A Novel Endoscopic Technique in Treating Single Nerve Entrapment Syndromes with Special Attention to Ulnar Nerve Transposition and Tarsal Tunnel Release: Clinical Application

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-89-ONS-100 ◽  
Author(s):  
Kartik G. Krishnan ◽  
Thomas Pinzer ◽  
Gabriele Schackert
Keyword(s):  
Ulnar Nerve ◽  
Clinical Results ◽  
Nerve Compression ◽  
Endoscopic Technique ◽  
Tarsal Tunnel ◽  
Ulnar Nerve Transposition ◽  
Meralgia Paraesthetica ◽  
Single Nerve ◽  
Nerve Transposition

Abstract OBJECTIVE: To describe a simple retractor integrated endoscopic technique for treating idiopathic solitary compression neuropathies with special attention to the anterior transposition of the ulnar nerve and tarsal tunnel release, and to present the clinical results. METHODS: Eleven patients with ulnar sulcus syndrome, eight with tarsal tunnel syndrome, and one with meralgia paraesthetica (seven females and 13 males; age range, 12–64 yr) were treated with endoscopic anterior ulnar nerve transposition and in situ decompression of the tibial (eight patients) and lateral femoral cutaneous nerves (one patient), respectively. The selection criteria were: classical nerve compression symptoms, failed conservative treatment, abnormal electrophysiology, and a nonviolated anatomic region. The degree of nerve compression (after Dellon) was rated as moderate in five out of 20 patients and as severe in 15 out of 20 patients. Electrophysiological studies were conducted independently by physicians specializing in these techniques. Postoperative recovery was evaluated according to the nine-point Bishop rating system. RESULTS: Of the 11 patients with anterior ulnar nerve transposition, seven scored excellent, three scored good, and one scored fair (mean follow-up, 15.5 mo; range, 6–27 mo). Five patients with tarsal tunnel release scored excellent and three scored good (mean follow-up, 10.1 mo; range, 3–24 mo). The patient with meralgia paraesthetica showed an excellent score at 28 months after surgery. There were no technical or postoperative complications. None of the operations had to be converted to open surgery. CONCLUSION: We describe a new endoscopic technique for transposing the ulnar nerve and decompressing the tibial nerve. This technique could be extrapolated to release other single nerve entrapments. The simplicity of the technique, and our preliminary clinical results, may encourage other groups to adapt this method.

scholarly journals Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110554
Author(s):  
Somnath Rao ◽  
Taylor D’Amore ◽  
Donald P. Willier ◽  
Richard Gawel ◽  
Robert A. Jack ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Ulnar Nerve Transposition ◽  
The Mean ◽  
Ulnar Neuritis ◽  
Nerve Transposition

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%.

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

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.

scholarly journals Early Complications of Ulnar Collateral Ligament Repair With Collagen-Coated Suture Tape Augmentation

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110383
Author(s):  
Marcus A. Rothermich ◽  
Glenn S. Fleisig ◽  
Hunter E. Lucas ◽  
Michael K. Ryan ◽  
Benton A. Emblom ◽  
...  
Keyword(s):  
Operating Room ◽  
Ulnar Nerve ◽  
Major Complication ◽  
Ulnar Collateral Ligament ◽  
Early Complications ◽  
Collateral Ligament ◽  
Ulnar Nerve Transposition ◽  
Internal Brace ◽  
Nerve Transposition

