A little research into Ulnar Nerve Transposition

by scoot on Oct 14, 2008 4:06 PM EDT Comment 25 comments

Being in PT school, things like this surgery really intrigue me. So, I decided to do a little digging into the literature to see what the outcomes are for this particular surgery. I did my digging through my schools ebscohost search engine, using CINAHL and MEDLINE, if any of you have access to those resources and would like to check out the articles. I don't think that they will be available for everyone though.

"Postoperative Clinical Results in Cubital Tunnel Syndrome" - This is an article published in the Orthopedics Journal in April 2006. In this study, they followed 111 operated limbs, all of which had the same, or similar, procedure that Pujols had. The procedures included medial epicondylectomy on 66 limbs, anterior transposition on 41 limbs, and simple decompression on 4 limbs. Of these, 13 limbs were operated on for habitual dislocation, which appears to be the reason Albert had his surgery according to the Goold article. Also, from what I gathered in the Goold article, Pujols underwent the anterior transposition procedure.

postoperative results at the final evaluation were excellent in 37 limbs, good in 39 limbs, fair in 26 limbs, and poor in 9 limbs.
Age was a factor in the results of this study, with a correlation between age at surgery and results of the surgery. The younger the patient, the better the outcome.

There was no difference found in this study for the reason the patients had the surgery, or for the procedure they underwent.

FWIW, this study doesn't really reveal much, if anything regarding my questions. I went into this wanting to know :

What is the rate of success for the procedure Albert had
Is that going to be as successful for the etiology (reason) of Albert's injury.
What is the usual recovery time for this procedure

My opinion going into this project was that Goold's use of McClellan's operation breeds false hope. My understanding is Pujols had a more involved procedure, whereas McClellan more than likely had the simple decompression procedure talked about in the article. Then I found this article abstract from the Journal of Bone and Joint Surgery. The most important thing I found was in the results: No difference between simple decompression and transposition was found.

I was unable to find anything on the time of recovery, but the timeline given by Goold seems to be along what I have learned so far. Three weeks of rest, then begin to work on regaining strength and ROM.

Hope that my ramblings helped to shed some light on the subject!

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wow

Posts like this are why the fanposting mechanism exists. Great stuff.

by DanUpBaby on Oct 14, 2008 4:32 PM EDT reply actions 0 recs

I completely agree

Well done!

Prospects are good. Especially when they aren't rushed.

by CraveCase on Oct 15, 2008 1:47 PM EDT up reply actions 0 recs

good work

Great info. This is the kind of research I love to see but hate trying to do myself.

Thanks for the hard work.

-- Aidan Sonoda
In necessariis unitas, in dubiis libertas, in omnibus caritas.

by Aidan Sonoda on Oct 14, 2008 8:23 PM EDT reply actions 0 recs

nice.

I just posted a much more haphazard and less statistically- based rant under the main post’s comments, but I’ll throw my over 100k worth of med school debt into the pot that says that this really isn’t a big deal. it truly is a different problem than his ulnar collateral ligament injury/noninjury. The fact that decompression and transposition yielded the same results doesn’t mean that decompression isn’t also a surgery. Having assisted on multiple of each procedure, there really isn’t one that I’d rather choose over the other for less morbidity.

Nice post, and I’ll echo the sentiment that albert’s nerve will be happy and ready for action closer to winter meetings, not spring training.

by ribbij on Oct 14, 2008 8:23 PM EDT reply actions 0 recs

Thank you for the informative post :)

I had a lot of concerns and questions and this pretty much answered them all.

"It ain't braggin' if you can back it up."
-Dizzy Dean

by thegashousegang on Oct 14, 2008 8:35 PM EDT reply actions 0 recs

Wonderful

One question, if it’s not too late to dig back into your source of info: You say that age is a big factor in recovery. Does is say what the age range is? Is 28 old on the scale, or young? Is this procedure more common in children or in middle-aged men?

Wonderful write-up. Kudos.

defy, cards, defy. hey logic --- you suck.

by effin fisk on Oct 14, 2008 9:22 PM EDT reply actions 0 recs

I was wondering this, too

Amazing bit of info, thanks for taking the time to look it up and share it with us.

by mojowo11 on Oct 14, 2008 9:51 PM EDT up reply actions 0 recs

28 is very young

Going from memory, the way that they broke it down was an average age, giving a success rate for each age group. The youngest age group they had listed was an average of about 36, going up from there to an average of somewhere in the 60s. The younger, the better the success rate. Sorry for the confusion.

"Baseball is like Church, many attend, few understand" - Wes Westrum

by scoot on Oct 14, 2008 11:56 PM EDT up reply actions 0 recs

Awesome stuff

Makes me jealous that my break from grad school leaves me without access to things like EBSCO.

Oh well, just have to wait until I’m back in grad school in January! (Of course, I’m getting my Master’s in British Literature, so it’s nowhere near the same, but I think EBSCO access is EBSCO access regardless of field).

by mtalken on Oct 14, 2008 10:40 PM EDT reply actions 0 recs

You are correct

I can access all the different databases. I like CINAHL for full text articles. MEDLINE gives a lot more results, but there’s no full text articles. They try to help you link to full text, but I always have problems making that work.

