ABSTRACT
Radial closing-wedge osteotomy is a widely accepted treatment for Kienböck's disease. However, despite favorable long-term clinical outcomes, its impact on lunate perfusion has not been documented. The purpose of this study was to determine whether radial closing wedge osteotomy improved lunate perfusion on gadolinium (Gd)-enhanced magnetic resonance imaging (MRI). We conducted a retrospective review of 12 patients with Kienböck's disease who received radial closing wedge osteotomy. Mean age at surgery was 25 years. Preoperative Gd-enhanced MRI was performed in 7 patients. After bone union, implants were removed and MRI was repeated. Two patients were classified as Lichtman stage IIIA, and 5 as stage IIIB. Percentage pre- to post-operative perfused lunate volume was compared on MRI. At last follow-up, mean QuickDASH score improved from 43.7 to 6.2. Pre- to post-operative lunate fragmentation, collapse and perfusion were compared qualitatively on MRI. On quantitative analysis, perfusion increased from 24% to 54% (p = 0.018) using our method of measuring percentage perfused lunate volume. The method showed satisfactory reproducibility. Investigation using Gd-enhanced MRI suggested that radial closing wedge osteotomy increases lunate perfusion.
Subject(s)
Lunate Bone , Osteonecrosis , Humans , Lunate Bone/diagnostic imaging , Lunate Bone/surgery , Osteonecrosis/diagnostic imaging , Osteonecrosis/surgery , Osteotomy/methods , Perfusion , Reproducibility of ResultsABSTRACT
AIMS: The aim of this study was to compare the efficacy of a corticosteroid injection for the treatment of carpal tunnel syndrome (CTS) in patients with and without Raynaud's phenomenon. PATIENTS AND METHODS: In a prospective study, 139 patients with CTS were treated with a corticosteroid injection (10 mg triamcinolone acetonide); 34 had Raynaud's phenomenon and 105 did not (control group). Grip strength, perception of touch with a Semmes-Weinstein monofilament and the Boston Carpal Tunnel Questionnaires (BCTQ) were assessed at baseline and at six, 12 and 24 weeks after the injection. The Cold Intolerance Severity Score (CISS) questionnaire was also assessed at baseline and 24 weeks after the injection. RESULTS: The two groups had similar baseline BCTQ scores, but the scores in the Raynaud's phenomenon group were significantly higher than those in the control group at 12 and 24 weeks after the injection. Throughout the 24-week follow-up, there were no significant differences in the mean grip strength between the groups, whereas the mean Semmes-Weinstein monofilament sensory index for the control group was significantly higher than that of the Raynaud's phenomenon group. The mean CISSs were not significantly different between the groups at baseline and at 24 weeks. After 24 weeks, 11 patients (32%) in the Raynaud's phenomenon group and 16 (15%) in the control group required carpal tunnel decompression (p = 0.028). Multivariable analysis indicated that concurrent Raynaud's phenomenon (odds ratio (OR) 2.6) and severe electrophysiological grade (OR 2.1) were independently associated with a failure of treatment after a corticosteroid injection. CONCLUSION: Although considerable improvements in symptoms will probably occur in patients with Raynaud's phenomenon who have CTS, they have higher risk of poor functional outcomes and failure of treatment than those without Raynaud's phenomenon. Cite this article: Bone Joint J 2017;99-B:1637-42.
Subject(s)
Carpal Tunnel Syndrome/drug therapy , Glucocorticoids/administration & dosage , Raynaud Disease/etiology , Triamcinolone Acetonide/administration & dosage , Adult , Carpal Tunnel Syndrome/complications , Female , Humans , Injections , Male , Middle Aged , Prospective Studies , Treatment OutcomeABSTRACT
Metabolic syndrome is a constellation of medical conditions that arise from insulin resistance and abnormal adipose deposition and function. In patients with metabolic syndrome and De Quervain tenosynovitis this might affect the outcome of treatment by local corticosteroid injection. A total of 64 consecutive patients with De Quervain tenosynovitis and metabolic syndrome treated with corticosteroid injection were age- and sex-matched with 64 control patients without metabolic syndrome. The response to treatment, including visual analogue scale score for pain, objective findings consistent with De Quervain tenosynovitis (tenderness at first dorsal compartment, Finkelstein test result), and Disability of the Arm, Shoulder, and Hand score were assessed at 6, 12, and 24 weeks follow-up. Treatment failure was defined as persistence of symptoms or surgical intervention. Prior to treatment, patients with metabolic syndrome had mean initial pain visual analogue scale and Disability of the Arm, Shoulder, and Hand scores similar to those in the control group. The proportion of treatment failure in the metabolic syndrome group (43%) was significantly higher than that in the control group (20%) at 6 months follow-up. The pain visual analogue scale scores in the metabolic syndrome group were higher than the scores in the control group at the 12- and 24-week follow-ups. The Disability of the Arm, Shoulder, and Hand scores of the metabolic syndrome group were higher (more severe symptoms) than those of the control group at the 12- and 24-week follow-ups. Although considerable improvements in symptom severity and hand function will likely occur in patients with metabolic syndrome, corticosteroid injection for De Quervain tenosynovitis is not as effective in these patients compared with age- and sex-matched controls in terms of functional outcomes and treatment failure. LEVEL OF EVIDENCE: III.
