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@#Tardy ulnar nerve palsy is a known complication of cubitus valgus. The options for treating the ulnar neuropathy include anterior nerve transposition or neurolysis. We report on an 11-year-old boy who had a tardy ulnar nerve palsy due to cubitus valgus resulting from a non-union of a lateral condyle fracture of the humerus. Anterior transposition of the ulnar nerve was not done after the closing wedge osteotomy of the distal humerus. The close wedge osteotomy relieved the tension on the nerve and not transposing the ulnar nerve anteriorly prevented an iatrogenic nerve injury. The patient had no restriction with activities of daily living at the six years follow-up although neurological recovery was incomplete.
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Leprosy is very common disease in India. It is known for its deformities and social problem associated with it. Our study was aimed to follow that surgical decompression and its anterior transposition of ulnar nerve prevents the progress of claw hand in leprosy. During last 20 years study was conducted at centers mentioned and statistic collected. It was found that all cases which did not responded to drugs or had deformity beforehand did responded to surgery and were made patient comfortable. Methods: ?. Results: ?. Conclusion: ?.
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@#AIM: To explore the application of anterior transposition of inferior oblique muscle with unequal excision in treatment of segregated vertical strabismus with asymmetric inferior oblique hyperfunction.<p>METHODS: A total of 22 patients(10 males and 12 females, 28 eyes in all)who underwent anterior transposition of the unequal excisional inferior oblique muscle for dissociated vertical deviation with asymmetric inferior oblique muscle overaction were studied retrospectively. The patients were admitted from June 2015 to June 2017,with mean age at 12.32±6.81 years old(ranging from 3 to 28 years old). The binocular vision, the curative effect of DVD, the curative effect of inferior oblique muscle overaction, eye position and compensatory head posture, complications were examined postoperatively, follow-up survey was conducted at 6 to 18mo, meanly at 10.05±3.87mo.<p>RESULTS: Recovery of binocular vision: 11 cases did not have binocular vision(50%); 6 cases recovered to the first level of binocular vision(27%); 3 cases recovered to the second level of binocular vision(14%); 2 cases recovered to the third level of binocular vision(9%). The curative effect of DVD shows: 17 cases with satisfaction(77%), 5 cases with improvement(23%), and 0 case with no avail. The curative effect of inferior oblique muscle overaction shows: 13 cases with cured(59%), 9 cases with improvement(41%), and 0 case with no avail. Postoperative eye position and compensatory head posture: 1)Horizontal eye position: 1 case of under correction after exotropia correction surgery, 1 case of under correction after esotropia correction surgery, 0 case of overcorrection, 20 cases of correction; 2)Vertical eye position: 13 cases show vertical strabism deviation less than 5△, 9 cases show vertical strabism deviation between 5△ to 10△ meanly at 5.55△±2.35△, vertical eye position without overcorrection; 3)Compensatory head posture: 6 cases were disappeared, 1 case was improved. Complications: Mild anti-elevation syndromeoccurred in 1 case, narrowed palpebral fissueoccurred in 1 case, and narrowed quantity less than 1mm.<p>CONCLUSION: In general, the curative effect of anterior transposition of the unequal excisional inferior oblique muscle for dissociated vertical deviation with asymmetric inferior oblique muscle overactionis satisfactory, standard preoperative examination, individualized surgical design and surgical techniques are necessary.
