Arthroscopic Extra-articular Ulnar Nerve Release in the Setting of Stiff Elbow

Abstract

Elbow stiffness can severely affect a patient’s quality of life. If conservative treatment is ineffective, surgical treatment including open or arthroscopic release could be applied. With the advantages of being minimally invasive, reducing pain and scars, accelerating early rehabilitation, and so on, arthroscopic release has increased in popularity compared with open surgery over the years, whereas limiting factors such as the close proximity of the neurovasculature to the working field and narrow working space still have to be faced by the elbow arthroscopist, with an increasing risk of iatrogenic injury with portal creation and operations adjacent to the nerves and vessels. When elbow arthritis occurs concomitantly with cubital tunnel syndrome, osteophytes on the medial ridge of the olecranon and trochlea occur as obstacles to the elbow extending or the posterior bundle of the medial collateral ligament has to be released for extension contractures, and open procedures for the medial gutter are routinely performed. To reduce the risk of injury and produce even less scar tissue, we present a surgical technique applicable to posteromedial elbow pathology by 2 medial portals. Through this technique, the entire course of the ulnar nerve is exposed and released under arthroscopy, with the ulnar nerve retracted medially, and medial gutter osteophytectomy and soft-tissue release can freely proceed.