gms | German Medical Science

Objectives/Interrogation: Endoscopic carpal tunnel release (eCTR) performed in conjunction with endoscopic cubital tunnel release (eCuTR) would have a high rate of success in relieving symptoms related to both carpal and cubital tunnel syndrome, with low rates of complications and revisions.

Methods: We conducted a retrospective study of consecutive patients who underwent endoscopic decompression of the ulnar nerve at the elbow and median nerve at the wrist over a 5-year interval. Patients with less than 3 months of follow-up were excluded. Modified McGowan Grades were assigned to each patient pre- ad postoperatively. Comparison of pre- and postoperative numerical outcomes was performed using paired t-testing.

Results and Conclusions: 103 patients with mean age 55.4 ± 11.6 years satisfied inclusion. QuickDASH scores improved significantly from 55.4 ± 23.2 preoperatively to 12.2 ± 15.9 postoperatively (paired t-test; P < 0.001). Grip strength improved from 89.8 ± 35.5% of the contralateral side preoperatively to 97.1 ± 36.8% postoperatively, although this difference only approached statistical significance (paired t-test; P = 0.071). Similarly, key pinch strength improved insignificantly from 96.5 ± 44.0% of to 99.3 ± 34.6% (paired t-test; P = 0.65).

One patient was converted to open surgery with a modified medial epicondylectomy after the ulnar nerve was found to be unstable intraop and had complete resolution of his symptoms. Two patients had worsened McGowan grades postoperatively (Table 2) and required revision for recurrent symptoms; one male was found to have massive perineural scarring at 6.5 months and underwent revision neurolysis with anterior subcutaneous transposition, while the 2nd patient was found to have moderate scarring with a subluxating nerve at 3.5 months when she underwent a revision neurolysis with modified medial epicondylectomy. Both patients were active smokers, as smoking was the lone predictive factor of needing revision surgery (Fisher's exact; P = 0.023). Eight patients had no change in their postoperative McGowan grade, while the remaining 93 patients improved by at least one grade.

Combined endoscopic decompression of the ulnar and median nerves is a safe and effective treatment option for patients with concomitant ipsilateral cubital and carpal syndrome. Patient-rated outcome scores improved significantly after surgery, while improvements in grip and pinch strength were not significant. Active smokers were at higher risk for requiring revision surgery and worsening of symptoms.