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Revision ulnar neuroplasty

W B Kleinman1

  • 1Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis.

Hand Clinics
|August 1, 1994
PubMed
Summary
This summary is machine-generated.

Revision ulnar neuroplasty addresses persistent ulnar nerve entrapment after initial surgery. Reoperation reveals inadequate decompression or nerve tension as common causes, necessitating careful nerve release and repositioning.

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Area of Science:

  • Orthopedic Surgery
  • Neurosurgery
  • Microsurgery

Background:

  • Recurrence or persistence of ulnar nerve entrapment neuropathy at the elbow after cubital tunnel release is a clinical challenge.
  • Initial surgical failures often stem from inadequate decompression at all potential compression sites or postoperative nerve tension.

Purpose of the Study:

  • To outline the indications and surgical technique for revision ulnar neuroplasty at the elbow.
  • To identify common causes of persistent ulnar nerve entrapment following initial cubital tunnel surgery.

Main Methods:

  • Revision ulnar neuroplasty involves formal neurolysis and epineurotomy under loupe magnification.
  • Identifying and releasing all sites of persistent nerve compression is crucial.
  • Placing the neurolysed nerve within a muscle sleeve of the flexor-pronator mass is recommended.

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Main Results:

  • Common sites of persistent compression include the medial intermuscular septum, arcade of Struthers, and Osborne's ligament.
  • Severe perineural fibrosis can compromise intraneural microcirculation, especially after submuscular transposition.
  • Proper nerve decompression and placement are key to successful revision surgery.

Conclusions:

  • Revision ulnar neuroplasty is indicated for recurrent or persistent ulnar neuropathy symptoms post-cubital tunnel release.
  • Thorough nerve decompression and appropriate nerve placement within a muscle sleeve are essential for optimal outcomes.