title: Surgical approaches for nonneurogenic elbow heterotopic ossification with ulnar neuropathy.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Kweishan, Taiwan, Republic of China.
authors.forename: En-Kai
authors.initials: EK
authors.lastname: Chao
authors.forename: Alvin Chao-Yu
authors.initials: AC
authors.lastname: Chen
authors.forename: Mel Shiuann-Sheng
authors.initials: MS
authors.lastname: Lee
authors.forename: Steve Wen-Neng
authors.initials: SW
authors.lastname: Ueng
mesh_terms: 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*