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Zhu L, Yang F, Zhao X, Shen Y, Qiu Y, Xu W. Revision surgery for recurrent ulnar nerve compression following failed subcutaneous transposition. Acta Neurochir (Wien) 2024; 166:362. [PMID: 39249132 DOI: 10.1007/s00701-024-06255-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 09/04/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Recurrent ulnar nerve compression after primary anterior subcutaneous transposition is relatively rare, and revision surgery is challenging. This study retrospectively evaluated the clinical outcomes of revision anterior subcutaneous transposition for recurrent ulnar nerve compression. METHODS Eight patients who underwent revision anterior subcutaneous transposition for recurrent ulnar nerve compression were enrolled in this study. The outcomes were based on preoperative and postoperative symptoms, physical examination findings, and electromyographic evaluation. RESULTS Ulnar nerve enlargement was preoperatively found in all patients with a mean cross sectional area of 0.15 cm2 (range, 0.14-0.18 cm2). Intraoperative findings showed that recurrent compression occurred in three areas, including the medial intermuscular septum (n = 5), the medial epicondyle (n = 6) and nerve entrance to forearm fascia (n = 1). Post-operation, significant improvements were observed in ring/little finger numbness (from severe to mild, p = 0.031), grip strength (from 48.00% to 80.38% of the intact side, p < 0.001) and McGowan grade (from Grade III to Grade I, p = 0.049). Postoperative electromyography test also showed significant improvement in motor nerve conduction at elbow (velocity, 23.30 ± 9.598 vs. 35.30 ± 9.367, p = 0.012; amplitude, 3.40 ± 3.703 vs. 5.65 ± 2.056, p = 0.007) and sensory nerve conduction at wrist (velocity, 27.04 ± 22.450 vs. 36.45 ± 18.099, p = 0.139; amplitude, 1.44 ± 1.600 vs. 4.00 ± 2.642, p = 0.011). Seven of the eight patients reported satisfaction with the postoperative results. CONCLUSIONS Revision anterior subcutaneous transposition was an effective treatment for recurrent ulnar nerve compression from prior failed procedures.
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Affiliation(s)
- Lingkang Zhu
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Fangjing Yang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xuanyu Zhao
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Yundong Shen
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Fudan University, Shanghai, China
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanqun Qiu
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Fudan University, Shanghai, China.
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.
- Research Unit of Synergistic Reconstruction of Upper and Lower Limbs After Brain Injury, Chinese Academy of Medical Sciences, Beijing, China.
| | - Wendong Xu
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Fudan University, Shanghai, China
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- The National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
- Institutes of Brain Science, Fudan University, Shanghai, China
- State Key Laboratory of MedicalNeurobiology, Collaborative Innovation Center of Brain Science, Fudan University, Shanghai, China
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China
- Research Unit of Synergistic Reconstruction of Upper and Lower Limbs After Brain Injury, Chinese Academy of Medical Sciences, Beijing, China
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Andersson S, Zimmerman M, Perez R, Rydberg M, Dahlin LB. Presurgical management of ulnar nerve entrapment in patients with and without diabetes mellitus. Sci Rep 2024; 14:15595. [PMID: 38971864 PMCID: PMC11227510 DOI: 10.1038/s41598-024-66592-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/02/2024] [Indexed: 07/08/2024] Open
Abstract
Diabetes mellitus (DM) is a risk factor for the development of ulnar nerve entrapment (UNE). Differences in surgical outcomes for UNE between patients with and without DM have been reported, but studies on presurgical management are scarce. This study aimed to evaluate the presurgical management of UNE in patients with (DM diagnosis < 2 years of UNE diagnosis) and without DM regarding the level of care for diagnosis and the proportion that proceeds to surgery. Data from 6600 patients with UNE between 2004 and 2019 were included from the Skåne Health Care Register (SHR) and cross-linked with data from the Swedish National Diabetes Register (NDR). The group with UNE and DM was compared to the group with UNE without DM and prevalence ratios were calculated using Cox regression analysis. Patients with DM more often got their first UNE diagnosis in secondary care than in primary care (643/667, 96% vs. 5361/5786; 93%). Patients with and without DM, regardless of the type of DM, presence of retinopathy, or HbA1c levels, were surgically treated for UNE to the same extent (258/667, 39% of patients with DM vs. 2131/5786, 37% of patients without DM). The proportion of surgically treated was significantly lower among patients diagnosed with UNE in primary care compared to secondary care (59/449, 13% vs. 2330/5786, 38%). Men were more often surgically treated than women (1228/3191, 38% vs.1161/3262 36%). Patients with UNE and DM are surgically treated to the same extent as patients with UNE but without DM and are more likely to be diagnosed in specialized care.
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Affiliation(s)
- Stina Andersson
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Malin Zimmerman
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden.
