Keywords
decompression
decompression
Gr. McGowan
Gr. McGowan
dynamic test
dynamic test
clinical stage
clinical stage
operative technique
operative technique
How to Cite
Abstract
Importance: Ulnar neuropathy at the elbow is the second most frequent entrapment neuropathy, affecting 6% of the population. Surgical criteria are based on a general agreement but remain controversial about which procedure is associated with the best results and the fewest complications. This data can help evaluate the effectiveness of operative techniques in symptomatic cure.
Material and Methods: The study analysis included 26 out of 35 patients with 'Ulnar neuropathy at elbow' diagnosis, treated between January 2017- March 2022 at the Department of Neurosciences, University Service of Neurosurgery, University Hospital Center “Mother Theresa”, Tirana, Albania.
9 patients from the time period January-June 2018 were excluded from this study analysis due to lack of access to data. Data sources such as medical records and documentation copies of instrumental examinations were extracted from archives of Statistics Service and Hospital Registers, University Hospital Center “Mother Theresa”, Tirana, Albania. Phone follow-up was applied as well.
Results: We report 26 patients analyzed retrospectively (female: male ratio 1:2.71). 29 operated extremities were studied: 26 with Cubital Tunnel Syndrome, of which 2 presented with ipsilateral Carpal Tunnel Syndrome and 1 bilateral; 2 with contralateral Carpal Tunnel Syndrome. There were 11 patients gr. II McGowan and 15 patients gr. III McGowan.
There are no positive elbow flexion-extension test cases, indicative of the transposition technique. All patients were clinically evaluated at a distance of 1-3 years post-operatively and 19% presented objective symptoms. Long-term follow-up shows the motor and sensory improvement for gr. II McGowan patients, while gr. III McGowan patients show only sensory and grip improvement, with the persistence of muscular atrophy.
The most frequent cause of compression was determined fibrosis and hypertrophy around the Osborne ligament (13/26).
Conclusions: Clinical stage of neuropathy is the decisive factor influencing prognosis. Simple decompression in situ is sufficient in most cases. Dynamic intraoperative testing of sulcus competence, to assess (sub)luxation of the ulnar after decompression, determines the final operative technique.
References
Trehan, Samir K., John R. Parziale and Edward Akelman. “Cubital tunnel syndrome: diagnosis and management.” Medicine and health, Rhode Island 95 11 (2012): 349-52.
Vincent A. Thamburaj. Textbook of contemporary neurosurgery. (1st ,2nd ed.) ISBN - 9789350252390
Ramez Kirollos, Adel Helmy, Simon Thomson, Peter Hutchinson. (2019). Oxford Textbook of Neurological Surgery. ISBN 978-0-19-874670-6
Wade RG, Griffiths TT, Flather R, Burr NE, Teo M, Bourke G. Safety and Outcomes of Different Surgical Techniques for Cubital Tunnel Decompression: A Systematic Review and Network Meta-analysis. JAMA Netw Open. 2020 Nov 2;3(11):e2024352. doi: 10.1001/jamanetworkopen.2020.24352. PMID: 33231636; PMCID: PMC7686867
John Kiel. (November 2020). Cubital Tunnel Syndrome. WIKI SMorg. Principles of neurological surgery. (3rd ed.). Elsevier.
Kenneth W Lindsay, Ian Bone, Geraint Fuller. Neurology and Neurosurgery Illustrated 5th Edition - May 21, 2010, eBook ISBN: 9780702049170
Cristian Gragnaniello; Thomas M. DeBerardino. Ulnar Nerve Release Technique: Approach Considerations, In-Situ Decompression, Minimalist Approach for Simple Decompression. (27 August 2020). https://emedicine.medscape.com/article/1973549-technique#showall
Bradon J Wilhelmi, MD Leonard J Weiner, MD, Hiram J Polk, Jr, Nerve Compression Syndromes of the Hand: Overview, Anatomy, Pathophysiology. Medscape.com. https://emedicine.medscape.com/article/1285531-overview#a7
Amgad Saddik Hanna, Nerve Entrapment Syndromes Guidelines: Guidelines Summary. Medscape.com. https://emedicine.medscape.com/article/249784-guidelines
Assmus H, Antoniadis G, Bischoff C, Hoffmann R, Martini AK, Preissler P, Scheglmann K, Schwerdtfeger K, Wessels KD, Wüstner-Hofmann M. Cubital tunnel syndrome - a review and management guidelines. Cent Eur Neurosurg. 2011 May;72(2):90-8. doi: 10.1055/s-0031-1271800. Epub 2011 May 4. PMID: 21547883.
Jun Kimura. Handbook of Clinical Neurophysiology. (7th ed.).
Alimehmeti, R., A. Seferi, and F. Crotti. "Late ulnar neuropathy due to compression from traumatic synovial cyst: Case report and review." Chirurgia 24.4 (2011): 213-4.
A. Lee Dellon. (2019). Joint Denervation an Atlas of Surgical Techniques.
R. Alimehmeti, A Seferi, D. Agolli, G. Vyshka, F. Dashi, J. Kruja, M. Petrela. CONy.
Surgical outcome of non-traumatic ulnar entrapment neuropathy at elbow. (2010)
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