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. 2023 Mar 28;5(4):503-509.
doi: 10.1016/j.jhsg.2023.03.002. eCollection 2023 Jul.

Recalcitrant Neuropathies in the Upper Extremity

Hannah C Langdell  1 , Steven L Zeng  1 , Tyler S Pidgeon  2 , Suhail K Mithani  1
Affiliations

Recalcitrant Neuropathies in the Upper Extremity

Hannah C Langdell et al. J Hand Surg Glob Online. .

Abstract

Carpal and cubital tunnel syndrome can cause debilitating pain and weakness in the hand and upper extremities. Although most patients have a resolution of their symptoms after primary decompression, managing those with recalcitrant neuropathies is challenging. The etiology of persistent, recurrent, or new symptoms is not always clear and requires careful attention to the history and physical examination to confirm the diagnosis or consider other causes prior to committing to surgery. Nevertheless, revision surgery is often needed in the setting of recalcitrant neuropathies in order to improve patients' symptoms. Revision surgery typically entails wide exposure and neurolysis to release residual compression. In addition, vascularized tissue and nerve wraps have been routinely used to create a favorable perineural environment that decreases recurrent scar formation. This review discusses the etiologies of recalcitrant upper extremity neuropathies, the current treatment options, and surgical outcomes.

Keywords: Carpal tunnel syndrome; Cubital tunnel syndrome; Hypothenar fat pad flap; Recurrent neuropathies.

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Figures

Figure 1
Figure 1
A Revision decompression of the median nerve (∗). B Elevation of a hypothenar fat pad flap for recalcitrant carpal tunnel syndrome. C Transposition of a hypothenar fat pad flap, so the median nerve is completely covered.
Figure 2
Figure 2
A Anterior subcutaneous transposition of the ulnar nerve after decompression. B A 10 mm x 40 mm Axogen nerve protector is loosely wrapped around the nerve at the level of the medial epicondyle. The nerve wrap is then sutured to the flexor-pronator mass, and stable anterior transposition is ensured through a full range of motion.
Figure 3
Figure 3
A Elevation of an adipofascial flap for recalcitrant cubital tunnel syndrome. Courtesy of Dr Marc Richard. B Inset of an adipofascial flap posterior to the ulnar nerve. Courtesy of Dr Marc Richard.
See this image and copyright information in PMC

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