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden.
| | - Raquel Perez
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
- Unit for Social Epidemiology, Department of Clinical Sciences (Malmö), Faculty of Medicine, Lund University, 20502, Malmö, Sweden
| | - Mattias Rydberg
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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3
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van der Heijden B, Dailiana ZH, Giele HP. State of the art review. Upper extremity revision nerve compression surgery. J Hand Surg Eur Vol 2024; 49:687-697. [PMID: 38488612 DOI: 10.1177/17531934241238533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Although surgical release of upper extremity nerve compression syndromes is highly effective, persistence or recurrence of symptoms and signs may occur. Thorough investigation is necessary in this situation before treatment is recommended. If the symptoms cannot be explained by other pathology than compression of the affected nerve and if conservative management has not provided improvement, reoperation may be considered. This review provides an overview of the diagnostic and surgical considerations in the revision of carpal tunnel syndrome, cubital tunnel syndrome and thoracic outlet syndrome.Level of evidence: V.
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Affiliation(s)
- Brigitte van der Heijden
- Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Hospital's-Hertogenbosch, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Henk P Giele
- Department of Plastic, Reconstructive and Hand Surgery, John Radcliffe Hospital, Oxford, UK
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Onyekwere IC, Victoria C, Kim A, Zielinski E, Nwawka OK, Osei DA. Surgical Decision Making for Mild-to-Moderate Cubital Tunnel Syndrome. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:390-394. [PMID: 38817757 PMCID: PMC11133938 DOI: 10.1016/j.jhsg.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/25/2024] [Indexed: 06/01/2024] Open
Abstract
Purpose The management of ulnar neuropathy remains unclear as there are neither consensus guidelines nor compelling data available to inform optimal treatment. Identifying patients in the mild-to-moderate group that would benefit most from surgery is challenging as their symptoms can be subtle and less debilitating. This study investigated predictors of surgical intervention among patients presenting with McGowan mild or moderate cubital tunnel syndrome (CuTS). Methods This is an institutional review board-approved study. Patients evaluated from March 2016 to July 2022 were included if they were diagnosed with McGowan mild or moderate CuTS and underwent concurrent electrodiagnostic and ultrasound evaluations. Patient demographics, symptom presentation, and clinical and diagnostic test findings were analyzed. Variables were analyzed using Student t test, Mann-Whitney U test, or Pearson's chi-square test. Multivariable logistic regression was used to assess the association of covariates and surgery. Results Seventy-three patients and 103 elbows were identified. The mean age and body mass index were 51 years and 26.9, respectively. Most patients were men, right-handed, and unilaterally symptomatic in the dominant hand. Twenty-six elbows were surgically treated. Bivariable analyses by surgical treatment showed that patients who underwent surgery more often had positive electrodiagnostic findings including motor nerve conduction velocity <50 m/s and a >10 m/s conduction velocity difference across the forearm compared with elbow. Fifty-nine cases were categorized as electrodiagnostically normal. Of the electrodiagnostically normal cases, 29 had positive findings of CuTS on ultrasound. Logistic regression model showed that electrodiagnostically severe cases had 3.7 times higher odds of being surgically treated than normal counterparts (adjusted odds ratio, 3.7; 95% CI, 1.11-12.6; P = .03). Conclusions Not many differences in objective findings identify patients who should receive operative treatment. In addition to test results, more subjective findings from patients such as patient-reported level of impairment may be able to bridge this gap in surgical decision making. Clinical relevance This study contributes to treatment decision making for mild and moderate CuTS.
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Affiliation(s)
- Ikenna C. Onyekwere
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
| | - Christian Victoria
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
| | - Arin Kim
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
| | - Elizabeth Zielinski
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
| | - Ogonna K. Nwawka
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
| | - Daniel A. Osei
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
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Morrell NT, Dahlberg RK, Scott KL. Electrical Stimulation Use in Upper Extremity Peripheral Nerve Injuries. J Am Acad Orthop Surg 2024; 32:156-161. [PMID: 38109725 DOI: 10.5435/jaaos-d-23-00437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/08/2023] [Indexed: 12/20/2023] Open
Abstract
Peripheral nerve injuries can be debilitating and often have a variable course of recovery. Electrical stimulation (ES) has been used as an intervention to attempt to overcome the limits of peripheral nerve surgery and improve patient outcomes after peripheral nerve injury. Little has been written in the orthopaedic literature regarding the use of this technology. The purpose of this review was to provide a focused analysis of past and current literature surrounding the utilization of ES in the treatment of various upper extremity peripheral nerve pathologies including compression neuropathies and nerve transection. We aimed to provide clarity on the clinical benefits, appropriate timing for its employment, risks and limitations, and the need for future studies of ES.
