Revision Surgery for the Ulnar Nerve at the Elbow
Cubital tunnel syndrome is the second most common compressive neuropathy of the upper extremity. The literature reports a general success rate of primary surgery to be around 90%. Failure can be in two forms: incomplete release resulting in failure to improve and recurrent symptoms after an initial period of symptom improvement. If revision surgery is undertaken, the entire nerve should be explored and transposed anterior to the medial epicondyle. External neurolysis should be performed if significant perineural fibrosis exists, and the triceps should be addressed if the medial head is snapping over the medial epicondyle. In the setting of perineural fibrosis, consideration should be given to nerve wrap with synthetic material or autologous vein.
KeywordsUlnar nerve Recurrence Cubital tunnel Transposition Triceps
Conflicts of Interest: No author has any relevant financial or personal conflicts of interest to disclose.
Copyright: No copyright permissions needed.
Snapping medial triceps. Visible snap at the medial epicondyle when the elbow is brought into approximately 120° of flexion. The patient has had prior ulnar nerve decompression (MOV 21280 kb)
Intraoperative demonstration of snapping medial head of the triceps after prior ulnar nerve decompression (MOV 21658 kb)
A second patient. Intraoperative video demonstrates the ulnar nerve dislocated anterior to the medial epicondyle with a second snap as the medial head of the triceps dislocates anterior to the medial epicondyle as well (WMV 34064 kb)