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

• Jegal M
• Yu KW
• Park SB
• Kim JP

• KMID: 2369567
• DOI: http://doi.org/10.4055/jkoa.2017.52.1.15

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).

Reference

1. Szabo RM, Kwak C. Natural history and conservative management of cubital tunnel syndrome. Hand Clin. 2007; 23:311–318. v–vi.

2. Tsujino A, Itoh Y, Hayashi K, Uzawa M. Cubital tunnel reconstruction for ulnar neuropathy in osteoarthritic elbows. J Bone Joint Surg Br. 1997; 79:390–393.

3. Kurosawa H, Nakashita K, Nakashita H, Sasaki S. Pathogenesis and treatment of cubital tunnel syndrome caused by osteoarthrosis of the elbow joint. J Shoulder Elbow Surg. 1995; 4:30–34.

4. Kato H, Hirayama T, Minami A, Iwasaki N, Hirachi K. Cubital tunnel syndrome associated with medial elbow Ganglia and osteoarthritis of the elbow. J Bone Joint Surg Am. 2002; 84:1413–1419.

5. Morrey BF. Primary degenerative arthritis of the elbow. Treatment by ulnohumeral arthroplasty. J Bone Joint Surg Br. 1992; 74:409–413.

6. Forster MC, Clark DI, Lunn PG. Elbow osteoarthritis: prognostic indicators in ulnohumeral debridement--the Outerbridge-Kashiwagi procedure. J Shoulder Elbow Surg. 2001; 10:557–560.

7. Adams JE, Wolff LH 3rd, Merten SM, Steinmann SP. Osteoarthritis of the elbow: results of arthroscopic osteophyte resection and capsulectomy. J Shoulder Elbow Surg. 2008; 17:126–131.

8. Savoie FH 3rd, Nunley PD, Field LD. Arthroscopic management of the arthritic elbow: indications, technique, and results. J Shoulder Elbow Surg. 1999; 8:214–219.

9. Lim TK, Koh KH, Lee HI, Shim JW, Park MJ. Arthroscopic débridement for primary osteoarthritis of the elbow: analysis of preoperative factors affecting outcome. J Shoulder Elbow Surg. 2014; 23:1381–1387.

10. Kelly EW, Morrey BF, O'Driscoll SW. Complications of elbow arthroscopy. J Bone Joint Surg Am. 2001; 83:25–34.

11. McGowan AJ. The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg Br. 1950; 32:293–301.

12. Kleinman WB, Bishop AT. Anterior intramuscular transposition of the ulnar nerve. J Hand Surg Am. 1989; 14:972–979.

13. Rettig LA, Hastings H 2nd, Feinberg JR. Primary osteoarthritis of the elbow: lack of radiographic evidence for morphologic predisposition, results of operative debridement at intermediate follow-up, and basis for a new radiographic classification system. J Shoulder Elbow Surg. 2008; 17:97–105.

14. Park MJ. Wrist and elbow arthroscopy. Seoul: Youngchang;2009.

15. Lim YW, van Riet RP, Mittal R, Bain GI. Pattern of osteophyte distribution in primary osteoarthritis of the elbow. J Shoulder Elbow Surg. 2008; 17:963–966.

16. Kashiwagi D. Intraarticular changes of the osteoarthritic elbow, especially about the fossa olecrani. J Jpn Orthop Assoc. 1978; 52:1367–1382.

17. Oka Y. Debridement arthroplasty for osteoarthrosis of the elbow: 50 patients followed mean 5 years. Acta Orthop Scand. 2000; 71:185–190.

18. Cheung EV, Adams R, Morrey BF. Primary osteoarthritis of the elbow: current treatment options. J Am Acad Orthop Surg. 2008; 16:77–87.

19. Hirasawa Y, Katsumi Y, Kojima O. Cubital tunnel syndrome due to osteoarthritis of the elbow. A surgical approach. Peripheral Nerve Repair Regen. 1986; 2:53–62.

20. Kawanishi Y, Miyake J, Omori S, Murase T, Shimada K. The association between cubital tunnel morphology and ulnar neuropathy in patients with elbow osteoarthritis. J Shoulder Elbow Surg. 2014; 23:938–945.

21. Moritomo H, Tada K, Yoshida T. Early, wide excision of heterotopic ossification in the medial elbow. J Shoulder Elbow Surg. 2001; 10:164–168.

22. Wada T, Ishii S, Usui M, Miyano S. The medial approach for operative release of post-traumatic contracture of the elbow. J Bone Joint Surg Br. 2000; 82:68–73.

23. Wada T, Isogai S, Ishii S, Yamashita T. Débridement arthroplasty for primary osteoarthritis of the elbow. J Bone Joint Surg Am. 2004; 86-A:233–241.

24. Galle SE, Beck JD, Burchette RJ, Harness NG. Outcomes of elbow arthroscopic osteocapsular arthroplasty. J Hand Surg Am. 2016; 41:184–191.

25. Nabhan A, Ahlhelm F, Kelm J, Reith W, Schwerdtfeger K, Steudel WI. Simple decompression or subcutaneous anterior transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg Br. 2005; 30:521–524.

26. Biggs M, Curtis JA. Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition. Neurosurgery. 2006; 58:296–304. discussion 296-304.

27. Gervasio O, Gambardella G, Zaccone C, Branca D. Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: a prospective randomized study. Neurosurgery. 2005; 56:108–117. discussion 117.

28. Blonna D, Huffmann GR, O'Driscoll SW. Delayed-onset ulnar neuritis after release of elbow contractures: clinical presentation, pathological findings, and treatment. Am J Sports Med. 2014; 42:2113–2121.

29. Lim BH, Toh CL, Wong HP, Pho RW. Cadaveric study on the vascular anatomy of the ulnar nerve at the elbow: a basis for anterior transposition? Ann Acad Med Singap. 1992; 21:689–693.

30. Iba K, Wada T, Aoki M, Oda T, Ozasa Y, Yamashita T. The relationship between the pressure adjacent to the ulnar nerve and the disease causing cubital tunnel syndrome. J Shoulder Elbow Surg. 2008; 17:585–588.