scholarly journals In Situ Neurolysis of Ulnar Nerve for Patients With Failed Anterior Subcutaneous Transposition – A Case Series

2021 ◽  
Author(s):  
Ji Sup Hwang ◽  
Yohan Lee ◽  
Kee Jeong Bae ◽  
Jihyeung Kim ◽  
Goo Hyun Baek
Keyword(s):  
Pain Score ◽  
Ulnar Nerve ◽  
Surgical Techniques ◽  
Case Series ◽  
Pathologic Finding ◽  
Dash Score ◽  
Tunnel Syndrome ◽  
Subcutaneous Transposition

Abstract BACKGROUND Various surgical techniques have been attempted to treat patients with failed anterior subcutaneous transposition performed for cubital tunnel syndrome. OBJECTIVE To analyze intraoperative findings of failed anterior subcutaneous transposition and to report the outcome of in Situ neurolysis of ulnar nerve. METHODS Patients who, under diagnosis of failed anterior subcutaneous transposition of ulnar nerve, underwent in Situ neurolysis between 2001 and 2018 were included in this study. We excluded patients with follow-up of less than one year, records of traumatic ulnar nerve injury, and concomitant double crush syndrome such as cervical spondylosis causing radicular pain, ulnar tunnel syndrome, or thoracic outlet syndrome. Surgical outcomes were evaluated using visual analog scale (VAS) pain score and Disabilities of the Arm, Shoulder, and Hand (DASH) score, which were assessed before and after surgery. A total of 28 elbows in 27 patients whose average age was 58.5 (range, 31-76) yr were enrolled, and the duration of follow-up was 5.8 (range, 1.0-14.9) yr. RESULTS The most common pathologic finding identified during operation was severe adhesion of the transposed nerve in all elbows, followed by incomplete decompression of deep flexor-pronator aponeurosis in 26 elbows (93%). The average VAS pain score improved from 4.9 (range, 2-7) to 1.3 (range, 0-5), and the average DASH score from 31.7 (range, 18.1-66.7) to 14.1 (range, 5.0-46.6). Of the 28 elbows, 27 (96.4%) showed improvement of preoperative symptoms. CONCLUSION In Situ neurolysis of ulnar nerve for patients with failed anterior subcutaneous transposition resulted in satisfactory outcome.

Long-term Reoperation Rate for Cubital Tunnel Syndrome: Subcutaneous Transposition Versus In Situ Decompression

Hand ◽  
2019 ◽  
pp. 155894471987315
Author(s):  
Douglas T. Hutchinson ◽  
Ryan Sullivan ◽  
Micah K. Sinclair
Keyword(s):  
Ulnar Nerve ◽  
Reoperation Rate ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Multicenter Cohort Study ◽  
Tunnel Syndrome ◽  
Subcutaneous Transposition

Background: The purpose of this study was to compare the long-term revision rate of in situ ulnar nerve decompression with anterior subcutaneous transposition surgery for idiopathic cubital tunnel syndrome. Methods: This retrospective, multicenter, cohort study compared patients who underwent ulnar nerve surgery with a minimum 5 years of follow-up. The primary outcome studied was the need for revision cubital tunnel surgery. In total, there were 132 cases corresponding to 119 patients. The cohorts were matched for age and comorbidity. Results: The long-term reoperation rate for in situ decompression was 25% compared with 12% for anterior subcutaneous transposition. Seventy-eight percent of revisions of in situ decompression were performed within the first 3 years. Younger age and female sex were identified as independent predictors of need for revision. Conclusions: In the long-term follow-up, in situ decompression is seen to have a statistically significant higher reoperation rate compared with subcutaneous transposition.

scholarly journals Anconeus Epitrochlearis Muscle Associated With Cubital Tunnel Syndrome: A Case Series

