J Korean Orthop Assoc.  2017 Feb;52(1):15-24. 10.4055/jkoa.2017.52.1.15.

The Effectiveness of Arthroscopic Debridement with Mini-Open Ulnar Nerve Decompression in Primary Osteoarthritis of the Elbow with Ulnar Neuropathy

Affiliations
  • 1Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, Korea. kimjp@dankook.ac.kr
  • 2Department of Orthopaedic Surgery, MS Jaegeon Hospital, Daegu, Korea.

Abstract

PURPOSE
The aim of this study was to determine the effectiveness of arthroscopic debridement with mini-open ulnar nerve decompression in primary osteoarthritis of the elbow with ulnar neuropathy.
MATERIALS AND METHODS
Between May of 2006 and July of 2014, a total of 43 patients who had undergone surgery for primary osteoarthritis of the elbow with ulnar neuropathy were included in this study. We divided the subjects into two groups according to the method of surgery: group 1 (n=18) received mini-open ulnar nerve decompression only, and group 2 (n=25) received arthroscopic debridement with mini-open ulnar nerve decompression. Patients were assessed for the following clinical outcomes: visual analogue scales (VAS) score, range of motion of the elbow joint, Mayo elbow performance score (MEPS), and disabilities of the arm, shoulder and hand (DASH) at the time before surgery and 6 months after surgery. We analyzed the recovery of the ulnar nerve by the McGowan grade and Bishop rating score preoperatively and at 6 months after the surgery.
RESULTS
The VAS score, range of motion of the elbow joint, MEPS, and DASH showed significant statistical difference after the surgery (p <0.05). However, between the 2 groups, there was no significant difference. For the McGowan grade, all cases of both groups-except one case each group-showed at least one grade improvement. Moreover, group 2 showed a greater significant difference than group 1 (p=0.001). At the final follow-up, according to the Bishop rating score, group 2 had a greater significant difference than group 1 (p=0.036).
CONCLUSION
Arthroscopic debridement with mini-open ulnar nerve decompression in primary osteoarthritis of the elbow with ulnar neuropathy is a useful technique, which has several advantages, including the benefits associated with a minimally invasive surgery and also the improvement of elbow joint function and excellent recovery of the ulnar nerve.

Keyword

elbow; osteoarthritis; ulnar neuropathies; arthroscopy; decompression

MeSH Terms

Arm
Arthroscopy
Debridement*
Decompression*
Elbow Joint
Elbow*
Follow-Up Studies
Hand
Humans
Methods
Minimally Invasive Surgical Procedures
Osteoarthritis*
Range of Motion, Articular
Shoulder
Ulnar Nerve*
Ulnar Neuropathies*
Weights and Measures

Figure

  • Figure 1 Ulnar nerve is exposed following an incision of the overlying ligament of Osborne.

  • Figure 2 (A) Ulnar nerve is identified and pulled gently using a vessel loop. (B) Care must be taken not to damage the ulnar nerve during posteromedial approach of the elbow.

  • Figure 3 (A) Postoperative outcome of the McGowan grade (group 1). The marked number beside the line reveals each number of patients. (B) Postoperative outcome of the McGowan grade (group 2). The marked number beside the line reveals each number of patients. Group 1 received miniopen ulnar nerve decompression only. Group 2 received arthroscopic debridement with mini-open ulnar nerve decompression.

  • Figure 4 Postoperative outcome of the Bishop rating score (*p=0.036).


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