Intra-Operative Subluxation Of The Ulnar Nerve - Use Of A Triceps Sling Reconstruction Technique To Avoid Transposition
Loukia K. Papatheodorou, MD; Dean G. Sotereanos, MD
UPMC, University of Pittsburgh, Pittsburgh, PA
Introduction
In situ release of the ulnar nerve at the elbow has proven to be an effective treatment of cubital tunnel syndrome. However, ulnar nerve subluxation may occur in up to 17% of patients after simple decompression. Several surgical techniques have been discribed to adrress the ulnar nerve subluxation, including anterior transposition of the ulnar nerve, and minimal medial epicondylectomy. None of which have been reported to be objectively superior to the other in the literature. We retrospectively analyzed the outcomes of 9 patients who underwent a triceps sling reconstruction for intraoperative ulnar nerve subluxation after in situ decompression of the nerve.
Materials & Methods
There were 6 women and 3 men with a mean age of 42 years (range, 34-56 years). The subluxation of the ulnar nerve over the medial epicondyle of the elbow was noted with flexion and extention of the elbow after cubital tunnel release with release of Osborne's ligament as posterior as possible. In all patients, a distally based small strip of triceps tendon was harvested. The strip was sutured to the posterior aspect of Osborne's ligament creating a sling to prevent the ulnar nerve subluxation. At completion, the elbow was flexed and extended, noting no further subluxation of the ulnar nerve through the entire range of motion.
Results
The mean final follow-up was 27 months (range, 24 to 32 months). Symptoms were improved in all patients. There was no postoperative subluxation of the ulnar nerve. No patients required additional surgery. No other complications were encountered. All patients returned to full activities.
Conclusions
Triceps sling in patients with intraoperative ulnar nerve subluxation after in situ decompression of the nerve is a safe and effective alternative procedure.
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