triceps recession

Jamie Dezenzo

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Hello Ortho coders!!!

This procedure is new to me...

Pre/Post Dx: Snapping triceps syndrome, lt upper extremity with prior hx of prior transposition of ulnar nerve

Prior medial scar site excised, with extension proximal and distal for a total of approximately 7 cm proximal and 6 cm distal to medial epicondyle just anterior. Extensive scar plane encountered of which spreading performed and transection longitudinally with Beaver blade and tenotomy scissors under loupe magnification with retractors inserted. The ulnar nerve was identified anterior to medial epicondyle just proximal to medial epicondyle within prior Eaton sling. Proximal external neurolysis performed with partial distal visualization maintaining its place within its prior anterior transposed position (preoperatively patient without ulnar nerve symptoms). The ulnar nerve visibly was without significant erythema or flattening. Medial intermuscular septum was present, and I did not resect it. The tourniquet was deflated. (64718)


Bipolar electrocautery used to control localized bleeders. Patient then asked to actively flex and extend the elbow. Video was taken of the snapping medial head of the triceps over the medial epicondyle. The patient was then sedated once again.

A medial epicondylectomy performed with hand osteotomes and mallet, using rasps for smoothing, taking care to avoid medial collateral ligament take off to prevent iatrogenic instability. (24358)

The medial head triceps recession performed of approximately 1 cm medial distal triceps fibers just proximal to its olecranon insertion of fascial bands and muscle, creating posteromedial rent. The patient was then reawoken and asked to actively flex and extend and was unable to reproduce previous well documented actively reproducible dynamic snapping. Therefore, we were satisfied. The patient was resedated. (24301 or 24305??)

Copious sterile saline lavage irrigation performed. Undyed 4-0 Vicryl for subcutaneous tissue reapproximation, 4-0 nylon for horizontal mattress interrupted skin closure. A sugar tong applied with elbow at 90 degrees of flexion, wrist 20 degrees of extension. Digits with good color and warmth.

Thanks for any help :)
Jamie
 
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