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Affiliation(s)
- Nathan T Morrell
- Department of Orthopedics and Rehabilitation, University of New Mexico, Albuquerque, NM (Morrell and Dahlberg), Banner University Medical Center, Glendale, AZ (Scott)
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Simon O, Tranier M, Bigorre N, Marteau É, Bacle G. Recurrence of ulnar tunnel syndrome: Long-term clinical and functional results of surgical management using revision neurolysis and subcutaneous anterior transposition. HAND SURGERY & REHABILITATION 2024; 43:101614. [PMID: 37935334 DOI: 10.1016/j.hansur.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE Recurrence after primary ulnar tunnel syndrome surgery is observed in 1.4%-25% of patients. However, the outcome of revision surgery is uncertain and limited. This study aimed to assess the clinical and functional outcomes of neurolysis combined with anterior subcutaneous transposition in cases of recurrence. PATIENTS AND METHODS This retrospective single-center study included patients who were operated on for iterative ulnar tunnel syndrome at the elbow between January 1996 and December 2020, with a minimum follow-up of 24 months. Demographic data, pre- and post-operative clinical evaluations, surgical details, and satisfaction levels were collected. RESULTS Twenty-eight patients were reviewed. Mean follow-up was 11.7 years (range, 2.1-26.4 years). The secondary procedure led to significant improvement in mean Quick-DASH score, from 25.3 (range, 11-50) to 20.0 (range, 11-49) (p = 0.023), with a satisfaction rate of 78.5%. Symptoms of pain (p = 0.033), amyotrophy (p = 0.013), hypoesthesia (p < 0.01), and paresthesia (p < 0.001) also showed significant improvement. There were 7 cases of failure (25.0%). CONCLUSION The combination of neurolysis and anterior subcutaneous transposition was a reliable technique, improving clinical outcome in recurrent ulnar tunnel syndrome after previous surgery. LEVEL OF EVIDENCE IV - retrospective study.
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Affiliation(s)
- Ophélie Simon
- Département de Chirurgie Orthopédique, Chirurgie de la Main et des Nerfs Périphériques, Centre Hospitalo-Universitaire Tours, Université de Médecine de Tours François-Rabelais, Avenue de la République, 37170 Chambray-Lès-Tours, France.
| | - Manon Tranier
- Service de Chirurgie Orthopédique, Chirurgie de la Main et des Nerfs Périphériques, Centre Hospitalier d'Albi, 22 Boulevard du Général Sibille, 81000 Albi, France
| | - Nicolas Bigorre
- Centre de la Main, 47 Rue de la Foucaudière, 49800 Trélazé, France
| | - Émilie Marteau
- Département de Chirurgie Orthopédique, Chirurgie de la Main et des Nerfs Périphériques, Centre Hospitalo-Universitaire Tours, Université de Médecine de Tours François-Rabelais, Avenue de la République, 37170 Chambray-Lès-Tours, France
| | - Guillaume Bacle
- Département de Chirurgie Orthopédique, Chirurgie de la Main et des Nerfs Périphériques, Centre Hospitalo-Universitaire Tours, Université de Médecine de Tours François-Rabelais, Avenue de la République, 37170 Chambray-Lès-Tours, France
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Schloemann DT, Thirukumaran CP, Hammert WC. Incidence and Risk Factors for Revision Within 1 Year of Primary Carpal Tunnel Release. Hand (N Y) 2023:15589447231211608. [PMID: 37981749 DOI: 10.1177/15589447231211608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND The annual volume of carpal tunnel release (CTR) in the United States has been estimated to be 577 000 per year. Our objectives were to evaluate the incidence and risk factors for revision CTR within 1 year of primary CTR. METHODS We identified all adult patients undergoing primary CTR from October 2015 to September 2019 in the New York Statewide Planning and Research Cooperative System database using Current Procedural Terminology (CPT) codes. We used the CPT modifier codes to determine laterality of index and revision procedures. We estimated multivariable hierarchical logistic regression models to evaluate risk factors for revision CTR within 1 year. RESULTS Of the 80 423 primary CTR procedures, 178 (0.22%) underwent a revision CTR within 1 year of the index surgery. The mean (SD) age of the entire cohort was 58.69 (14.43) years, 61.1% were women, 73.2% were non-Hispanic white, 42.9% were covered through private insurance, and 9.5% had diabetes mellitus. Workers' compensation insurance (odds ratio [OR] = 1.83, 95% confidence interval [CI], 1.13-2.98, P = .02) and simultaneous bilateral CTR (OR = 14.91, 95% CI, 9.62-23.12, P < .001) were associated with revision CTR within 1 year of the index procedure. No models demonstrated an association between endoscopic technique or surgeon volume and revision CTR. CONCLUSIONS The incidence of revision CTR within 1 year was lower than that previously reported. Patients covered by workers' compensation and those undergoing simultaneous bilateral CTR had higher likelihood of a revision CTR within 1 year, whereas endoscopic technique and surgeon volume were not associated with revision CTR within 1 year.
