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Treatment of Failed Submuscular Ulnar Nerve Transposition
Loukia K. Papatheodorou, MD; Sophia Leung, MD; Dean G. Sotereanos, MD
University of Pittsburgh, Pittsburgh, PA

Previous studies have demonstrated failure rates of submuscular ulnar nerve transposition from 3-7.5%. The purpose of this study was to evaluate the clinical outcomes of revision submuscular ulnar nerve transposition with minimal medial epicondylectomy and decompression to eliminate the z deformity and straighten the course of the revised nerve. We believe that minimal medial epicondylectomy along with revision decompression will address the anterior tether of the ulnar nerve by the epicondyle and subsequently reduce pain and improve outcomes.

Materials & Methods
We retrospectively reviewed the outcomes of 18 patients who had failed submuscular ulnar nerve transposition. The mean patients age was 47.8 years. Patients had an average of 2 previous procedures. The primary reason for revision was severe elbow pain in 12 patients and poor hand function in 6 patients. Our surgical approach included revision ulnar nerve decompression with minimal medial epicondylectomy. If abundant cicatrix was encasing the nerve, the nerve was wrapped with either a xenograft nerve wrap (5 patients) or an autologous saphenous vein (6 patients). Primary outcomes assessed included pain by VAS scale, two-point discrimination, interosseous strength and McGowen grade.

At a mean follow-up of 52 months (range, 30-102 months), pain improved from 8.7 (range 6-10) to 2.6 (range 0-6) on a VAS pain scale (p<0.001). Two-point discrimination improved from 12.8 mm preoperatively to 7.8 mm postoperatively (p<0.001). There was a significant improvement in McGowan grade from 2.1 preoperatively to 1.7 postoperatively (p=0.01) and interosseous strength from 4 to 4.5 (p=0.001). No patients lost strength after the procedure. No significant difference in outcomes between the 3 subgroups (no wrapping, vein wrapping, xenograft wrapping).

Revision ulnar nerve decompression with minimal medial epicondylectomy for treatment of failed submuscular transposition provides the nerve with an environment for tension free healing, improving pain and ulnar nerve motor and sensory function.

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