Cubital Tunnel Release Impormasyon Pahintulot

Bakit iminungkahi ang operasyong ito

Si Dr Kieran Hirpara, isang upper-limb surgeon sa Mater Private Hospital Rockhampton, ay nagsisimula sa mga opsyon na hindi gaanong invasive na angkop sa iyong kondisyon. Ang mga pasyente ay karaniwang nirerefer sa aming klinika ng kanilang GP; kung iminungkahi ng isang physiotherapist na magpatingin sa amin, kakailanganin mo pa rin ng referral mula sa iyong GP upang maging eligible para sa Medicare rebate. Sa iyong appointment, kumukuha kami ng history, sinusuri ang iyong braso, at nag-aayos ng imaging o nerve tests kung kinakailangan. Ang cubital tunnel syndrome ay ang tawag sa pressure sa isang nerve sa loob ng iyong siko. Ang pressure na ito ay nagdudulot ng pamamanhid o tingling sa iyong kalingkingan at sa bahagi ng ring finger ng iyong kamay, at maaari itong lumala kapag ang iyong siko ay nakabaluktot sa loob ng mahabang panahon. Para sa isang matagal nang problema na tulad nito, karaniwan naming sinusubukan muna ang non-operative care: pagbabago sa aktibidad, physiotherapy o hand therapy, at splinting. Isinasaalang-alang namin ang surgery kapag ang mga hakbang na iyon ay hindi nagbigay sa iyo ng sapat na pagbuti.

Ang operasyon ay tinatawag na cubital tunnel release. Binabawasan nito ang pressure sa nerve upang ang iyong mga sintomas ay humupa. Higit sa 90% ng mga taong sumasailalim sa surgery na ito ay gumagaling o nagpapakita ng pagbuti. Pag-uusapan namin ang mga bagay na mahalaga sa iyo at magpapasya nang magkasama kung ito ang tamang susunod na hakbang.

Bago ang operasyon

Kapag nakatakda na ang operasyon, bibigyan ka namin ng malinaw na mga tagubilin na dapat sundin. Kakailanganin mong itigil ang pagkain at pag-inom pitong oras bago ang iyong operasyon. Humihingi kami ng pitong oras sa halip na anim upang maaaring ilipat nang mas maaga ang oras ng iyong operasyon kung maagang matapos ang listahan sa theatre. Ang ilang mga gamot ay maaaring kailangang itigil muna bago ang operasyon, at sasabihin sa iyo ng iyong surgeon kung alin sa mga ito at kailan. Magdala ng listahan ng lahat ng iyong iniinom o ginagamit, kabilang ang mga tabletas, injection at mga cream. Mag-ayos ng taong maghahatid sa iyo pauwi pagkatapos, dahil hindi mo magagawang magmaneho nang mag-isa. Magsuot ng maluwag at komportableng damit na may manggas na madaling tanggalin. Ang mga imaging tulad ng X-ray, ultrasound o MRI scan ay maaaring na-iskedyul na upang makatulong sa pagpaplano ng iyong operasyon. Kung mayroon kang iba pang kondisyong medikal, maaaring kailanganin mo ng mga blood test o pagsusuri kasama ang anaesthetist, ngunit karamihan sa mga tao ay hindi.

Sa araw ng operasyon

Darating ka sa surgical admissions unit ng ospital, kung saan ka ire-rehistro at ihahanda para sa theatre. Makikilala mo ang anaesthetist, isang doktor na mag-aalaga sa iyong komportable at kaligtasan habang isinasagawa ang operasyon. Ang operasyong ito ay ginagawa sa ilalim ng general anaesthetic. Ikaw ay tulog na tulog sa buong operasyon. Ang ilang pasyente ay maaaring bigyan din ng regional nerve block para sa pagbawas ng sakit pagkatapos ng operasyon; ang anaesthetist ang magdedesisyon sa araw na iyon base sa iyong indibidwal na kalagayan. Pagkatapos ay dadalhin ka sa operating theatre, kung saan isasagawa ang operasyon.

