In-situ Decompression of Ulnar Nerve Entrapment: A Controlled Randomized Study Comparing Decompression using Two Small Transverse Incisions with Standard Open Decompression
Ashraf N. Moharram, MD; Mostafa Mahmoud, MD; Ayman Mansour, MD; Ayman Shaheen, MD; Ahmed Afifi, MD
Orthopedic Department, Cairo University, Cairo, Egypt
Introduction: Ulnar Nerve entrapment is the second most common nerve entrapment in the upper limb in adults. Many methods of treatment have been advised including transposition, in-situ decompression as well as endoscopic decompression.
Method: We performed in-situ ulnar nerve decompression for 60 patients with ulnar nerve entrapment who were randomized into 2 groups. In group I decompression was performed through basically 2 transverse incisions each less than 2cm long which were placed 4cm above and 3 cm below the medial epicondyle and centered on the course of the ulnar nerve which was decompressed and all potentially compressing structures were released from the medial intermuscular septum down to the 2 heads of the flexor carpi ulnaris muscle. In group II decompression was performed through a standard curvilinear approach averaging 8cm based anterior to the medial epicondyle.
Patients who had symptoms of ulnar nerve instability, cubitus valgus, elbow osteoarthritis or significant local scaring were considered to be indicated for ulnar nerve transposition and were excluded from the study.
Results: Outcome measures used included Visual Analogue Scale (VAS) for pain, time of return to work, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Gabel and Amadio score, and grip and pinch strengths as well as local scar tenderness. At final follow up, which averaged 6.3 months (5-8.5months), there was no statistically significant difference in either the DASH score, the Gabel and Amadio outcome scores or grip and pinch strength between both groups. However group I showed significantly less pain on VAS scores, faster return to work, less scar tenderness and less disfiguring scar.
Conclusion: These results are similar to those of endoscopic release of the ulnar nerve but avoiding the need for special equipment and thus less added time and expense as well as a long learning curve.
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