Subject(s)
De Quervain Disease/complications , De Quervain Disease/drug therapy , Glucocorticoids/therapeutic use , Metabolic Syndrome/complications , Triamcinolone Acetonide/therapeutic use , Adult , Cohort Studies , De Quervain Disease/physiopathology , Female , Humans , Injections, Intra-Articular , Male , Middle Aged , Recovery of Function , Treatment Outcome , Young AdultABSTRACT
We compared bone mineral density (BMD) and trabecular bone score (TBS) in postmenopausal women with a distal radius fracture older than 50 years with controls. Total hip BMD was significantly different, but TBS was not different between two groups, suggesting TBS does not reflect microarchitectural changes of the distal radius. INTRODUCTION: The purpose of this study was to determine whether trabecular bone score (TBS) has additive value for discriminating distal radius fracture (DRF) independent of BMD. METHODS: We compared BMD and TBS in 258 postmenopausal women with a DRF older than 50 years of age with age- and body mass index (BMI)-matched controls who had no history of osteoporotic fracture. BMD was measured at the lumbar spine and hip using dual energy X-ray absorptiometry scans (GE Lunar Prodigy). TBS was calculated on the same spine image. A multivariate logistic regression analysis was used to analyze the odds ratio (OR) for the occurrence of DRF using age, BMI, lumbar spine BMD, total hip BMD, and TBS. RESULTS: Patients with a DRF had significantly lower BMDs at hip (neck, trochanter and total) than those of controls: 0.752 ± 0.097, 0.622 ± 0.089, and 0.801 ± 0.099 in patients and 0.779 ± 0.092, 0.648 ± 0.089, 0.826 ± 0.101 in controls. However, lumbar spine BMD and TBS were not significantly different between the groups (p = 0.400 and 0.864, respectively). The multivariate analysis indicated that only total hip BMD was significantly associated with the occurrence of DRF (OR, 10.231; 95 % confidence interval, 1.724-60.702; p = 0.010). CONCLUSIONS: TBS was not different between women with a DRF and those without a history of osteoporotic fracture, suggesting that TBS measured at the lumbar spine does not reflect early microarchitectural changes of the distal radius. Only total hip BMD is associated with the risk of DRF in Korean women.
Subject(s)
Bone Density , Cancellous Bone/pathology , Osteoporotic Fractures/pathology , Radius Fractures/pathology , Absorptiometry, Photon , Aged , Case-Control Studies , Female , Humans , Lumbar Vertebrae , Middle Aged , PostmenopauseABSTRACT
Diffuse peripheral nerve impairment is common in metabolic syndrome: in patients with metabolic syndrome and carpal tunnel syndrome this might affect the outcome of treatment by local corticosteroid injection. A total of 55 consecutive patients with carpal tunnel syndrome and metabolic syndrome treated with corticosteroid injection (10 mg triamcinolone acetonide) were age and sex matched with 55 control patients without metabolic syndrome. Grip strength, perception of touch with Semmes-Weinstein monofilaments and Boston Carpal Tunnel Questionnaires were assessed at the baseline and at 6, 12 and 24 weeks follow-up. The two groups had similar pre-operative grip strength and Boston Carpal Tunnel Questionnaire scores. The Boston Carpal Tunnel Questionnaire symptom and function scores of the metabolic syndrome group were significantly greater than the control group at 12 and 24 weeks follow-up. Except for significantly greater grip strength at the 12-week follow-up in the control group, there were no significant differences in grip strength between the groups. Semmes-Weinstein monofilament sensory index for the control group was significantly greater than that of the metabolic syndrome group throughout the 24-week follow-up. After 24 weeks, five patients (13%) in the control group and 13 patients (27%) in the metabolic syndrome group had had carpal tunnel surgery. Patients with metabolic syndrome are at risk for poor functional outcome and failure of treatment after corticosteroid injection for carpal tunnel syndrome. LEVEL OF EVIDENCE: Treatment benefits III.