Magigising ka sa recovery area, kung saan babantayan ka ng mga nurse habang nawawala ang bisa ng anaesthetic. Kapag stable ka na, maaaring pumunta ka sa ward o uuwi na, depende sa procedure at sa iyong paggaling. Maraming tao ang nakakauwi sa mismong araw na iyon. Bago ka umalis, ipapaliwanag namin kung paano aalagaan ang iyong braso at kung ano ang dapat asahan sa mga susunod na araw.

Ano ang kinapapalooban ng operasyon

Ang operasyon ay tinatawag na cubital tunnel release. Gagawa ang iyong surgeon ng isang hiwa sa panloob na bahagi ng iyong siko, sa likuran lamang ng nakaumbok na buto na nararamdaman mo roon. Sa pamamagitan ng hiwang ito, hahanapin ng iyong surgeon ang ulnar nerve, ang nerve na naipit at nagiging sanhi ng pangingilig sa iyong kalingkingan at ring finger. Ang nerve ay dumadaan sa isang tunnel ng tissue malapit sa siko, na tila isang kable na dumadaan sa isang makitid na conduit. Bubuksan ng iyong surgeon ang tunnel na iyon upang hindi na maipit ang nerve. Tinatawag itong decompression, na nangangahulugang pag-aalis ng pressure sa nerve.

Minsan, kailangan ding ilipat ang nerve sa isang bagong posisyon sa harap ng siko upang manatili itong ligtas kapag ibinabaluktot mo ang iyong braso. Magdedesisyon ang iyong surgeon habang isinasagawa ang operasyon kung sapat na ang pag-release sa tunnel, o kung mas makabubuti sa iyo ang paglilipat ng nerve. Ang pagpili ay nakadepende sa iyong pagsusuri at sa makikita ng iyong surgeon.

Kapag malaya na ang nerve, isasara ng iyong surgeon ang hiwa. Isang manipis na self-adhesive mesh ang ilalagay muna sa ibabaw ng sugat, upang pagdikitin ang mga gilid ng balat. Pagkatapos ay papahiran ng liquid skin glue ang mesh, kung saan ito titigas at selyuhan ang lahat bilang isang closure. Mananatili ito nang humigit-kumulang isa hanggang dalawang linggo, pagkatapos ay kusa itong aangat at mababalat, kaya wala nang kailangang tanggalin.

Pagkatapos ng operasyon

Magigising ka sa recovery area, kung saan babantayan ka ng mga nurse habang nawawala ang bisa ng anaesthetic. Ito ay isang day case, kaya uuwi ka sa araw ring iyon. Ang sakit ay karaniwang mild hanggang moderate at maaaring ma-manage gamit ang simpleng pain relief; ipapaliwanag namin kung ano ang dapat inumin bago ka umalis. Ang iyong braso ay magkakaroon ng soft dressing sa ibabaw ng sugat, at maaari mong igalaw ang iyong mga daliri, kamay, at balikat hangga't komportable ka. Walang cast o brace, at hindi mo kakailanganin ng sling maliban kung ipapayo namin ito. Mangyaring mag-ayos ng isang tao na sasama sa iyo sa unang 24 oras pagkauwi mo sa bahay. Hahayaan naming nakalagay ang dressing sa loob ng humigit-kumulang 10 araw; mangyaring huwag itong tatanggalin bago ang panahong iyon maliban kung sinabi namin sa iyo. Papalitan o tatanggalin namin ito kapag nakita ka namin.

Paggaling

Karamihan sa mga tao ay napapansin na ang pangingilig sa kanilang kalingkingan at ring finger ay mabilis na nawawala pagkatapos ng operasyon. Marami ang nag-uulat na mas nakakatulog nang maayos sa loob ng ilang araw, dahil ang discomfort sa gabi ay maagang nababawasan. Kung malala ang iyong mga sintomas, ang pamamanhid o panghihina ay maaaring mas matagal bago mawala. Ang pakiramdam ay maaaring bumalik nang unti-unti, at maaaring tumagal ito ng mga linggo, buwan o mas matagal pa depende sa kung gaano katindi ang pagkakaipit ng nerve. Karamihan sa mga taong may malalang sintomas ay bumubuti pa rin, kahit na mabagal ang paggaling.