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Ence AK, DeGeorge BR. Management of Failed Carpal and Cubital Tunnel Release: An Evidence-Based Guide to Success. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:510-518. [PMID: 37521553 PMCID: PMC10382932 DOI: 10.1016/j.jhsg.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/11/2023] [Indexed: 08/01/2023] Open
Abstract
Carpal tunnel and cubital tunnel syndromes are the most common compressive neuropathies of the upper extremity with surgical treatment having high success rates for both conditions. Although uncommon, persistent or recurrent carpal and cubital tunnel syndrome presents a challenge for patients and providers. Diagnosis of persistence versus recurrence of the pathology is key in establishing an appropriate treatment plan to provide the best possible patient outcomes. After an established diagnosis, a wide array of treatment options exist which varies based on previous procedures performed. This review discusses relevant anatomy, etiology, and clinical presentations of persistent and recurrent carpal and cubital tunnel syndromes. The range of treatment options is presented based on history and diagnostic findings. Treatment options span from revision of nerve decompression to the use of soft tissue rearrangement procedures. Some specific treatment options discussed include simple revision nerve decompression, external neurolysis, soft tissue rearrangement, such as the hypothenar fat flap or various transposition techniques, and the use of nerve wraps. Included is an evidence-based management guide for diagnosis and treatment of persistent versus recurrent carpal and cubital tunnel syndromes.
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Affiliation(s)
- Andrew K. Ence
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Brent R. DeGeorge
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA
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Abstract
BACKGROUND The outcomes of cubital tunnel syndrome surgery are affected by preoperative disease severity. The aim of this study was to identify factors associated with clinical and electrodiagnostic severity of cubital tunnel syndrome at presentation. METHODS We retrospectively identified 213 patients with electrodiagnostically confirmed cubital tunnel syndrome who underwent cubital tunnel surgery from July 2008 to June 2013. Our primary response variable was clinical cubital tunnel syndrome severity assessed by the McGowan grade. Our secondary response variables were sensory nerve action potential (SNAP) recordability, presence of fibrillations, and motor nerve conduction velocities (CVs) in the abductor digiti minimi (ADM) and first dorsal interosseous (FDI). Bivariate analysis was used to screen for factors associated with disease severity; significant variables were selected for multivariable regression analysis. RESULTS Older age was associated with higher McGowan grade and diabetes mellitus was associated with unrecordable SNAPs on bivariate analysis. No other variables met inclusion criteria for multivariable regression analysis for McGowan grade or unrecordable SNAPs. Multivariable regression analysis showed older age and higher Distressed Communities Index (DCI) to be associated with decreased motor nerve CVs in ADM. Multivariable regression analysis showed higher body mass index (BMI) and higher DCI to be associated with decreased motor nerve CVs in FDI. No variable was associated with the presence of fibrillations. CONCLUSIONS A subset of patients with cubital tunnel syndrome may benefit from earlier referral for hand surgery evaluation and earlier surgery. Older patients, with higher BMI, with diabetes mellitus, and with economic distress are at higher risk for presentation with more severe disease.
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Affiliation(s)
- Dafang Zhang
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Brandon E. Earp
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Scott H. Homer
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Philip Blazar
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Anker I, Nyman E, Zimmerman M, Svensson AM, Andersson G, Dahlin LB. Preoperative Electrophysiology in Patients With Ulnar Nerve Entrapment at the Elbow-Prediction of Surgical Outcome and Influence of Age, Sex and Diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:756022. [PMID: 36992728 PMCID: PMC10012145 DOI: 10.3389/fcdhc.2022.756022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022]
Abstract
The impact of preoperative electrophysiology on outcome of surgical treatment in ulnar nerve entrapment at the elbow (UNE) is not clarified. Our aim was to evaluate influence of preoperative electrophysiologic grading on outcome and analyse how age, sex, and in particular diabetes affect such grading. Electrophysiologic protocols for 406 UNE cases, surgically treated at two hand surgery units reporting to the Swedish National Quality Register for Hand Surgery (HAKIR; 2010-2016), were retrospectively assessed, and graded as normal, reduced conduction velocity, conduction block or axonal degeneration. Outcome of surgery after primary and revision surgery was evaluated using QuickDASH and a doctor reported outcome measure (DROM) grading. No differences in QuickDASH or DROM were found between the four groups with different electrophysiologic grading preoperatively, or at three and 12 months or at follow up, respectively. When dichotomizing the electrophysiologic grading into normal and pathologic electrophysiology, cases with normal electrophysiology had worse QuickDASH than cases with pathologic electrophysiology preoperatively (p=0.046). Presence of a conduction block or axonal degeneration indicated a worse outcome by DROM grading (p=0.011). Primary surgeries had electrophysiologic more pronounced nerve pathology compared to revision surgeries (p=0.017). Cases of older age, men, and those with diabetes had more severe electrophysiologic nerve affection (p<0.0001). In the linear regression analysis, increasing age (unstandardized B=0.03, 95% CI 0.02-0.04; p<0.0001) and presence of diabetes (unstandardized B=0.60, 95% CI 0.25-0.95; p=0.001) were associated with a higher risk of a worse electrophysiologic classification. Female sex was associated with a better electrophysiologic grading (unstandardized B=-0.51, 95% CI -0.75- -0.27; p<0.0001). We conclude that older age, male sex, and concomitant diabetes are associated with more severe preoperative electrophysiologic nerve affection. Preoperative electrophysiologic grade of ulnar nerve affection may influence surgical outcome.