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@#AIM: To investigate the effect of anterior transposition of inferior oblique muscle on the treatment of dissociated vertical deviation(DVD)in children with inferior oblique overaction(IOOA)and unequal inferior oblique transposition of the treatment of IOOA with the eyes of the asymmetry of DVD efficacy, associated with the lower oblique hyperfunction DVD patients to provide more effective treatment. <p>METHODS: Eighty patients with hyperfunction who were treated in our hospital from January 2014 to December 2015 were randomly selected and treated with anterior transposition of inferior oblique muscle. Patients were followed up for 1 to 30mo. We compared the vertical incline at the original incline from far(5m), near(33cm)distance and IOOA degree before and after operations, and the correlation between the two. We also compared the vertical incline at the original incline from far(5m), near(33cm)distance and IOOA degree before and after operations in 30 eyes(20 patients)with bilateral asymmetry DVD and IOOA who received unequal inferior oblique transposition. The incidence of antielevation syndrome(AES)was observed after operations. <p>RESULTS: The mean prism diopters(PD)at 5m before operations was 19.5±0.15, the average PD after operations was 3.5±0.18, at 5m the original incline was 16±0.21PD. The mean PD at 33cm was 18.6±0.20 before operation, 4.5±0.26 after operations, and 14.1±0.16 at 33cm the original incline, the difference was statistically significant(<i>P</i><0.05). Preoperatively, inferior oblique muscle hyperfunction +2 and +3 was 50 eyes, + 1 was 20 eyes, and 12 eyes still showed inferior oblique muscle hyperfunction after operation, but the degree of hyperactivity was +1. There was a significant positive correlation between the degree of IOOA and the vertical inclination(33cm: <i>r</i>=0.554, <i>P</i><0.01; 5m: <i>r</i>=0.454, <i>P</i> <0.01). There were significant differences(<i>P</i><0.05)in the vertical incline in 20 patients(30 eyes)with bilateral asymmetry DVD and IOOA and the degree of IOOA was significantly lower. In contrast, 18 patients(24 eyes)underwent anterior transposition of the inferior oblique muscle had AES in different degrees, which had statistically significant difference(<i>P</i><0.05)compared with patients(30 eyes)with IOOA treated with unequal inferior oblique transposition. <p>CONCLUSION: Anterior transposition of the inferior oblique muscle has a good therapeutic effect on isolated vertical strabismus patients with inferior oblique hyperfunction. While the incidence of postoperative AES is low in patients received unequal inferior oblique muscle transposition.
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Purpose: To evaluate the alteration of lower lid configuration and function with anterior transposition surgery of the inferior oblique (IO) muscle. Patients and Methods: A prospective clinical trial was conducted on a consecutive series of patients underwent anterior transposition of the IO as a sole operation. All patients received a thorough ophthalmic examination 1 day before and 3 months after surgery. Output parameters were consisted of palpebral fissure, margin reflex distance 1–2, lower lid function, hertel value, and lower lid crease. The differences of the collected data were calculated for statistical significance by using the Wilcoxon test. Results: A total of 19 eyes of 16 consecutive patients were included. The median preoperative grade of IO overaction was 3.5 (ranging from 3 to 4), which decreased to 0 (ranging from 0 to 2) postoperatively (P < 0.05). No significant change was observed in all parameters 3 months postoperatively (P > 0.05). Conclusion: In this study, no significant effect on lower lid configuration and function was observed following IO anterior transposition in which the disinserted muscle was placed posterior to inferior rectus insertion.
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PURPOSE: Simple decompression of the ulnar nerve has outcomes similar to anterior transposition for cubital tunnel syndrome; however, there is no consensus on the proper technique for patients with an unstable ulnar nerve. We hypothesized that 1) simple decompression or anterior ulnar nerve transposition, depending on nerve stability, would be effective for cubital tunnel syndrome and that 2) there would be determining factors of the clinical outcome at two years. MATERIALS AND METHODS: Forty-one patients with cubital tunnel syndrome underwent simple decompression (n=30) or anterior transposition (n=11) according to an assessment of intra-operative ulnar nerve stability. Clinical outcome was assessed using grip and pinch strength, two-point discrimination, the mean of the disabilities of arm, shoulder, and hand (DASH) survey, and the modified Bishop Scale. RESULTS: Preoperatively, two patients were rated as mild, another 20 as moderate, and the remaining 19 as severe according to the Dellon Scale. At 2 years after operation, mean grip/pinch strength increased significantly from 19.4/3.2 kg to 31.1/4.1 kg, respectively. Two-point discrimination improved from 6.0 mm to 3.2 mm. The DASH score improved from 31.0 to 14.5. All but one patient scored good or excellent according to the modified Bishop Scale. Correlations were found between the DASH score at two years and age, pre-operative grip strength, and two-point discrimination. CONCLUSION: An ulnar nerve stability-based approach to surgery selection for cubital tunnel syndrome was effective based on 2-year follow-up data. Older age, worse preoperative grip strength, and worse two-point discrimination were associated with worse outcomes at 2 years.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Cubital Tunnel Syndrome/diagnosis , Decompression, Surgical/methods , Follow-Up Studies , Hand/surgery , Hand Strength , Neurosurgical Procedures/methods , Prospective Studies , Recovery of Function , Surveys and Questionnaires , Treatment Outcome , Ulnar Nerve/physiopathologyABSTRACT
In this report, a case of a 70-year-old man with a large ganglion cyst formed after anterior transposition of the left ulnar nerve is presented. Three months after the index surgery, the patient presented with a painless superficial ovoid, soft mass measuring 5x4x2 cm in size located at the posteromedial aspect of the left elbow, the previously operated site. Magnetic resonance imaging showed a well demarcated cystic mass with a stalk connecting to the elbow joint. Excisional biopsy was performed and pathologic findings showed that the cystic wall had no definite lining cells with myxoid degeneration compatible with findings of ganglion cyst.