Ang iyong braso ay magkakaroon ng malambot na dressing, na pananatilihin namin sa loob ng humigit-kumulang 10 araw. Maaari mong igalaw ang iyong mga daliri, kamay at balikat hangga't komportable ka. Panatilihing tuyo ang sugat at sundin ang mga tagubilin sa pag-aalaga na ibibigay namin sa iyo bago ka umuwi. Ang hand therapy pagkatapos ng operasyon ay kasama si Ruby Doolan sa Extend Rehabilitation. Gagabayan ka ng iyong hand therapist sa iyong mga ehersisyo at gagawa ng splint para sa iyo kung kinakailangan. Ang banayad na paggalaw ay tumutulong sa pag-glide ng nerve at pinipigilan ang paninigas ng iyong siko.

Maaari mong gawin ang karamihan sa mga pang-araw-araw na gawain sa bahay sa sandaling komportable na itong gawin, gamit ang iyong kabilang braso kung kinakailangan. Kapag natanggal na ang dressing at humupa na ang sugat, maaari ka nang bumalik sa mga light activities. Karaniwan nang maaari kang magmaneho kapag natanggal na ang anumang splint at kaya mo nang hawakan ang manibela at mag-react nang mabilis nang walang sakit; tingnan ang aming pahina sa Driving after upper-limb surgery. Ang pagbabalik sa trabaho at sports ay depende sa kung ano ang kinapapalooban ng iyong trabaho at mga hobby, at ang talahanayan sa itaas ay nagbibigay ng mga tipikal na timeframe.

Ang paggaling ay nag-iiba sa bawat indibidwal. Maaaring magkaiba ang iyong timeline, at gagabayan ka namin sa prosesong ito.

Ano ang maaaring maging problema

Karamihan sa mga pasyente ay gumagaling nang maayos, ngunit paminsan-minsan ay maaaring magkaroon ng mga problema. Binabantayan kayo nang maigi ng inyong surgeon at ng team upang maagapan ang anumang isyu.

Minsan, ang mga orihinal na sintomas ay hindi nawawala, o bumabalik ang mga ito pagkatapos ng isang panahon ng ginhawa. Maaaring mapansin ninyong bumabalik ang pangingilig o pamamanhid sa inyong kalingkingan at ring finger, o ang pananakit sa panloob na bahagi ng inyong siko na hindi nawawala. Kung mangyari ito, banggitin ito sa inyong susunod na review. Posible ang karagdagang operasyon upang muling i-release ang nerve, at marami pa ring tao ang nakakaranas ng pagbuti mula rito, bagaman ang mga resulta ay hindi kasing-predictable ng unang operasyon.

Maaaring ma-infect ang sugat. Bantayan ang tumitinding sakit sa paligid ng hiwa, pamumula na kumakalat mula rito, pamamaga, o paglabas ng discharge. Kung mapansin ang alinman sa mga ito, makipag-ugnayan agad sa klinika. Ang mga impeksyon ay karaniwang ginagamot ng mga antibiotic at wound care, kaya mahalaga ang maagang review.

Ang isang maliit na nerve na dumadaan malapit sa panloob na siko ay maaaring mairita habang nag-o-operasyon. Maaari itong mag-iwan ng bahagi na manhid o isang sensitibong spot sa panloob na bahagi ng inyong forearm, o paminsan-minsan ay isang maliit at masakit na bukol kung saan ang nerve ay gumaling bilang scar tissue. Kung mapansin ang bagong pamamanhid o pagiging sensitibo sa bahaging iyon, banggitin ito sa inyong review appointment.

Ang ulnar nerve mismo ay maaaring maging unstable paminsan-minsan pagkatapos ng release, kung saan ito ay gumagalaw pabalik-balik sa bony bump habang ibinabaluktot ninyo ang inyong siko. Maaari ninyong maramdaman o makita ang isang flicking sa panloob na siko. Sabihin sa inyong surgeon kung mapansin ito.

