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American Association for Hand Surgery

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Functional Outcomes of Cubital Tunnel Release in Patients with Negative Electrodiagnostic Studies
Clay Townsend, MD1, Brian M Katt, MD2, Amr Tawfik, BA2, Michael DeMarco, BS3, Kevin F Lutsky, MD4, Jonas Matzon, MD5, Michael Rivlin, M.D.6 and Pedro K Beredjiklian, M.D.6, (1)Rothman Institute at Thomas Jefferson University Hopsital, Philadelphia, PA, (2)Rothman Orthopaedic Institute, Philadelphia, PA, (3)Philadelphia College of Osteopathic Medicine, Philadelphia, PA, (4)Rothman Institute, University of Vermont Medical Center, South Burlington, PA, (5)Rothman Institute, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, (6)Rothman Institute, Philadelphia, PA

Introduction
Cubital tunnel syndrome (CuTS) is the second most common compression neuropathy of the upper extremity. Electrodiagnostic studies (EDS) are often used to confirm diagnosis. However, negative EDS can present a difficult clinical challenge. The purpose of this study was to determine the functional outcomes and symptom improvement for patients with a clinical diagnosis of CuTS, but with negative EDS, who are treated surgically.
Materials & Methods
Institutional Review Board approval was obtained prior to initiation of this study. Patients who had EDS prior to ulnar nerve surgery at our institution were identified via database search. Manual chart review was performed on 867 cases to identify those with negative EDS. Twenty-nine ulnar nerve surgeries in 27 patients performed by 10 orthopaedic hand surgeons were included in final analysis. This group consisted of 17 women and 10 men with an average age of 45.6 years (range 23-73). Chart review was performed to record preoperative and postoperative patient symptoms, physical exam findings, and outcome measures [Disabilities of the Arm, Shoulder, and Hand (DASH), and Patient-Rated Ulnar Nerve Evaluation (PRUNE)].
Results
At a mean follow up of 17.9 months (range 0.4 - 55.1 months), 18/29 cases (62.1%) had no complaints of any residual symptoms. All 11 cases with complaints of residual symptoms had subjective improvement in their preoperative complaints, and zero cases had worsening of their preoperative complaints. Based on preoperative McGowan Classification, 9/17 (52.9%) McGowan I cases and 2/12 (16.7%) McGowan II cases complained of residual symptoms at their latest follow-up visit. The mean preoperative DASH score was 47.9, which significantly decreased to a mean of 23.5 at final follow up (p<.01). The mean postoperative PRUNE score was 16.9.
Conclusions
The findings of our study demonstrate that most patients with CuTS and normal EDS treated surgically can be expected to have favorable outcomes with respect symptoms and improvement in functional outcome scores. After ruling out confounding diagnoses, we continue to offer surgical intervention for these patients when non-operative treatment has failed.


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