Purpose
The purposes of this study were to determine whether delayed-onset ulnar neuritis
(DOUN) after elbow contracture release can be prevented and to compare the efficacy
of ulnar nerve decompression versus subcutaneous transposition.
Methods
A retrospective study of 563 consecutive arthroscopic elbow contracture releases was
conducted. The prophylactic efficacy of (1) subcutaneous transposition, (2) ulnar
nerve decompression, (3) limited ulnar nerve decompression (7 to 8 cm), and (4) mini-decompression
(4 to 6 cm) was assessed prospectively. The efficacy of prophylactic strategies (transposition,
decompression, limited decompression, or mini-decompression) in preventing DOUN was
compared by univariate survival analysis. Patients who underwent a subcutaneous transposition
were matched with patients who underwent a standard open decompression or a limited
decompression, according to gender, age (±10 years), diagnosis, and preoperative motion.
This analysis was repeated after we excluded the patients who underwent associated
open procedures (e.g., hardware removal).
Results
DOUN occurred in 26 of 235 patients (11%) who did not undergo any prophylactic procedure
versus 8 of 295 patients (3%) who underwent a prophylactic ulnar nerve decompression
or transposition at the time of contracture release (P < .001). The neurologic impairment was significantly less severe after prophylactic
decompression compared with patients without any prophylactic intervention (grade
on Neuropathy Grading Scale, 2 v 4; P = .03). Ulnar nerve transposition and decompression were equally protective. The
decompression length was the only factor significantly related to the failure of the
prophylactic intervention (odds ratio, 0.19; P = .02). A mini-decompression was not as effective as a prophylactic procedure, whereas
a limited decompression was equal to a standard decompression. The case-control analysis
showed that the decompression and transposition had equal preventive effects but the
transposition was associated with a higher rate of wound complications (19% v 4%, P = .03).
Conclusions
DOUN is a complication of arthroscopic elbow contracture release. Its incidence and
severity can be reduced by limited open ulnar nerve decompression or transposition.
Level of Evidence
Level II, prospective comparative study with retrospective analysis.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clinical assessment and open and arthroscopic surgical treatment of the stiff elbow.in: Jupiter J. The stiff elbow. American Academy of Orthopaedic Surgeons, Rosemont, IL2006: 9-19
- Arthroscopic osteocapsular arthroplasty.in: Yamaguchi K. King G. McKee M. O'Driscoll S. Advanced reconstruction elbow. Ed 1. American Academy of Orthopaedic Surgeons, Rosemont, IL2007: 59-68
- The arthroscopic treatment of the stiff elbow.in: Celli A. Celli L. Morrey B.F. Treatment of elbow lesions: New aspects in diagnosis and surgical techniques. Springer, New York2008: 211-219
- Elbow arthroscopy: Where are we now?.Arthroscopy. 2007; 23: 1231-1236
- Revision arthroscopic contracture release in the elbow resulting in an ulnar nerve transection: A case report.J Bone Joint Surg Am. 2010; 92: 1246-1249
- Complete transection of the median and radial nerves during arthroscopic release of post-traumatic elbow contracture.Arthroscopy. 1999; 15: 784-787
- Ulnar nerve laceration as a result of elbow arthroscopy.J Hand Surg Br. 1998; 23: 109
- Complications of elbow arthroscopy.J Bone Joint Surg Am. 2001; 83: 25-34
Blonna D, Huffman GR, O'Driscoll SW. Delayed onset ulnar neuritis after release of elbow contracture: Clinical presentation, pathology and treatment. Am J Sports Med. In press.
- Ulnohumeral arthroplasty for primary degenerative arthritis of the elbow: Long-term outcome and complications.J Bone Joint Surg Am. 2002; 84: 2168-2173
- Post-traumatic contracture of the elbow. Operative release using a lateral collateral ligament sparing approach.J Bone Joint Surg Br. 1998; 80: 805-812
- Health status after open elbow contracture release.J Bone Joint Surg Am. 2010; 92: 2187-2195
- The contracted elbow: Is ulnar nerve release necessary?.J Shoulder Elbow Surg. 2012; 21: 1632-1636
- Osteoarthritis of the elbow: Results of arthroscopic osteophyte resection and capsulectomy.J Shoulder Elbow Surg. 2008; 17: 126-131
- Arthroscopic restoration of terminal elbow extension in high level athletes.Am J Sports Med. 2010; 38: 2509-2515
- Functional outcomes of arthroscopic capsular release of the elbow.Arthroscopy. 2006; 22: 842-849
- The stiff elbow.Bull NYU Hosp Jt Dis. 2007; 65: 24-28
- The stiff elbow.Hand (N Y). 2009; 4: 368-379
- Arthroscopic release of the stiff elbow.J Hand Surg Am. 2009; 34: 540-544
- Arthroscopic capsular release of the elbow.J Shoulder Elbow Surg. 2010; 19: 13-19
- Prevention of nerve injury during arthroscopic capsulectomy of the elbow utilizing a safety-driven strategy.J Bone Joint Surg Am. 2013; 95: 1373-1381
- Osteocapsular arthroplasty of the elbow: Surgical technique.Essent Surg Tech. 2013; 3 (1-9): e15
- Arthroscopic treatment of stiff elbow.ISRN Surg. 2011; 2011: 378135
- The results of transposition of the ulnar nerve for traumatic ulnar neuritis.J Bone Joint Surg Br. 1950; 32: 293-301
- Treatment for ulnar neuropathy at the elbow.Cochrane Database Syst Rev. 2011; : CD006839
Article Info
Publication History
Published online: June 25, 2014
Accepted:
March 21,
2014
Received:
July 11,
2013
Footnotes
The authors report the following potential conflict of interest or source of funding: S.W.O. receives royalties from Acumed , Tornier , Aircast .
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
