Article
Therapeutic approach for ulnar nerve entrapment in performing musicians
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Authors
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Adriana Pemoff
- Hospital Fernandez, Fundación Las Manos del Músico, Climba, Buenos Aires, Argentina
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Candelaria Torre
- Hospital Fernandez, Fundación Las Manos del Músico, Buenos Aires, Argentina
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Hernán Blanchetiere
- Hospital Fernandez, Fundación Las Manos del Músico, Climba, Buenos Aires, Argentina
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Soledad Lett
- Hospital Fernandez, Fundación Las Manos del Músico, Buenos Aires, Argentina
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Ivonne Gomez Avellaneda
- Hospital Fernandez, Fundación Las Manos del Músico, Buenos Aires, Argentina
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Fernanda Coscueta
- Fundación Las Manos del Músico, Buenos Aires, Argentina
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: There are some instrumentalist musicians who present risk factors that increase the incidence of ulnar nerve entrapment, such as valgus and forced elbow flexion, during their performance.
The aim of this study is to report incidence and therapeutic approach of ulnar nerve entrapment at the elbow in performing musicians treated in our center. We propose the surgical technique of Osborne ligament reconstruction in patients with risk of dislocation of the ulnar nerve due to a vicious postures during their instrument execution.
Methods: We performed a retrospective, descriptive study between 2001 and 2018. We included 2387 instrumentalist musicians treated at our center. There were 71 patients with related symptoms of ulnar nerve entrapment and confirmed diagnosis with electrophysiological and image studies, always performed by the same professional. Of the total population, 15 were violinists, 27 guitarists, 5 double bass players, 7 bandoneonist, 9 pianists and 8 cellists. All of them presented epitrochlear pain and sensitive symptoms during their performance. Risk factors were identified as posture execution in flexion and forced elbow valgus, with scapular dyskinesia. The initial therapeutic approach was the treatment of these risk factors asociated with physiotherapy and music counseling. Most of them responded to conservative treatment by improving their execution posture, but 8 required surgical intervention. The surgical technique consisted of internal elbow approach, with complete liberation of the ulnar nerve according to conventional technique and the additional Osborne ligament reconstruction with triceps fascial flap.
Results and Conclusions: A total of 71 patients with ulnar nerve entrapment were included. 63 had resolution of their symptoms, by improving scapular dyskinesia, vicious postures and forced elbow valgus during their instrument performance. 8 patients continued with symptoms, and were treated by surgical intervention consisting of ulnar nerve release associated with Osborne ligament reconstruction to avoid dislocation of the ulnar nerve due to the forced elbow valgus remnant.
In performing musicians population with ulnar nerve entrapment, the initial approach is aimed to correct vicious postures like forced elbow valgus and the improvement of scapular dyskinesia. In cases of failure in conservative treatment, surgical intervention is proposed, and must include, in addition to the nerve release, a mechanism of nerve containment, due to the risk of dislocation.
