Anterior subcutaneous transposition for persistent ulnar neuropathy after neurolysis
| Autor: | Justus L. Groen, Martijn J. A. Malessy, Willem Pondaag, Job L. A. Eekhof, Mirjam Datema, Jort A N van Gent |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Weakness medicine.medical_treatment Elbow ulnar nerve entrapment at the elbow Ulnar neuropathy law.invention 03 medical and health sciences Young Adult 0302 clinical medicine Randomized controlled trial law medicine Humans Ulnar nerve entrapment Treatment Failure Neurolysis Aged Retrospective Studies 030222 orthopedics business.industry revision surgery Retrospective cohort study Nerve Block General Medicine Middle Aged medicine.disease Decompression Surgical Ulnar Nerve Compression Syndromes Surgery subcutaneous transposition medicine.anatomical_structure Treatment Outcome Anesthesia Nerve block Female Neurology (clinical) medicine.symptom business Ulnar Neuropathies 030217 neurology & neurosurgery |
| Zdroj: | Neurosurgical focus, 42(3) |
| Popis: | OBJECTIVE Little is known about optimal treatment if neurolysis for ulnar nerve entrapment at the elbow fails. The authors evaluated the clinical outcome of patients who underwent anterior subcutaneous transposition after failure of neurolysis of ulnar nerve entrapment (ASTAFNUE). METHODS A consecutive series of patients who underwent ASTAFNUE performed by a single surgeon between 2009 and 2014 was analyzed retrospectively. Preoperative and postoperative complaints in the following 3 clinical modalities were compared: pain and/or tingling, weakness, and numbness. Six-point satisfaction scores were determined on the basis of data from systematic telephonic surveys. RESULTS Twenty-six patients were included. The median age was 56 years (range 22–79 years). The median duration of complaints before ASTAFNUE was 23 months (range 8–78 months). The median interval between neurolysis and ASTAFNUE was 11 months (range 5–34 months). At presentation, 88% of the patients were experiencing pain and/or tingling, 46% had weakness, and 50% had numbness of the fourth and fifth fingers. Pain and/or tingling improved in 35%, motor function in 23%, and sensory disturbances in 19% of all the patients. Improvement in at least 1 of the 3 clinical modalities was found in 58%. However, a deterioration in 1 of the 3 modalities was noted in 46% of the patients. On the patient-satisfaction scale, 62% reported a good or excellent outcome. Patients with a good/excellent outcome were a median of 11 years younger than patients with a fair/poor outcome. No other factor was significantly related to satisfaction score. CONCLUSIONS A majority of the patients were satisfied after ASTAFNUE, even though their symptoms only partly resolved or even deteriorated. Older age is a risk factor for a poor outcome. Other factors that affect outcome might play a role, but they remain unidentified. One of these factors might be earlier surgical intervention. The modest results of ASTAFNUE should be mentioned when counseling patients after failure of neurolysis of ulnar nerve entrapment to manage their expectations. Patients, especially those who are elderly, might even consider not undergoing a secondary procedure. A randomized trial that includes a conservative treatment group and groups undergoing one of the several possible surgical procedures is needed to find the definitive answer for this clinical problem. |
| Databáze: | OpenAIRE |
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