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Published in: HAND 2/2015

01-06-2015 | Surgery Articles

Prospective cohort study of symptom resolution outside of the ulnar nerve distribution following cubital tunnel release

Authors: Peter C. Chimenti, Allison W. McIntyre, Sean M. Childs, Warren C. Hammert, John C. Elfar

Published in: HAND | Issue 2/2015

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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 release of the ulnar nerve at the elbow.

Methods

Twenty patients with isolated cubital 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. The same data were collected at 6-week follow-up. Paired t tests or non-parametric Wilcoxon Signed-Rank tests were used where appropriate to examine for significant (p ≤ 0.05) changes between pre- and post-operative scores.

Results

Probability of resolution was greater outside of the ulnar nerve distribution than within at early follow-up. There was a decrease in pain, numbness, and tingling symptoms both within and outside the ulnar distribution after cubital tunnel release. There was a decrease in pain as measured by several validated questionnaires.

Conclusion

This study documents resolution of symptoms in an extra-ulnar distribution after cubital tunnel release. Improvement in pain and function after cubital tunnel release may be associated with an improvement in symptoms both within and outside the ulnar nerve distribution. Future studies could be directed at correlating pre-operative disease severity with probability of extra-territorial symptom resolution using a larger sample population.
Literature
1.
go back to reference Ablove RH, Moy OJ, Peimer CA, et al. Pressure changes in Guyon's canal after carpal tunnel release. J Hand Surg [Am]. 1996;21(5):664–5.CrossRef Ablove RH, Moy OJ, Peimer CA, et al. Pressure changes in Guyon's canal after carpal tunnel release. J Hand Surg [Am]. 1996;21(5):664–5.CrossRef
2.
go back to reference Caliandro P, La Torre G, Padua R, et al. Treatment for ulnar neuropathy at the elbow. Cochrane Database syst Rev (Online). 2012;7, CD006839. Caliandro P, La Torre G, Padua R, et al. Treatment for ulnar neuropathy at the elbow. Cochrane Database syst Rev (Online). 2012;7, CD006839.
3.
go back to reference Chimenti PC, Hammert WC. Ulnar neuropathy at the elbow: an evidence-based algorithm. Hand Clin. 2013;29(3):435–42.CrossRefPubMed Chimenti PC, Hammert WC. Ulnar neuropathy at the elbow: an evidence-based algorithm. Hand Clin. 2013;29(3):435–42.CrossRefPubMed
4.
go back to reference Chung KC, Pillsbury MS, Walters MR, et al. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg [Am]. 1998;23(4):575–87.CrossRef Chung KC, Pillsbury MS, Walters MR, et al. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg [Am]. 1998;23(4):575–87.CrossRef
5.
go back to reference Elfar JC, Calfee RP, Stern PJ. Topographical assessment of symptom resolution following open carpal tunnel release. J Hand Surg [Am]. 2009;34(7):1188–92.CrossRef Elfar JC, Calfee RP, Stern PJ. Topographical assessment of symptom resolution following open carpal tunnel release. J Hand Surg [Am]. 2009;34(7):1188–92.CrossRef
6.
go back to reference Elhassan B, Steinmann SP. Entrapment neuropathy of the ulnar nerve. J Am Acad Orthop Surg. 2007;15(11):672–81.PubMed Elhassan B, Steinmann SP. Entrapment neuropathy of the ulnar nerve. J Am Acad Orthop Surg. 2007;15(11):672–81.PubMed
7.
