The failed ulnar nerve transposition. Etiology and treatment

Area of Science:

• Orthopedics
• Neurology
• Surgical Innovation

Background:

• Cubital tunnel syndrome, a common compressive neuropathy, has various surgical treatment options.
• Persistent symptoms after initial surgery necessitate evaluation of revision procedures.
• Ulnar nerve compression at the elbow can lead to significant pain, paresthesia, and motor weakness.

Purpose of the Study:

• To evaluate the outcomes of revision surgery for persistent cubital tunnel syndrome.
• To identify causes of persistent ulnar nerve compression after initial surgical interventions.
• To assess the efficacy of neurolysis and submuscular transposition in revision cases.

Main Methods:

• Retrospective evaluation of fourteen patients with persistent symptoms after prior cubital tunnel surgery.
• Clinical and electromyographic assessment to confirm persistent ulnar nerve compression.
• Revision surgery involving neurolysis and submuscular transposition of the ulnar nerve.

Main Results:

• Revision surgery was highly successful in relieving pain and paresthesias.
• Identified causes of persistent compression include retained septa, perineural fibrosis, adhesions, and nerve subluxation.
• Recovery of motor function and sensibility following revision surgery was variable and unpredictable.

Conclusions:

• Revision surgery is effective for symptom relief in persistent cubital tunnel syndrome.
• Thorough decompression and addressing specific anatomical issues are crucial for successful revision.
• Patient outcomes regarding motor and sensory recovery require further investigation and realistic expectation setting.