Background: Recent innovative techniques have led to renewed interest in ulnar collateral ligament (UCL) repair. Although early outcome data regarding the clinical outcome of overhead athletes undergoing UCL repair with augmentation have been encouraging, long-term data are still needed to evaluate both the appropriate indications and success rate for this procedure. Purpose: To describe and evaluate the acute complications seen in a large cohort of patients who underwent UCL repair with internal brace augmentation at a single institution. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective chart review of a prospectively collected database, consisting of all patients who underwent UCL repair with internal brace augmentation utilizing a collagen-dipped FiberTape at our institution from August 2013 to January 2020. Patient characteristics, injury setting, side of surgery, and concomitant ulnar nerve transposition procedures were recorded. Early complications of UCL repair (within 6 months of the procedure) were evaluated and characterized as either minor or major, depending on whether the patient required a return to the operating room. Results: Of the 353 patients who underwent UCL repair at our institution with a minimum of 6-month follow-up, 84.7% (299/353) reported no complications, 11.9% (42/353) reported minor complications—including ulnar nerve paresthesia, postoperative medial elbow pain, and postoperative superficial wound complications—and 3.4% (12/353) required a return to the operating room because of a major complication requiring ulnar nerve exploration/debridement, primary ulnar nerve transposition, or heterotopic ossification excision. Conclusion: The low major complication rate identified in this study further validates the efficacy of the UCL repair with the internal bracing augmentation technique. Longer term follow-up data are needed to more adequately assess the outcomes and durability of this procedure.

A new endoscopic technique to decompress lumbar nerve roots affected by spondylolysis

2003 ◽  
Vol 98 (3) ◽  
pp. 290-293 ◽  
Author(s):  
Koichi Sairyo ◽  
Shinsuke Katoh ◽  
Tadanori Sakamaki ◽  
Shinji Komatsubara ◽  
Natsuo Yasui
Keyword(s):  
Clinical Outcome ◽  
Nerve Root ◽  
Clinical Results ◽  
Skin Incision ◽  
Endoscopic Technique ◽  
Spinal Instability ◽  
Nerve Roots ◽  
Content Type ◽  
Proximal Stump

✓ The authors describe a new endoscopic technique to decompress lumbar nerve roots affected by spondylolysis. Short-term clinical outcome was evaluated. Surgery-related indications were: 1) radiculopathy without low-back pain; 2) no spinal instability demonstrated on dynamic radiographs; and 3) age older than 40 years. Seven patients, four men and three women, fulfilled these criteria and underwent endoscopic decompressive surgery. Their mean age was 60.9 years (range 42–70 years). No subluxation was present in four patients, whereas Meyerding Grade I slippage was demonstrated in three. For endoscopic decompression, a skin incision of 16 to 18 mm in length was made, and fenestration was performed to identify the affected nerve root. The proximal stump of the ragged edge of the spondylotic lesion, and the fibrocartilaginous mass compressing the nerve root were removed. The follow-up period ranged from 6 to 22 months (mean 11.7 months). Clinical outcome was evaluated using Gill criteria; in three patients the outcome was excellent, and in four it was good. This new endoscopic technique was useful in the decompression of nerve roots affected by spondylolysis, the technique was minimally invasive, and the clinical results were acceptable.

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

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.

Severe ulnar nerve entrapment at the elbow: functional outcome after minimally invasive in situ decompression

2012 ◽  
Vol 37 (2) ◽  
pp. 115-122 ◽  
Author(s):  
K. Karthik ◽  
R. Nanda ◽  
S. Storey ◽  
J. Stothard
Keyword(s):  
Minimally Invasive ◽  
Grip Strength ◽  
Ulnar Nerve ◽  
Nerve Compression ◽  
Ulnar Nerve Compression ◽  
Pinch Grip ◽  
Simple Decompression

The role of in situ decompression in patients with severe ulnar nerve compression is still controversial. Thirty patients with severe ulnar nerve compression confirmed clinically and electrophysiologically underwent simple decompression. The mean age of the patients was 58 (range 26–87) years. Through incisions ≤4 cm the nerves were fully visualized and decompressed. Outcome was measured prospectively using Modified Bishop’s score (BS), grip and pinch strengths and two-point discrimination (2PD). Significant improvement in power (p = 0.01) and pinch grip (p = 0.001) was noted at 1 year. The grip strength continued to improve up to 1 year. According to the BS, 24 patients (80%) had good to excellent results at 1 year. Minimally invasive in situ decompression is technically simple, safe and gives good results in patients with severe nerve compression. The BS and 2PD were more reliable than grip strength in assessing these patients at follow-up.

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