go back to reference Giladi AM, Gaston RG, Haase SC, et al. Trend of recovery after simple decompression for treatment of ulnar neuropathy at the elbow. Plast Reconstr Surg. 2013;131(4):563e–73e.CrossRefPubMed Giladi AM, Gaston RG, Haase SC, et al. Trend of recovery after simple decompression for treatment of ulnar neuropathy at the elbow. Plast Reconstr Surg. 2013;131(4):563e–73e.CrossRefPubMed
8.
go back to reference Ginanneschi F, Milani P, Mondelli M, et al. Ulnar sensory nerve impairment at the wrist in carpal tunnel syndrome. Muscle Nerve. 2008;37(2):183–9.CrossRefPubMed Ginanneschi F, Milani P, Mondelli M, et al. Ulnar sensory nerve impairment at the wrist in carpal tunnel syndrome. Muscle Nerve. 2008;37(2):183–9.CrossRefPubMed
9.
go back to reference Greenwald D, Blum 3rd LC, Adams D, et al. Effective surgical treatment of cubital tunnel syndrome based on provocative clinical testing without electrodiagnostics. Plast Reconstr Surg. 2006;117(5):87e–91e.CrossRefPubMed Greenwald D, Blum 3rd LC, Adams D, et al. Effective surgical treatment of cubital tunnel syndrome based on provocative clinical testing without electrodiagnostics. Plast Reconstr Surg. 2006;117(5):87e–91e.CrossRefPubMed
10.
go back to reference Huang JH, Samadani U, Zager EL. Ulnar nerve entrapment neuropathy at the elbow: simple decompression. Neurosurgery. 2004;55(5):1150–3.CrossRefPubMed Huang JH, Samadani U, Zager EL. Ulnar nerve entrapment neuropathy at the elbow: simple decompression. Neurosurgery. 2004;55(5):1150–3.CrossRefPubMed
11.
go back to reference Levine DW, Simmons BP, Koris MJ, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75(11):1585–92.PubMed Levine DW, Simmons BP, Koris MJ, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75(11):1585–92.PubMed
12.
go back to reference Malan TP, Ossipov MH, Gardell LR, et al. Extraterritorial neuropathic pain correlates with multisegmental elevation of spinal dynorphin in nerve-injured rats. Pain. 2000;86(1–2):185–94.CrossRefPubMed Malan TP, Ossipov MH, Gardell LR, et al. Extraterritorial neuropathic pain correlates with multisegmental elevation of spinal dynorphin in nerve-injured rats. Pain. 2000;86(1–2):185–94.CrossRefPubMed
13.
go back to reference Palmer BA, Hughes TB. Cubital tunnel syndrome. J Hand Surg [Am]. 2010;35(1):153–63.CrossRef Palmer BA, Hughes TB. Cubital tunnel syndrome. J Hand Surg [Am]. 2010;35(1):153–63.CrossRef
14.
go back to reference Richman JA, Gelberman RH, Rydevik BL, et al. Carpal tunnel syndrome: morphologic changes after release of the transverse carpal ligament. J Hand Surg [Am]. 1989;14(5):852–7.CrossRef Richman JA, Gelberman RH, Rydevik BL, et al. Carpal tunnel syndrome: morphologic changes after release of the transverse carpal ligament. J Hand Surg [Am]. 1989;14(5):852–7.CrossRef
15.
go back to reference Song JW, Waljee JF, Burns PB, et al. An outcome study for ulnar neuropathy at the elbow: a multicenter study by the surgery for ulnar nerve (SUN) study group. Neurosurgery. 2013;72(6):971–81. discussion 981–972; quiz 982.CrossRefPubMed Song JW, Waljee JF, Burns PB, et al. An outcome study for ulnar neuropathy at the elbow: a multicenter study by the surgery for ulnar nerve (SUN) study group. Neurosurgery. 2013;72(6):971–81. discussion 981–972; quiz 982.CrossRefPubMed
16.
go back to reference Tamburin S, Cacciatori C, Praitano ML, et al. Ulnar nerve impairment at the wrist does not contribute to extramedian sensory symptoms in carpal tunnel syndrome. Clin Neurophysiol. 2009;120(9):1687–92.CrossRefPubMed Tamburin S, Cacciatori C, Praitano ML, et al. Ulnar nerve impairment at the wrist does not contribute to extramedian sensory symptoms in carpal tunnel syndrome. Clin Neurophysiol. 2009;120(9):1687–92.CrossRefPubMed
