Risk factors for revision cubital tunnel surgery^✰

While surgical management of cubital tunnel syndrome (CuTS) results in the improvement of pain, paresthesia and restoration of motor function, there is a subset of patients who do not improve after primary surgery and require revision. The purpose of this study was to evaluate the incidence and risk factors for revision after primary CuTS. A retrospective review of patients who underwent revision CuTS after unsuccessful primary surgery from February 1989 to May 2009 was performed. Data regarding patients’ demographics, age at primary and revision surgeries, handedness, presenting symptoms and the duration, physical examination, McGowan grading, electrodiagnostic findings and final outcomes were collected. A total of 1239 patients undergoing 1279 cubital tunnel surgeries were identified; of which 17 patients who underwent 18 revision CuTS met our inclusion criteria. Forty-one randomly selected consecutive patients who underwent primary CuTS (control cohort) were compared to identify the risk factors associated with revision CuTS. Younger age at presentation, greater static 2-point discrimination (S2PD) and a history of diabetes were associated with a greater number of revision surgeries. Patients requiring revision for primary CuTS were 8.4 years on average younger, had greater S2PD and were more likely to have diabetes. Pain as a presenting symptom compared to weakness and numbness was also a more common complaint in this cohort of patients. Future larger multicenter prospective studies are recommended.