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Managing Ulnar Nerve Subluxation with a Medial Intermuscular Septum Sling
Alexander Shikhman, D.O.
Elizabeth Santucci, M.E.
Brandon Larson, M.D.
John Dietrich, M.D.
Summa Health/NEOMED
2022-01-15
Presenter: Alexander Shikhman, D.O.
Affidavit:
All original work of presenting fellow
Director Name: Ananth Murthy
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Introduction
Surgical management of nerve compression syndromes continues to evolve. In cubital tunnel syndrome, there is a growing recognition of ulnar nerve subluxation pathology. We sought to evaluate a novel technique to treat subluxation involving minimal dissection and creation of a stabilizing fascial sling in patients with cubital tunnel syndrome and ulnar nerve subluxation.
Methods
We performed a retrospective review of 19 patients who underwent decompression and a fascial sling. Patients were diagnosed by physical exam and electromyography. Treatment consisted of open nerve decompression and a distally-based medial intermuscular septum to stabilize the nerve in its native position. We examined patient demographics, qDASH and SANE scores, and patient outcomes. Chi-square and student's t-test were used for all analysis.
Results
All 19 patients were included for analysis with nerve subluxation confirmed intra-operatively. The average age was 62 and average follow up of 136 days. There was no significant differences within our group regarding handedness, affected side, or smoking status (all p>0.05). Patients were more likely to be male (15 males vs 4 females p<0.05). Importantly, SANE scores improved significantly after surgery (62 to 83 p<0.05); Quick-DASH scores decreased significantly after surgery (51 to 31.5 p<0.05). One patient developed recurrent subluxation requiring reoperation with nerve transposition.
Conclusion
In patients with cubital tunnel syndrome and ulnar nerve subluxation, nerve decompression with creation of an intermuscular sling is an effective method to prevent subluxation and improve hand function.