Ang paninigarilyo ay maaaring makaapekto sa husay ng inyong paggaling, kaya mahalagang banggitin ito sa amin bago ang operasyon. Ang nakaraang fracture o dislocation ng parehong siko ay maaari ring magpataas ng posibilidad ng karagdagang operasyon, na tatalakayin namin kapag pinaplano na ang inyong operasyon.

Ang complications table sa pahinang ito ay naglilista ng mga tipikal na rate kung nais ninyo ang mga detalye.

Kailan dapat tumawag sa amin

Karamihan sa mga problema ay lumalabas nang maaga, at mas gusto naming malaman ang mga ito nang mas maaga kaysa huli na. Tumawag sa amin kung ikaw ay may lagnat, kung ang pamumula sa paligid ng sugat ay kumakalat, o kung may lumalabas na discharge mula rito. Tumawag din sa amin kung ang iyong sakit ay patuloy na lumalala sa halip na humupa, o kung may lumitaw na bagong pamamanhid sa iyong kamay. Pumunta sa emergency kung ikaw ay may pamamaga o sakit sa binti (calf), hirap sa paghinga, biglaang matinding sakit sa iyong braso, o kung hindi mo na maigalaw ang iyong braso.

Saan maaaring magbasa nang higit pa tungkol sa kondisyon

Ang pahinang ito ay tungkol sa operasyon mismo. Ang kondisyong ginagamot nito, kabilang ang kung ano ang ipinapakita ng ebidensya tungkol sa kung kailan nakatutulong ang operasyon at kung kailan hindi, ay tinalakay nang mas detalyado sa pahinang Cubital Tunnel Syndrome.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Anatomy & Pathophysiology

Epidemiology & Clinical Presentation

Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper extremity behind carpal tunnel syndrome [1].
The incidence of cubital tunnel syndrome is reported to be nearly 21 cases per 100,000 people per year [1].
The prevalence of cubital tunnel syndrome in the United States population is between 1.8% and 5.9% [9].
Pain is not a common symptom of cubital tunnel syndrome, but an aching pain localized to the elbow or proximal forearm may be reported [1].
Patients typically present with worsening sensory numbness of the hand and digits in an ulnar distribution [1].
Clinical progression may involve motor weakness of the hypothenar musculature and clawing of the hand due to loss of intrinsic musculature [1].
Dysesthesias in the small finger and ulnar side of the ring finger are exacerbated by prolonged elbow flexion [8].
Advanced clinical findings include intrinsic muscle weakness of the hand, hypothenar wasting, and resulting functional impairment [8].
Patients with cubital tunnel release often have a history of trauma to the anatomic site of the cubital tunnel [9].
Male gender is a risk factor for cubital tunnel syndrome [9].

Anatomical & Biomechanical Factors

The ulnar nerve’s posterior location and superficial course make it susceptible to irritation, compression, and traction with elbow motion [8].
Elbow flexion diminishes the volume of the cubital tunnel and elongates the nerve [8].
Both compression and nerve tension can contribute to cubital tunnel syndrome [8].
Ulnar nerve compression may stem from space-occupying lesions [8].
Compression may occur proximally at the ligament of Struthers (medial intermuscular septum) [8].
Compression may occur distally from fascial bands between the ulnar and humeral heads of the flexor carpi ulnaris [8].
Compression may occur about the roof of the cubital tunnel in patients with an anconeus epitrochlearis [8].
Subluxation or dislocation of the ulnar nerve during elbow flexion can be palpated and may be associated with increased symptoms [1].
Ulnar nerve mobility may be associated with dislocation of the medial head of the triceps [1].

