Patients were enrolled in clinic at their pre-operative visit. Indication for surgical intervention included failure of non-operative treatment with persistent symptoms. EDX studies consisting of nerve conduction and electromyographic components were routinely obtained to confirm the diagnosis and exclude co-existing pathology at other sites of potential compression including cervical nerve root or brachial plexus. Although the literature does not support one single physical exam test as perfectly sensitive or specific for the diagnosis of carpal tunnel syndrome, we chose to use the carpal tunnel compression test as a means of standardizing our inclusion criteria. A positive examination for all maneuvers was required for inclusion in this study. Patients also demonstrated a positive carpal tunnel compression test. Physical exam revealed positive Tinel’s sign over the cubital tunnel and reproduction of cubital tunnel symptoms with elbow flexion. Clinical diagnosis was made based on a history of numbness and/or parasthesias in the small finger exacerbated with prolonged elbow flexion in addition to numbness and/or parasthesias in the radial three fingers. 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. All EDX were performed by one electrophysiologist under standardized conditions. 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. Institutional review board approval for this study was obtained prior to study initiation. This study was designed to provide prognostic information to improve the quality of pre-operative guidance for patients with combined cubital and carpal tunnel syndrome. Based on this data, we sought to investigate whether that a similar phenomenon would be found among patients undergoing combined ipsilateral concurrent cubital and carpal tunnel release.
They found a greater than ninety percent likelihood of symptom resolution outside of the median nerve distribution. In 2009, Elfar and colleagues reported a prospective study in which the distribution of subjective complaints of patients undergoing carpal tunnel release was examined at early follow-up. Improvement in subjective symptom reports both within and outside of the typical median nerve distribution after carpal tunnel release has been shown previously. However, many patients with CuTS also report symptoms outside of the expected ulnar nerve distribution. 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. Median nerve compression at the wrist typically produces numbness or parasthesias in the thumb, index, and middle finger but can also cause pain in the radial three fingers or hand. The diagnosis of either CuTS or CTS is made by a combination of clinical assessment with adjunctive electrodiagnostic studies (EDX). The incidence of patients presenting with ipsilateral combined carpal and cubital tunnel syndrome is not known however, it is the author’s experience that the two diagnoses may frequently occur together. Cubital tunnel syndrome (CuTS) is also quite common and represents the second most common cause of peripheral nerve compression. 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.
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