What complications can occur after a medial epicondylectomy 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

After medial epicondylectomy, medial instability may occur. To prevent this complication, the flexor-pronator origin is carefully detached to preserve the fibers of the medial collateral ligament. According to O’Driscoll et al, excision of more than 20% (1-4 mm) of the width of the medial epicondyle in the coronal plane violates the important anterior band of the ligament. [13]

Removal of the optimal amount of medial epicondyle, without creating instability, also improves results. Heithoff and Millender found in their series that a complete osteotomy resulted in 81% good and excellent results. [88] A partial osteotomy yielded a 67% rate of good or excellent results, and a minimal osteotomy yielded a 50% rate of good or excellent results.

Tenderness at the operative site can occur after medial epicondylectomy, sometimes resulting in prolonged and persistent discomfort during bone healing. In addition, loss of the protection afforded by the medial epicondyle may render the ulnar nerve more susceptible to trauma. To prevent the nerve from adhering to the osteotomy site postoperatively, it is important to preserve and close the periosteum at the end of the procedure.

Detachment of the flexor-pronator origin can result in weakness. Patients may develop an elbow flexion contracture that is often attributed to reattachment of the flexor-pronator muscle origin while the elbow is flexed or to delayed or inadequate postoperative mobilization.


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