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Setting Expectations Following Endoscopic Cubital Tunnel Release
Tyson K. Cobb, MD1; Anna L. Walden, DC2; Jon H. Lemke, PhD3
1Director of Hand Surgery, Orthopaedic Specialists, PC, Davenport, IA; 2Clinical Research, Palmer Center for Chiropractic Research, Davenport, IA;3Biostatistics, Genesis Medical Center, Davenport, IA

Introduction: The purposes of this study were: 1) to report outcomes of a large series of patients undergoing endoscopic cubital tunnel release (ECuTR) to establish expectations for return to activity, patient satisfaction and resolution rates of common preoperative complaints and findings, and 2) to compare return-to-work times to a cohort of patients undergoing anterior transposition of the ulnar nerve (ATUN).

Materials & Methods: IRB approval and consents were obtained. Cases undergoing ECuTR were prospectively enrolled (n=190). Eighteen without positive electrophysiological testing were excluded, leaving 172 cases in 148 patients. There were 56 females and 92 males. Mean follow-up was 30 months. Kaplan-Meier analyses were used to assess return to activity without minimum follow-up criteria. Subjective and objective data assessed pre- and postoperatively are displayed in Table 1. A cohort of ATUN patients (10 females, 5 males) was reviewed for comparison to ECuTR return-to-work times. Other statistical analyses included multiple logistic regression, exact permutation, and Fisher's exact tests.

Results: Half of ECuTR patients returned to normal work within 8 days postoperatively versus 71 days following ATUN (p<0.001) (Figure 1). Variables significantly negatively affecting return to work were male sex (p=0.006), manual labor (p< 0.001), and worker's compensation (p<0.001). Preoperative Dellon's Classes 1, 2, and 3 were completely satisfied postoperatively in 95%, 72%, and 61% of cases respectively. Of all the preoperative variables, Dellon's best predicted postoperative satisfaction (p=0.012). Postoperative Bishop's rating was 76% excellent, 19% good and 5% fair. Preoperative ulnar nerve subluxation prevalence was higher in females (17%) versus males (6%) (p=0.018) but had no effect on resolution of pain (p=0.69), numbness and tingling (p=0.53) or satisfaction (p=0.37). Preoperative pain resolved in a higher percentage of men (94%) compared to women (68%) (p=0.002). There were 4 failures.

Conclusions: Half of ECuTR patients were back to regular duty within 8 days versus 71 days for ATUN patients. Male sex, manual labor and worker's compensation were negative predictors of return to work. Females were less likely to have resolution of preoperative pain. Preoperative Dellon's score was the best predictor of satisfaction. Preoperative ulnar nerve subluxation did not affect postoperative outcomes following ECuTR.

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