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. CONCLUSION: 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.