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Anterior subcutaneous transposition for persistent ulnar neuropathy after neurolysis.

Abstract 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.
PMID
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Authors

Mayor MeshTerms
Keywords

ASTAFNUE = anterior subcutaneous transposition after FNUE

FNUE = failure of neurolysis of ulnar nerve entrapment

UNE = ulnar nerve entrapment

revision surgery

subcutaneous transposition

ulnar nerve entrapment at the elbow

Journal Title neurosurgical focus
Publication Year Start




PMID- 28245664
OWN - NLM
STAT- MEDLINE
DA  - 20170301
DCOM- 20170308
LR  - 20170308
IS  - 1092-0684 (Electronic)
IS  - 1092-0684 (Linking)
VI  - 42
IP  - 3
DP  - 2017 Mar
TI  - Anterior subcutaneous transposition for persistent ulnar neuropathy after
      neurolysis.
PG  - E8
LID - 10.3171/2016.11.FOCUS16451 [doi]
AB  - 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.
FAU - van Gent, Jort A N
AU  - van Gent JA
AD  - Departments of 1 Neurosurgery and.
FAU - Datema, Mirjam
AU  - Datema M
AD  - Neurology, Leiden University Medical Centre; and.
FAU - Groen, Justus L
AU  - Groen JL
AD  - Departments of 1 Neurosurgery and.
FAU - Pondaag, Willem
AU  - Pondaag W
AD  - Departments of 1 Neurosurgery and.
FAU - Eekhof, Job L A
AU  - Eekhof JL
AD  - Department of Neurology, Alrijne Hospital, Leiden, The Netherlands.
FAU - Malessy, Martijn J A
AU  - Malessy MJ
AD  - Departments of 1 Neurosurgery and.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurosurg Focus
JT  - Neurosurgical focus
JID - 100896471
SB  - IM
MH  - Adult
MH  - Aged
MH  - Decompression, Surgical/*methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Nerve Block/*trends
MH  - Retrospective Studies
MH  - Treatment Failure
MH  - Treatment Outcome
MH  - Ulnar Nerve Compression Syndromes/diagnosis/*surgery
MH  - Ulnar Neuropathies/diagnosis/*surgery
MH  - Young Adult
OTO - NOTNLM
OT  - ASTAFNUE = anterior subcutaneous transposition after FNUE
OT  - FNUE = failure of neurolysis of ulnar nerve entrapment
OT  - UNE = ulnar nerve entrapment
OT  - revision surgery
OT  - subcutaneous transposition
OT  - ulnar nerve entrapment at the elbow
EDAT- 2017/03/02 06:00
MHDA- 2017/03/09 06:00
CRDT- 2017/03/02 06:00
AID - 10.3171/2016.11.FOCUS16451 [doi]
PST - ppublish
SO  - Neurosurg Focus. 2017 Mar;42(3):E8. doi: 10.3171/2016.11.FOCUS16451.

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