PMC7276630_01
Pain could be reproduced when the patient applied wrist flexion and ulnar deviation (a and b). The patient achieving full pronosupination, palpable, and visible extensor carpi ulnaris dislocation (c) was equally addressed in both limbs.
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F1
When achieving full pronosupination, palpable and visible ECU dislocation was equally addressed in both limbs (Fig. 1).
Right arm (a and b): Ulnar nerve reduced in 130 degrees of elbow extension. Ulnar nerve subluxed anteriorly sliding over the medial epicondyle when the patient reaching 40 degrees of elbow flexion. The left arm same maneuver (c and d).
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F2
When reaching 30 degrees of elbow flexion, UN subluxed anteriorly sliding over the medial epicondyle; this phenomenon was found to be bilateral (Fig. 2).
Wrist magnetic resonance imaging. Bilateral extensor carpi ulnaris dislocation. Tendonitis and tendinosis areevidenced.
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F3
A magnetic resonance imaging disclosed bilateral ECU dislocation together with tendonitis and tendinosis (Fig. 3).
Dorsal approach of the fifth and sixth compartments (a). Ulnar groove of the sixth compartment's floor was deepened to give better support to the tendon (b). Three 2.0mm bone anchors anchored to the lateral ulnar cortex (c). An extensor retinaculum flap was made and extensor carpi ulnaris was finally wrapped around the flap and attached above the fifth compartment using the anchors (d).
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F4
ECU was finally wrapped around the flap and attached above the fifth compartment using absorbable 2.0 bone anchors (Fig. 4).
Incision over the course of the nerve between the medial epicondyle and the olecranon (a). Ulnar nerve dislocation with flexion of the elbow (b). Osborne's ligament and the arcade of Struthers incised, together with the deep flexor-pronator mass fascia (c). Anterior subcutaneous transposition maintained with a facial flap (d).
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F5
Once the nerve was released, anterior subcutaneous transposition was performed and maintained in its new position with a facial flap (Fig. 5).