What is the prognosis following surgery for ulnar neuropathy?

Updated: Jun 08, 2018
  • Author: Charles F Guardia, III, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Bartels et al performed a meta-analysis of the literature from 1970 to 1997, which included 3024 patients. [84] Irrespective of preoperative status, simple decompression had the best outcomes, and subcutaneous and submuscular transposition had the worst. For severe compression (McGowan grade III), anterior intramuscular transposition had the best outcome, and simple decompression and submuscular transposition had the next best outcomes.

Heithoff reviewed 14 clinical studies, covering 516 patients, in which a simple decompression was performed for cubital tunnel syndrome. Results were satisfactory in 75-92% of the patients. [85]

Steiner et al monitored 41 patients who underwent simple ulnar nerve decompression for an average follow-up period of 2 years. [86] Results were good or very good in 89% of the patients; 8% of the patients had no improvement.

Lluch studied 20 patients who underwent decompression in situ through a transverse incision. [87] A retrospective review of 22 patients noted a 24% incidence of complications from unsightly scarring and injury to the posterior branches of the medial antebrachial cutaneous nerve. To avoid this complication, a transverse incision was used for decompression in 20 patients, allowing easier identification and protection of the nerve branches. No problems with dysesthesia or amputation neuromas occurred, and a good cosmetic result was obtained.

Heithoff and Millender reviewed 12 clinical studies involving 350 patients in which a medial epicondylectomy was performed for cubital tunnel syndrome. Results were satisfactory in 72-94% of the patients. [88]

Kaempffe and Farbach reviewed 27 patients who underwent partial medial epicondylectomies and were monitored for an average of 13 months. [89] Subjective improvement was noted in 93% of cases. Results were excellent in 8 patients, good in 10, and fair in 8; 1 patient had a poor result.

To assess factors influencing outcome after medial epicondylectomy, Seradge and Owen studied 160 patients over a 10-year period and monitored them for 3 years postoperatively. [90] In all, 21 patients had a recurrence—defined as a return of symptoms 3 months or longer after surgery—and 44% of these recurrences occurred in the fourth decade of life. The rate of recurrence was 18% in females and 10% in males. The rate of recurrence was twice as high in patients who did not return to work within 3 months.

When concomitant ipsilateral carpal tunnel syndrome was present, the recurrence rate was 17%, compared with 9% when this syndrome was absent. [90] When concomitant thoracic outlet syndrome was present, the recurrence rate was 20%, compared with 9% when this syndrome was absent. In conclusion, Seradge and Owen noted a high recurrence rate after medial epicondylectomy in middle-aged women with ipsilateral carpal tunnel syndrome or thoracic outlet syndrome who did not return to work within 3 months postoperatively.

Seradge also examined the results of medial epicondylectomy in patients on workers’ compensation. [91] These patients stayed out of work longer, used a longer period of conservative treatment without a positive impact on surgical outcome, had a less favorable surgical result, and had a higher recurrence rate.

Glowacki and Weiss reviewed the results of anterior intramuscular transpositions in 45 patients who were monitored for an average of 15 months. [92] In 87% of patients, symptoms resolved or improved. The 24 patients receiving workers’ compensation had a 33% rate of complete symptom resolution, whereas those who were not receiving workers’ compensation had a 57% rate of complete symptom resolution.

Geutjens et al conducted a prospective study of 52 patients, comparing medial epicondylectomy with anterior transposition. [93] Results were better with medial epicondylectomy: More patients were satisfied, more stated that they would have the operation again, and fewer complained of mild pain in their hand postoperatively. No significant differences were present in motor power or nerve conduction rates at follow-up visits.

Kleinman and Bishop monitored 47 patients after anterior intramuscular transposition for an average of 28 months. [94] Results were good or excellent in 87%, with return of normal grip strength and two-point discrimination. None of the patients required a repeat operation.

Asami et al monitored 35 patients for an average of 70-72 months after anterior intramuscular transposition performed with or without preservation of the extrinsic vasculature. [95] Nerve conduction velocities and clinical results were better in the group whose extrinsic vessels were preserved. When the extrinsic vessels were sacrificed, 3 excellent, 3 good, 4 fair, and no poor results were obtained; when they were preserved, 16 excellent, 12 good, 3 fair, and no poor results were obtained.

Nouhan and Kleinert monitored 33 limbs in 31 patients who underwent anterior submuscular transposition for an average of 49 months. [96] A flexor-pronator Z-lengthening technique was performed without internal neurolysis and yielded 36% excellent, 61% good, and 3% poor results.

Tsujino et al followed 16 patients after cubital tunnel reconstruction for ulnar nerve neuropathy in osteoarthritic elbows. [97] A simple decompression with resection of the osteophytes from the epicondylar groove was performed. Patients were monitored for an average of 36 months. All patients were relieved of their preoperative discomfort and recovered all or some part of their motor and sensory function.

In a 2011 Cochrane review, Caliandro et al found no difference in clinical outcomes between simple decompression and transposition of the ulnar nerve in terms of both clinical improvement and neurophysiologic improvement. Transposition was associated with a higher incidence of wound infections. [98]


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