Management of Secondary Cubital Tunnel Syndrome

Abstract

Learning Objectives: After studying this article, the participant should be able to: 1. Describe the general anatomical features and dynamics of the ulnar nerve, as well as its most common points of potential compression. 2. Describe the clinical presentation associated with secondary cubital tunnel syndrome, with the appropriate differential diagnoses. 3. Discuss the diagnostic test results and physical findings important for determining the correct treatment for patients presenting for revision surgical treatment. 4. Discuss the different nonsurgical and surgical interventions for patients with recurrent or persistent ulnar nerve compression at the elbow.Ulnar nerve compression at the elbow is a peripheral nerve disorder that is second in incidence only to carpal tunnel syndrome. The successful treatment of cubital tunnel syndrome can at times be unsatisfactory, with clinical failure rates of approximately 25 percent after surgical treatment. There are a variety of explanations for surgical failure or secondary ulnar nerve compression at the elbow, including improper diagnosis or treatment, incomplete release of the nerve, postoperative scarring, and improper postoperative rehabilitation. This article reviews the relevant history, anatomical features, and presentation of secondary ulnar nerve compression at the elbow. It also attempts to identify the important risk factors for recurrent, persistent, and new disease and to make clinical recommendations regarding diagnosis, management, and surgical treatment. (Plast. Reconstr. Surg. 113: 1e, 2004.)

Cubital Tunnel Syndrome

“…After transposition, attention should be focused on these areas as well as on the proximal and distal sites of transposition, where the nerve crosses from posterior to anterior and back again. 51 Surgical options for failed cubital tunnel syndrome include anterior submuscular transposition, anterior intramuscular transposition, and anterior subcutaneous transposition. 52,53 Medial epicondylectomy is another option; however, anterior transposition remains the preferred technique.…”

Vein wrapping at cubital tunnel for ulnar nerve problems

“…6 The management of recurrent entrapment neuropathy is much more difficult and poses a unique and challenging problem for the surgeon. 1,7,18 Repeated nerve decompression, alone or accompanied with external or internal neurolysis, does not always relieve symptoms, and the results are unpredictable. Recurrence is often secondary to cicatrix, or scar tissue, that develops around the nerve at the site of decompression and causes further compression.…”

Repetitive strain injury

“…97 Such treatment aims for return to functional strength and mobility of the aff ected arm, and consists of manual therapy, splinting, stretching exercises, and pain management. Surgery might be necessary if conservative therapies fail, although optimum surgi cal management is controversial.…”