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. 2018 Feb 5;131(3):282-288.
doi: 10.4103/0366-6999.223851.

Anterior Subcutaneous Transposition of the Ulnar Nerve Affects Elbow Range of Motion: A Mean 13.5 Years of Follow-up

Xing-Hua Liu  1 , Mao-Qi Gong  1 , Yang Wang  1 , Chang Liu  2 , Shao-Liang Li  1 , Xie-Yuan Jiang  1
Affiliations

Anterior Subcutaneous Transposition of the Ulnar Nerve Affects Elbow Range of Motion: A Mean 13.5 Years of Follow-up

Xing-Hua Liu et al. Chin Med J (Engl). .

Abstract

Background: Surgical decompression of the ulnar nerve is effective for cubital tunnel syndrome. However, deep approaches may result in iatrogenic elbow stiffness. This long-term study was to evaluate the range of motion (ROM) of the elbow and functional outcomes after anterior subcutaneous transposition.

Methods: A total of 115 patients (78 male and 37 female; mean age: 46.6 years) who underwent anterior subcutaneous transposition of the ulnar nerve between 2001 and 2005 were evaluated retrospectively; mean follow-up was 13.5 years. Elbow ROM was measured as flexion arc, flexion, and extension preoperatively and at the final follow-up, and compared via a mixed analysis of variance adjusting for age. Neuropathy was assessed preoperatively using a modified McGowan neuropathy grade and postoperatively using modified Wilson-Krout criteria. An ordinal logistic regression analysis used postoperative modified Wilson-Krout criteria as the outcome and preoperative factors as predictors.

Results: Preoperative McGowan grades were Grade 1 in 14 patients (12.2%), Grade 2A in 28 (24.3%), Grade 2B in 53 (46.1%), and Grade 3 in 20 (17.4%) patients. Postoperatively, 66 patients (57.4%) had excellent results, 26 (22.6%) had good results, 16 (13.9%) had fair results, and 7 (6.1%) had poor results at the final follow-up, as per the Wilson-Krout criteria. There were no complications. Pre- and postoperative elbow ROM was significantly decreased in patients with previous trauma or surgery of the elbow compared with those without (P < 0.05). Anterior subcutaneous transposition of the ulnar nerve did not significantly affect elbow ROM regardless of previous trauma or surgical history nor preoperative ROM (P > 0.05), after adjusting for age. Patients with prolonged symptoms prior to surgery and worse neuropathy tended to have less satisfactory functional outcomes (P < 0.05), after adjusting for covariates.

Conclusions: Anterior subcutaneous transposition of the ulnar nerve is an effective and reliable treatment of cubital tunnel syndrome with satisfactory outcomes and minimal effect on elbow ROM.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Preoperative modified McGowan grading of patients.
Figure 2
Figure 2
Postoperative modified Wilson–Krout grading of patients.
Figure 3
Figure 3
Thorough release of ulnar nerve.
Figure 4
Figure 4
Subcutaneous transposition of ulnar nerve held by fasciodermal sling in position.
Figure 5
Figure 5
Profile plots of elbow ROMs (flexion, extension, and flexion arc) showing the pre- and postoperative differences between patients with and without trauma/surgical history. *P < 0.05, elbow ROMs significantly different between patients. †P > 0.05, elbow ROMs not significantly different within patients. ROMs: Range of motions.
Figure 6
Figure 6
Correlation between modified McGowan grade and modified Wilson–Krout criteria. OR: Odds ratio; CI: Confidence interval.
See this image and copyright information in PMC

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