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The Journal of Bone and Joint Surgery (American). 2004;86:169-179
© 2004 The Journal of Bone and Joint Surgery, Inc.

Results of the Musculofascial Lengthening Technique for Submuscular Transposition of the Ulnar Nerve at the Elbow

A. Lee Dellon, MD1 and J. Henk Coert, MD2

1 Division of Plastic Surgery and Department of Neurosurgery, Johns Hopkins University School of Medicine, 3333 North Calvert Street, Suite 370, Baltimore, Maryland 21218. E-mail address: aldellon{at}erols.com
2 Division of Plastic Surgery, Groningen University School of Medicine, Groningen, The Netherlands

Investigation performed at Union Memorial Hospital, Baltimore, Maryland

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 85-A, pp. 1314-1320, July 2003

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated. A.L. Dellon has a proprietary interest in the pressure-specified sensory device.

The line drawings in this article are the work of Jennifer Fairman (jfairman{at}fairmanstudios.com).

BACKGROUND:

In the absence of a randomized, prospective study comparing different surgical approaches for decompression of the ulnar nerve at the elbow, the choice of an approach relies on the individual surgeon's training and experience. The present report describes the results of a prospective, long-term evaluation of the musculofascial lengthening technique in a large series of patients. In these patients, the degree of ulnar nerve compression was staged with use of a numerical grading system that included measures of both motor and sensory function.

METHODS:

From 1985 through 1991, 121 consecutive patients (161 ex-tremities) in whom the ulnar nerve was entrapped at the elbow were treated with surgical decompression with use of a musculofascial lengthening technique. In addition to the patient history and physical examination, measurements of sensory and motor function were obtained prospectively to permit staging of the severity of the compression by means of a grading scale. The preoperative and postoperative scores on this scale were evaluated. The mean duration of follow-up after surgery was 45.6 months.

RESULTS:

On the basis of traditional criteria, 105 limbs (65%) had an excellent result; thirty-seven (23%), a good result; six (4%), afair result; twelve (7.5%), a failure; and one (0.5%), a recurrence. There was significant improvement in ulnar nerve function in terms of both the sensory (p < 0.001) and motor (p < 0.001) components of the grading scale. Comparisons of clinical subgroups revealed significant improvement in patients with diabetes, those with a Workers' Compensation claim, and those who had a severe degree of compression rather than a mild degree of compression.

CONCLUSIONS:

Surgical decompression of ulnar nerve entrapment at the elbow by means of a musculofascial lengthening technique was associated with an 88% rate of good to excellent results. The results of the present study demonstrate the feasibility of performing a statistical analysis of surgical results by using a numerical grading system to stage the degree of nerve compression. This method may be used to study different surgical techniques for the treatment of this common nerve compression syndrome.


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Related articles in JBJS:

Results of the Musculofascial Lengthening Technique for Submuscular Transposition of the Ulnar Nerve at the Elbow
A Lee Dellon and J. Henk Coert
JBJS 2003 85: 1314-1320. [Abstract] [Full Text]