Subject(s)
Aged , Humans , Biopsy , Cubital Tunnel Syndrome , Elbow , Elbow Joint , Ganglion Cysts , Magnetic Resonance Imaging , Ulnar NerveABSTRACT
In this report, a case of a 70-year-old man with a large ganglion cyst formed after anterior transposition of the left ulnar nerve is presented. Three months after the index surgery, the patient presented with a painless superficial ovoid, soft mass measuring 5x4x2 cm in size located at the posteromedial aspect of the left elbow, the previously operated site. Magnetic resonance imaging showed a well demarcated cystic mass with a stalk connecting to the elbow joint. Excisional biopsy was performed and pathologic findings showed that the cystic wall had no definite lining cells with myxoid degeneration compatible with findings of ganglion cyst.
Subject(s)
Aged , Humans , Biopsy , Cubital Tunnel Syndrome , Elbow , Elbow Joint , Ganglion Cysts , Magnetic Resonance Imaging , Ulnar NerveABSTRACT
Cubital tunnel syndrome is compressive neuropathy, entrapment of the ulnar nerve around the medial epicondyle of the elbow joint, and the second most common neuropathy after carpal tunnel syndrome. Patients complain of hypoesthesia or paresthesia in the ulnar half of the ring and small fingers early in the disease. Advanced disease is complicated by irreversible muscle weakness or atrophy and claw hand deformity of the ring and small fingers. Although traditional decompression and anterior transposition of the ulnar nerve is known as standard treatment, according to recent reports only simple decompression has a good outcome. So, variety of surgical treatment options are available. In this paper, we purpose to describe the causes, clinical features and recent surgical treatments of cubital tunnel syndrome.
Subject(s)
Animals , Humans , Atrophy , Carpal Tunnel Syndrome , Cubital Tunnel Syndrome , Decompression , Elbow Joint , Fingers , Hand Deformities , Hoof and Claw , Hypesthesia , Muscle Weakness , Nerve Compression Syndromes , Paresthesia , Ulnar NerveABSTRACT
Objective To compare the traditional anterior transposition and anterior subcutaneous with blood supply of the ulnar nerve for the treatment of cubital tunnel syndrome.Methods Eighty cases with cubital tunnel syndrome were enrolled in the retrospective study from January 2009 to March 2013,40 cases (control group) were treated by traditional anterior transposition while the others (observation group) were treated by anterior subcutaneous with blood supply.According to the evaluation criteria of ulnar nerve,evaluated the function of patients and compared the scores of two groups and the improved rate of different level patients.Results The scores of two groups before surgery were (3.6 ± 0.4),(3.7 ± 0.5) scores,after surgery were (7.5 ± 0.9),(7.4 ± 0.6) scores respectively,there was significant difference between two groups before and after surgery (P ＜ 0.05),but there was no significant difference between two groups (P ＞0.05).The improved rate of observation group was 87.5％ (35/40),which was higher than that of control group [85.0％ (34/40)],but without statistical difference (P ＞ 0.05).In two groups the patients with middle scores showed no statistical significance in improved rate [90.0％ (27/30) vs.96.4％ (27/28)] (P ＞ 0.05).Two treatments showed a significant difference for the low scores patients 8/10 vs.7/12 (P ＜0.05).Conclusion Anterior subcutaneous with blood supply of the ulnar nerve is better than traditional anterior transposition for the gross cubital tunnel syndrome patients.
