title: Combined Cubital and Carpal Tunnel Release Results in Symptom Resolution Outside of the Median or Ulnar Nerve Distributions.
abstract: BACKGROUND
  Resolution of symptoms including pain, numbness, and tingling outside of the median nerve distribution has been shown to occur following carpal tunnel release. We hypothesized that a similar effect would be found after combined release of the ulnar nerve at the elbow with simultaneous release of the median nerve at the carpal tunnel.
  
  
  METHODS
  20 patients with combined cubital and carpal tunnel syndrome were prospectively enrolled. The upper extremity was divided into six zones and the location of pain, numbness, tingling, or strange sensations was recorded pre-operatively. Two-point discrimination, Semmes-Weinstein monofilament testing, and validated questionnaires were collected pre-operatively and at six-week follow-up.
  
  
  RESULTS
  Probability of resolution was greater in the median nerve distribution than the ulnar nerve for numbness (71% vs. 43%), tingling (86% vs. 75%). Seventy percent of the cohort reported at least one extra-anatomic symptom pre-operatively, and greater than 80% of these resolved at early follow-up. There was a decrease in pain as measured by validated questionnaires.
  
  
  CONCLUSIONS
  This study documents resolution of symptoms in both extra-ulnar and extra-median distributions after combined cubital and carpal tunnel release. Pre-operative patient counseling may therefore include the likelihood of symptomatic improvement in a non-expected nerve distribution after this procedure, assuming no other concomitant pathology which may cause persistent symptoms. Future studies could be directed at correlating pre-operative disease severity with probability of symptom resolution using a larger population.
authors.affiliation: University of Rochester Medical Center, Rochester, New York, United States.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Chimenti
authors.affiliation: University of Rochester Medical Center, Rochester, New York, United States.
authors.forename: Allison W
authors.initials: AW
authors.lastname: McIntyre
authors.affiliation: University of Rochester Medical Center, Rochester, New York, United States.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Childs
authors.affiliation: University of Rochester Medical Center, Rochester, New York, United States.
authors.forename: Warren C
authors.initials: WC
authors.lastname: Hammert
authors.affiliation: University of Rochester Medical Center, Rochester, New York, United States.
authors.forename: John C
authors.initials: JC
authors.lastname: Elfar
keywords: Carpal Tunnel Syndrome; Cubital Tunnel Syndrome; Extra-Median; Extra-Ulnar; Median Nerve; Ulnar Nerve; Ulnar Neuropathy