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 477-482
Author(s):  
Nicholas Kim ◽  
Ryan Stehr ◽  
Hani S. Matloub ◽  
James R. Sanger
Keyword(s):  
Ulnar Nerve ◽  
Nerve Conduction ◽  
Case Series ◽  
Cubital Tunnel Syndrome ◽  
Nerve Conduction Studies ◽  
Cubital Tunnel ◽  
Persistent Symptoms ◽  
Compressive Neuropathy ◽  
Tunnel Syndrome

Background: Cubital tunnel syndrome is a common compressive neuropathy of the upper extremity. The anconeus epitrochlearis muscle is an unusual but occasional contributor. We review our experience with this anomalous muscle in elbows with cubital tunnel syndrome. Methods: We retrospectively reviewed charts of 13 patients noted to have an anconeus epitrochlearis muscle associated with cubital tunnel syndrome. Results: Ten patients had unilateral ulnar neuropathy supported by nerve conduction studies. Three had bilateral cubital tunnel syndrome symptoms with 1 of those having normal nerve conduction studies for both elbows. Eight elbows were treated with myotomy of the anconeus epitrochlearis muscle and submuscular transposition of the ulnar nerve. The other 8 elbows were treated with myotomy of the anconeus epitrochlearis muscle and in situ decompression of the ulnar nerve only. All but 1 patient had either clinical resolution or improvement of symptoms at follow-up ranging from 2 weeks to 1 year after surgery. The 1 patient who had persistent symptoms had received myotomy and in situ decompression of the ulnar nerve only. Conclusions: An anomalous anconeus epitrochlearis occasionally results in compression of the ulnar nerve but is usually an incidental finding. Its contribution to compression neuropathy can be tested intraoperatively by passively ranging the elbow while observing the change in vector and tension of its muscle fibers over the ulnar nerve. Regardless of findings, we recommend myotomy of the muscle and in situ decompression of the ulnar nerve. Submuscular transposition of the ulnar nerve may be necessary if there is subluxation.

scholarly journals Subcutaneous vs Submuscular Ulnar Nerve Transposition in Moderate Cubital Tunnel Syndrome

2009 ◽  
Vol 3 (1) ◽  
pp. 78-82 ◽  
Author(s):  
Dhia A.K Jaddue ◽  
Salwan A Saloo ◽  
Arkan S Sayed-Noor
Keyword(s):  
Postoperative Pain ◽  
Ulnar Nerve ◽  
Operative Time ◽  
Surgical Techniques ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Anterior Transposition ◽  
Tunnel Syndrome ◽  
And Gender ◽  
Subcutaneous Transposition

Background: The surgical treatment of Cubital tunnel syndrome (CubTS) is still a matter of debate. No consensus exists about the necessity of anterior transposition of the ulnar nerve after decompression. However, this technique is fairly common in clinical practice. Material and Methodology: In the present study we compared the operative technique (incision length, operative time), postoperative care (postoperative pain and complications) and the outcome between subcutaneous transposition and submuscular transposition of the ulnar nerve as two surgical modalities in treating moderate CubTS. Between March 2004 and March 2007, twenty six patients with moderate CubTS (according to Dellon’s grading system) were stratified according to age and gender into these two surgical techniques. The two groups were prospectively followed up 2 weeks, 6 months and 12 months postoperatively by the same observer and the operation outcome was assessed using the Bishop rating system. Results: We found that the subcutaneous transposition of the ulnar nerve was associated with shorter incision, shorter operative time, less postoperative pain, less postoperative complication and better outcome compared with the submuscular transposition. Conclusion: The authors recommend the subcutaneous technique when considering anterior transposition of the ulnar nerve in treating moderate CubTS.

scholarly journals Endoscopic cubital tunnel decompression – Review of the literature

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902098208
Author(s):  
Margaret Woon Man Fok ◽  
Tyson Cobb ◽  
Gregory I Bain
Keyword(s):  
Ulnar Nerve ◽  
Randomized Study ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Short Term ◽  
Compressive Neuropathy ◽  
Endoscopic Guidance ◽  
Tunnel Syndrome ◽  
Subcutaneous Transposition

Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb. Endoscopic cubital tunnel decompression has gained popularity in recent years as this enables surgeons to achieve decompression of the ulnar nerve along its course using a small incision. This article describes the technical peals in performing endoscopic cubital tunnel decompression. In conditions which anterior transposition of the ulnar nerve is needed, subcutaneous transposition can be performed under endoscopic guidance. In addition, current literature is reviewed, and outcomes are presented. While short term results are encouraging, further prospective randomized study with longer follow-up is recommended.

scholarly journals Incidence of Re-Operation and Subjective Outcome Following in Situ Decompression of the Ulnar Nerve at the Cubital Tunnel

2009 ◽  
Vol 34 (3) ◽  
pp. 379-383 ◽  
Author(s):  
C. A. GOLDFARB ◽  
M. M. SUTTER ◽  
E. J. MARTENS ◽  
P. R. MANSKE
Keyword(s):  
Ulnar Nerve ◽  
Failure Rate ◽  
Chart Review ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Persistent Symptoms ◽  
Additional Surgery ◽  
Tunnel Syndrome

The purpose of this investigation was to determine the failure rate of in situ decompression for cubital tunnel syndrome as determined by the need for additional surgery. We performed a comprehensive chart review of 56 adult patients who had undergone in situ decompression for cubital tunnel syndrome in 69 extremities with more than 1 year follow-up. The patients completed a comprehensive questionnaire concerning preoperative and postoperative pain, numbness, and weakness. After decompression, symptoms were improved substantially or resolved. Five limbs (7%) with persistent symptoms postoperatively were treated successfully with anterior submuscular transposition. These data suggest that in situ decompression of the ulnar nerve is a reliable treatment for cubital tunnel syndrome and has a low failure rate. The uncommon patient with continued symptoms after decompression can be treated effectively with transposition of the ulnar nerve.

scholarly journals Trapeziometacarpal Joint Arthroplasty of the Thumb without Osseous Tunnels and Carpal Tunnel Release via a Radial Approach; Technique, and Results

2019 ◽  
Vol 05 (03) ◽  
pp. e120-e125
Author(s):  
Chung Ming Chan ◽  
Efraín Farías Cisneros ◽  
Tsu-Min Tsai
Keyword(s):  
Grip Strength ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Case Series ◽  
Dash Score ◽  
Radial Approach ◽  
Functional Scores ◽  
Tunnel Syndrome ◽  
Bone Tunnels

Abstract Background Numerous surgeries have been described for osteoarthritis of the trapeziometacarpal (TMC) joint. We describe the senior author's experience with his technique of concurrent arthroplasty of the TMC joint, and carpal tunnel release (CTR) via a radial approach. Methods The study is a case series of patients managed over a 3-year period. We included 86 patients over 40 years of age that had concurrent CTR. We used the paired t-test to compare the preoperative and postoperative grip strength and functional scoring (including the Levine-Katz questionnaire for carpal tunnel syndrome, disabilities of the arm shoulder and hand [DASH] score and QuickDASH9). Results Mean age at surgery was 62.8 years, and mean follow-up was 13.1 months. Functional outcomes were analyzed in 65 patients. Grip strength returned to the preoperative measurement by 3 months. Analysis of the nine patients followed up for more than 13 months postoperatively showed a significant increase in grip strength at last follow-up. The grip strength in both hands was also similar beyond 13 months. Significant decreases in the functional scores recorded indicated a reduction in disability, symptom severity, and functional impairment. Conclusions In conclusion, we present the favorable results of this technique of TMC arthroplasty and CTR involving no bone tunnels and short-term immobilization.

scholarly journals Partial 2-Stage Revision in Chronic Hip Arthroplasty Infections: A Review

2018 ◽  
Vol 3 (3) ◽  
pp. 72-75 ◽  
Author(s):  
Francesco Castagnini ◽  
Luca Busanelli ◽  
Giovanni Bracci ◽  
Enrico Tassinari ◽  
Federico Biondi ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Standard Procedure ◽  
Surgical Techniques ◽  
Case Series ◽  
Stem Retention ◽  
Hip Arthroplasties ◽  
Highly Virulent

