American Association for Hand Surgery
Theme: Beyond Innovation

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Submuscular Transposition of the Ulnar Nerve for Persistent or Recurrent Cubital Tunnel Syndrome: Results of a Prospective Case Series
ZoŽ Buijnsters, MD; Godard De Ruiter, MD
Medical Center Haaglanden, The Hague, Netherlands

Cubital tunnel syndrome (CuTS) frequently persists or recurs following decompression or subcutaneous transposition of the ulnar nerve. In these cases, submuscular transposition (SMT) of the ulnar nerve can be performed as a second procedure. The effectiveness of this procedure however has only been reported for a few small retrospective case series. The goal of this study was to investigate the outcome for this procedure prospectively,

Between May 2014 and March 2017 thirty consecutive patients, that were referred to our hospital because of persistent or recurrent symptoms of CuTS despite decompression (24) or subcutaneous transposition (6), were followed prospectively. SMT was performed in these patients at a mean interval of 21 months after the previous surgery. Clinical outcome was assessed at multiple intervals after the surgery (6 weeks, 3, 6 9 and 12 months) using the Likert scale. In addition, patient-reported outcome was assessed before and at the same intervals after the surgery using the patient-rated ulnar nerve evaluation (PRUNE). As control groups, we prospectively followed 20 patients, that underwent simple decompression as primary procedure.

Good outcome (Likert 1 or 2) was obtained in 70% of the patients after SMT for persistent or recurrent CuTS compared with 85% of the patients after simple decompression performed as primary procedure. Results of the PRUNE showed that after a follow-up of 3 months, patients experienced less pain and numbness 3 months after secondary SMT (P < 0.001), and also had less problems concerning the function of the affected hand (P<0.05). Similar results were found after primary decompression (P< 0.001).

The results of this prospective study show that SMT is good secondary procedure in case CuTS persists or recurs after primary decompression or subcutaneous transposition of the ulnar nerve. Results for the total follow-up of 1 year will be presented at the meeting

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