Subject(s)
Carpal Tunnel Syndrome/complications , Carpal Tunnel Syndrome/drug therapy , Glucocorticoids/therapeutic use , Metabolic Syndrome/complications , Triamcinolone Acetonide/therapeutic use , Adult , Case-Control Studies , Female , Hand Strength , Humans , Injections, Intra-Articular , Male , Middle Aged , Surveys and Questionnaires , Treatment OutcomeSubject(s)
Carpometacarpal Joints/diagnostic imaging , Carpometacarpal Joints/physiopathology , Joint Instability/diagnostic imaging , Joint Instability/etiology , Thumb , Adult , Aged , Female , Humans , Joint Instability/physiopathology , Middle Aged , Range of Motion, Articular , Surface PropertiesABSTRACT
UNLABELLED: Studies suggest that vitamin D has a role in neuroprotection. We investigated whether vitamin D status is associated with carpal tunnel syndrome. Vitamin D levels were compared between carpal tunnel syndrome women (n = 135) and healthy control women (n = 135) or patients with other upper limb conditions (n = 135). There were no differences in vitamin D levels between the patients with carpal tunnel syndrome and the controls. However, women with carpal tunnel syndrome younger than 50 years old had significantly lower vitamin D levels than age-matched healthy control women (P = 0.023) or patients with other upper limb conditions (P = 0.035). When women with carpal tunnel syndrome and healthy control women were pooled, the incidence of carpal tunnel syndrome was higher in vitamin D deficient women than in non-deficient women, especially in those younger than 50 years. This study suggests a potential link between vitamin D status and the occurrence of carpal tunnel syndrome in women younger than 50 years but causation is not established. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic Level III.
Subject(s)
Carpal Tunnel Syndrome/blood , Carpal Tunnel Syndrome/epidemiology , Vitamin D Deficiency/complications , Vitamin D/analogs & derivatives , Adult , Age Factors , Case-Control Studies , Female , Humans , Incidence , Middle Aged , Sex Factors , Vitamin D/blood , Vitamin D Deficiency/diagnosisABSTRACT
Macrodactyly of the foot is a rare but disabling condition. We present the results of surgery on 18 feet of 16 patients, who underwent ray amputation and were followed-up for more than two years at a mean of 80 months (25 to 198). We radiologically measured the intermetatarsal width and forefoot area pre-operatively and at six weeks and two years after surgery. We also evaluated the clinical results using the Oxford Ankle Foot Questionnaire for children (OxAFQ-C) and the Questionnaire for Foot Macrodactyly. The intermetatarsal width and forefoot area ratios were significantly decreased after surgery. The mean OxAFQ-C score was 42 (16 to 57) pre-operatively, improving to 47 (5 to 60) at two years post-operatively (p = 0.021). The mean questionnaire for Foot Macrodactyly score two years after surgery was 8 (6 to 10). Ray amputation gave a measurable reduction in foot size with excellent functional results. For patients with metatarsal involvement, a motionless toe, or involvement of multiple digits, ray amputation is a clinically effective option which is acceptable to patients.
Subject(s)
Amputation, Surgical/methods , Foot Deformities, Congenital/surgery , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Foot Deformities, Congenital/diagnostic imaging , Humans , Infant , Male , Radiography , Surveys and Questionnaires , Time Factors , Treatment OutcomeABSTRACT
This study investigates the question of whether open repair of acute distal radioulnar joint instability at the time of volar plating of distal radius fractures would enable early mobilization of the wrist without the risk of distal radioulnar joint instability. We evaluated 29 patients of mean age 53 years with a distal radius fracture and acute distal radioulnar joint instability who underwent volar plating of the radius combined with surgical repair of the triangular fibrocartilage complex or an ulnar styloid base fracture, followed by active motion exercise of the wrist at 1 week after surgery. At 1 year after treatment, all patients had a stable distal radioulnar joint and grip strength averaged 90% of the normal side. This study demonstrates that surgical repair of the triangular fibrocartilage complex or ulnar styloid fracture followed by early mobilization did not result in distal radioulnar joint instability, and suggests that the surgical treatment of distal radioulnar joint instability may permit early mobilization of the wrist in patients who are considered suitable for rapid rehabilitation after surgery. Type of study: Therapeutic Level IV.
