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Concomitant Endoscopic Carpal and Cubital Tunnel Release: Safety and Efficacy
Danielle Cross, MD; Kristofer Matullo , MD

Orthopaedic Surgery, St. Luke's Hospital and Health Network, Bethlehem , PA

Background: When performed alone, endoscopic carpal tunnel release and endoscopic cubital tunnel release are effective surgical options for the treatment of carpal and cubital tunnel syndromes, respectively. However, there is currently no literature that describes the performance of both procedures concomitantly. We describe the results of seventeen cases in which dual endoscopic carpal and cubital tunnel releases were performed for the treatment of concurrent carpal and cubital tunnel syndromes.

Methods: A retrospective review of all patients in a single surgeon practice that presented with concomitant ipsilateral carpal and cubital tunnel syndrome was performed. Nineteen patients had undergone concomitant ipsilateral endoscopic carpal and cubital tunnel release after failing conservative treatment within an 8 month period. Pre and post operative data were collected, and included subjective numbness, subjective pain, pre-operative EMGs, Quick-DASH, static 2-point discrimination, grip strength, chuck pinch strength, key pinch strength, and manual muscle testing of the abductor pollicis brevis (APB).

Results: 15 male and 4 female patients underwent dual endoscopic cubital and carpal tunnel release. Two patients were eliminated from analysis, as they were lost to follow up. Pre and post-op comparisons were completed for median DASH scores, grip strength, chuck pinch strength, and key pinch strengths at baseline and at 12 weeks. DASH scores improved from a median of 67.5 to 16 (p= 0.001), grip strengths improved from 42 pounds to 55.0 pounds (p= 0.30), chuck pinch strength improved from 11 to 15.5 pounds (p=0.02) and key pinch strengths increased from 13 to 18 pounds (p= 0.003). Average static 2-point discrimination decreased from 5.9mm to 4.8mm. 83% of patients had complete resolution of pain, and the remaining 17% experienced pain only with strenuous activity. 53% of patients had complete resolution of tingling symptoms, 24% had significant improvement, and 13% had residual ulnar tingling. APB strength is available for 12 of the 17 patients, and 92% of patients had improvement to 5/5 strength post-operatively.

Conclusions: Dual endoscopic carpal and cubital tunnel release is a safe and effective treatment option for patients who present with concurrent carpal and cubital tunnel syndromes recalcitrant to non-surgical management. Post-operative results and complications are comparable to endoscopic carpal and cubital tunnel releases performed alone. LEVEL: III
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