Revision Arthroscopic Contracture Release in the Elbow Resulting in an Ulnar Nerve Transection

Abstract

The indications for elbow arthroscopy have expanded over the past several years. Currently, it is used for removal of loose bodies, treatment of lateral epicondylitis, synovectomy, contracture release, and management of osteochondritis dissecans1-4. Although elbow arthroscopy is a relatively safe procedure, the reported complication rate is as high as 10%, which is higher than that seen with knee and shoulder arthroscopy3,5,6. The rate of neurovascular complications is reported to range from 0% to 14%5,6. In a review of a large series of patients treated with elbow arthroscopy, Kelly et al.5 reported a 2.5% rate of neurovascular complication, all of which were transient neurapraxias. In the literature, there are only a few reports of complete nerve transection occurring during elbow arthroscopy7-10. In the present report, we describe a patient who presented, following an arthroscopic release of an elbow contracture, with a complete transection of a previously transposed ulnar nerve. The patient was informed that data concerning the case would be submitted for publication, and he consented. Institutional review board approval was obtained. A forty-five-year-old left-hand-dominant construction worker fell and sustained a small avulsion fracture of the coronoid process of the right ulna without an elbow dislocation. The elbow was immobilized in a posterior splint for four weeks. On removal of the splint, there was a restricted range of motion of the elbow. Intensive physical therapy was initiated with the aid of a turnbuckle-type splint to improve flexion. At four months after the injury, the active and passive ranges of motion were still limited (10° of extension to 70° of flexion, with full forearm rotation). The patient underwent an open release of the contracture and a subcutaneous ulnar nerve transposition with postoperative radiation …