Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition.
OBJECTIVE
To help clarify the optimal surgical strategy for idiopathic, symptomatic ulnar nerve compression at the elbow in terms of overall outcome and morbidity by using objective criteria.


METHODS
Forty-four surgical candidates were recruited prospectively and were randomized into the neurolysis (n = 23) or transposition (n = 21) arm of the study. Preoperative and postoperative outcomes were assessed symptomatically and by performance on McGowen and Louisiana State University Medical Center grading systems at 1 month, 6 months, and 1 year.


RESULTS
Both procedures were equally effective in producing objective neurological improvement (61% in the neurolysis group, 67% in the transposition group). Wound complications, however, were more significant in the transposition group. Three of 21 in the transposition group compared with 0 of 23 in the neurolysis group experienced a deep wound infection.


CONCLUSIONS
Idiopathic symptomatic ulnar nerve compression at the elbow is adequately treated by both neurolysis in situ and submuscular transposition. Submuscular transposition was associated with a higher incidence of complications. The authors therefore suggest the simpler procedure of neurolysis in situ as the treatment of choice. Submuscular transposition remains appropriate in certain circumstances.
Biggs
Michael
M
Department of Neurosurgery, Royal North Shore Hospital, North Shore Medical Centre, St. Leonards, Sydney, New South Wales, 2065, Australia. biggs@idx.com.au
Curtis
Jonathan A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D017769:Ulnar Nerve Compression Syndromes / Q000145:classification / Q000473:pathology / Q000601:surgery*