TY - JOUR
T1 - Surgical management of bony encasement of the ulnar nerve secondary to heterotopic ossification of the elbow
AU - Salazar, Dane
AU - Lee, Woo Seung
AU - Aghdasi, Bayan
AU - Golz, Andrew
AU - Israel, Heidi
AU - Marra, Guido
N1 - Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Heterotopic ossification (HO) is the most common extrinsic cause of elbow contracture. However, associated ulnar neuropathy at the elbow due to HO is uncommon. The purpose of the study is to describe the surgical management and investigate the effect of operative treatment of HO about the ulnar nerve on neuropathic symptoms. A retrospective review of all patients treated with bony encasement of the ulnar nerve secondary to HO over a 13-year period was performed. All patients underwent surgery for clinically symptomatic or debilitating HO of the elbow. Each patient received HO prophylaxis postoperatively. Subjects underwent regimented physical therapy and utilized a continuous passive motion machine in the postoperative period. Eighteen elbows with complete bony encasement of the ulnar nerve were identified (13 burns, 4 trauma, 1 closed head injury). There was a statistically significant decrease in ulnar neuropathy symptoms, as evidenced by a reduction of mean McGowan grade (1.5 to 1, P<0.02). Twenty-five percent of symptomatic patients (4/16) had complete resolution of their neuropathy symptoms. The mean arc of motion improved from 14 to 98 degrees following surgery and rehabilitation. Comparison of preoperative and postoperative motion demonstrated a statistically significant improvement in elbow extension, flexion, and total arc of motion (P<0.01). Average time from initial visit until surgery was 266 days (range, 76 to 797 d), while mean postoperative follow-up was 16 months (range, 1 to 51 mo). Surgical management combined with postoperative HO prophylaxis may be an effective treatment for treating patients with HO of the elbow with bony encasement of the ulnar nerve, resulting in superior range of motion and improved or resolved ulnar neuropathy.
AB - Heterotopic ossification (HO) is the most common extrinsic cause of elbow contracture. However, associated ulnar neuropathy at the elbow due to HO is uncommon. The purpose of the study is to describe the surgical management and investigate the effect of operative treatment of HO about the ulnar nerve on neuropathic symptoms. A retrospective review of all patients treated with bony encasement of the ulnar nerve secondary to HO over a 13-year period was performed. All patients underwent surgery for clinically symptomatic or debilitating HO of the elbow. Each patient received HO prophylaxis postoperatively. Subjects underwent regimented physical therapy and utilized a continuous passive motion machine in the postoperative period. Eighteen elbows with complete bony encasement of the ulnar nerve were identified (13 burns, 4 trauma, 1 closed head injury). There was a statistically significant decrease in ulnar neuropathy symptoms, as evidenced by a reduction of mean McGowan grade (1.5 to 1, P<0.02). Twenty-five percent of symptomatic patients (4/16) had complete resolution of their neuropathy symptoms. The mean arc of motion improved from 14 to 98 degrees following surgery and rehabilitation. Comparison of preoperative and postoperative motion demonstrated a statistically significant improvement in elbow extension, flexion, and total arc of motion (P<0.01). Average time from initial visit until surgery was 266 days (range, 76 to 797 d), while mean postoperative follow-up was 16 months (range, 1 to 51 mo). Surgical management combined with postoperative HO prophylaxis may be an effective treatment for treating patients with HO of the elbow with bony encasement of the ulnar nerve, resulting in superior range of motion and improved or resolved ulnar neuropathy.
KW - Elbow
KW - bony encasement
KW - heterotopic ossification
KW - ulnar nerve
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U2 - 10.1097/BTE.0000000000000157
DO - 10.1097/BTE.0000000000000157
M3 - Article
AN - SCOPUS:85056385576
SN - 1523-9896
VL - 19
SP - 145
EP - 152
JO - Techniques in Shoulder and Elbow Surgery
JF - Techniques in Shoulder and Elbow Surgery
IS - 4
ER -