Return to Sport Following Ulnar Nerve Transposition/Decompression in Professional Baseball Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00166 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0016

Author(s):

Brandon J. Erickson ◽

Peter Nissen Chalmers ◽

John D’Angelo ◽

Kevin Ma ◽

Anthony A. Romeo

Keyword(s):

Ulnar Nerve ◽

Performance Metrics ◽

Return To Sport ◽

Professional Baseball ◽

Baseball Players ◽

Nerve Decompression ◽

Ulnar Nerve Transposition ◽

Significant Difference ◽

And Performance ◽

Nerve Transposition

Background: Isolated ulnar nerve decompression/transposition is an uncommon surgery amongst professional baseball players. Purpose: To determine the rate of return to sport (RTS) and performance upon RTS in professional baseball players following isolated ulnar nerve decompression/transposition, including those who required an ulnar nerve transposition/decompression following ulnar collateral ligament reconstruction (UCLR), and to determine if outcomes differ between players with isolated ulnar nerve decompression/transposition and matched controls. Hypothesis: There is a high rate of RTS in professional baseball players undergoing isolated ulnar nerve decompression/transposition with no significant difference in RTS rate or performance (specifically related to the primary outcome performance variables of earned run average (ERA), WHIP ((walks +hits)/innings pitched), wins above replacement (WAR), and on base + slugging percentage (OPS)) between cases and controls. Methods: All professional baseball players who underwent isolated ulnar nerve decompression/transposition between 2010-2016 were included. Demographic and performance data (pre and post surgery) for each player was recorded. Performance metrics were then compared between cases and a group of matched controls. Results: Overall 52 players, 83% pitchers (14 who underwent prior UCLR) were included. Most surgeries (92%) were anterior subcutaneous transpositions. Overall, 62% of players were able to successfully RTS and 56% returned to the same or a higher level. There was no significant difference between cases and controls in the majority of performance metrics pre-operative or post-operatively, specifically ERA, WHIP, WAR, and OPS. When players who had a UCLR prior to their ulnar nerve transposition/decompression were compared to controls with a history of a UCLR but who did not go on to have an ulnar nerve transposition/decompression, the only performance difference of all the recorded metrics was cases allowed more walks per 9 innings (4.4 vs. 2.8; p=0.011). Conclusion: Anterior subcutaneous transposition is the most common surgery in professional baseball players to address ulnar nerve compression. Players have a 62% rate of RTS. Upon RTS, players performance compared to matched controls remains the same in the majority of performance metrics including ERA, WHIP, WAR, and OPS. Post-operatively, pitchers with a UCLR prior to ulnar nerve transposition/decompression performed the same as matched controls with prior UCLR.

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Subcutaneous Ulnar Nerve Transposition

Operative Dictations in Orthopedic Surgery ◽

10.1007/978-1-4614-7479-1_84 ◽

2013 ◽

pp. 307-309

Author(s):

Said Saghieh

Keyword(s):

Ulnar Nerve ◽

Ulnar Nerve Transposition ◽

Nerve Transposition

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29 Submuscular Ulnar Nerve Transposition

Hand Surgery ◽

10.1055/b-0040-177444 ◽

2020 ◽

Keyword(s):

Ulnar Nerve ◽

Ulnar Nerve Transposition ◽

Nerve Transposition

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Curved skin incision for Ulnar nerve transposition in Cubital Tunnel Syndrome: Cadaveric and clinical study to avoid injury of medial cutaneous nerve

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2020.03.003 ◽

2020 ◽

Vol 106 (4) ◽

pp. 757-763

Author(s):

Soonwook Kwon ◽

Zhu Bin ◽

Maria Florencia Deslivia ◽

Hyun-Joo Lee ◽

Im Joo Rhyu ◽

...

Keyword(s):

Clinical Study ◽

Ulnar Nerve ◽

Skin Incision ◽

Cubital Tunnel Syndrome ◽

Cutaneous Nerve ◽

Cubital Tunnel ◽

Ulnar Nerve Transposition ◽

Tunnel Syndrome ◽

Nerve Transposition

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Submuscular Ulnar Nerve Transposition

Operative Techniques: Shoulder and Elbow Surgery ◽

10.1016/b978-0-323-50880-3.00058-5 ◽

2019 ◽

pp. 594-596

Author(s):

Raj M. Amin ◽

John V. Ingari

Keyword(s):

Ulnar Nerve ◽

Ulnar Nerve Transposition ◽

Nerve Transposition

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Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes

The American Journal of Sports Medicine ◽

10.1177/0363546520921160 ◽

2020 ◽

Vol 49 (1) ◽

pp. 236-248

Author(s):

Austin M. Looney ◽

David X. Wang ◽

Christine M. Conroy ◽

Jake E. Israel ◽

Blake M. Bodendorfer ◽

...

Keyword(s):

Systematic Review ◽

Ulnar Nerve ◽

Systematic Reviews ◽

Meta Analysis ◽

Ulnar Collateral Ligament ◽

Likelihood Method ◽

Collateral Ligament ◽

Ulnar Nerve Transposition ◽

Significant Difference ◽

Nerve Transposition

Background: The modified Jobe and docking techniques are the most common techniques used for elbow ulnar collateral ligament (UCL) reconstruction. Previous systematic reviews have suggested that the docking technique results in superior outcomes as compared with the Jobe (figure-of-8) technique. However, these included results from earlier studies in which the flexor-pronator mass (FPM) was detached and an obligatory submuscular ulnar nerve transposition was performed. Purpose/Hypothesis: The purpose was to compare the outcomes and return-to-play (RTP) time between the docking and figure-of-8 techniques for UCL reconstruction. We hypothesized that there would be no significant difference in the proportion of excellent outcomes between techniques when the FPM was preserved and no obligatory submuscular ulnar nerve transposition was performed. We also hypothesized that there would be no significant difference in RTP time between techniques. Study Design: Systematic review and meta-analysis. Methods: This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In the primary analysis, techniques were compared in random effects models by using the restricted maximum likelihood method, with weighted effect sizes calculated as the Freeman-Tukey double-arcsine transformed proportion of excellent outcomes for variance stabilization and with summary effects estimated from the inverse double-arcsine transformation per the harmonic mean of the sample sizes. Mean RTP times for techniques were compared in a separate model. Results: There were 21 eligible articles identified, with results for 1842 UCL reconstructions (n = 320, docking; n = 1466, figure-of-8). Without controlling for the effects of flexor-pronator detachment and submuscular ulnar nerve transposition, a significantly larger proportion of excellent outcomes was observed with docking reconstruction (86.58%; 95% CI, 80.42%-91.85%) than with figure-of-8 reconstruction (76.76%; 95% CI, 69.65%-83.25%; P = .031); however, there was no significant difference between techniques when controlling for FPM preservation or detachment with submuscular nerve transposition ( P = .139). There was no significant difference between techniques in time to return to sports ( P = .729), although no reconstructions with FPM detachment and submuscular ulnar nerve transposition were available for RTP time analysis. Conclusion: There was no significant difference in the proportion of excellent Conway Scale outcomes or RTP time between the docking and modified Jobe techniques for UCL reconstruction when the FPM was preserved and routine submuscular ulnar nerve transposition was not performed.

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