Diagnostic Localization

The dorsal ulnar cutaneous nerve innervates the ulnar aspect of the dorsum of the hand and arises from the ulnar nerve approximately 6 cm proximal to the wrist [1].
Diminished sensation in the dorsal ulnar cutaneous nerve territory localizes the lesion proximal to this branch, likely within the cubital tunnel [1].
Preserved dorsal sensation may localize the lesion to Guyon canal in the wrist [1].
Ultrasonography sensitivity for diagnosing ulnar neuropathy at the elbow ranges from 46% to 100% [1].
Ultrasonography specificity for diagnosing ulnar neuropathy at the elbow ranges from 43% to 97% [1].
MRI sensitivity for diagnosing ulnar neuropathy at the elbow is as high as 95% [1].
MRI specificity for diagnosing ulnar neuropathy at the elbow is 80% [1].
MRI can demonstrate enlarged, T2-hyperintense nerve lesions proximal to a point of compression with distal muscle atrophy [1].
Ultrasonography can demonstrate hypoechoic, enlarged nerve fascicles [1].
Electrodiagnostic studies are critical in the differential diagnosis and localization of the level of compression [7].
If sensory loss far exceeds motor complaints, a sensory neuropathy should be considered [7].
If motor complaints exceed sensory complaints, compression in the Guyon canal should be considered, especially if proximal extrinsic hand muscles are normal and there is no thenar atrophy [7].
If there is additional thenar atrophy, radiculopathy or compression in the thoracic outlet should be considered [7].
If extrinsic motors are equally involved, brachial plexus neuritis or upper motor neuron disease may be considered if deep tendon reflexes are increased [7].

Clinical Presentation

Cubital tunnel syndrome is the second most common peripheral nerve entrapment disorder of the upper extremity after carpal tunnel syndrome [8].
Pain is not a common symptom of cubital tunnel syndrome, but an aching pain localized to the elbow or proximal forearm may be reported by patients [1].
Clinical manifestations include dysesthesias in the small finger and ulnar side of the ring finger exacerbated by prolonged elbow flexion [8].
Patients may report numbness and tingling in the ulnar one and one-half digits of the affected upper extremity [8].
Patients may report pain and numbness along the ulnar forearm and elbow [8].
The disease progresses to involve motor weakness of the hypothenar musculature [1].
Advanced findings include intrinsic muscle weakness of the hand, hypothenar wasting, and resulting functional impairment [8].
Later in the disease process, patients may complain of grip weakness and hand atrophy [8].
Clawing of the hand due to loss of intrinsic musculature is a typical presentation feature [1].
In mild-to-moderate cubital tunnel syndrome, patients are instructed to avoid prolonged elbow flexion for sleeping [9].
The severity of cubital tunnel syndrome is divided into three categories: mild dysfunction (intermittent paresthesias and subjective weakness), moderate dysfunction (intermittent paresthesias and measurable weakness), and severe dysfunction (persistent paresthesias and measurable weakness) [9].
A detailed ulnar nerve examination should assess the presence or absence of sensation in the distribution of the dorsal ulnar cutaneous nerve [1].
If sensation is diminished in the dorsal ulnar cutaneous nerve territory, the localization is proximal to this nerve and likely within the cubital tunnel [1].
With preserved dorsal sensation, the lesion may be localized to Guyon canal in the wrist [1].
Identification of dislocating structures is important as it may affect surgical decision making [1].
Many conditions can mimic cubital tunnel syndrome, including amyotrophic lateral sclerosis and Pancoast tumors [7].
If there is additional thenar atrophy, radiculopathy or rarely compression in the thoracic outlet with the very rare Gilliatt “true” neurogenic thoracic outlet syndrome should be considered [7].
If extrinsic motors are equally involved, brachial plexus neuritis can be considered or upper motor neuron disease if the deep tendon reflexes are increased [7].
Electrodiagnostic studies by an experienced examiner are critical in the differential diagnosis and localization of the level of compression [7].
EMG/NCS may be ordered to confirm the extent of compression as well as sites, including identifying additional sites of compression such as above the elbow in the cervical spine [8].
Electrophysiology is helpful to ensure proper diagnosis and targeted treatment [1].

