Surgical approaches for nonneurogenic elbow heterotopic ossification with ulnar neuropathy.
BACKGROUND
Few reports are available concerning elbow heterotopic ossification (HO) and its optimal management in nonneurologic or nonburn patients after repetitive elbow manipulation. The unique anatomic relationship of the ulnar nerve at the elbow renders it rather vulnerable to injury when elbow HO occurs medially or posteromedially and extends into the vicinity of the cubital tunnel.


METHODS
A total of 16 consecutive patients without neurologic injury were diagnosed with heterotopic ossification formation in the elbow and referred to the Upper Extremity Unit of Chang Gung Memorial Hospital. All 16 patients were diagnosed with ulnar palsy, and 14 were found to have sensory dysfunction and muscle wasting for an average of 5.2 months.


RESULTS
Fourteen of 16 patients achieved functional range of motion or more after surgery. The final gain in range of motion averaged 80.3 degrees. All except one had complete neurologic recovery postoperatively. The patient who had ulnar palsy for 1 year presurgery did not achieve any neurologic recovery.


CONCLUSIONS
Forceful and repetitive manipulation may add further damage to an already stiffened elbow and should be avoided in an elbow after immobilization or surgery. Early surgical resection of HO and ulnar nerve decompression followed by gentle and aggressive physical therapy terminate the vicious cycle and yield encouraging results.
Chao
En-Kai
EK
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Kweishan, Taiwan, Republic of China.
Chen
Alvin Chao-Yu
AC
Lee
Mel Shiuann-Sheng
MS
Ueng
Steve Wen-Neng
SW
D000293:Adolescent; D000328:Adult; D004550:Elbow / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D017769:Ulnar Nerve Compression Syndromes / Q000503:physiopathology / Q000601:surgery*