Abstract
Background:Resolution of symptoms including pain, numbness, and tingling outside of the median nerve distribution has been shown to occur following carpal tunnel release. We hypothesized that a similar effect would be found after combined release of the ulnar nerve at the elbow with simultaneous release of the median nerve at the carpal tunnel. Methods:20 patients with combined cubital and carpal tunnel syndrome were prospectively enrolled. The upper extremity was divided into six zones and the location of pain, numbness, tingling, or strange sensations was recorded pre-operatively. Two-point discrimination, Semmes-Weinstein monofilament testing, and validated questionnaires were collected pre-operatively and at six-week follow-up.Results:Probability of resolution was greater in the median nerve distribution than the ulnar nerve for numbness (71% vs. 43%), tingling (86% vs. 75%). Seventy percent of the cohort reported at least one extra-anatomic symptom pre-operatively, and greater than 80% of these resolved at early follow-up. There was a decrease in pain as measured by validated questionnaires.Conclusion:This study documents resolution of symptoms in both extra-ulnar and extra-median distributions after combined cubital and carpal tunnel release. Pre-operative patient counseling may therefore include the likelihood of symptomatic improvement in a non-expected nerve distribution after this procedure, assuming no other concomitant pathology which may cause persistent symptoms. Future studies could be directed at correlating pre-operative disease severity with probability of symptom resolution using a larger population.
Highlights
The prevalence of carpal tunnel syndrome (CTS) has been reported to be between 3 and 5% and is the most common compression neuropathy of the upper extremity [1]
Patients were considered eligible for the study if they met the following inclusion criteria: age greater than 18, clinical history and physical examination consistent with the diagnosis of combined cubital and carpal tunnel syndromes, EDX demonstrating slowing of ulnar nerve conduction across the elbow as well as median nerve conduction across the wrist
Exclusion criteria included any evidence of cervical radiculopathy, diabetes mellitus, diffuse polyneuropathy present on the EDX studies, or history of any prior surgical intervention for cubital or carpal tunnel syndrome at the medial elbow or wrist
Summary
The prevalence of carpal tunnel syndrome (CTS) has been reported to be between 3 and 5% and is the most common compression neuropathy of the upper extremity [1]. Cubital tunnel syndrome (CuTS) is quite common and represents the second most common cause of peripheral nerve compression [2]. The incidence of patients presenting with ipsilateral combined carpal and cubital tunnel syndrome is not known; it is the author’s experience that the two diagnoses may frequently occur together. Compression of the ulnar nerve at the level of the elbow may result in parasthesias or numbness in the small finger and pain throughout the medial forearm from elbow to small finger [4, 7]. Many patients with CuTS report symptoms outside of the expected ulnar nerve distribution. Resolution of symptoms including pain, numbness, and tingling outside of the median nerve distribution has been shown to occur following carpal tunnel release. We hypothesized that a similar effect would be found after combined release of the ulnar nerve at the elbow with simultaneous release of the median nerve at the carpal tunnel
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