Cubital tunnel surgery. Complications and treatment of failures.

Cubital tunnel surgery should be considered a failure if patients have no relief of their symptoms of if the symptoms recur shortly after the surgery. Choice of treatment should be based on careful examination and evaluation of patient expectations, general medical condition, level of activity, and duration and severity of symptoms. Failure of the initial procedure may be the result of inadequate release, instability, subluxation, inadvertent creation of a new site of compression, and intraoperative nerve injury. Certain clinical manifestations specify the cause for failure. A positive Tinel's sign, for example, may indicate the exact location of persistent nerve compression. A palpable mobile mass on the medial aspect of the elbow is consistent with recurrent subluxation. Localized point tenderness along the course of the incision may indicate a neuroma secondary to injury to the medial antebrachial cutaneous nerve. In all cases, it is imperative that the surgeon be familiar with all the possible anatomic sources of compression as well as the variations in the ulnar nerve and the medial antebrachial cutaneous nerve. Once operative failure has been determined, efforts should be directed at completely releasing the nerve through external neurolysis, eliminating any mechanical stretch, and releasing any sites of compression or kinking. Some improvement should be expected if the surgeon thoroughly understands the anatomy, chooses the appropriate revision technique based on patient history, and adheres to the technical details of the chosen revision technique.