Subject(s)
Fracture Fixation, Internal , Joint Instability/etiology , Joint Instability/surgery , Radius Fractures/complications , Radius Fractures/surgery , Wrist Joint , Adult , Aged , Bone Plates , Female , Follow-Up Studies , Humans , Male , Middle Aged , Suture Techniques , Treatment Outcome , Triangular Fibrocartilage/surgeryABSTRACT
Spontaneous flexor tendon rupture is a rare condition and the aetiology is not clear. We report 12 elderly Korean farmers with spontaneous flexor tendon ruptures. We found the rupture in the dominant hand in ten patients. A rupture in the little finger was found in all 12 patients (seven with both flexor tendons ruptured and five with only the profundus ruptured), in the ring finger in four patients (the profundus ruptured in all and both flexor tendons in two patients), and in the middle finger a partial rupture of the profundus in one patient. The tendons were ruptured close to the hook of the hamate. Repetitive friction between the flexor tendons and the hamate hook may cause the ruptures. The hamate hook was excised and the ruptured profundus tendons were reconstructed with tendon transfers with quite favourable functional recovery at follow-up of 1 to 2 years. The ruptured superficialis tendons were not reconstructed. Level of Evidence IV.
Subject(s)
Hand Injuries/surgery , Orthopedic Procedures/methods , Plastic Surgery Procedures/methods , Tendon Injuries/surgery , Adolescent , Adult , Humans , Metacarpophalangeal Joint/physiopathology , Range of Motion, Articular , Recovery of Function , Republic of Korea , Retrospective Studies , Rupture , Young AdultABSTRACT
AIM: To compare motion of the capitate, scaphoid, and lunate in wrists with a malunited distal radius and contralateral normal wrists during dart-throwing motion (DTM) by three-dimensional kinematic studies using computed tomography (CT) images. MATERIALS AND METHODS: CT was performed simultaneously on both wrists in six patients with a unilateral distal radius malunion at three stepwise positions simulating DTM. Using volume registration technique, the kinematic variables of helical axis motion of the capitate, scaphoid, and lunate were calculated and compared between both wrists. The helical motion of the capitate was also evaluated in a scaphoid- and lunate-based coordinate system. RESULTS: Among the average rotation and translation of the scaphoid, lunate, and capitate during DTM, only the average rotation of the capitate was significantly different between the uninjured (88.9°) and the injured (70°) wrist (p = 0.0075). Rotation of the capitate relative to the scaphoid (26.3° versus 37.8°, p = 0.029) or lunate (39.2° versus 59.3°, p = 0.028) was smaller in the malunited wrist. The centres of helical axis motion of the three carpal bones were located more dorsally and radially in the injured wrist. CONCLUSIONS: The present study showed that decreased DTM in wrists with a distal radius malunion resulted from decreased midcarpal motion. The present study of the capitate, scaphoid, and lunate in wrists with distal radius malunion might be the first to present a 3D kinematic analysis of the effect of distal radius malunion on the carpal bones.
Subject(s)
Fractures, Malunited/physiopathology , Imaging, Three-Dimensional , Radius Fractures/physiopathology , Range of Motion, Articular , Tomography, X-Ray Computed , Wrist Injuries/physiopathology , Aged , Aged, 80 and over , Biomechanical Phenomena , Carpal Bones/physiopathology , Female , Fractures, Malunited/diagnostic imaging , Humans , Male , Middle Aged , Motion , Radius/physiopathology , Radius Fractures/diagnostic imaging , Task Performance and Analysis , Ulna/physiopathology , Wrist Injuries/diagnostic imagingABSTRACT
As carpal tunnel syndrome is more common in women, particularly around the menopause, female-related risk factors are suspected to play a role in its pathogenesis. We have assessed whether female hormone-related symptoms are associated with upper extremity disabilities in women undergoing carpal tunnel release. A total of 92 women with a mean age of 53 years scheduled for surgery for carpal tunnel syndrome were assessed preoperatively for female hormone-related symptoms using the menopausal rating scale and other female-related factors such as menopausal status, pregnancy number and serum female hormone levels. Upper extremity disability was evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. DASH scores had a moderate correlation with total menopausal rating scale scores, but not with other female-related factors assessed. This study suggests that female hormone-related symptoms are associated with subjective upper extremity disabilities in women with carpal tunnel syndrome. This information may be helpful in addressing patients' complex symptoms or interpretation of outcomes in women with carpal tunnel syndrome.
