Vascularized Transposition of the Ulnar Nerve in Entrapment Syndrome at the Elbow

Abstract

Abstract Background and Purpose: The surgical treatment of Cubital Tunnel Syndrome still hasunsatisfactory results due mainly to arteriovenous ischemia of the nerve in the Epitrochlear Canal. The purpose of our biological procedure is to restore the vascularization of the nerve, transposed together with its vascular pedicle anteriorly to epicondyle, to immediately reactivate the axonal conduction of the Ulnar Nerve and thereby improve clinical results. Methods: From 1987 to 2022, a vascularized Anteposition was performed on 87 limbs for UlnarNerve Entrapment Syndrome at the elbow in 82 patients. Results: Fifty-seven Patients returned for follow-up, 52 Patients obtained excellent and good resultsand effective recovery of sensibility and muscular activity; the electromyographic examination showed many positive changes in the SCV and MCV with increased nerve conduction velocity. Patients with fair results (5 Patients) showed worthwhile recovery of the hand but they recorded many sensory and motor disturbances already present before the operation, even if more attenuated. Conclusions: Our surgical technique of Vascularised Anteposition of the Ulnar Nerve at the Elbowis able to resolve the mechanical aspect of the chronic neuritis of the Ulnar Nerve at the Elbow but also (preserving its vascularity) the biological aspect of its nutrition. The procedure, allowing effective, quick recovery of hand function in most of the patients of our Study-an improvement in all of them-is a step forward in the treatment of this disease.