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Affiliation(s)
- Ilka Anker
- Department of Translational Medicine – Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Erika Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, Linköping, Sweden
| | - Malin Zimmerman
- Department of Translational Medicine – Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Ann-Marie Svensson
- National Diabetes Register, Centre of Registers, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Gert S. Andersson
- Department of Neurophysiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lars B. Dahlin
- Department of Translational Medicine – Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- *Correspondence: Lars B. Dahlin,
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11
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Patient Expectations for Symptomatic Improvement before Cubital Tunnel Release. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4174. [PMID: 35265448 PMCID: PMC8901200 DOI: 10.1097/gox.0000000000004174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
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12
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Smit JA, Hu Y, Brohet RM, van Rijssen AL. Identifying Risk Factors for Recurrence After Cubital Tunnel Release. J Hand Surg Am 2022; 48:514.e1-514.e7. [PMID: 35184920 DOI: 10.1016/j.jhsa.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 10/31/2021] [Accepted: 12/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE This study investigated specific risk factors for recurrent surgery of ulnar nerve entrapment (ie, ipsilateral clinical symptoms within 5 years after initial cubital tunnel release [CuTR]) in a large cohort. We hypothesized that recurrence is associated with lifestyle variables (eg, smoking, drinking alcohol, a high body mass index [BMI]) or comorbidities). METHODS A retrospective cohort study was performed using the Current Procedural Terminology codes for all patients who underwent CuTR between January 2012 and November 2018. Demographic data, including sex, age, weight, height, BMI, comorbidities, smoking, and alcohol consumption, were collected. The primary outcome was the need for revision surgery after initial CuTR. Univariate and multivariate analyses were performed to identify potential risk factors for revision surgery. RESULTS Of the 678 patients who underwent CuTR, 120 patients (18%) needed revision surgery within 5 years. Sixty-six patients required subfascial transposition (55%) and 47 patients (39%) received in situ releases. Also, sex, BMI, smoking, alcohol consumption, and comorbidities (except for spinal disc herniation) were similar between the primary and revision subgroup. Age at first occurrence was significantly lower in the revision group (48 years for revision vs 52 years for primary surgery). Moreover, cervical spinal disc herniation was associated with revision surgery (13% vs 6% in the primary group). CONCLUSIONS Age and medical history of cervical spinal disc herniation are associated with an increased risk of revision surgery. More importantly, BMI, smoking, alcohol consumption, and other comorbidities are not associated with increased risk of revision surgery within our sample. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Johannes A Smit
- Department of Plastic Surgery, Isala Hospital, Zwolle, The Netherlands.
| | - Yaxi Hu
- Department of Plastic Surgery, Isala Hospital, Zwolle, The Netherlands
| | - Richard M Brohet
- Department of Epidemiology and Statistics, Isala Hospital, Zwolle, The Netherlands
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Węgiel A, Zielinska N, Tubbs RS, Olewnik Ł. Possible points of compression of the ulnar nerve: Tricks and traps that await clinicians from an anatomical point of view. Clin Anat 2021; 35:155-173. [PMID: 34610170 DOI: 10.1002/ca.23798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022]
Abstract
The ulnar nerve can be subject to numerous types of compression. The most common are cubital tunnel and ulnar tunnel syndromes, but there are many others with more uncommon etiologies. The existence of additional communicating branches, median nerve involvement, various types of injuries, and unusual anatomical variations can be a challenge for both diagnosis and treatment. This review presents a comprehensive depiction of ulnar nerve entrapment syndromes with particular reference to their anatomical background, risk factors, and clinical evaluation. Even common disorders can result from atypical morphological changes. It is important to be familiar with them as it is a key ability in daily medical practice.
