Recurrent Cubital Tunnel Syndrome

Tang, Peter; Hoellwarth, Jason Shih; Chauhan, Aakash

doi:10.2106/jbjs.rvw.o.00022

Cited by 15 publications

(20 citation statements)

References 47 publications

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“…The deep fascia is an anatomically tough structure that lies immediately against the course of the ulnar nerve. This anatomical correlation explains the significant reoperation rate, i.e., 10 out of 14 patients in the report by Filippi et al and >90% in the report by Tang et al after an ulnar nerve release operation [ 2 , 5 ]. This is attributable to an incomplete resection of the deep fascia during the primary operation and postoperative scar tissue formation, leading to iatrogenic compressions of the ulnar nerve and subsequent recurrent neuropathy.…”

Section: Discussionmentioning

confidence: 97%

“…Significant degrees of improvement were noted in all of the 36 patients who were treated endoscopically and 64% had a complete recovery without scarring or contracture seen during their 16-month follow-up and only one patient had a recurrence [ 13 ]. On the other hand, Tang et al suggest that the endoscopic technique carries an equal success rate as do the other techniques, e.g., medial epicondylectomy, anterior transposition, in situ decompression [ 1 , 2 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…A revision surgery for cubital tunnel syndrome carries a high risk of ulnar nerve damage since the dense fibrosis and scar tissue, which develop after the primary operation, prevents a safe dissection of the nerve [ 5 ]. Therefore, it is best to perform a successful one-time procedure, which does not lead to a risky reoperation.…”

Section: Discussionmentioning

confidence: 99%

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The Deep Fascia of the Forearm and the Ulnar Nerve: An Anatomical Study

Choi¹,

Nwaogbe²,

Iwanaga³

et al. 2018

Cureus

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IntroductionA reoperation for a cubital tunnel syndrome is not uncommon. Patients often complain of sensorimotor symptoms in the ulnar nerve distribution after their primary surgery. The documented etiologies for such a phenomenon include a “new” kinking of the distal ulnar nerve and a “new” compression of the ulnar nerve by the fascial septum in between or tendinous bands over the muscles of the forearm. The deep fascial plane along which the ulnar nerve travels in the forearm has had scant attention. We present an anatomical study to provide a better understanding of such etiologies to aid physicians in performing successful primary ulnar nerve release that does not lead to risky reoperations and ultimately yields improved patient satisfaction.Materials and methodsThe forearms of 12 fresh frozen cadavers (24 arms) underwent dissection, during which the fascial relationships between the ulnar nerve and muscles of the anterior compartment were explored with a blunt technique. The relationship between the fascial planes and the ulnar nerve was quantitatively and qualitatively documented. The ranges of motion of the elbow were also observed for any potential compression points on the nerve during the movement.ResultsIn all specimens (n = 24), the ulnar nerve entered the forearm between the humeral and ulnar heads of the flexor carpi ulnaris, after which it routed deep to a deep fascia between the anterior surface of the flexor carpi ulnaris and the posterior surface of the flexor digitorum superficialis. Ulnar nerve branches to the flexor carpi ulnaris pierced this fascial septum while en route to the posterior surface of the muscle. Medially, the branches to the flexor digitorum profundus also pierced this fascial plane. In most arms, the fascia became thinner near the junction between the proximal two-thirds and distal one-third of the forearm. On no side was the ulnar nerve found to be grossly compressed by this deep fascia. However, with the extension of the elbow, a degree of angulation of the proximal ulnar nerve was observed due to its compact connection with the deep fascia.ConclusionOur study revealed that there is an intimate relationship between the ulnar nerve and the deep fascia of the forearm. Since the ulnar branches to the overlying flexor carpi ulnaris pierce this deep structure, a care should be given to its anatomical course during surgery in this region to prevent denervation of the muscle.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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The Deep Fascia of the Forearm and the Ulnar Nerve: An Anatomical Study

Choi¹,

Nwaogbe²,

Iwanaga³

et al. 2018

Cureus

View full text Add to dashboard Cite

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“… 29 With neo-compression points as common sites of failure, 30 it highlights the importance of ensuring that all fascial structures are addressed. 31 This should include excising a triangular piece of medial intermuscular septum from its insertion to the humerus proximal to the epicondyle and any fascial layers between the flexor/pronator muscles in a submuscular transposition. A good or excellent result was reported in 75% of patients who underwent subcutaneous transposition after a previous failed procedure, regardless of primary technique.…”

Section: Discussionmentioning

confidence: 99%

The management of failed cubital tunnel decompression

2021

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Cubital tunnel decompression is a commonly performed operation with a much higher failure rate than carpal tunnel release. Failed cubital tunnel release generally occurs due to an inadequate decompression in the primary procedure, new symptoms due to an iatrogenic cause, or development of new areas of nerve irritation. Our preferred technique for failed release is revision circumferential neurolysis with medial epicondylectomy, as this eliminates strain, removes the risk of subluxation, and avoids the creation of secondary compression points. Adjuvant techniques including supercharging end-to-side nerve transfer and nerve wrapping show promise in improving the results of revision surgery. Limited quality research exists in this subject, compounded by the lack of consensus on diagnostic criteria, classification, and outcome assessment. Cite this article: EFORT Open Rev 2021;6:735-742. DOI: 10.1302/2058-5241.6.200135

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“…The clinical results are equivalent for both procedures [100,107,108]. In recurrent cases, the most frequent finding is incomplete decompression either at the distal flexor-pronator muscle group or proximally at the intermuscular septum [109,110]. …”

Section: Ulnar Nerve Compression At the Elbowmentioning

confidence: 92%

Peripheral Nerve Entrapment and their Surgical Treatment

Vanaclocha‐Vanaclocha¹,

Saiz-Sapena²,

MaríaOrtiz‐Criado³

et al. 2017

Peripheral Nerve Regeneration - From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Deve

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Nerves pass from one body area to another through channels made of connective tissue and/or bone. In these narrow passages, they can get trapped due to anatomic abnormalities, ganglion cysts, muscle or connective tissue hypertrophy, tumours, trauma or iatrogenic mishaps. Nearly all nerves can be affected. The clinical presentation is pain, paraesthesia, sensory and motor power loss. The specific clinical features will depend on the affected nerve and on the chronicity, severity, speed and mechanism of compression.Its incidence is higher under some occupations and is some systemic conditions: diabetes mellitus, hypothyroidism, acromegaly, alcoholism, oedema and inflammatory diseases. The diagnosis is suspected with the clinical presentation and provocative clinical test, being confirmed with electrodiagnostic and/or ultrasonographic studies. Magnetic Resonance Studies (MRI) rule out ganglion cysts or tumours. Conservative medical treatment is often sufficient. In refractory ones, surgical decompression should be performed before nerve damage and muscle atrophy are irreversible. The 'double crash' syndrome happens when a peripheral nerve is compressed at more than one point along its trajectory. In cases with marked muscle atrophy, a 'supercharge end-to-side' nerve transfer can be added to the decompression. After decompression in those few cases with refractory pain, a nerve neurostimulator can be applied.

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Recurrent Cubital Tunnel Syndrome

Cited by 15 publications

References 47 publications

The Deep Fascia of the Forearm and the Ulnar Nerve: An Anatomical Study

The Deep Fascia of the Forearm and the Ulnar Nerve: An Anatomical Study

The management of failed cubital tunnel decompression

Peripheral Nerve Entrapment and their Surgical Treatment

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