Short-term symptom aggravation after cubital tunnel decompression: Clinical features and mechanistic insights from a...

While surgical decompression for cubital tunnel syndrome (CuTS) generally leads to favorable outcomes, some patients experience early postoperative worsening marked by transient symptom flare-ups. The underlying mechanisms remain poorly understood. We retrospectively analyzed 127 patients who underwent anterior ulnar nerve transposition without corticosteroids. Clinical scores (VAS, PRUNE, two-point discrimination) and electrophysiological parameters (CMAP, SNCV, MNCV) were assessed preoperatively, at 2 weeks, and at 6 months. Early worsening was defined as deterioration in any clinical indicator at 2 weeks. At 6 months, most patients improved significantly. However, 26.8% showed early worsening at 2 weeks, with elevated PRUNE scores, reduced sensory discrimination, and declines in CMAP, SNCV, and MNCV (all p < 0.001). These changes resolved spontaneously without surgical failure. Likely contributors include inflammatory edema, mechanical stress, transient ischemia, and central sensitization. Early postoperative worsening affects over one-quarter of CuTS patients but is typically self-limiting. Awareness of this pattern can prevent misdiagnosis, reduce unnecessary interventions, and improve patient counseling. Future research should identify predictive markers and develop mitigation strategies.