From the Rothman Institute at Thomas Jefferson University.
Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School.
Plast Reconstr Surg. 2023 Jul 1;152(1):110e-115e. doi: 10.1097/PRS.0000000000010185. Epub 2023 Jun 29.
Cubital tunnel syndrome (CuTS) is the second most common compression neuropathy of the upper extremity. Electrodiagnostic studies (EDSs) are often used to confirm diagnosis. However, negative EDSs 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 EDSs, who are treated surgically.
Patients who had EDSs before ulnar nerve surgery were identified by means of database search. Chart review was performed on 867 cases to identify those with negative EDSs. Twenty-five ulnar nerve operations in 23 patients were included in analysis. Chart review was performed to record preoperative and postoperative symptoms, physical examination findings, and outcome measures (ie, Disabilities of the Arm, Shoulder and Hand questionnaire and the Patient-Rated Ulnar Nerve Evaluation).
At a mean follow-up period of 20.7 ± 14.9 months, 15 of 25 cases (60.0%) had complete resolution of all preoperative symptoms. All 10 patients who had residual symptoms endorsed improvement in their preoperative complaints. The median preoperative Disabilities of the Arm, Shoulder and Hand score was 40.0 [interquartile range (IQR), 23.9 to 58.0], which significantly decreased to a median of 6.8 (IQR, 0 to 22.7) at final follow-up ( P < 0.01). The median postoperative Patient-Rated Ulnar Nerve Evaluation score was 9.5 (IQR, 1.5 to 19.5).
Patients with CuTS and normal EDSs treated surgically can be expected to have favorable outcomes with respect to symptoms and improvement in functional outcome scores. After ruling out confounding diagnoses, the authors continue to offer surgical intervention for these patients when nonoperative treatment has failed.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
肘管综合征（CuTS）是上肢第二常见的压迫性神经病。电诊断研究（EDSs）常用于确诊。然而，阴性 EDSs 可能会带来困难的临床挑战。本研究的目的是确定经手术治疗的临床诊断为 CuTS 但 EDSs 阴性的患者的功能结果和症状改善情况。
通过数据库搜索确定接受过手术前尺神经 EDSs 的患者。对 867 例患者进行图表回顾，以确定 EDSs 阴性的患者。共纳入 23 名患者的 25 例尺神经手术进行分析。对图表回顾记录术前和术后症状、体格检查结果和结果测量（即，手臂、肩部和手残疾问卷和患者评定的尺神经评估）。
平均随访 20.7±14.9 个月，25 例中的 15 例（60.0%）完全缓解了所有术前症状。所有 10 例仍有症状的患者均表示术前症状改善。术前手臂、肩部和手残疾问卷中位数为 40.0[四分位距（IQR），23.9 至 58.0]，最终随访时显著降至 6.8（IQR，0 至 22.7）（P<0.01）。术后患者评定的尺神经评估中位数为 9.5（IQR，1.5 至 19.5）。
经手术治疗的 CuTS 伴正常 EDSs 的患者有望在症状和功能结果评分改善方面取得良好的结果。在排除混杂性诊断后，作者继续对非手术治疗失败的这些患者进行手术干预。
临床问题/证据水平：治疗，IV。
