title: Recurrent cubital tunnel syndrome treated with revision neurolysis and amniotic membrane nerve wrapping.
abstract: BACKGROUND
  Perineural scarring of the ulnar nerve is a predominant cause of symptom recurrence after surgical treatment for primary cubital tunnel syndrome (CuTS). We report our preliminary experience in revision ulnar nerve decompression and nerve wrapping with an amniotic membrane allograft adhesion barrier for treatment of recurrent CuTS.
  
  
  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 elbow motion, grip and pinch strengths, pain level on the visual analog scale level, and the 11-item version of the Disabilities of the Arm, Shoulder and Hand functional outcome score were compared with postoperative values using paired t testing. Symptom characteristics, physical examination findings, complications, and level of satisfaction were also obtained.
  
  
  RESULTS
  Eight patients (mean age, 47.5 years) who had undergone at least 2 prior ulnar nerve operations satisfied study inclusion. At mean postoperative follow-up of 30 months, significant improvements were noted across all patients in visual analog scale pain levels (-3.5 vs. preoperatively; P < .0001), 11-item version of the Disabilities of the Arm, Shoulder and Hand scores (-30 vs. preoperatively; P < .0001), and grip strength (+25 pounds vs. preoperatively; P < .0001). Pinch strength and elbow motion were also significantly improved for those patients with comparative preoperative data available. All patients expressed subjective satisfaction with their results. No adverse reactions or complications occurred in any patients.
  
  
  CONCLUSIONS
  Ulnar nerve wrapping with amniotic membrane allograft, when combined with revision neurolysis, was a safe and subjectively effective treatment for patients with debilitating recurrent CuTS.
authors.affiliation: Department of Orthopaedic Surgery, The Philadelphia Hand Center, P.C., Thomas Jefferson University, Philadelphia, PA, USA. Electronic address: michaelpgaspar@gmail.com.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Gaspar
authors.affiliation: Department of Orthopaedic Surgery, The Philadelphia Hand Center, P.C., Thomas Jefferson University, Philadelphia, PA, USA; Department of Orthopaedic Surgery and Sports Medicine, Temple University Health System, Philadelphia, PA, USA.
authors.forename: Hesham M
authors.initials: HM
authors.lastname: Abdelfattah
authors.affiliation: Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Ian W
authors.initials: IW
authors.lastname: Welch
authors.affiliation: Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Vosbikian
authors.affiliation: Department of Orthopaedic Surgery, The Philadelphia Hand Center, P.C., Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Kane
authors.affiliation: Department of Orthopaedic Surgery, The Philadelphia Hand Center, P.C., Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Rekant
mesh_terms: D000328:Adult; D064591:Allografts; D000650:Amnion / Q000637:transplantation*; D020430:Cubital Tunnel Syndrome / Q000601:surgery*; D019299:Decompression, Surgical; D004185:Disability Evaluation; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012008:Recurrence; D012189:Retrospective Studies; D062707:Return to Work; D014459:Ulnar Nerve / Q000601:surgery*; D064232:Visual Analog Scale
keywords: Adhesion barrier; CuTS; amniotic membrane allograft; compression neuropathy; nerve wrapping; recurrent cubital tunnel syndrome; revision peripheral neurolysis; ulnar nerve entrapment