Congenital constriction band syndrome causing ulnar nerve palsy: Early diagnosis and surgical release with long-term follow-up

Three children with congenital constriction band syndrome affecting their u pper extremities demonstrated clinical and electrophysiologic signs of a co mplete ulnar nerve palsy. Two of the children were diagnosed immediately po stpartum with the subtle findings of an intrinsic minus posture of their ha nd and inability to actively extend their fingers at the proximal interphal angeal joints. One child had at least 5.5 months of intrauterine compressio n of the ulnar nerve detected by ultrasound examination at 18 weeks. Despit e early release of the constriction bands, at 3 months in 2 children and at 6 months in 1 child, the ulnar nerve palsies persisted for a mean follow-u p period of 7 years. If clinical examination of an infant with constriction band syndrome is indicative of a complete ulnar nerve palsy, the constrict ion band should be released as early as possible. If surgical exploration r eveals significant compression of the ulnar nerve, consideration should be given to excising the involved segment of nerve with immediate primary nerv e repair or nerve grafting because even early release of the constriction b and does not seem to result in neurologic improvement in long-term follow-u p studies. Copyright (C) 2001 by the American Society for Surgery of the Ha nd.