Arthroscopic Osteocapsular Arthroplasty with Mini-Open Ulnar Nerve Decompression for Elbow Arthritis

Abstract

Patients with elbow osteoarthritis present with painful limited motion and report ulnar nerve symptoms occasionally. Arthroscopic osteocapsular arthroplasty for arthritis have showed pain relief and improved range of motion. However, few studies about treatment and outcomes of concomitant ulnar neuropathy have been reported. The purpose of this study was to evaluate clinical outcomes after arthroscopic osteocapsular arthroplasty combined with ulnar nerve decompression for the treatment of elbow osteoarthritis with concomitant ulnar neuropathy. Among 45 patients with elbow osteoarthritis underwent arthroscopic osteocapsular arthroplasty, 22 patients with preoperative concomitant ulnar neuropathy were included in this study. Surgical procedures included arthroscopic debridement and capsulectomy with miniopen ulnar nerve decompression. Preoperatively, extent of ulnar nerve dysfunction was classified according to the McGowan stage. Postoperative elbow function was assessed using VAS, range of motion, and Mayo Elbow Performance Index (MEPI) and ulnar nerve function was assessed using the modified Bishop score. At a mean follow-up of 21 months, significant improvement occurred in the mean pain, from VAS 4.1 to 1.5and total arc of motion, from 95° to 115°. Average MEPI scores were 67 preoperatively and 85 at final follow-up and 81% of patients showed good to excellent results according to MEPI scores. Improvement of paresthesia and weakness were noted in 18 cases and and 16 cases respectively. According to the modified Bishop score, 10 patients had excellent, 7 good, 3 fair and 2 poor results. Arthroscopic osteocapsular arthroplasty combined with miniopen decompression of the ulnar nerve showed satisfactory outcomes in patients with elbow arthritis concomitant ulnar neuropathy. Miniopen ulnar nerve decompression was safe and effective procedure and can be indicated for ulnar neuropathy in the setting of elbow osteoarthritis.