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The Contracted Elbow: Is Ulnar Nerve Release Necessary?
D.G. Sotereanos, MD; B.G. Williams, MD; A.I. Venouziou, MD; C. Jarrett, MD; M.E. Baratz, MD
Allegheny General Hospital, Pittsburgh, PA

Hypothesis: Prophylactic release of the ulnar nerve in patients undergoing capsular release for significant loss of elbow flexion has been recommended, although there is limited data to support this claim. Our hypothesis was that more severely limited preoperative flexion and extension would be associated with a higher incidence of postoperative ulnar nerve symptoms in patients undergoing capsular release.

Methods: A retrospective review of patients undergoing open and arthroscopic elbow capsular release for elbow stiffness between 2003 and 2010 was conducted. The ulnar nerve was decompressed in situ or transposed if the patient had preoperative ulnar nerve symptoms or a positive Tinelís test. Preoperative and postoperative range of motion was measured using a goniometer. The incidence of preoperative and postoperative ulnar nerve symptoms was noted. Statistical analysis was made using a paired t-test, with a χ2  test for non-parametric data.

Results: 164 patients underwent elbow capsular release (45 arthroscopic, 110 open, 9 combined). Mean elbow extension improved from 39.2° to 18.5° (p<0.0001), and mean elbow flexion improved from 110.5° to 126.5° (p<0.011), with a mean improvement in the arc of motion of 36.7°.  Perioperative complications included one hematoma and one infection, both of which were treated with surgical debridement. One patient undergoing an ulnar nerve decompression (UND) had a partial transection of the nerve that was repaired, and this patient was excluded from the calculations.

Of the 101 without preoperative ulnar nerve symptoms, 14 underwent UND. None of these 14 patients developed postoperative ulnar nerve symptoms, whereas 7/87 patients (8.1%) who did not undergo UND developed postoperative ulnar nerve symptoms (p=.27). Five of these patients with persistent symptoms eventually underwent UND, (three as part of another procedure on the same elbow). Patients without preoperative symptoms had a higher rate of developing postoperative symptoms if they had preoperative flexion ≤ 100° (15.2%) compared to those with preoperative flexion >100° (3.6%, p=0.047). There was no association between preoperative extension and postoperative symptoms.

Conclusions: The overall rate of ulnar nerve symptoms following elbow contracture release is low, and only two patients underwent reoperation specifically for UND.  Release of the ulnar nerve is indicated in patients with preoperative ulnar nerve symptoms or a positive Tinelís test.  There was a higher rate of ulnar nerve symptoms in patients with more severe contractures (≤ 100 degrees of preoperative flexion), and prophylactic decompression of the ulnar nerve may be indicated in these patients.


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