What are the contraindications for surgery in ulnar neuropathy?

Updated: Jun 08, 2018
  • Author: Charles F Guardia, III, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Answer

Contraindications for the various operative procedures used to decompress the ulnar nerve are as follows:

  • Decompression in situ - This procedure should not be used in cases of severe posttraumatic neuropathy with scarring, chronic subluxation, or dislocation of the ulnar nerve from the epicondylar groove and soft-tissue masses in the epicondylar groove

  • Decompression with anterior subcutaneous transposition - This procedure does not release the ulnar nerve completely, leaving the distal course from the cubital tunnel as a possible site of compression; thus, it may not be the best choice for transposition in a thin person who lacks significant adipose tissue at the site of transposition, because of the possibility of repeated trauma to the nerve at the elbow [19]

  • Decompression with anterior intramuscular transposition - This is the most controversial of the procedures because of the claim of severe postoperative scarring

  • Decompression with anterior submuscular transposition - This procedure is contraindicated in the presence of scarring of the joint capsule or irregularity of the elbow joint due to malunited fracture, severe arthritis, or previous excisional arthroplasty

  • Medial epicondylectomy - This procedure is not used when double-crush syndrome with entrapment at the distal end of the cubital tunnel or soft-tissue masses in the epicondylar groove are suspected


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