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.
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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.
