Anthony A. Romeo, MD

Steven B. Cohen, MD, and colleagues retrospectively reviewed their patient records for individuals who were baseball players that had an ulnar nerve transposition. In their hands, that procedure is performed in baseball players using a subcutaneous transposition. The nerve is released and then moved anterior to the medial epicondyle underneath the skin, but not underneath the muscle. It’s a relatively limited amount of trauma to the elbow with the intention that the athletes would be able to return back to their sport with very little limitations or get back to the same level.

They followed their athletes and what they found, remarkably, is that one out of three had difficulty returning back to the same level of throwing. They were surprised at this, but there were no specific high-risk complications or problems, which suggests from their paper that, while the ulnar nerve may be the sentinel findings on these athletes in terms of their elbow bothering them, there may be something else that’s going on that’s causing a part of the reason that one out of three baseball players with this surgery were not able to get back to same level. This is remarkably similar to a recent paper that was published by Brandon J. Erickson, MD, and colleagues that was a review of the health information database from Major League Baseball. In the published series, which is multiple pitchers from multiple teams, it was almost the same result that one out of three, despite not appearing to have another problem, just ulnar nerve symptoms, were not able to return back to the same level of performance.

The conclusion is that the operation is safe, it works very well, it reduces the discomfort related to the ulnar nerve symptoms and two out of three will return back to the same level of performance. However, surgeons should be aware that there may be other pathologies in the same elbow in some of the athletes that make it difficult returning back to the same level, even if they get back to throwing.

Cohen and his colleagues should be congratulated on an excellent paper. It tells us that the operation works well in their hands and it tells us that we just need to be aware that we should look for other problems, such as a problem with ulnar collateral ligament or Tommy John ligament or a problem with their flexor pronator mass or possibly with their pitching mechanics, as a contributor to some of the athletes not getting back to the same level of performance after this operation.

Erickson BJ, et al. AM J Sports Medicine. 2019;doi:10.1177/0363546519829159.