Revision Cubital Tunnel: Surgical Options

State of the art review. Upper extremity revision nerve compression surgery

“…Anterior transposition of the UN may lead to a new compression site. The unresected intramuscular septum has been reported as a common compression site during revision cases, while kinking of the UN as it passes between the heads of the flexor carpi ulnaris muscle after anterior transposition can also be associated with revision cases (Bavelou et al., 2020; Kholinne et al., 2019; Tang et al., 2016).…”

“…The next steps in revision surgery aim to alleviate strain on the UN, and to prevent instability or new scar formation. This may include submuscular, subfascial or subcutaneous transposition (Bavelou et al., 2020; Grandizio et al., 2018; Tang et al., 2016), although this can cause additional nerve devascularization (Aleem et al., 2014) and secondary compression. Limited medial epicondylectomy prevents UN tethering to the medial epicondyle and relieves pressure of the nerve (Burahee et al., 2021).…”

“…Where in situ revision surgery is performed, instability can occur in approximately 7% of the cases, with the nerve subluxing anterior to the medial epicondyle during elbow flexion (Bavelou et al., 2020; Kholinne et al., 2019; Tang et al., 2016). Anterior transposition of the UN may lead to a new compression site.…”

“…US can be useful in assessing changes on the nerve’s diameter, the presence of scar tissue along the course of the nerve, and to define location of the nerve both statically and dynamically (Bavelou et al., 2020; Grandizio et al., 2018; Tang et al., 2016). MRI is the investigation of choice to assess potential cervical disk herniation as well as tumours/tumour-like lesions at the elbow and Guyon canal.…”