Objective: Despite being the second most common neuropathy in the upper limb, surgical treatment of ulnar syndrome remains controversial, in part because the published studies are heterogeneous in terms of surgical technique and variables studied. This study aims to assess the poor satisfaction prognostic factors in several patients treated by the same surgeon and the same surgical technique.
Material and methods: We reviewed retrospectively all patients who underwent a submuscular anterior transposition of the ulnar nerve between 2011 to 2017. The duration of symptoms, grade of neuropathy (McGowan score and electromyographic scale study) pain, paresthesia and motor alterations were recorded before surgery and at present. Satisfaction was evaluated according to the modified Bishop score.
Results: A total of 43 cases in 42 patients were reviewed. with an average follow-up of 34.9 months. There was an improvement in pain in 75% of patients, paresthesia’s in 64% and motor alterations in 67%. According to the modified Bishop score, 82% of patients reported good or excellent results. Low satisfaction was associated with residuals postoperative symptoms (p<0.001), low postoperative McGowan grade (p<0.001), reinterventions cases (p=0.03) and with the duration of symptoms before surgery (p=0.003). No relationship between satisfaction and age, preoperative symptoms, preoperative grade of neuropathy or preoperative electromyographic alteration was found.
Conclusion: Submuscular transposition is a safe and effective technique for ulnar neuropathy. Overall, good and excellent satisfaction were archived in 82% of patients. The duration of preoperative symptoms are the main prognostic factors, so surgical treatment should be advised as soon as possible. On the other hand, periprosthetic fractures represent an independent risk factor for non-union.
Ulnar neuropathy, Submuscular transposition, Outcomes, Prognostic