Subject(s)
Carpal Tunnel Syndrome/blood , Gonadotropins, Pituitary/blood , Menopause/blood , Adult , Aged , Carpal Tunnel Syndrome/surgery , Disability Evaluation , Female , Humans , Middle Aged , Republic of Korea , Risk Factors , Surveys and QuestionnairesABSTRACT
The purpose of this study is to evaluate the effects of FK-506 and cytotoxic T lymphocyte-associated antigen-4 immunoglobulin fusion protein (CTLA4--Ig) on nerve allografts. Adult male inbred C3H mice (mean weight, 25 g) surgically received 8 mm posterior tibial nerve defects, and donor nerve allografts from donor male C57BL mice were implanted. The experimental animals were divided into five groups of 12 animals each that were distinguished from each other by administration of FK-506 and CTLA4--Ig, that is, isografts interposed in the gap between contralateral posterior tibial nerves (group A, positive control); allografts from C57BL mice implanted without administering any treatment (group B, negative control); allografts from C57BL mice implanted and FK-506 injections administered (group C); allografts from C57BL mice implanted and CTLA4--Ig injections administered (group D); and allografts from C57BL mice implanted and FK-506 and CTLA4--Ig injections administered (group E). Postoperative walking-track functional analysis and histomorphometric studies were then conducted. Data were statistically analysed using the Kruskal-Wallis test. Compared with the negative control (group B), mice treated with both FK-506 and CTLA4--Ig (group E) demonstrated better results at 3 weeks post operation. Similar values were observed in all groups, and there were no statistical differences at 6 weeks post operation. Our results demonstrate that a co-administration of FK-506 and CTLA4--Ig results in functional and histomorphometric recovery that is superior to that seen in the absence of these medications.
Subject(s)
Allografts/drug effects , Immunoconjugates/pharmacology , Immunosuppressive Agents/pharmacology , Peripheral Nerves/physiology , Peripheral Nerves/transplantation , Tacrolimus/pharmacology , Abatacept , Allografts/anatomy & histology , Animals , Gait/drug effects , Male , Mice , Mice, Inbred C3H , Mice, Inbred C57BL , Peripheral Nerves/anatomy & histology , RegenerationABSTRACT
The purpose of this study was to evaluate the risk of late displacement after the treatment of distal radial fractures with a locking volar plate, and to investigate the clinical and radiological factors that might correlate with re-displacement. From March 2007 to October 2009, 120 of an original cohort of 132 female patients with unstable fractures of the distal radius were treated with a volar locking plate, and were studied over a follow-up period of six months. In the immediate post-operative and final follow-up radiographs, late displacement was evaluated as judged by ulnar variance, radial inclination, and dorsal angulation. We also analysed the correlation of a variety of clinical and radiological factors with re-displacement. Ulnar variance was significantly overcorrected (p < 0.001) while radial inclination and dorsal angulation were undercorrected when compared statistically (p < 0.001) with the unaffected side in the immediate post-operative stage. During follow-up, radial shortening and dorsal angulation progressed statistically, but none had a value beyond the acceptable range. Bone mineral density measured at the proximal femur and the position of the screws in the subchondral region, correlated with slight progressive radial shortening, which was not clinically relevant. Volar locking plating of distal radial fractures is a reliable form of treatment without substantial late displacement.
