scholarly journals The management of failed cubital tunnel decompression

2021 ◽  
Vol 6 (9) ◽  
pp. 735-742
Author(s):  
Abdus S. Burahee ◽  
Andrew D. Sanders ◽  
Dominic M. Power

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

2021 ◽  
Vol 46 (3) ◽  
pp. 260-264
Author(s):  
Nick A. Johnson ◽  
Oliver Darwin ◽  
Dimitrious Chasiouras ◽  
Anna Selby ◽  
Chris Bainbridge

The relationship between surgery for cubital tunnel and carpal tunnel syndrome was examined in this retrospective study. Between 1997 and 2018, data from consecutive patients who underwent carpal tunnel release (8352 patients), cubital tunnel release (1681 patients) or both procedures (692 patients) were analysed. The relative risk of undergoing cubital tunnel release in the population who had carpal tunnel release compared with those with no carpal tunnel release was 15.3 (male 20.3; female 12.5). The relative risk of undergoing carpal tunnel release in the population who had cubital tunnel release compared with those who did not undergo carpal tunnel release was 11.5 (male 16.5; female 9.1). Our study showed that men and women who undergo carpal tunnel release are over 20 times and 10 times more likely to have cubital tunnel release than those who did not undergo carpal tunnel release, respectively. These findings suggest that the two conditions may share a similar aetiology. Level of evidence: IV


2006 ◽  
Vol 31 (1) ◽  
pp. 68-71 ◽  
Author(s):  
N. STÜTZ ◽  
A. GOHRITZ ◽  
J. VAN SCHOONHOVEN ◽  
U. LANZ

Carpal tunnel release (CTR) is regarded as a common and successful operative procedure in hand surgery. However, an increasing number of patients with complications have been referred to our hospital. This retrospective investigation was undertaken to clarify the reasons for persisting or recurrent symptoms in 200 patients who underwent secondary exploration during a 26 month period at a single institution. In 108 cases, the flexor retinaculum was found to have been released incompletely. In 12 patients, a nerve laceration had occurred during the primary intervention. In 46 patients, symptoms were due to the nerve being tethered in scar tissue. The re-exploration revealed circumferential fibrosis around and within the median nerve in 17 patients and a tumour in the carpal tunnel in four patients. In 13 patients, no specific reason was found for recurrence of symptoms. We conclude that CTR seems to be a widely underestimated procedure and revision surgery could be largely avoided by reducing technical errors during the primary operation.


Author(s):  
Grainne Bourke ◽  
Mobin Syed

Peripheral nerve entrapment is common. Patients present with tingling and pain in the distribution of the affected nerve. This will progress to altered sensation and weakness with prolonged and/or increasing pressure. The most common nerve entrapment syndromes are carpal tunnel affecting the median nerve at the wrist and cubital tunnel affecting the ulnar nerve at the elbow. They affect the working population, so time-efficient diagnosis and robust effective treatment strategies are important to minimize the financial implications to industry. Aetiology, diagnosis, and management strategies for carpal tunnel, cubital tunnel, and meralgia paraesthetica are discussed in this chapter along with a brief overview of other entrapment syndromes. Current controversies between open and endoscopic carpal tunnel release are also reviewed.


PM&R ◽  
2009 ◽  
Vol 1 ◽  
pp. S133-S133
Author(s):  
Faguna Patel ◽  
Qiang G. Fang ◽  
John M. Ventrudo

2020 ◽  
pp. 175319342093938
Author(s):  
Nick A. Johnson ◽  
Oliver Darwin ◽  
Dimitrious Chasiouras ◽  
Anna Selby ◽  
Chris Bainbridge

We sought to establish whether carpal and cubital tunnel syndrome requiring surgery is associated with deprivation in England. Data from 10,496 adult patients who were treated in our hand unit over a 20-year period were reviewed. The Index of Multiple Deprivation was used to measure deprivation from the patients’ postcode. The mean age at surgery in the most deprived three quintiles was significantly lower than in the least deprived two quintiles for carpal tunnel release (55 vs 59 years, respectively) and cubital tunnel release (52 vs 57 years, respectively). The incidence rate was significantly lower for the three least deprived quintiles when compared with the most deprived quintile for both conditions. The incidence rate ratio of the least deprived quintile compared with the most deprived quintile for carpal tunnel release was 0.70 for men and 0.76 for women. The incidence rate ratio of the least deprived quintile compared with the most deprived quintile for cubital tunnel release was 0.79 for men and 0.49 for women. Carpal tunnel and cubital tunnel syndrome requiring surgery is more common in deprived patients and occurs at an earlier age. Level of evidence: IV


2012 ◽  
Vol 130 (6) ◽  
pp. 898e-899e
Author(s):  
Stefano Lucchina ◽  
Cesare Fusetti

2003 ◽  
Vol 8 (4) ◽  
pp. 4-5
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.


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