26 Open Ulnar Nerve Decompression at the Wrist

Hand Surgery ◽  
2020 ◽  
2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0016
Author(s):  
Brandon J. Erickson ◽  
Peter Nissen Chalmers ◽  
John D’Angelo ◽  
Kevin Ma ◽  
Anthony A. Romeo

Background: Isolated ulnar nerve decompression/transposition is an uncommon surgery amongst professional baseball players. Purpose: To determine the rate of return to sport (RTS) and performance upon RTS in professional baseball players following isolated ulnar nerve decompression/transposition, including those who required an ulnar nerve transposition/decompression following ulnar collateral ligament reconstruction (UCLR), and to determine if outcomes differ between players with isolated ulnar nerve decompression/transposition and matched controls. Hypothesis: There is a high rate of RTS in professional baseball players undergoing isolated ulnar nerve decompression/transposition with no significant difference in RTS rate or performance (specifically related to the primary outcome performance variables of earned run average (ERA), WHIP ((walks +hits)/innings pitched), wins above replacement (WAR), and on base + slugging percentage (OPS)) between cases and controls. Methods: All professional baseball players who underwent isolated ulnar nerve decompression/transposition between 2010-2016 were included. Demographic and performance data (pre and post surgery) for each player was recorded. Performance metrics were then compared between cases and a group of matched controls. Results: Overall 52 players, 83% pitchers (14 who underwent prior UCLR) were included. Most surgeries (92%) were anterior subcutaneous transpositions. Overall, 62% of players were able to successfully RTS and 56% returned to the same or a higher level. There was no significant difference between cases and controls in the majority of performance metrics pre-operative or post-operatively, specifically ERA, WHIP, WAR, and OPS. When players who had a UCLR prior to their ulnar nerve transposition/decompression were compared to controls with a history of a UCLR but who did not go on to have an ulnar nerve transposition/decompression, the only performance difference of all the recorded metrics was cases allowed more walks per 9 innings (4.4 vs. 2.8; p=0.011). Conclusion: Anterior subcutaneous transposition is the most common surgery in professional baseball players to address ulnar nerve compression. Players have a 62% rate of RTS. Upon RTS, players performance compared to matched controls remains the same in the majority of performance metrics including ERA, WHIP, WAR, and OPS. Post-operatively, pitchers with a UCLR prior to ulnar nerve transposition/decompression performed the same as matched controls with prior UCLR.


Author(s):  
José Marcos Pondé ◽  
Joana Bittencourt ◽  
Arlane Tanajura ◽  
Carlos Dias Ribeiro

Leprosy is an endemic condition in developing countries leading to physical deformities even when promptly treated. Surgical decompression is worldwide utilized although not entirely accepted as a therapeutic option. The authors emphasizes a case of an outpatient operated child with ulnar nerve involvement by leprosy after 1 year of clinical treatment and failure. The predominant symptoms were pain and physical deformity. There was a great improvement following the surgery even after delayed operation 


2021 ◽  
Vol 13 (3) ◽  
pp. 469-476
Author(s):  
Sebastien Durand ◽  
Wassim Raffoul ◽  
Thierry Christen ◽  
Nadine Pedrazzi

Background: Ulnar nerve compression at the elbow level is the second-most common entrapment neuropathy. The aim of this study was to use shear-wave elastography for the quantification of ulnar nerve elasticity in patients after ulnar nerve decompression with anterior transposition and in the contralateral non-operative side. Method: Eleven patients with confirmed diagnosis and ulnar nerve decompression with anterior transposition were included and examinations were performed on an AixplorerTM ultrasound system (Supersonic Imagine, Aix-en-Provence, France). Results: We observed significant differences at 0-degree (p < 0.001), 45-degree (p < 0.05), 90-degree (p < 0.01) and 120-degree (p < 0.001) elbow flexion in the shear elastic modulus of the ulnar nerve in the operative and non-operative sides. There were no statistically significant differences between the elasticity values of the ulnar nerve after transposition at 0-degree elbow flexion and in the non-operative side at 120-degree elbow flexion (p = 0.39), or in the ulnar nerve after transposition at 120-degree elbow flexion and in the non-operative side at 0-degree elbow flexion (p = 0.09). Conclusion: Shear-wave elastography has the potential to be used postoperatively as a method for assessing nerve tension noninvasively by the estimation of mechanical properties, such as the shear elastic modulus.


2017 ◽  
Vol 42 (7) ◽  
pp. 715-719 ◽  
Author(s):  
B. Butler ◽  
J. Peelman ◽  
L.-Q. Zhang ◽  
M. Kwasny ◽  
D. Nagle

Ten fresh frozen right cadaver arms were placed in a motorized jig and an in-situ ulnar nerve decompression was performed in 5 mm increments distally to the flexor carpi ulnaris (FCU) aponeurosis then proximally to the intermuscular septum. The elbows were ranged 0–135° after each incremental decompression and the ulnar nerve to medial epicodyle distance was measured to assess for nerve translation/subluxation compared with baseline (prerelease) values. None of the specimens had ulnar nerve subluxation (defined as anterior translation past the medial epicondyle) even after full decompression. Furthermore, there were no statistically significant ulnar nerve translations (defined as any difference in distance from ulnar nerve to medial epicondyle before and after each decompression) for any flexion angle or extent of decompression. This study provides biomechanical evidence that in situ ulnar nerve decompression from the FCU aponeurosis to the intermuscular septum does not result in significant ulnar nerve translation or subluxation.


2016 ◽  
Vol 35 (6) ◽  
pp. 1367-1368
Author(s):  
Jonathan K. Smith ◽  
Matthew E. Miller ◽  
David E. Reece ◽  
Yin-Ting Chen ◽  
Mark E. Landau

2016 ◽  
Vol 41 (3) ◽  
pp. 427-435 ◽  
Author(s):  
Michael P. Gaspar ◽  
Patrick M. Kane ◽  
Dechporn Putthiwara ◽  
Sidney M. Jacoby ◽  
A. Lee Osterman

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