Intraoperative Biceps/Brachialis Stimulation for Snapping Triceps With Ulnar Neuritis

Area of Science:

• Orthopedic Surgery
• Neurophysiology
• Musculoskeletal Disorders

Background:

• Snapping triceps syndrome involves medial triceps head dislocation over the medial epicondyle during elbow flexion.
• Surgical treatment, including resection or redirection, requires precise evaluation of the extent of muscle involvement.
• Assessing the adequacy of surgical intervention for snapping triceps can be challenging.

Purpose of the Study:

• To introduce and evaluate a novel intraoperative technique for managing snapping triceps.
• To utilize electrical stimulation of the musculocutaneous nerve to simulate elbow flexion and visualize triceps impingement.
• To improve the assessment of triceps resection or redirection during surgery for snapping triceps.

Main Methods:

• A patient with persistent bilateral snapping triceps and ulnar nerve symptoms underwent reoperation on the left elbow.
• Intraoperative electrical stimulation of the musculocutaneous nerve was employed to induce active elbow flexion.
• Direct visualization of the snapping triceps mechanism was achieved during simulated flexion.

Main Results:

• Electrical stimulation of the musculocutaneous nerve successfully activated biceps and brachialis muscles, causing powerful elbow flexion.
• This activation allowed clear visualization of the forceful snapping triceps.
• The technique facilitated assessment of the adequacy of the triceps muscle resection/redirection.

Conclusions:

• Intraoperative electrical stimulation of the musculocutaneous nerve is a viable method to assess snapping triceps.
• This technique aids surgeons in determining the appropriate extent of triceps muscle resection or redirection.
• The proposed method can enhance surgical decision-making for snapping triceps syndrome.