Article
Intra-operative Subluxation of the Ulnar Nerve: Use of a Triceps Sling Reconstruction to Avoid Transposition
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Authors
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Loukia Papatheodorou
- University of Pittsburgh Medical School, Orthopaedic Specialists - UPMC, Pittsburgh, United States
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Dean Sotereanos
- University of Pittsburgh Medical School, Orthopaedic Specialists - UPMC, Pittsburgh, United States
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Ulnar nerve subluxation may occur in up to 17% of patients after in situ release of the ulnar nerve for the treatment of cubital tunnel syndrome. 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 12 patients who underwent a triceps sling reconstruction for intraoperative ulnar nerve subluxation after in situ decompression of the nerve.
Methods: There were 8 women and 4 men with a mean age of 41 years (range, 33-56 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. Thus a "sling" is created between the medial epicondyle and the olecranon preventing the nerve from subluxating. At completion, the elbow was flexed and extended, noting no further subluxation of the ulnar nerve through the entire range of motion. Patients were clinically evaluated preoperatively and postoperatively.
Results and Conclusions: The mean final follow-up was 31 months (range, 24 to 38 months). There was no postoperative subluxation of the ulnar nerve. Mean patient visual analog pain scores significantly improved from 8.6 before surgery to 0.2 after surgery. Static 2-point discrimination was improved by a mean 9.1 mm preoperatively to 5.7 mm postoperatively. Strength significantly improved by a mean of 37% and 34% with grip and pinch, respectively. No patients required additional surgery. No other complications were encountered. All patients returned to full activities.
Triceps sling reconstruction is a safe and effective alternative procedure to anterior transposition of the ulnar nerve in patients with intraoperative ulnar nerve subluxation following in situ decompression. With the triceps sling reconstruction, the blood supply of the ulnar nerve is preserved.
