Medial elbow pain is a common complaint in overhead throwing athletes. The throwing motion places repetitive tensile and compressive forces on the elbow resulting in significant stress across the ulno-humeral joint. This stress can result in soft-tissue, ligamentous, and ulnar nerve injury. The purpose of this study was to retrospectively investigate the clinical findings and outcomes, including return to play rates, of patients who underwent ulnar nerve transposition surgery for isolated ulnar neuritis.
Throwing athletes who underwent isolated, primary ulnar nerve transposition surgery over an eight-year period, 2009 to 2017, were identified and included in our analysis. Non-throwing athletes, those who underwent revision ulnar nerve transposition surgery, and those who underwent concomitant ulnar collateral ligament reconstruction or repair were excluded. Patients were contacted to complete the Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score as well as a return to play rate questionnaire. The minimum follow-up was 2 years.
Fifteen patients met the inclusion criteria: 13 (86.7%) males and 2 (13.3%) females. The average age at the time of surgery was 19.2 years old (range 15.6 to 28.0). Pre-operatively, 13 (86.7%) patients played baseball and 2 (13.3%) patients played softball. Two patients (13.3%) underwent a previous ulnar collateral ligament reconstruction. There were no complications. The average final follow-up was 65.26 (range, 24.44 – 113.29) months with an average KJOC score of 64.51 (range, 28.60 – 100.00). Thirteen (86.7%) patients were able to return to their pre-injury sport, 2 to a higher level of competition, 8 to the same level and 3 to a lower level. Seven (46.7%) patients sustained a post-operative ipsilateral shoulder or elbow injury at an average of 19.57 (range, 7.00 – 36.00) months post-operatively. All patients reported sustaining the injury as a result of throwing.
The results of our study indicate that ulnar nerve transposition surgery in throwing athletes allows athletes to return to throwing with low re-operation rates. However, more than half of the athletes in our analysis sustained a subsequent ipsilateral shoulder or elbow injury. Further investigation regarding outcomes in throwing athletes following ulnar nerve transposition surgery is warranted.