Back to 2026 ePosters
Incidence and Patient-Level Risk Factors for Complex Regional Pain Syndrome Following Isolated Cubital Tunnel Release
Stephen J Perle, B.S., Nicholas C Bank, M.D., Sarah Conlon, M.D., Alexander D Jeffs, M.D.; Reid W Draeger, M.D.
The University of North Carolina School of Medicine, Chapel Hill, NC
Introduction: Complex regional pain syndrome (CRPS) is a debilitating complication occasionally reported after upper extremity surgeries, yet its true incidence following isolated cubital tunnel release (CuTR) remains undefined in large cohort studies. Existing literature examining the risk of CRPS following CuTR is sparse and limited to small case series. This study aimed to determine the incidence of CRPS after isolated CuTR using a large-scale global database and to identify independent patient-level risk factors.
Materials & Methods: A retrospective cohort analysis was conducted using the TriNetX research database. Patients who underwent a single CuTR procedure between 2000 and 2024 were identified. To isolate the effect of CuTR alone, individuals with any additional upper extremity trauma or surgical procedures between one year before and one year after CuTR were excluded. The primary outcomes of interest were the one-year incidences of CRPS type I and II. Additionally, Cox proportional hazards modeling was performed to evaluate associations between demographic and clinical factors with CRPS development, adjusting for key comorbidities such as psychiatric disorders, opioid dependence, nicotine dependence, obesity, and diabetes mellitus.
Results: The query identified 15,902 patients who met all inclusion and exclusion criteria. At one year postoperatively, the incidences of CRPS type I and type II were 0.20% and 0.10%, respectively. Female sex was associated with significantly increased risk of both CRPS I (HR 2.128; 95% CI, 1.718-2.632; p < 0.001) and CRPS II (HR 1.469; 95% CI, 1.079-1.995; p = 0.015). Prior opioid dependence was strongly associated with elevated risk of CRPS I (HR 1.896; 95% CI, 1.120-3.212; p = 0.017) and CRPS II (HR 2.386; 95% CI, 1.132-5.031; p = 0.022). A history of other chronic pain disorders was also significantly associated with increased risk of CRPS II (HR 1.814; 95% CI, 1.292-2.547; p = 0.001). Conversely, diabetes mellitus was associated with a significantly lower risk of CRPS II (HR 0.480; 95% CI, 0.302-0.765; p = 0.002).
Conclusions: CRPS following isolated CuTR is exceedingly rare, with overall one-year incidence rates approximately 0.3%. However, identifiable patient-level risk factors-including female sex, preexisting opioid dependence, and a history of chronic pain disorders-significantly increase relative risk and may inform preoperative counseling and postoperative monitoring strategies. These findings advance our understanding by providing a uniquely large and robust estimate of CRPS risk following CuTR, offering important reassurance to patients and clinicians while highlighting opportunities for individualized risk stratification.
Back to 2026 ePosters