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Cubital tunnel syndrome is the second most common nerve entrapment syndrome affecting the upper extremity. Surgical treatment is indicated for those who have motor weakness or when conservative measures have failed. Several different surgical techniques have been introduced, however, the optimal treatment for cubital tunnel syndrome is still under debate. In the recent years, well-performed prospective randomized studies show that there is no difference in outcome among various surgical techniques regardless of the severity and presence of subluxation. It is advised that in situ decompression is the preferred technique because it is simpler and less time consuming procedure. Although in situ decompression is effective in uncomplicated ulnar nerve subluxation, anterior transposition should be considered when the subluxation is painful or when the ulnar nerve actually snaps back and forth over the medial epicondyle. Anterior transposition of the ulnar nerve is still indicated for revision surgery, previous trauma around the elbow, distal humerus fractures, severe osteoarthritis needing medial spur excision, and severe valgus deformity of the elbow.
Subject(s)
Congenital Abnormalities , Cubital Tunnel Syndrome , Decompression , Elbow , Humerus , Nerve Compression Syndromes , Osteoarthritis , Ulnar Nerve , Upper ExtremityABSTRACT
PURPOSE: Paresis of the inferior oblique is the least likely to result in paralysis. We report a patient without a history of trauma successfully treated using contralateral IO recession and SR recession. CASE SUMMARY: A 25-year-old male patient presented to us with an extended history of abnormal head posture, manifested by a marked habitual left head tilt with a face turn to the right. A cover test in the primary position demonstrated 15 prism diopter right hypertropia, which increased to 25 prism diopter right hypertropia in right gaze and 20 prism diopter right hypertropia in right head tilt. The patient was diagnosed with IO palsy, and a right IO recession was performed. RESULTS: Following the IO recession, head tilt was completely resolved and face turn to the right was slightly resolved. Cover test in the primary position demonstrated 12 prism diopter right hypertropia, which increased to 20 prism diopter right hypertropia in right gaze. A head tilt test demonstrated a symmetrical 12 prism diopter right hypertropia. We performed a right SR recession to decrease face turn and hypertropia in the primary position. CONCLUSIONS: We report a patient manifesting abnormal head posture diagnosed with IO palsy, which was successfully treated using contralateral IO recession and SR recession.
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Adult , Humans , Male , Head , Paralysis , Paresis , Posture , StrabismusABSTRACT
PURPOSE: To compare the clinical outcomes of recession, anterior transposition, and myectomy of overacting inferior oblique (IO) muscles. METHODS: A total of 69 patients, (92 eyes) who underwent recession (38 eyes), anterior transposition (25 eyes), or myectomy (29 eyes) for overacting IO muscles in one or both eyes, were evaluated retrospectively with a follow-up period of 12.8 months (3~60 months). RESULTS: We applied a grading system with a 5-point scale to the IO muscle. (0 to 4 for IO muscle overaction and 0 to -4 for IO underaction) The average preoperative IOOA was +2.13+/-0.94 in recession, +2.35+/-0.88 in anterior transposition, and +2.04+/-0.81 in myectomy. These were reduced to +2.04+/-0.81, +2.35+/-0.88, and -0.02+/-0.23 respectively. The average preoperative and postoperative hyperdeviation in primary gaze was 10.25+/-4.54PD to 2.37+/-0.98PD in recession, 9.02+/-4.53PD to 3.64+/-1.23PD in anterior transposition, and 7.25+/-3.21PD to 0.67+/-0.51PD in myectomy. CONCLUSIONS: Recession, anterior transposition, and myectomy of the IO muscles were all effective in IOOA and hyperdeviation, and showed continuing drift towards orthotropia.
