Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleDelayed-Onset Ulnar Neuritis After Release of Elbow Contracture: Preventive Strategies Derived From a Study of 563 Cases
Section snippets
Methods
This study is composed of both a retrospective analysis and a prospective comparative study. The latter was conducted from February 2004 to June 2010.
After institutional review board approval, a retrospective study of 565 consecutive arthroscopic contracture releases of the elbows in 521 patients, from June 1993 to June 2010, was conducted. The patient chart review was performed by 2 investigators not involved in the patients' care.
A DOUN was defined as (1) new ulnar nerve symptoms in a patient
Incidence
DOUN developed in a total of 34 patients over the study period (6%) (Fig 1). DOUN occurred in 26 of 235 patients (11%) who did not undergo prophylactic ulnar nerve decompression or transposition compared with 8 of 295 patients (3%) in whom a prophylactic ulnar nerve decompression or transposition was performed at the time of contracture release (P < .001). DOUN did not develop in any of the 33 patients who had previously undergone an ulnar nerve transposition, before the arthroscopic
Discussion
This article reports the results of our efforts to prevent the occurrence of DOUN over the course of approximately 20 years of experience. The chronology of the strategies to prevent DOUN was the consequence of some observations that the senior author made during this experience. In the first series of patients (group A), the prophylactic strategy was in line with the traditional philosophy of preventing DOUN and a prophylactic subcutaneous ulnar nerve transposition was indicated for patients
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.
Acknowledgment
The authors gratefully acknowledge the contributions of Russell G. Huffman for his assistance with the chart review for this study.
References (25)
Elbow arthroscopy: Where are we now?
Arthroscopy
(2007)- et al.
Complete transection of the median and radial nerves during arthroscopic release of post-traumatic elbow contracture
Arthroscopy
(1999) - et al.
Ulnar nerve laceration as a result of elbow arthroscopy
J Hand Surg Br
(1998) - et al.
The contracted elbow: Is ulnar nerve release necessary?
J Shoulder Elbow Surg
(2012) - et al.
Osteoarthritis of the elbow: Results of arthroscopic osteophyte resection and capsulectomy
J Shoulder Elbow Surg
(2008) - et al.
Functional outcomes of arthroscopic capsular release of the elbow
Arthroscopy
(2006) - et al.
Arthroscopic release of the stiff elbow
J Hand Surg Am
(2009) - et al.
Arthroscopic capsular release of the elbow
J Shoulder Elbow Surg
(2010) Clinical assessment and open and arthroscopic surgical treatment of the stiff elbow
Arthroscopic osteocapsular arthroplasty
The arthroscopic treatment of the stiff elbow
Revision arthroscopic contracture release in the elbow resulting in an ulnar nerve transection: A case report
J Bone Joint Surg Am
Cited by (41)
Comparison of results of arthroscopic arthrolysis between traumatic and degenerative elbow stiffness
2023, Orthopaedics and Traumatology: Surgery and ResearchComparison of results of arthroscopic arthrolysis between traumatic and degenerative elbow stiffness
2023, Revue de Chirurgie Orthopedique et TraumatologiquePatients Use Fewer Opioids Than Prescribed After Arthroscopic Release of Elbow Contracture: An Evidence-Based Opioid Prescribing Guideline to Reduce Excess
2021, Arthroscopy, Sports Medicine, and RehabilitationPrimary Elbow Osteoarthritis: Evaluation and Management
2021, Journal of Clinical Orthopaedics and TraumaRehabilitation of Elbow Instability
2020, Hand ClinicsConditions and Injuries Affecting the Nerves Around the Elbow
2020, Clinics in Sports MedicineCitation Excerpt :Jobe performed the first ulnar collateral ligament reconstruction in 1974.129 Relatively high ulnar nerve–related complication rates associated with his original technique (which involves complete detachment of the common flexor origin) led to the development of alternative approaches that use a muscle splitting approach.98,126,130–139 In a recent systematic review including 1368 patients, Watson and colleagues129 compared complication rates of different ulnar collateral ligament reconstruction techniques.
The authors report the following potential conflict of interest or source of funding: S.W.O. receives royalties from Acumed, Tornier, Aircast.