How is medial epicondylectomy performed for 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

A longitudinal incision 10-15 cm in length is made over the course of the ulnar nerve, centered 1 cm anterior to the tip of the medial epicondyle. [180] The posterior branches of the medial brachial and antebrachial cutaneous nerves are identified and protected, and the nerve is decompressed as previously described.

A longitudinal incision is made over the medial epicondyle, which is then exposed by means of subperiosteal dissection. The flexor-pronator origin is detached from the epicondyle and reflected distally. With care taken to protect the nerve, the medial epicondyle, or a portion of it, is removed with an osteotome. It is important not to enter the elbow joint or cut the ulnar collateral ligament. Sharp edges of bone are smoothed with a rongeur or rasp.

The periosteum is then closed to prevent tethering of the nerve to the raw bone surface. The flexor-pronator origin is reattached with the elbow in extension to help prevent the development of a flexion contracture. The ulnar nerve is allowed to slide anteriorly. [181] Finally, a simple soft compressive dressing is applied.


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