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False Positive Cubital Tunnel Provocative Tests in Carpal Tunnel Release Patients
Jonathan Ghobrial, BS, WVU, Morgantown, WV and Shafic Sraj, MD, West Virginia University, Morgantown, WV

Cubital tunnel syndrome (CBTS) and carpal tunnel syndrome (CTS) are known to coexist, so clinical judgement is critical when a patient scheduled for carpal tunnel release (CTR) may consider a simultaneous cubital tunnel release. Such determination depends on preoperative assessment that includes ulnar nerve provocative tests (UNPT). For clinical evaluation of CBTS in the presence of CTS to be adequate, UNPT should have a low false positive rate (FPR). This study was designed to determine the FPR of UNPT in patients scheduled for CTR. The secondary goals were to determine the factors that contribute to FPR and their respective odds ratios (OR). We reviewed the medical records of 40 CTR patients (50 elbows) who had no signs of ulnar neuropathy and collected their preoperative UNPT that included the Tinel's test and elbow flexion compression (FC) test. Forty-eight percent and 44% of the elbows had a false positive Tinel's test and FC test, respectively. Thirty-four percent and 58% of the elbows had both or at least one false positive UNPT, respectively. Sex, diabetes, and alcohol consumption did not have a statistically significant effect, whereas smoking increased the odds of a FPR for both tests and age lowered the odds for the FC test but not the Tinel's test. The treating physician should be aware of the false positive rates of UNPT in CTS patients. This is especially important when the addition of cubital tunnel release at the time of CTR is being considered.


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