Step 1: Mobilize the Ulnar Nerve
Mobilize the ulnar nerve through the cubital tunnel with the accompanying superior ulnar collateral vessels.
Step 2: Dissect the Triceps and Resect the Posterior Aspect of the Capsule
Dissect the triceps from the distal part of the humerus and resect the posterior aspect of the capsule to expose the olecranon tip and fossa.
Step 3: Resect the Posterior Band of the Medial Collateral Ligament
Release the posterior band of the medial collateral ligament while continually checking the flexion arc until >130° of flexion can be achieved.
Step 4: Resect the Anterior Aspect of the Capsule
Perform an anterior approach if there is persistent flexion contracture or any impingement restricting full flexion.
Step 5: Lengthen the Triceps If Indicated
Consider triceps lengthening if you cannot achieve >130° of passive flexion with two fingers.
Step 6: Transpose the Ulnar Nerve Anteriorly
Locate the released ulnar nerve over the medial humeral epicondyle on the fascia overlying the common flexor-pronator muscles.
Step 7: Postoperative Management
Physical therapy consists of active-assisted and gentle passive flexion and extension exercises of the elbow, usually for two to six months.
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