Elsevier

The Journal of Hand Surgery

Volume 32, Issue 6, July–August 2007, Pages 855-858
The Journal of Hand Surgery

Carpal tunnel syndrome
Muscle Atrophy at Diagnosis of Carpal and Cubital Tunnel Syndrome

https://doi.org/10.1016/j.jhsa.2007.03.009Get rights and content

Purpose

This study was designed to test the hypothesis that patients with an initial diagnosis of cubital tunnel syndrome are more likely to present with muscle atrophy than patients with an initial diagnosis of carpal tunnel syndrome.

Methods

A list of patients presenting to the office of a single hand surgeon from January 2000 to June 2005 with an initial diagnosis of isolated, idiopathic carpal tunnel syndrome or cubital tunnel syndrome was generated from billing records. The medical records of 58 patients with cubital tunnel syndrome and 370 patients with carpal tunnel syndrome were reviewed for age, gender, diabetes, and presence of atrophy.

Results

Twenty-three of 58 patients with an initial diagnosis of cubital tunnel syndrome had atrophy compared with only 62 out 370 patients with an initial diagnosis of carpal tunnel syndrome. Multiple logistic regression revealed that age (odds ratio, 1.06; 95% CI, 1.04–1.08) and diagnosis (cubital tunnel patients were more likely than carpal tunnel patients to present with atrophy; odds ratio, 4.5; 95% CI, 2.7–8.6) were factors significantly associated with atrophy at presentation.

Conclusions

Patients with carpal tunnel syndrome present earlier in the course of their disease than patients with cubital tunnel syndrome. Patients with cubital tunnel syndrome are more likely to present with muscle atrophy, reflecting advanced nerve damage that may not respond to surgery.

Type of study/level of evidence

Prognostic IV.

Section snippets

Materials and Methods

A list of patients presenting to the office of a single hand surgeon from January 2000 through June 2005 was generated from billing records. Inclusion criteria included (1) patients with an initial diagnosis of carpal tunnel or cubital tunnel syndrome; (2) the compressive neuropathy was idiopathic; (3) this was the only diagnosis made—it was an isolated problem (eg, no cervical radiculopathy, elbow arthrosis, etc.).

Fifty-eight patients with cubital tunnel syndrome and 370 patients with carpal

Results

In univariate analysis, age, diabetes, and diagnosis (carpal tunnel vs cubital tunnel syndrome) were significantly associated with atrophy and gender showed a non-significant trend for association with atrophy (Table 2). Twenty-three of 58 (40%) patients with cubital tunnel syndrome and 62 of 370 (17%) patients with carpal tunnel syndrome presented with muscle atrophy (p < .0001).

Multivariate logistic regression revealed that older age (odds ratio, 1.06; 95% CI, 1.04–1.08) and diagnosis

Discussion

This study is limited by the fact that it represents a single surgeon’s practice and practice style, and electrophysiologic testing was not used routinely to confirm the diagnosis. Use of the neurophysiologist’s overall rating, although practical in a retrospective study, is also somewhat subjective. It is possible that the patients presenting to this surgeon and the diagnostic criteria used by this surgeon and neurophysiologist cannot be generalized to the average practice. An additional

References (12)

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Supported by unrestricted research grants from AO Foundation, Wright Medical, Joint Active Systems, Smith and Nephew Richards, and Small Bone Innovations.

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