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Affiliation(s)
- Andrzej Węgiel
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Łódź, Poland
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Łódź, Poland
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Anatomical Sciences, St. George's University, True Blue, Grenada
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Łódź, Poland
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14
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Ulnar nerve dislocation in ulnar nerve entrapment at the elbow. Influence on surgical outcome. HAND SURGERY & REHABILITATION 2021; 41:96-102. [PMID: 34583086 DOI: 10.1016/j.hansur.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/01/2021] [Accepted: 09/10/2021] [Indexed: 11/22/2022]
Abstract
Our aim was to assess the incidence of symptomatic ulnar nerve dislocation and its influence on surgical outcome after primary and revision surgeries in ulnar nerve entrapment at the elbow (ulnar neuropathy at the elbow (UNE) or cubital tunnel syndrome). The influence of pre- or intra-operative ulnar nerve dislocation on postoperative outcome was assessed in 548 surgically treated cases (548 nerves) from two hand surgery departments reporting to the Swedish National Quality Registry for Hand Surgery, using QuickDASH, a patient-reported outcome measure (PROM), before surgery and at 3 and 12 months postoperatively, and a doctor-reported outcome measure (DROM), grading as "cured-improved "or "unchanged-worsened," at a median follow-up of 3.0 months [IQR, 1.5-6.0]. 109 of the 548 cases (20%) showed documented pre- or intra-operative ulnar nerve dislocation; more often found at revision (35/75, 47%) than at primary surgery (74/473, 16%) (p < 0.0001). Cases with dislocation presented higher QuickDASH scores at 12 months (p = 0.026). A linear regression model, adjusted for age and gender, predicted higher QuickDASH scores at 12 months postoperatively for cases with dislocation (unstandardized B 11.3 [95% CI 0.4-22.2], p = 0.043). DROM grading as unchanged-worsened at a median 3 months predicted worse QuickDASH scores (p < 0.0001) than in cured-improved cases at 3 (unstandardized B, 18.4 [95% CI 9.4-27.3]) and 12 months (unstandardized B, 18.1 [9.1-27.0]). Primary surgeries had better DROM grading than revision surgeries (p = 0.033; cured-improved, 75% and 63%, respectively), but QuickDASH scores did not differ. Presence of a clinically relevant ulnar nerve dislocation resulted in worse outcome, perhaps due to more extensive surgery with transposition. Nerve dislocation needs attention when treating UNE patients.
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15
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Management of Recalcitrant Cubital Tunnel Syndrome. J Am Acad Orthop Surg 2021; 29:635-647. [PMID: 33999876 DOI: 10.5435/jaaos-d-20-01381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/02/2021] [Indexed: 02/01/2023] Open
Abstract
Cubital tunnel syndrome is a common upper extremity compressive neuropathy. Recalcitrant cubital tunnel syndrome poses diagnostic and treatment challenges. Potential etiologies of persistent or recurrent symptoms after surgical treatment include an inaccurate preoperative diagnosis, incomplete nerve decompression, iatrogenic injury, postsurgical perineural adhesions, irreversible nerve pathology, or conditions associated with secondary nerve compression. Confirmation of recalcitrant ulnar nerve pathology relies on a thorough history to consider symptoms and chronology, careful examination to quantify nerve function and to assess for focal nerve provocation, and objective testing to highlight a possible nerve lesion such as ultrasonography and electrodiagnostic testing. Conservative treatment may provide symptomatic relief; however, surgical management such as revision neuroplasty, neurolysis, nerve reconstruction, and/or anterior transposition may be indicated. Optimizing the biology of the local nerve environment is critical. No surgical treatment procedure has shown superiority over another; however, individualized treatment is emphasized to improve symptoms and maximize nerve recovery potential.
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Mirzayan R, Syed SP, Shean CJ. Dissection of an Ulnar Nerve Previously Transposed and Wrapped with Human Amniotic Membrane: A Report of 3 Cases. JBJS Case Connect 2021; 11:01709767-202109000-00046. [PMID: 34319920 DOI: 10.2106/jbjs.cc.21.00066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASES We present 3 patients who underwent ulnar nerve transposition and wrapping of the nerve with human amniotic membrane (HAM). All 3 patients subsequently required a reoperation for the original pathologic condition (not for ulnar nerve symptoms), necessitating the exploration and dissection of the transposed ulnar nerve. We demonstrate the lack of scar formation and ease of separation between nerve and surrounding tissue, as well as histology in one case taken from the perineural tissues (previous amniotic membrane), demonstrating no inflammatory cells or absence of scar tissue formation. CONCLUSION Exploration and dissection of a previously transposed ulnar nerve can be facilitated by wrapping the nerve with HAM to prevent scarring and perineural fibrosis.
