Revision Surgery for the Ulnar Nerve at the Elbow

  • Erica J. Gauger
  • Erich M. Gauger
  • Deana MercerEmail author


Cubital tunnel syndrome is the second most common compressive neuropathy of the upper extremity. The literature reports a general success rate of primary surgery to be around 90%. Failure can be in two forms: incomplete release resulting in failure to improve and recurrent symptoms after an initial period of symptom improvement. If revision surgery is undertaken, the entire nerve should be explored and transposed anterior to the medial epicondyle. External neurolysis should be performed if significant perineural fibrosis exists, and the triceps should be addressed if the medial head is snapping over the medial epicondyle. In the setting of perineural fibrosis, consideration should be given to nerve wrap with synthetic material or autologous vein.


Ulnar nerve Recurrence Cubital tunnel Transposition Triceps 



Conflicts of Interest: No author has any relevant financial or personal conflicts of interest to disclose.

Copyright: No copyright permissions needed.

Supplementary material

Video 101.1

Snapping medial triceps. Visible snap at the medial epicondyle when the elbow is brought into approximately 120° of flexion. The patient has had prior ulnar nerve decompression (MOV 21280 kb)

Video 101.2

Intraoperative demonstration of snapping medial head of the triceps after prior ulnar nerve decompression (MOV 21658 kb)

Video 101.3

A second patient. Intraoperative video demonstrates the ulnar nerve dislocated anterior to the medial epicondyle with a second snap as the medial head of the triceps dislocates anterior to the medial epicondyle as well (WMV 34064 kb)


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Copyright information

© ISAKOS 2020

Authors and Affiliations

  • Erica J. Gauger
    • 1
  • Erich M. Gauger
    • 2
  • Deana Mercer
    • 1
    Email author
  1. 1.Department of Orthopaedics and RehabilitationUniversity of New MexicoAlbuquerqueUSA
  2. 2.United States Air Force Academy, 10th Medical GroupDenverUSA

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