17.
go back to reference Tecchio F, Padua L, Aprile I, et al. Carpal tunnel syndrome modifies sensory hand cortical somatotopy: a MEG study. Hum Brain Mapp. 2002;17(1):28–36.CrossRefPubMed Tecchio F, Padua L, Aprile I, et al. Carpal tunnel syndrome modifies sensory hand cortical somatotopy: a MEG study. Hum Brain Mapp. 2002;17(1):28–36.CrossRefPubMed
18.
go back to reference Tomaino MM, Brach PJ, Vansickle DP. The rationale for and efficacy of surgical intervention for electrodiagnostic-negative cubital tunnel syndrome. J Hand Surg [Am]. 2001;26(6):1077–81.CrossRef Tomaino MM, Brach PJ, Vansickle DP. The rationale for and efficacy of surgical intervention for electrodiagnostic-negative cubital tunnel syndrome. J Hand Surg [Am]. 2001;26(6):1077–81.CrossRef
19.
go back to reference Watts AC, Bain GI. Patient-rated outcome of ulnar nerve decompression: a comparison of endoscopic and open in situ decompression. J Hand Surg [Am]. 2009;34(8):1492–8.CrossRef Watts AC, Bain GI. Patient-rated outcome of ulnar nerve decompression: a comparison of endoscopic and open in situ decompression. J Hand Surg [Am]. 2009;34(8):1492–8.CrossRef
20.
go back to reference Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798–804.CrossRefPubMed Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798–804.CrossRefPubMed
21.
go back to reference Witt JC, Hentz JG, Stevens JC. Carpal tunnel syndrome with normal nerve conduction studies. Muscle Nerve. 2004;29(4):515–22.CrossRefPubMed Witt JC, Hentz JG, Stevens JC. Carpal tunnel syndrome with normal nerve conduction studies. Muscle Nerve. 2004;29(4):515–22.CrossRefPubMed
22.
go back to reference Zanette G, Cacciatori C, Tamburin S. Central sensitization in carpal tunnel syndrome with extraterritorial spread of sensory symptoms. Pain. 2010;148(2):227–36.CrossRefPubMed Zanette G, Cacciatori C, Tamburin S. Central sensitization in carpal tunnel syndrome with extraterritorial spread of sensory symptoms. Pain. 2010;148(2):227–36.CrossRefPubMed
23.
go back to reference Zanette G, Marani S, Tamburin S. Extra-median spread of sensory symptoms in carpal tunnel syndrome suggests the presence of pain-related mechanisms. Pain. 2006;122(3):264–70.CrossRefPubMed Zanette G, Marani S, Tamburin S. Extra-median spread of sensory symptoms in carpal tunnel syndrome suggests the presence of pain-related mechanisms. Pain. 2006;122(3):264–70.CrossRefPubMed
24.
go back to reference Zlowodzki M, Chan S, Bhandari M, et al. Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome. A meta-analysis of randomized, controlled trials. J Bone Joint Surg. 2007;89(12):2591–8.CrossRefPubMed Zlowodzki M, Chan S, Bhandari M, et al. Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome. A meta-analysis of randomized, controlled trials. J Bone Joint Surg. 2007;89(12):2591–8.CrossRefPubMed
Metadata
Title
Prospective cohort study of symptom resolution outside of the ulnar nerve distribution following cubital tunnel release
Authors
Peter C. Chimenti
Allison W. McIntyre
Sean M. Childs
Warren C. Hammert
John C. Elfar
Publication date
01-06-2015
Publisher
Springer US
Published in
HAND / Issue 2/2015
Print ISSN: 1558-9447
Electronic ISSN: 1558-9455
DOI
https://doi.org/10.1007/s11552-014-9688-9

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