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Submuscular Transposition of the Ulnar Nerve

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Compressive Neuropathies of the Upper Extremity

Abstract

Ulnar neuropathy resulting from compression at the elbow (cubital tunnel) is a relatively common pathology. Various techniques have been described for surgical management, ranging from simple in situ release to more elaborate transposition. This chapter will explore the surgical technique of submuscular transposition of the ulnar nerve and cover the history of nerve transposition, the indications, described modifications of surgical technique, and outcomes. The authors’ preferred surgical technique and postoperative care for submuscular transposition of the ulnar nerve are also included.

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References

  1. Vogel RB, Nossaman BC, Rayan GM. Revision anterior submuscular transposition of the ulnar nerve for failed subcutaneous transposition. Br J Plast Surg. 2004;57(4):311–6.

    Article  PubMed  Google Scholar 

  2. Ruchelsman DE, Lee SK, Posner MA. Failed surgery for ulnar nerve compression at the elbow. Hand Clin. 2007;23(3):359–71, vi–vii.

    Article  PubMed  Google Scholar 

  3. Lee SK, Sharma S, Silver BA, Kleinman G, Hausman MR. Submuscular versus subcutaneous anterior ulnar nerve transposition: a rat histologic study. J Hand Surg Am. 2009;34(10):1811–4.

    Article  PubMed  Google Scholar 

  4. Kleinman WB. Cubital tunnel syndrome: anterior transposition as a logical approach to complete nerve decompression. J Hand Surg Am. 1999;24(5):886–97.

    Article  CAS  PubMed  Google Scholar 

  5. Macnicol MF. The results of operation for ulnar neuritis. J Bone Joint Surg Br. 1979;61–B(2):159–64.

    Article  PubMed  Google Scholar 

  6. Gervasio O, Gambardella G, Zaccone C, Branca D. Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: a prospective randomized study. Neurosurgery. 2005;56(1):108–17.

    Article  PubMed  Google Scholar 

  7. Henry M. Modified intramuscular transposition of the ulnar nerve. J Hand Surg Am. 2006;31(9):1535–42.

    Article  PubMed  Google Scholar 

  8. Zhang D, Earp BE, Blazar P. Rates of complications and secondary surgeries after in situ cubital tunnel release compared with ulnar nerve transposition: a retrospective review. J Hand Surg Am. 2017;42(4):294.e1–5.

    Article  Google Scholar 

  9. Learmonth J. Technique for transplantation of the ulnar nerve. Surg Gynecol Obstet. 1942;75:792–3.

    Google Scholar 

  10. Williams EH, Dellon AL. Anterior submuscular transposition. Hand Clin. 2007;23(3):345–58.

    Article  PubMed  Google Scholar 

  11. Dellon A. Operative technique for submuscular transposition of the ulnar nerve. Oper Orthop. 1988;16:17–24.

    Google Scholar 

  12. Dellon AL, Coert JH. Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow. J Bone Joint Surg Am. 2004;86–A(Suppl 1(Pt 2)):169–79.

    Article  Google Scholar 

  13. Adson A. The surgical treatment of progressive ulnar nerve paralysis. Minn Med. 1918;1:455–60.

    Google Scholar 

  14. Leone J, Bhandari M, Thoma A. Anterior intramuscular transposition with ulnar nerve decompression at the elbow. Clinial Orthop Relat Res. 2001;387:132–9.

    Article  Google Scholar 

  15. Kleinman WB, Bishop AT. Anterior intramuscular transposition of the ulnar nerve. J Hand Surg Am. 1989;14(6):972–9.

    Article  CAS  PubMed  Google Scholar 

  16. Glowacki KA, Weiss APC. Anterior intramuscular transposition of the ulnar nerve for cubital tunnel syndrome. J Shoulder Elb Surg. 1997;6(2):89–96.

    Article  CAS  Google Scholar 

  17. Emamhadi M, Emamhadi A, Andalib S. Intramuscular compared with subcutaneous transposition for surgery in cubital tunnel syndrome. Ann R Coll Surg Engl. 2017;99(8):653–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Dellon AL, MacKinnon SE, Hudson AR, Hunter DA. Effect of submuscular versus intramuscular placement of ulnar nerve: experimental model in the primate. J Hand Surg Br. 1986;11(1):117–9.

    Article  CAS  PubMed  Google Scholar 

  19. Wright TW, Glowczewskie F, Cowin D, Wheeler DL. Ulnar nerve excursion and strain at the elbow and wrist associated with upper extremity motion. J Hand Surg Am. 2001;26(4):655–62.

    Article  CAS  PubMed  Google Scholar 

  20. Dellon AL, Chang E, Coert JH, Campbell KR. Intraneural ulnar nerve pressure changes related to operative techniques for cubital tunnel decompression. J Hand Surg Am. 1994;19(6):923–30.

    Article  CAS  PubMed  Google Scholar 

  21. Heithoff SJ. Cubital tunnel syndrome does not require transposition of the ulnar nerve. J Hand Surg Am. 1999;24(5):898–905.

    Article  CAS  PubMed  Google Scholar 

  22. Teoh LC, Yong FC, Tan SH, Andrew Chin YH. Anterior subfascial transposition of the ulnar nerve. J Hand Surg Br. 2003;28(1):73–6.

