The contracted elbow: is ulnar nerve release necessary?

Area of Science:

• Orthopedic Surgery
• Nerve Surgery
• Elbow Reconstruction

Background:

• Elbow contracture release is a common procedure for restoring motion.
• Prophylactic ulnar nerve release is sometimes recommended but lacks robust evidence.
• The relationship between preoperative elbow stiffness and postoperative ulnar nerve issues needs clarification.

Purpose of the Study:

• To investigate the association between preoperative elbow joint range of motion and the incidence of postoperative ulnar nerve symptoms.
• To evaluate the necessity of prophylactic ulnar nerve decompression in patients undergoing elbow capsular release.

Main Methods:

• Retrospective review of 164 patients undergoing elbow capsular release (2003-2010).
• Ulnar nerve decompression was performed selectively based on preoperative symptoms or a positive Tinel sign.
• Preoperative and postoperative range of motion and ulnar nerve symptom incidence were recorded.

Main Results:

• A mean improvement of 36.7° in the arc of motion was observed.
• 8.1% of patients without prophylactic decompression developed new postoperative ulnar nerve symptoms.
• A higher symptom rate (15.2%) was noted in patients with preoperative flexion ≤100° compared to those with >100° flexion (3.7%).

Conclusions:

• Selective ulnar nerve decompression in symptomatic patients or those with a positive Tinel sign resulted in a low overall rate of ulnar nerve symptoms.
• More severe preoperative elbow flexion contractures (≤100°) were associated with an increased, though not statistically significant, risk of postoperative ulnar nerve symptoms.