Investigations

Diagnosis of cubital tunnel syndrome is made by clinical history and physical examination, with adjunct electrophysiology and imaging as needed [1].
Diminished sensation in the dorsal ulnar cutaneous nerve territory localizes the lesion proximal to this branch and likely within the cubital tunnel [1].
Ultrasonography demonstrates hypoechoic, enlarged nerve fascicles in ulnar neuropathy at the elbow [1].
Ultrasonography sensitivity for diagnosing ulnar neuropathy at the elbow is reported between 46% and 100% [1].
Ultrasonography specificity for diagnosing ulnar neuropathy at the elbow is reported between 43% and 97% [1].
MRI demonstrates enlarged, T2-hyperintense nerve lesions proximal to a point of compression with distal muscle atrophy in ulnar neuropathy at the elbow [1].
MRI and ultrasonography can be used to evaluate recurrent or persistent symptoms after surgery [1].

Treatment

Non-Operative Management

Conservative management for cubital tunnel syndrome includes activity modification, anti-inflammatory medications, and therapy [1].
Many cases of cubital tunnel syndrome require surgical intervention despite attempts at conservative management [1].

Surgical Techniques: In Situ Decompression

In situ decompression is a commonly utilized technique for ulnar nerve surgery within the cubital tunnel [1].
Techniques for in situ decompression vary, with some surgeons unroofing the cubital tunnel and others performing circumferential neurolysis from the distal third of the arm (arcade of Struthers) through the cubital tunnel to distal structures (Osborne fascia) [1].
The reported success rate for in situ decompression is 65.3% to 94.1% [1].
The complication rate for in situ decompression is reported to be 3% [1].
The rate of secondary surgery for in situ decompression is 2.5% [1].
In patients with ulnar neuropathy and no evidence of active subluxation, in situ decompression is feasible and cost-effective [1].
A recent trend favors performing in situ decompression rather than ulnar nerve transposition due to similar outcomes but higher complication and revision surgery rates associated with transposition [1].

Surgical Techniques: Anterior Transposition

Anterior transposition is a commonly utilized technique for ulnar nerve surgery within the cubital tunnel [1].
Anterior transposition can be performed subcutaneously, intramuscularly, or in a submuscular fashion [1].
The reported success rate for subcutaneous transposition is 77.7% to 94% [1].
Complication rates for anterior transposition are reported to be up to 14%, likely due to the more extensive dissection required [1].
The rate of secondary surgery for anterior transposition is 11.1% [1].
Anterior transposition involves more mobilization of the nerve and more extensive degrees of dissection of the soft tissues around the elbow compared to in situ decompression [1].
Anterior transposition should be considered in patients where ulnar nerve subluxation or dislocation is apparent and reproducible during elbow flexion on physical examination [1].
Structures that may tether the nerve distally after transposition include branches of the medial antebrachial cutaneous nerve, vascular branches from the ulnar artery, Osborne fascia, ulnar motor branches to the flexor carpi ulnaris, the distal intermuscular septum, the flexor-pronator muscle origin, and the investing fascia of the flexor digitorum superficialis overlying the ulnar nerve [1].

Surgical Techniques: Endoscopic Release

Endoscopic techniques are being increasingly utilized for cubital tunnel release [1].
Outcomes for endoscopic cubital tunnel release have been similar to in situ decompression for symptom relief and return to work [1].
Patients undergoing endoscopic cubital tunnel release report higher scar satisfaction compared to other techniques [1].
For endoscopic cubital tunnel release, the patient is placed supine with the shoulder abducted and externally rotated, and the arm on an arm table [4].
A tourniquet is placed high on the brachium to avoid interfering with the surgical release during endoscopic cubital tunnel release [4].
The incision for endoscopic cubital tunnel release is 2 cm long, made through the skin over the cubital tunnel just posterior to the medial epicondyle [4].
During endoscopic cubital tunnel release, the dissection is carried down to the medial epicondyle while protecting superficial nerves and avoiding violation of the deep fascia during initial exposure [4].
The ulnar nerve is identified by palpation directly posterior to the medial epicondyle, and an incision is made through the roof of the canal [4].
A spatula is used to open the space between the ulnar nerve and the roof of the canal (fascia) during endoscopic release [4].
A trocar/cannula is placed into the canal, with an attached retractor sliding on the external surface of the fascia to elevate superficial nerves [4].
The roof of the canal (fascia) is divided with a blade along the superior slot of the cannula during endoscopic release [4].