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Affiliation(s)
- Raffy Mirzayan
- Department of Orthopaedic Surgery, Kaiser Permanente Southern California, Baldwin Park, California
| | - Sajjad P Syed
- Department of Pathology, Kaiser Permanente Southern California, Baldwin Park, California
| | - Christopher J Shean
- Department of Orthopaedic Surgery, Kaiser Permanente Southern California, Baldwin Park, California
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17
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Zimmerman M, Anker I, Karlsson A, Arner M, Svensson AM, Eeg-Olofsson K, Nyman E, Dahlin LB. Ulnar Nerve Entrapment in Diabetes: Patient-reported Outcome after Surgery in National Quality Registries. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2740. [PMID: 32440410 PMCID: PMC7209826 DOI: 10.1097/gox.0000000000002740] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 02/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ulnar nerve entrapment at the elbow (UNE) is overrepresented in patients with diabetes, but the outcome of surgery is unknown. We aimed to evaluate patient-reported outcome in patients with and without diabetes, and to assess potential sex differences and compare surgical treatment methods. METHODS Data on patients operated for UNE (2010-2016, n = 1354) from the Swedish National Registry for Hand Surgery were linked to the Swedish National Diabetes Register. Symptoms were assessed preoperatively (n = 389), and 3 (n = 283), and at 12 months postoperatively (n = 267) by QuickDASH and HQ-8 (specific hand surgery questionnaire-8 questions). Only simple decompressions were included when comparing groups. RESULTS Men with diabetes reported higher postoperative QuickDASH scores than men without diabetes. Women scored their disability higher than men on all time-points in QuickDASH, but showed larger improvement between preoperative and 12 months postoperative values. Patients operated with transposition scored 10.8 points higher on QuickDASH than patients who had simple decompression at 12 months (95% confidence interval 1.98-19.6). CONCLUSIONS Women with diabetes benefit from simple decompression for UNE to the same extent as women without diabetes. Men with diabetes risk not to benefit from simple decompression as much as women do. Ulnar nerve transposition had a higher risk of residual symptoms compared to simple decompression.
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Affiliation(s)
- Malin Zimmerman
- From the Department of Translational Medicine—Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Ilka Anker
- From the Department of Translational Medicine—Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Anna Karlsson
- From the Department of Translational Medicine—Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Marianne Arner
- HAKIR, National Registry for Hand Surgery, Department of Hand Surgery, South General Hospital, Stockholm, Sweden
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Ann-Marie Svensson
- National Diabetes Register, Centre of Registers, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Eeg-Olofsson
- Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenberg, Sweden
| | - Erika Nyman
- Division of Clinical Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
| | - Lars B. Dahlin
- From the Department of Translational Medicine—Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
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Patient Characteristics in Ulnar Nerve Compression at the Elbow at a Tertiary Referral Hospital and Predictive Factors for Outcomes of Simple Decompression versus Subcutaneous Transposition of the Ulnar Nerve. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5302462. [PMID: 31950042 PMCID: PMC6948284 DOI: 10.1155/2019/5302462] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/19/2019] [Indexed: 11/18/2022]
Abstract
Patient characteristics and predictive factors for outcomes were analysed in 202 cases undergoing simple decompression, primary subcutaneous transposition, or secondary subcutaneous transposition for ulnar nerve compression at the elbow at a tertiary referral hospital. Data from medical charts and a survey were evaluated. The mean patient age was 49 years with revision surgery cases being significantly younger. Sixty-one percent of cases were female, and 31% were smokers. The comorbidity was extensive, including other nerve compression lesions as well as neck and shoulder problems. Overall, 53% reported being pleased with the result of surgery and 57% of the cases rated function as better or completely recovered after surgery. The median postoperative DASH (Disabilities of the Arm, Shoulder and Hand) score was 26 (IQR 11–49), which is in accordance with unpublished national data. No significant differences in DASH scores were found between surgical groups, but a higher preoperative McGowan grade was significantly associated with a poorer postoperative DASH score. Women scored greater disability postoperatively than men. There was a significantly increased risk of complications, which was doubled for smokers, following primary and secondary transposition compared to simple decompression. Surgical cases with ulnar nerve compression treated at a tertiary referral hospital constitute a heterogeneous group with great comorbidity and frequent concomitant nerve compression lesions. We suggest simple decompression as the procedure of first choice. Transposition can be used in selected cases or when simple decompression fails. All patients should be strongly recommended to stop smoking considering the remarkably increased risk for complications among smokers.
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Retrospective, nonrandomized analysis of subcutaneous anterior transposition versus in situ decompression of the ulnar nerve of military service members. J Shoulder Elbow Surg 2019; 28:751-756. [PMID: 30885312 DOI: 10.1016/j.jse.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The objective of this study was to compare the subjective and objective midterm functional clinical outcomes of subcutaneous anterior transposition (SAT) vs. in situ decompression (SD) of the ulnar nerve for the treatment of cubital tunnel syndrome. METHODS The US Military Health System was queried to identify all cases of ulnar neuroplasty (Current Procedural Terminology code 64718) between 2006 and 2010. Patient charts were reviewed to identify cases of isolated SAT and SD, and demographic and surgical variables were collected. The primary outcome variable was the Disabilities of the Arm, Shoulder and Hand score. The inclusion criteria were isolated primary SAT or SD and adult active-duty service members with a minimum 6-year telephone follow-up. Terminal follow-up was determined by a telephone interview. The exclusion criteria were revision procedures, trauma, cases that included other procedures (eg, medial epicondylectomy, submuscular transposition, arthroscopy, or fracture fixation), non-active-duty service members, patients without a minimum 6-year telephone follow-up, and patients who had incomplete medical records or could not be reached to complete the survey. RESULTS A total of 65 SD and 67 SAT patients met the inclusion and exclusion criteria, with a 72% telephone interview response rate. The average age was 32.3 years for all patients, with an average follow-up period of 6.5 years for SD patients and 6.3 years for SAT patients. SD patients had a lower mean Disabilities of the Arm, Shoulder and Hand score than SAT patients. No difference in reoperation rate was found. CONCLUSION The active-duty cohort reported positive outcomes and a low reoperation rate at 6-year follow-up both after SAT and after SD. SD patients had mildly superior clinical outcomes compared with SAT patients.
