American Society for Peripheral Nerve

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The Musculofascial Lengthening Technique for Submuscular Transposition of the Ulnar Nerve in Patients with Persistent or Recurrent Cubital Tunnel Syndrome: a Retrospective Case Series
Nick Wever, MD1; Godard C.W. de Ruiter, MD2; J. Henk Coert, MD1
1Plastic Surgery, Erasmus University, Rotterdamn, Netherlands; 2Neurosurgery, Medical Center Haaglanden, The Hague, Netherlands

Introduction: Persistence or recurrence of cubital tunnel syndrome (CuTS) occurs in up to 10-25% following primary decompression interventions. There are several strategies for revision surgery, including subcutaneous or submuscular transposition. Only a small number of studies have investigated the effectiveness of these procedures in patients with persistent or recurrent ulnar neuropathy. In this study, we present the results of 34 cases of submuscular transposition of the ulnar nerve for persistent or recurrent CuTS using the musculofascial lengthening technique described by Dellon and Coert1(also known as the Z-lengthening technique).

Materials & Methods: Between January 2003 and January 2014, submuscular transposition of the ulnar nerve for recurrent or persistent CuTS was performed in a total of 40 adult patients. Six patients were excluded because of concomitant radiculopathy, poly-neuropathy of the upper extremities and lost to follow up after 2 weeks. The objective outcome was assessed with the Likert scale. A satisfactory result was defined as Likert 1 (complete recovery) and 2 (almost complete recovery). In addition patient self-reported outcome was assessed with the questionnaire reported by Novak et al2.

Results: All patients were followed with a mean duration of 7.4 months (+/- 6.2, range 1.5 – 30.6). Successful clinical outcome (Likert 1 and 2) was observed in 65% and complete recovery in 27%. All symptoms improved significantly after revision surgery (paraesthesias= 0.000, pain= 0.004, sensibility= 0.002 and strength 0.016). Results of the questionnaire, which was obtained at a mean follow-up period of 2.62 years (+/- 2.55, range 0.21 – 9.59), showed that 47% of the patients had subjectively improved of which 22% completely. Seventy-two percent were satisfied or partly satisfied. Subjectively the reduction in pain, parestheasias and pain at the elbow were statistically significant (p< 0.012, 0.000, 0.39 respectively).

Conclusions: This retrospective case series shows that submuscular transposition of the ulnar with the musculofascial lengthening technique can be an effective treatment for patients with recurrent or persistent cubital tunnel syndrome. To obtain more evidence a prospective study and/or randomized trial comparing the submuscular and subcutaneous transposition is needed.
1. Dellon AL, Coert JH. Results of the Musculofacial Lengthening Technique for Submuscular Transposition of the Ulnar Nerve at the Elbow. J Bone Joint Surg Am. 2004;86:169 – 179
2. Novak CB, Mackinnon SE, Stuebe AM. Patiënt self-reported outcome after ulnar nerve transposition. Ann Plast Surg. 2002 Mar;48(3)274-80

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