Surgical Techniques: Open Decompression with Epicondylectomy

An 8-cm skin incision is made along the course of the ulnar nerve centered over the posterior aspect of the medial epicondyle for open decompression with epicondylectomy [4].
The medial epicondyle is exposed subperiosteally, incising the common flexor-pronator origin while protecting the ulnar collateral ligament [4].
The entire medial epicondyle and a portion of the supracondylar ridge are removed with an osteotome or rongeur to release the insertion of the medial intermuscular septum [4].
The medial intermuscular septum is exposed and excised proximally to the insertion of the coracobrachialis muscle to release the arcade of Struthers [4].
A bone rasp is used to ensure that no bony ridges remain in the area of the osteotomy [4].
The periosteum is reattached to the common flexor-pronator tendon to separate the raw cancellous surface from the ulnar nerve [4].
The ulnar nerve is allowed to seek its own position adjacent to the medial humeral condyle after decompression [4].
Postoperative care involves protecting the wound in a soft bulky dressing and allowing early range of motion as tolerated [4].

Comparative Outcomes and Complications

A Cochrane review demonstrated no difference in symptom severity scores at 6 and 12 months follow-up between in situ decompression and anterior transposition techniques [1].
There was insufficient evidence in the Cochrane review to recommend a best treatment between in situ decompression and anterior transposition [1].
Complications from both in situ decompression and anterior transposition include ulnar instability, infection, and medial antebrachial cutaneous nerve injury [1].
Cohorts reporting success rates for in situ decompression and subcutaneous transposition are small and subject to significant publication bias [1].

Revision Surgery

Recurrent or persistent symptoms after cubital tunnel surgery can be difficult to treat [1].
In patients with recurrent symptoms, 77% can experience either motor and/or sensory improvement after revision cubital tunnel decompression [1].
23% of patients with recurrent symptoms achieve complete recovery from symptoms at final follow-up after revision cubital tunnel decompression [1].
Improvement in recurrent symptoms after revision surgery may be due to pain relief even when neurologic findings do not improve [1].

Complications

Complications from in situ decompression and anterior transposition include ulnar instability, infection, and medial antebrachial cutaneous nerve injury [1].
The reported complication rate for in situ decompression is 3% [1].
The reported complication rate for anterior transposition is up to 14% [1].
Higher complication rates for anterior transposition are likely due to the more extensive dissection required to complete the nerve transposition [1].
Rates of secondary surgery were higher in patients undergoing anterior transposition compared to in situ release (11.1% vs 2.5%) [1].
In patients with recurrent symptoms after surgery, 77% can experience either motor and/or sensory improvement after revision cubital tunnel decompression [1].
In patients with recurrent symptoms after surgery, 23% achieve complete recovery from symptoms at final follow-up after revision cubital tunnel decompression [1].

References

[1] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Neuropathies, Vascular Conditions: Buerger’s, Raynaud’s; Degenerative Conditions > Upper Extremity Neuropathies > Cubital Tunnel Syndrome.

[4] Campbell S Operative Orthopaedics 4 Volume Set. COMPRESSIVE NEUROPATHIES OF THE HAND, FOREARM, AND ELBOW > ENDOSCOPIC CUBITAL TUNNEL RELEASE.

[7] Green S Operative Hand Surgery. Median Nerve Compression at the Elbow and Forearm > Recurrent Cubital Tunnel Syndrome.

[8] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Elbow Degenerative Conditions and Nerve Disorders > Nerve Disorders > Cubital Tunnel Syndrome.

[9] Campbell S Operative Orthopaedics 4 Volume Set. COMPRESSIVE NEUROPATHIES OF THE HAND, FOREARM, AND ELBOW > CUBITAL TUNNEL SYNDROME AND TARDY ULNAR NERVE PALSY.