Subject(s)
Bone Plates , Fracture Fixation, Internal/methods , Osteoporotic Fractures/surgery , Radius Fractures/surgery , Aged , Aged, 80 and over , Female , Follow-Up Studies , Fracture Fixation, Internal/instrumentation , Fractures, Comminuted/diagnostic imaging , Fractures, Comminuted/pathology , Fractures, Comminuted/surgery , Humans , Middle Aged , Osteoporotic Fractures/diagnostic imaging , Osteoporotic Fractures/pathology , Radiography , Radius Fractures/diagnostic imaging , Radius Fractures/pathology , Retrospective Studies , Treatment OutcomeABSTRACT
We retrospectively reviewed 633 hands in 362 patients who had idiopathic carpal tunnel syndrome and underwent carpal tunnel release between 1999 and 2009. Electrophysiological studies and simple radiographs of the wrist, cervical spine, and basal joint of the thumb were routinely checked, and patients were also assessed for the presence of trigger digit or de Quervain's disease before and after surgery. Among 362 patients, cervical arthritis was found in 253 patients (70%), and C5-C6 arthritis was the most common site. Basal joint arthritis of the thumb was observed in 216 (34%) of the 633 hands. Trigger digit or de Quervain's disease was observed in 85 of the 633 hands (13%) before surgery, and developed in 67 hands (11%) after surgery. Cervical arthritis, basal joint arthritis, and trigger digit commonly coexist with idiopathic carpal tunnel syndrome. Patient education about these disorders is very important when they coexist with idiopathic carpal tunnel syndrome.
Subject(s)
Arthritis/complications , Carpal Tunnel Syndrome/complications , Cervical Vertebrae , De Quervain Disease/complications , Hand Joints , Trigger Finger Disorder/complications , Age Factors , Aged , Arthritis/diagnosis , Arthritis/therapy , Carpal Tunnel Syndrome/diagnosis , Carpal Tunnel Syndrome/surgery , De Quervain Disease/diagnosis , De Quervain Disease/therapy , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Sex Factors , Trigger Finger Disorder/diagnosis , Trigger Finger Disorder/therapyABSTRACT
We reviewed retrospectively seven patients with Apert acrosyndactyly and measured the size of the capitate ossification centre relative to that of the hamate and determined the relative position of the middle finger metacarpal relative to the ring finger metacarpal. We then compared those parameters in 197 normal children. In all patients, the middle finger metacarpal bone had migrated proximally relative to the ring finger metacarpal and the size of the capitate ossification centre was smaller than that of the hamate. After surgical release of the middle finger, relative proximal migration of the middle finger metacarpal was partially relieved and catch-up growth of the capitate was observed within several months. As fusion of the distal phalanges creates a diamond-shaped configuration, bone growth is markedly impaired in the middle finger ray. Therefore, early separation of the middle finger may be as important as early separation of the border digits.
Subject(s)
Acrocephalosyndactylia/diagnostic imaging , Hand Bones/abnormalities , Hand Bones/diagnostic imaging , Hand Bones/surgery , Acrocephalosyndactylia/surgery , Capitate Bone/abnormalities , Capitate Bone/diagnostic imaging , Case-Control Studies , Child , Child, Preschool , Female , Hamate Bone/abnormalities , Hamate Bone/diagnostic imaging , Humans , Infant , Infant, Newborn , Male , Metacarpal Bones/abnormalities , Metacarpal Bones/diagnostic imaging , Radiography , Plastic Surgery Procedures , Retrospective StudiesSubject(s)
Elbow Joint/physiopathology , Radius/abnormalities , Range of Motion, Articular , Synostosis/physiopathology , Ulna/abnormalities , Child , Elbow Joint/diagnostic imaging , Elbow Joint/surgery , Humans , Male , Radiography , Radius/diagnostic imaging , Radius/surgery , Synostosis/diagnostic imaging , Synostosis/surgery , Ulna/diagnostic imaging , Ulna/surgeryABSTRACT
The outcome of surgery in patients with medial epicondylitis of the elbow is less favourable in those with co-existent symptoms from the ulnar nerve. We wanted to know whether we could successfully treat such patients by using musculofascial lengthening of the flexor-pronator origin with simultaneous deep transposition of the ulnar nerve. We retrospectively reviewed 19 patients who were treated in this way. Seven had grade I and 12 had grade IIa ulnar neuropathy. At a mean follow-up of 38 months (24 to 48), the mean visual analogue scale pain scores improved from 3.7 to 0.3 at rest, from 6.6 to 2.1 with activities of daily living, and from 7.9 to 2.3 at work or sports, and the mean disabilities of the arm, shoulder and hand scores improved from 42.2 to 23.5. These results suggest that this technique can be effective in treating patients with medial epicondylitis and coexistent ulnar nerve symptoms.