From the Denver Health Medical Center, Denver, CO (Lauder), the University of Colorado School of Medicine, Aurora, CO (Lauder, Bolson, Leversedge), the TriHealth Hand Surgery Specialists, Cincinnati, OH (Chen), and the Rocky Mountain Regional VA Medical Center, Aurora, CO (Bolson).
J Am Acad Orthop Surg. 2021 Aug 1;29(15):635-647. doi: 10.5435/JAAOS-D-20-01381.
Cubital tunnel syndrome is a common upper extremity compressive neuropathy. Recalcitrant cubital tunnel syndrome poses diagnostic and treatment challenges. Potential etiologies of persistent or recurrent symptoms after surgical treatment include an inaccurate preoperative diagnosis, incomplete nerve decompression, iatrogenic injury, postsurgical perineural adhesions, irreversible nerve pathology, or conditions associated with secondary nerve compression. Confirmation of recalcitrant ulnar nerve pathology relies on a thorough history to consider symptoms and chronology, careful examination to quantify nerve function and to assess for focal nerve provocation, and objective testing to highlight a possible nerve lesion such as ultrasonography and electrodiagnostic testing. Conservative treatment may provide symptomatic relief; however, surgical management such as revision neuroplasty, neurolysis, nerve reconstruction, and/or anterior transposition may be indicated. Optimizing the biology of the local nerve environment is critical. No surgical treatment procedure has shown superiority over another; however, individualized treatment is emphasized to improve symptoms and maximize nerve recovery potential.
肘管综合征是一种常见的上肢压迫性神经病。顽固性肘管综合征在诊断和治疗方面具有挑战性。手术治疗后持续性或复发性症状的潜在病因包括术前诊断不准确、神经减压不彻底、医源性损伤、术后神经周围粘连、不可逆的神经病变或与继发性神经压迫相关的疾病。顽固性尺神经病变的确切诊断依赖于全面的病史，以考虑症状和病程，仔细的检查以量化神经功能和评估局灶性神经激发，以及客观的检查以突出可能的神经病变，如超声和电诊断检查。保守治疗可能会缓解症状；然而，可能需要手术治疗，如修正性神经成形术、神经松解术、神经重建术和/或前移位术。优化局部神经环境的生物学特性至关重要。没有一种手术治疗方法优于另一种；然而，强调个体化治疗以改善症状并最大限度地恢复神经功能。
