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Delayed Onset Ulnar Neuropathy after Arthroscopic Elbow Contracture Release (SS-63)

      Objectives

      Arthroscopic treatment of elbow contractures results in excellent restoration of motion with a low rate of reported complications. The objectives of this study are to define delayed onset ulnar neuropathy occuring after arthroscopic elbow contracture release and to identify risk factors associated with its development.

      Methods

      One hundred ninety-one consecutive arthroscopic elbow contracture release patients met the study criteria. A total anterior and posterior capsulectomy was performed arthroscopically. Postoperative pain was managed by placement of an indwelling catheter for continuous brachial plexus block after confirming that no neurological deficits had developed during surgery. CPM through a full arc of motion was employed for three days while in the hospital, after which the block was discontinued and the patient discharged when neurological status had returned fully. Data were collected as part of a prospective database and retrospectively assessed using univariate and multivariate survival analyses.

      Results

      The mean patient age was 41 years old (11 to 82 years). The mean preoperative flexion-extension arc was 87 degrees +21 degrees and increased to 117 degrees +21 degrees. Twenty-four patients (12%) developed a delayed-onset ulnar neuropathy. The mean time after surgery to develop a neuropathy was 8 days (range 3 to 39 days). Patients presenting with neuropathy typically complained of progressive loss of motion and increasing pain at the cubital tunnel and/or paresthesias with increased elbow flexion (16/24), extension (4/24) or during both flexion and extension (4/24). Motor neuropathy varied from absent to severe. Seventeen of the cases underwent ulnar nerve transposition at a mean of 15 days postoperatively. The remainder of cases was managed by restricting motion to allow nerve recovery. Factors associated with development of neuropathy included diminished preoperative flexion (p=0.046), extension (p=0.017) and flexion-extension arc (p<0.005); history of prior elbow surgery (p=0.009); and a diagnosis of post-traumatic stiffness (p<0.001). Recovery of ulnar nerve function was complete in 9 patients, near complete in 11, partial in 3, and absent in one. A step-wise multivariate analysis revealed preoperative flexion-extension arc (p=0.038) and post-traumatic arthritis (p=0.007) as risk factors for developing neuropathy.

      Conclusion

      Delayed onset ulnar neuropathy compromises functional gains and potentially leads to severe neurologic deficit after elbow contracture release. This complication may be prevented through surgeon awareness and knowledge of preoperative risk factors.