In the absence of a randomized, prospective study comparing different
surgical approaches for decompression of the ulnar nerve at the elbow, the
choice of an approach relies on the individual surgeon's training and
experience. The present report describes the results of a prospective,
long-term evaluation of the musculofascial lengthening technique in a large
series of patients. In these patients, the degree of ulnar nerve compression
was staged with use of a numerical grading system that included measures of
both motor and sensory function.
From 1985 through 1991, 121 consecutive patients (161 ex-tremities) in whom
the ulnar nerve was entrapped at the elbow were treated with surgical
decompression with use of a musculofascial lengthening technique. In addition
to the patient history and physical examination, measurements of sensory and
motor function were obtained prospectively to permit staging of the severity
of the compression by means of a grading scale. The preoperative and
postoperative scores on this scale were evaluated. The mean duration of
follow-up after surgery was 45.6 months.
On the basis of traditional criteria, 105 limbs (65%) had an excellent
result; thirty-seven (23%), a good result; six (4%), afair result; twelve
(7.5%), a failure; and one (0.5%), a recurrence. There was significant
improvement in ulnar nerve function in terms of both the sensory (p <
0.001) and motor (p < 0.001) components of the grading scale. Comparisons
of clinical subgroups revealed significant improvement in patients with
diabetes, those with a Workers' Compensation claim, and those who had a severe
degree of compression rather than a mild degree of compression.
Surgical decompression of ulnar nerve entrapment at the elbow by means of a
musculofascial lengthening technique was associated with an 88% rate of good
to excellent results. The results of the present study demonstrate the
feasibility of performing a statistical analysis of surgical results by using
a numerical grading system to stage the degree of nerve compression. This
method may be used to study different surgical techniques for the treatment of
this common nerve compression syndrome.