"Baseball is like Church, many attend, few understand" - Wes Westrum

by scoot on Oct 14, 2008 11:58 PM EDT up reply actions 0 recs

This

…is without a doubt the most terrifying elbow surgery I’ve ever heard of as a fan…not because of the surgery itself, but rather the elbow that is being fixed belongs to Albert Pujols, and the surgery was done by Dr. Paletta.

Perhaps I’m being unfair to Dr. Paletta, it’s just that he’s not necessarily the most confidence-inspiring person associated with the Cardinals right now. Ask this guy.

"Your Holiness, I'm Joseph Medwick. I, too, used to be a Cardinal."-Joe Medwick, to Pope Pius XII.

by redbirdnation8206 on Oct 15, 2008 10:40 AM EDT reply actions 0 recs

You are being unfair

the guy is a good surgeon, period.

Plus, it’s not like Mulder didn’t get 2nd and 3rd opinions on this thing. His shoulder was shredded before Paletta ever touched it. and in my opinion, the Cards acquired damaged goods as his hip and lumbar injuries were well documented in Oakland.

If anything, blame LaJocketty for taking so many chances with injured pitchers. Eventually it comes back to bite you in the ass. The Cards have a Jaws-size scar from that regime.

I believe that Mo has learned his lesson the hard way after having to bite the bullet with Muldoo, Clement, and now possibly Carpenter (who is the reason we’re in this mess-he was a needle in a haystack).

by silent_bob on Oct 17, 2008 6:08 PM EDT up reply actions 0 recs

Totally agree

Mark Mulder arrived in St. Louis with his labrum already torn. One full season later and it was literally beyond repair. Lay off of Paletta. The guy is a top orthopedic surgeon and James Andrews agrees with him on Mulder, Carpenter and Pujols.

Walt Jocketty is the guy who didn’t give a fig about pitcher mechanics. I’m sure he’ll sign some doozies for CIncinnati.

by Red in Chicago on Oct 20, 2008 11:14 AM EDT up reply actions 0 recs

I agree

that Mulder arrived injured. But Paletta is a top surgeon why? Because people say he is, and it perpetuates his reputation.

I know someone whose shoulder was operated on by Paletta – twice – to poor results. This person (who is an athlete, but not a baseball player) found a different surgeon, who finally fixed him. Before he was operated on the third time, he could barely lift his arm to shoulder-height, and couldn’t lift it over his head.

Do I think Paletta doesn’t know what he’s talking about or what he’s doing? Of course not. Do I think that just because the Cardinals refer their players to see him that he’s automatically a top surgeon, worthy of no doubt? No. He’s human. Doctors make mistakes all the time.

Also, people have different bodies. Some people scar easier than others. Some people heal slowly. There are too many variables to account for.

by spants on Oct 20, 2008 3:15 PM EDT up reply actions 0 recs

i don't mean to drag this on and on, just wanted to clarify something

it seems like you’re simply arguing for a reasonable level of taking a critical eye to Dr. Paletta? if so, i would agree. obviously there is no perfect doctor. however, i also think there’s a little too much chorus of “Paletta stinks” around here for some of us. these types never seem to offer anything intelligent, nor do they appear to bring any expertise to the discussion; they merely repeat the same old argument, ie carpenter+mulder+rolen=cardinals doctors suck. it’s perfectly possible that Paletta has made mistakes with cardinals in the past, but it’s stupid to take it as a forgone conclusion.

by mattybobo on Oct 20, 2008 4:53 PM EDT up reply actions 0 recs

Exactly.

I personally know he’s not perfect, that he makes mistakes, and that he’s not the World’s Greatest Surgeon. But that doesn’t mean he’s breaking the Cardinals players.

by spants on Oct 21, 2008 2:12 PM EDT up reply actions 0 recs

I've personally rehabbed 10+ of Dr. Paletta's patients

and have achieved great outcomes.

I say he’s an excellent surgeon because of what he’s accomplished and also because I’ve treated his patients.

by silent_bob on Oct 21, 2008 2:16 PM EDT up reply actions 0 recs

Bob

What are the odds of getting a clinical rotation at your clinic/hospital . . . whichever it is?

"Baseball is like Church, many attend, few understand" - Wes Westrum

by scoot on Oct 21, 2008 2:22 PM EDT up reply actions 0 recs

darn you scoot

i too am in pt school and spent an hour today researching this same thing…i was even going to use one of the sources you cited

anyways…well stated…as long as albert does his therapy and no infection sets it, he will be ready for ST

by VolsnCards5 on Oct 15, 2008 5:36 PM EDT reply actions 0 recs

What school

I go to SBU, where do you go? Glad to see that someone else is staying from their duties of grad school to take an hour or so to research these things.

"Baseball is like Church, many attend, few understand" - Wes Westrum

by scoot on Oct 15, 2008 6:03 PM EDT up reply actions 0 recs

nice to read a well thought out fanpost!

thanks

go rays

by Cards Fan in Chitown on Oct 16, 2008 12:37 PM EDT up reply actions 0 recs

i'm at UT-Memphis

looking up stuff on injuries is way more exciteing that going over PNF patterns

by VolsnCards5 on Oct 16, 2008 1:21 PM EDT up reply actions 0 recs

So true

and its not like I’m not learning about something PT related while I’m doing it, so I dont even have to feel bad about it. You know, building on the evidence based practice stuff.

"Baseball is like Church, many attend, few understand" - Wes Westrum

by scoot on Oct 16, 2008 11:12 PM EDT up reply actions 0 recs