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Severe Recurrent Cubital Tunnel Syndrome Treated With Revision Neurolysis And Amniotic Membrane Nerve Wrapping
Michael P. Gaspar, MD1; Patrick M. Kane, MD1; Michael M. Vosbikian, MD2; Hesham Abdelfattah, MD1; Mark S. Rekant, MD1
1Philadelphia Hand Center of Thomas Jefferson University, Philadelphia, PA, 2Beth Israel Deaconess Medical Center of Harvard University, Boston, MA
Introduction: Perineural scarring of the ulnar nerve is a predominant cause of symptom recurrence following surgical treatment for primary cubital tunnel syndrome (CuTS). We report our preliminary experience with revision ulnar nerve decompression and nerve wrapping using an amniotic membrane allograft adhesion barrier.
Methods: We performed a retrospective review with prospective follow-up of patients with recurrent CuTS who were treated with revision neurolysis with amniotic membrane nerve wrapping. Preoperative grip strength, Visual Analog Scale (VAS) rated pain level, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) functional outcome score were compared to postoperative values using paired t-testing. Changes in symptom characteristics and physical exam findings over the course of treatment, incidence of complications, and level of satisfaction, were also obtained.
Results: Eight patients (mean age, 47.5 years) satisfied study inclusion. All 8 patients had undergone at least two prior ulnar nerve surgeries before revision neurolysis with amnion placement. At a mean follow-up interval of 30 months after surgery, significant improvements were noted in VAS pain levels (-3.5 vs. preoperatively; P < 0.0001), QuickDASH scores (-30 vs. preoperatively; P < 0.0001), and grip strength (+25 pounds vs. preoperatively; P < 0.0001) All patients expressed some degree of subjective satisfaction with their results. Importantly, no adverse reactions or complications occurred in any patients.
Conclusions: Ulnar nerve wrapping with an amniotic membrane adhesion barrier in conjunction with revision neurolysis, is a safe and effective treatment option for patients with severe and debilitating recurrent cubital tunnel syndrome.
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