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Sun Z, Cui H, Liang J, Li J, Wang X, Fan C. Determining the effective timing of an open arthrolysis for post-traumatic elbow stiffness: a retrospective cohort study. BMC Musculoskelet Disord 2019; 20:122. [PMID: 30909899 PMCID: PMC6434886 DOI: 10.1186/s12891-019-2506-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/13/2019] [Indexed: 01/17/2023] Open
Abstract
Background Following trauma, the elbow is the most susceptible to restricted motion among all joints. Open arthrolysis is often performed for post-traumatic elbow stiffness if that stiffness does not improve with non-operative management. However, the optimal timing for performing an open arthrolysis remains controversial. The purpose of this study was to compare the outcome (elbow motion and function) and the rate of complications among patients who had undergone early, median and late release procedures to establish an optimal time interval following the injury, after which, an effective open arthrolysis can be performed. Methods In this retrospective cohort study, we included total 133 patients, who had undergone open arthrolysis for post-traumatic elbow stiffness. The subjects were divided into 3 groups, with 31 patients in the early release group (arthrolysis performed at 6–10 months after injury), 78 patients in the median release group (at 11–20 months), and 24 patients in the late release group (at > 20 months). The release procedure in all patients was performed by the same surgeon, using the same technique. The general data, functional performance, and complications, if any, were retrospectively documented for all patients and statistically analysed. Results The demographic data and disease characteristics of all patients were comparable at baseline. Postoperatively, no significant differences were found among the three groups with respect to the range of motion (p = 0.067), Mayo Elbow Performance Score (p = 0.350) and its ratings (p = 0.329), visual analog scale score for pain (p = 0.227), Dellon classification for ulnar nerve symptoms (p = 0.497), and each discrete complication (all p values > 0.05). Conclusions At the final follow-up, our results showed no significant difference in the postoperative elbow motion capacities, functional scores and the rates of complications among patients who had undergone an early, median, and late release. Therefore, we have recommended that an early arthrolysis would be preferable due to its multiple advantages, and the conventionally observed interval of > 1 year after the injury, could be shortened. Level of evidence Level III; Retrospective Cohort Design; Therapeutic Study.
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Affiliation(s)
- Ziyang Sun
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Haomin Cui
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Jiaming Liang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Juehong Li
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Xu Wang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Cunyi Fan
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China. .,Department of Orthopedics, Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, People's Republic of China.
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Clinical features affecting the patient-based outcome after minimal medial epicondylectomy for cubital tunnel syndrome. J Plast Reconstr Aesthet Surg 2018; 71:1446-1452. [DOI: 10.1016/j.bjps.2018.05.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/12/2018] [Accepted: 05/26/2018] [Indexed: 02/03/2023]
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Sun Z, Xiong H, Fan C. Impact of different glucose metabolism status on clinical outcomes of open arthrolysis for post-traumatic elbow stiffness. J Shoulder Elbow Surg 2018; 27:1072-1077. [PMID: 29555120 DOI: 10.1016/j.jse.2018.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/12/2018] [Accepted: 01/22/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Diabetes and prediabetes are worldwide public health problems and are considered predisposing factors for adverse functional outcomes after various orthopedic operations. The purpose of this retrospective study was to determine the impact of glucose metabolism status on functional outcomes and complications after open arthrolysis for post-traumatic elbow stiffness. METHODS The study included 152 patients with post-traumatic elbow stiffness undergoing arthrolysis, including 120 in the normoglycemic group, 21 in the impaired glucose regulation group, and 11 in the diabetes mellitus group. General patient data, functional performance, and complications were documented and analyzed. RESULTS Demographic data and disease characteristics were comparable at baseline. Postoperatively, significant differences were found in range of motion and the Mayo Elbow Performance Score: the diabetes mellitus group had the poorest clinical outcomes. However, there were no significant differences in forearm rotation, visual analog scale pain scores, and complication rates. CONCLUSION Patients with post-traumatic elbow stiffness and abnormal glucose metabolism were at increased risk of poorer outcomes after open arthrolysis, and patients with diabetes mellitus had the poorest performance. This study underlines the importance of glycemic control in patients with abnormal glucose metabolism before open arthrolysis.
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Affiliation(s)
- Ziyang Sun
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hao Xiong
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Cunyi Fan
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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