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Humans , Follow-Up Studies , Muscles , Retrospective StudiesABSTRACT
PURPOSE: To analyze the clinical outcomes of surgical treatment of distal humerus intercondylar fractures through the transolecranon approach combined with anterior transposition of the ulnar nerve. MATERIALS AND METHODS: Eight patients who had distal humerus intercondylar fractures were included in this study and underwent operative treatment through the transolecranon approach for sufficient operative field with anterior transposition of the ulnar nerve and fixed with reconstruction plate. RESULTS: The results were evaluated using Riseborough and Radin rating criteria. Seven cases of eight cases were achieved good results with flexion contracture less than 30 degrees and forward flexion more than 115 degrees. However, one case was acheived poor result with 40 degrees of flexion contractue and 70 degrees of forward flexion. There were no the compressive ulnar neuropathy. CONCLUSION: We found the transolecranon approach and anterior transposition of the ulnar nerve a viable option for surgical treatment of the distal humerus intercondylar fractures
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Humans , Contracture , Humerus , Ulnar Nerve , Ulnar NeuropathiesABSTRACT
Although many weakening procedures for the inferior oblique muscle have been advocated, there is some controversy as to the most beneficial procedure for weakening overacting inferior oblique muscles. This study was undertaken to determine if unilateral anterior transposition of the inferior oblique muscle alone could be a safe and effective procedure for treating unilateral superior oblique palsy from the perspective of hypertropia, inferior oblique overaction, and abnormal head posture. The records of 33 patients, who underwent anterior transposition of the inferior oblique muscle for unilateral superior oblique palsy at our institution between Jan 1995 and Dec 2002, were retrospectively reviewed. The average preoperative inferior oblique overaction was 2.3 +/-0.64, and the hypertropia in the primary position was 12.3 +/-7.69 prism diopter (PD). Twenty-six patients showed head tilt to the opposite direction preoperatively. After the anterior transposition of the inferior oblique, inferior oblique overaction was diminished in 32 patients (97%). Twenty-six out of 33 patients (79%) had no hypertropia in the primary position at last postoperative assessment. Of the 26 patients with head tilt before surgery, 21 patients (81%) achieved full correction after surgery. Satisfactory results were obtained in most of the patients in our study with the exception of three patients who required additional surgery. No patient demonstrated postoperative hypotropia in the primary position. None of the patients noticed elevation deficiency or lower lid elevation. The anterior transposition of the inferior oblique was found to be safe and effective for treating superior oblique palsy with secondary overaction of the inferior oblique muscle.
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Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Diplopia/physiopathology , Follow-Up Studies , Head , Oculomotor Muscles/transplantation , Posture , Retrospective Studies , Treatment Outcome , Trochlear Nerve Diseases/physiopathologyABSTRACT
PURPOSE: The authers studied the effect of modified anterior transposition of the inferior oblique muscle for hypertropia in superior oblique muscle palsy combined inferior oblique muscle overaction. METHODS: We retrospectively analysed 19 cases of superor oblique palsy, which were treated by modified inferior oblique muscle anterior transposition from January 1999 to march 2001. Mean follow-up was 14.6 months. The medial portion of inferior oblique muscle was transpositioned to 1mm posterior position of the temporal insertion of inferior rectus muscle and lateral portion of inferior oblique muscle was moved 5mm on imaginary line, which is the line of between temporal insertion of inferior rectus and inferior insertion of lareral rectus muscle, to the direction of inferior insertion of lateral rectus muscle from temporal insertion of inferior rectus muscle, then backward 6mm from that point perpendicularly. RESULTS: The success rates in modified anterior transposition were 94% in under 20delta of hypertropia and 89.5% in over +3 of IOOA. CONCLUSIONS: Modified anterior transposition is an effective procedure of +3 to +4 inferior oblique muscle overaction and hypertropia in superior oblique muscle palsy as a primary surgery.
