Abstract
Background We designed a survey to ascertain the current perspectives of hand surgeons on the
evaluation and management of ulnar nerve instability at the elbow. The secondary aim
was to assess the concordance of hand surgeons on definitions of the terms “subluxated”
and “dislocated” for classification of ulnar nerve instability.
Methods A questionnaire, including demographic practice variables, cubital tunnel practice
patterns, preoperative imaging and electrodiagnostic evaluation, and a series of standardized
intraoperative photographs of ulnar nerve instability at the elbow were developed
and distributed to the current American Society for Surgery of the Hand (ASSH) membership.
Results A total of 690 (26.8%) members completed the survey; 84.2% of respondents indicated
that they evaluate for ulnar nerve instability preoperatively with clinical examination,
whereas only 6.1% indicated they routinely obtained dynamic ultrasound. Respondents
indicated that the factors most strongly influencing their decision to proceed with
anterior transposition of the ulnar nerve were subluxation on physical examination
(89.6%), history consistent with ulnar nerve subluxation (85.8%), and muscle atrophy
(43.2%). On review of clinical photographs, respondents demonstrated varying degrees
of agreement on the terms “subluxated” or “dislocated” and recommendations for ulnar
nerve transposition at intermediate degrees of ulnar nerve instability.
Conclusion ASSH members routinely evaluate for ulnar nerve instability with history and clinical
examination without uniform use of preoperative ultrasound, and nearly half of the
time the decision to transpose the ulnar nerve is made intraoperatively. Definitions
for the degree of ulnar nerve instability at the elbow are not uniformly agreed upon,
and further development of a classification system may be warranted to standardize
treatment.
Keywords
anterior transposition of ulnar nerve - cubital tunnel syndrome - ulnar nerve instability
- ulnar nerve - perspective of hand surgeons
