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The Journal of Bone and Joint Surgery 82:1544 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

Stabilized Subcutaneous Ulnar Nerve Transposition with Immediate Range of Motion

Long-Term Follow-up*

Bradford T. Black, M.D.{dagger}, O. Alton Barron, M.D.{ddagger}, Peter F. Townsend, M.D.§, Steven Z. Glickel, M.D.{ddagger} and Richard G. Eaton, M.D.{ddagger}

Investigation performed at the C. V. Starr Hand Surgery Center and St. Luke's-Roosevelt Hospital, New York, N.Y.
A complete video supplement to this article is available from the Video Journal of Orthopaedics. A video clip is available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410.
*No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
{dagger}Department of Orthopedics, St. Luke's-Roosevelt Hospital Center, 114th Street and Amsterdam Avenue, New York, N.Y. 10025.
{ddagger}C. V. Starr Hand Surgery Center, 1000 Tenth Avenue, Third Floor, New York, N.Y. 10019.
§Delaware Orthopaedic Center, 2501 Silverside Road, Wilmington, Delaware 19810.

Background: Anterior transposition of the ulnar nerve at the elbow produces generally good results regardless of whether the nerve is transposed subcutaneously, intramuscularly, or submuscularly. The eventual recovery of nerve function is related less to the specific surgical technique than to the severity of the intrinsic nerve pathology. A primary variable in surgical management is the duration of postoperative elbow immobilization. The purpose of this study was to review the long-term results of a specific technique of subcutaneous anterior transposition of the ulnar nerve that utilizes a stabilizing fasciodermal sling. The study compared the results of immediate and late institution of a range of motion postoperatively.

Methods: Forty-seven patients with fifty-one elbows were reexamined, by an investigator who had not been involved in their treatment, at a minimum of two years (range, twenty-four months to fourteen years) after an anterior transposition. Of the fifty-one elbows, twenty-one were immobilized for two to three weeks whereas thirty were managed with an immediate range of motion.

Results: At the latest follow-up evaluation, there were occasional, mild paresthesias in 16 percent of the limbs and there was still subjective weakness of 19 percent. Both pinch and grip strength had increased substantially. No patient had lost elbow motion. A positive Tinel sign persisted in 31 percent of the limbs, but it was mildly positive in most of them. The elbow flexion test was uniformly negative. The results for 92 percent of the limbs were satisfactory to the patients, who stated that they would undergo the same procedure again if necessary. Overall, 73 percent of the limbs had an excellent result; 18 percent, a good result; 4 percent, a fair result; and 6 percent, a poor result. With the numbers available, no significant difference could be detected, with regard to these outcomes, between the group managed with elbow immobilization and that managed with immediate elbow mobilization. However, patients treated with a postoperative cast returned to work at an average of thirty days after surgery whereas the group treated with immediate motion of the elbow returned to work at an average of ten days.

Conclusions: This technique of stabilized subcutaneous anterior transposition of the ulnar nerve yielded predictably good results for a wide spectrum of patients. Patients returned to their occupation sooner when the elbow had been mobilized immediately.


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