Subject(s)
Follow-Up Studies , Paralysis , Retrospective Studies , StrabismusABSTRACT
PURPOSE: To evaluate the surgical outcomes and the clinical factors affecting the results of subcutaneous anterior transposition of the ulnar nerve in cubital tunnel syndrome. MATERIALS AND METHODS: Eighteen patients diagnosed as having cubital tunnel syndrome and treated by subcutaneous anterior transposition of ulnar nerve were investigated retrospectively. According to preoperative Dellon's staging, 2 patients (11%) were in mild stage, 5 (28%) in moderate and 11 (61%) in severe. Results were evaluated using Dellon's staging and Mowlavi's classification. RESULTS: According to Mowlavi's outcome status, 2 patients (11%) showed total relief, 10 (56%) improvement, 5 (28%) no change and 1 (6%) was worse, therefore the results were satisfactory in 12 patients (67%). Patients with less severe symptoms received surgery within a year of symptom onset and showed better results. CONCLUSION: The result of subcutaneous anterior transposition of ulnar nerve in cubital tunnel syndrome is comparable to that of other surgical methods, but it is easier technically. Better results may be anticipated when surgery is performed within a year of symptom onset.
Subject(s)
Humans , Classification , Cubital Tunnel Syndrome , Retrospective Studies , Ulnar NerveABSTRACT
PURPOSE: To compare decompression with anterior transposition as surgical treatment for ulnar nerve palsy at the elbow. MATERIALS & METHODS: Thirty-nine patients treated surgically, were reviewed retrospectively. 8 patients were in mild group, 7 in moderate and 24 in severe. Decompression was performed in 22 patients and subcutaneous ulnar nerve anterior transposition in 17. Result was classified as excellent, recurrent and worse. RESULTS: After decompression the clinical results were excellent in 59.1% and after anterior transposition, excellent in 82.3%. Better results were achieved in moderate and severe group. Less than one year of symptom duration, 82.3% of patient showed an excellent result but more than one year, only 66.7% showed an excellent result. With cubitus valgus deformity, excellent results showed 50% by decompression and 85.7% by anterior transposition. CONCLUSION: Better results could be obtained by anterior transposition in patient with moderate and severe degree, cubitus valgus deformity and long duration of symptoms.
Subject(s)
Humans , Congenital Abnormalities , Decompression , Elbow , Retrospective Studies , Ulnar Nerve , Ulnar NeuropathiesABSTRACT
There are a large number of reports documenting the effectiveness of the inferior oblique anterior transposition (IOAT)procedure for ipsilateral inferior oblique overaction (IOOA)occurring secondarily to the suprior oblique muscle palsy.However after this procedure, the limitation of elevation in abduction of operated eye may cause apparent IOOA of the contralateral eye, and differentiation of the causes should be required for proper treatment.The primary inferior oblique overaction, inferior oblique overaction in masked bilateral superior oblique palsy and pseudo inferior oblique overaction of the contralateral eye may be the possible causes.We performed IOAT procedure on a 35 year old man showing left hypertropia with IOOA becasuse of left superior oblique palsy.Five months after the operation, we observed the contralateral inferior oblique overaction and diagnosed as the pseudo inferior oblique overaction followed by the limitation of elevation of the operated eye.This patient was successfully treated by recessing the transpositioned inferior oblique muscle posteriorly.We report this case with literature review.
Subject(s)
Adult , Humans , Masks , Paralysis , StrabismusABSTRACT
Anterior transposition is one of the most commonly used inferior oblique weakening procedures. It has been known to be effective in the case of dissociated vertical deviation with inferior oblique overaction or hypertropia due to superior oblique palsy.this study was undertaken to determine whether anterior transposition is effective in the correction of vertical deviation and head tilt in 19 patients with hypertropia due to superior oblique palsy. Preoperative average scale of inferior oblique overaction was +2.4+/-0.7mm, and the elimination of overaction was noted in 14 patients(74%). Preoperative prism-cover for hypertropia in primary position averaged 12.7+/-6.2, and the mean reduction of hypertropia in primary position was about 10. Head tilt was uniformly eliminated in 9 of 12 patients(75%). Therefore, we can expect the reduction of hypertropia about 10 and the elimination of head tilt, using only anterior transposition in hypertropia and inferior oblique overaction due to superior oblique palsy, especially when the amount of vertical deviation is within 13.