Background: Periprosthetic hip infections (PHIs) are troublesome complications of hip arthroplasties. The gold standard procedure for treating chronic PHI is a 2-stage approach. Recently, however, more conservative approaches have been developed to spare the osseointegrated components and avoid sequestra, bone loss, devascularization, and difficult reconstructions. The partial two-stage approach, which leaves the well-fixed component in situ and removes the loosened component, may be an effective strategy. Objective: This paper, a narrative mini-review, analyzed the preliminary results of a partial 2-stage approach to treating chronic hip arthroplasty infections. Methods: Pertinent papers describing the partial 2-stage approach (leaving the well-fixed component in situ and removing the loosened component) were collected and evaluated. Results: Six main case series were selected. A total of 76 patients were included. Many patients were treated with socket removal and stem retention with quite similar surgical techniques. Many cases included highly virulent bacteria, and no pre-operative selection about comorbidities was performed. The first outcomes of this approach were promising, with a rate of infection control ranging from 81.3% to 100% at mid-term follow-up. Conclusion: This approach proved good at mid-term follow-up; however, many concerns still exist. In particular, the indications are imprecise, and the role of biofilm is still unclear. Despite the first good outcomes, the partial 2-stage approach for chronic PHI should be validated by multicenter prospective studies.

scholarly journals Least possible fixation techniques of 4-part valgus impacted fractures of the proximal humerus: a systematic review

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Andreas Panagopoulos ◽  
Irini Tatani ◽  
Dimitrios Ntourantonis ◽  
Ioannis Seferlis ◽  
Antonis Kouzelis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Avascular Necrosis ◽  
Proximal Humerus ◽  
Constant Score ◽  
Surgical Techniques ◽  
Case Series ◽  
Cochrane Library ◽  
Operation Rate ◽  
Fixation Techniques

The valgus-impacted (VI) 4-part fractures are a subset of fractures of the proximal humerus with a unique anatomic configuration characterized by a relatively lower incidence of avascular necrosis after operative intervention. We systematically reviewed clinical studies assessing the benefits and harms of least possible fixation techniques (LPFT) for this unique fracture type. Such information would be potentially helpful in developing an evidence-based approach in the management of these complex injuries. We performed analytic searches of PubMed, Embase, Web of Science, Google Scholar and the Cochrane Library, restricting it to the years 1991-2014. Included studies had to describe outcomes and complications after primary osteosynthesis with any type of LPFT apart from plate-screws and intramedullary nailing. Eligibility criteria were also included English language, more than 5 cases, minimum follow up of one year and report of clinical outcome using at least one relevant score (Constant, Neer or ASES). Based on 292 database hits we identified 12 eligible studies including 190 four-part valgus impacted fractures in 188 patients. All eligible studies were case series composed of min 8 to max 45 patients per study. The gender distribution was 60% (112) female and 40% (76) male. The average age of the patients at the time of injury was 54.5 years. In 8/12 studies an open reduction was used for fracture fixation using different surgical techniques including KW, cerclage wires, cannulated screws and osteosutures. Closed reduction and percutaneous fixation was used in 4 studies. Mean follow-up time ranged from 24 to 69 months. A good functional outcome (constant score >80) was reported in 9/12 studies. The most common complication was avascular necrosis of the humeral head with an overall incidence of 11% (range, 0-26.3%). Total avascular necrosis (AVN) was found in 15/188 patients (7.9%) and was more common in percutaneous techniques and partial AVN in 6/188 (3.1%) being more common in open techniques. The overall re-operation rate was very low (3.7%). Insufficient study designs cannot provide definite treatment recommendations and quantitative data synthesis of outcome. In general, LPFT for 4-part VI fractures leads to satisfactory outcomes with low incidence of complications. A considerable risk of biases can be attributed to fracture classification, proper radiological control, mean age of patients, mixed types of fixation methods, nonage adjusted clinical scoring and small follow up periods. These factors are discussed in detail. Level of evidence: systematic review of literature (level IV) as most of the studies were level IV.

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