    Article  CAS  PubMed  Google Scholar 

  23. Charles YP, Coulet B, Rouzaud JC, Daures JP, Chammas M. Comparative clinical outcomes of submuscular and subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg Am. 2009;34(5):866–74.

    Article  PubMed  Google Scholar 

  24. Biggs M, Curtis JA. Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition. Neurosurgery. 2006;58(2):296–304; discussion 296–304.

    Article  PubMed  Google Scholar 

  25. Zlowodzki M, Chan S, Bhandari M, Kalliainen L, Schubert W. Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome. J Bone Joint Surg Am Vol. 2007;89(12):2591–8.

    Article  Google Scholar 

  26. Chung KC. Treatment of ulnar nerve compression at the elbow. J Hand Surg Am. 2008;33(9):1625–7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Macadam SA, Gandhi R, Bezuhly M, Lefaivre KA. Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a meta-analysis. J Hand Surg Am. 2008;33(8):1314–24.

    Article  PubMed  Google Scholar 

  28. Soltani AM, Best MJ, Francis CS, Allan BJ, Panthaki ZJ. Trends in the surgical treatment of cubital tunnel syndrome: an analysis of the national survey of ambulatory surgery database. J Hand Surg Am. 2013;38(8):1551–6.

    Article  PubMed  Google Scholar 

  29. Adkinson JM, Zhong L, Aliu O, Chung KC. Surgical treatment of cubital tunnel syndrome: trends and the influence of patient and surgeon characteristics. J Hand Surg Am. 2015;40(9):1824–31.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Mackinnon SE. Comparative clinical outcomes of submuscular and subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg Am. 2009;34(8):1574–5; author reply 1575.

    Article  PubMed  Google Scholar 

  31. McGowan AJ. The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg Br. 1950;32–B(3):293–301.

    Article  PubMed  Google Scholar 

  32. Gambhir RPS, Valenti D, Rashid H. Compliance with physical therapy is a key determinant of success of thoracic outlet surgical decompression. J Am Coll Surg. 2015;221(3):778.

    Article  PubMed  Google Scholar 

  33. Novak CB, Collins ED, Mackinnon SE. Outcome following conservative management of thoracic outlet syndrome. J Hand Surg Am. 1995;20(4):542–8.

    Article  CAS  PubMed  Google Scholar 

  34. Coppieters MW, Bartholomeeusen KE, Stappaerts KH. Incorporating nerve-gliding techniques in the conservative treatment of cubital tunnel syndrome. J Manip Physiol Ther. 2004;27(9):560–8.

    Article  Google Scholar 

  35. Lund AT, Amadio PC. Treatment of cubital tunnel syndrome: perspectives for the therapist. J Hand Ther. 2006;19(2):170–9.

    Article  PubMed  Google Scholar 

  36. Szabo RM, Kwak C. Natural history and conservative management of cubital tunnel syndrome. Hand Clin. 2007;23:311–8.

    Article  PubMed  Google Scholar 

  37. Andrews K, Rowland A, Pranjal A, Ebraheim N. Cubital tunnel syndrome: anatomy, clinical presentation, and management. J Orthop. 2018;15:832–6.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Eberlin KR, Marjoua Y, Jupiter JB. Compressive neuropathy of the ulnar nerve: a perspective on history and current controversies. J Hand Surg. 2017;42:464–9.

    Article  Google Scholar 

  39. Dellon AL, Coert JH. Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow. J Bone Joint Surg Am. 2003;85–A(7):1314–20.

    Article  Google Scholar 

  40. Nouhan R, Kleinert JM. Ulnar nerve decompression by transposing the nerve and Z-lengthening the flexor-pronator mass: clinical outcome. J Hand Surg Am. 1997;22(1):127–31.

    Article  CAS  PubMed  Google Scholar 

  41. Lee SK, Lee GS, Choy WS. V-Y lengthening technique of the flexor-pronator mass for anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome. Ann Plast Surg. 2018;80(5):533–8.

    CAS  PubMed  Google Scholar 

  42. Bacle G, Marteau E, Freslon M, Desmoineaux P, Saint-Cast Y, Lancigu R, et al. Cubital tunnel syndrome: comparative results of a multicenter study of 4 surgical techniques with a mean follow-up of 92 months. Orthop Traumatol Surg Res. 2014;100(4 Suppl):S205–8.

    Article  CAS  PubMed  Google Scholar 

  43. Macadam SA, Bezuhly M, Lefaivre KA. Outcomes measures used to assess results after surgery for cubital tunnel syndrome: a systematic review of the literature. J Hand Surg Am. 2009;34(8):1482–91.

    Article  PubMed  Google Scholar 

  44. Song JW, Waljee JF, Burns PB, Chung KC, Gaston RG, Haase SC, et al. An outcome study for ulnar neuropathy at the elbow: a multicenter study by the surgery for ulnar nerve (SUN) study group. Neurosurgery. 2013;72(6):971–81.

    Article  PubMed  Google Scholar 

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Correspondence to Marco Rizzo .

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O’Shaughnessy, M.A., Rizzo, M. (2020). Submuscular Transposition of the Ulnar Nerve. In: Sotereanos, D., Papatheodorou, L. (eds) Compressive Neuropathies of the Upper Extremity. Springer, Cham. https://doi.org/10.1007/978-3-030-37289-7_15

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  • DOI: https://doi.org/10.1007/978-3-030-37289-7_15

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  • Online ISBN: 978-3-030-37289-7

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