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Prospective Cohort Study of Symptom Resolution Outside of the Ulnar Nerve Distribution Following Cubital Tunnel Release
Peter C. Chimenti, MD; Allison W. McIntyre, MPH; Sean Childs; Warren C. Hammert; John C. Elfar
University of Rochester, Rochester, NY
Introduction: Patients with ulnar neuropathy at the elbow often have symptoms outside the anatomical distribution. It has been shown in patients with carpal tunnel syndrome that resolution of symptoms including pain, numbness, and tingling outside of the median nerve distribution occurs following carpal tunnel release (Elfar et al, 2009). We hypothesized that a similar effect would be found after release of the ulnar nerve at the elbow.
Methods: A consecutive cohort of 18 patients undergoing cubital tunnel release were identified and examined preoperatively and at six weeks postoperatively. All patients had nerve conduction studies demonstrating isolated compression of the ulnar nerve at the elbow. All patients were asked to describe the location of four symptoms: pain, numbness, tingling, and "strange" symptoms (burning or shooting sensations). Ulnar nerve distribution was defined as the small finger and the ulnar half of the ring finger for tingling and numbness and for pain and "strange" symptoms, we also included the medial aspect of the arm and forearm. All other areas of the upper extremity were considered extra-ulnar in their distribution. Objective measurements included two-point discrimination and Semmes-Weinstein monofilament sensation. Subjective measurements included visual analogue scale (VAS), Michigan Hand Outcomes (MHQ) and Levine-Katz (LK) Questionnaires. 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: There was a significant decrease in pain (p=.003), numbness (p=.002), and tingling (p=0.021) along the ulnar distribution. There was also a significant decrease in pain (p=.021), numbness (p=.031), and tingling (p=0.005) symptoms outside of the ulnar nerve distribution. "Strange" sensations showed a trend toward improvement in both ulnar and non-ulnar distributions but these did not reach significance (p=.071 and p=.102 respectively). There was a significant decrease in pain on the VAS (p=.013) and improvement in the MHQ (p=.002) and the symptom severity scale of the LK (p=.009).
Conclusions: This is the first study to document resolution of symptoms outside the ulnar nerve 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 ulnar nerve distribution. Limitations of this study include a small patient population, and continued recruitment into the study is ongoing.
Elfar JC, Calfee RP, Stern PJ. Topographical assessment of symptom resolution following open carpal tunnel release. J Hand Surg. 2009;34A:1188-1192.
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