Incidence of Median and Ulnar Neuropathy Following Nonupper Extremity Surgery

TL;DR

This study finds that upper limb nerve issues like carpal tunnel syndrome can occur after surgeries on the neck, hip, or knee, with the highest rate after neck surgery.

Contribution

The study identifies a novel link between non-upper-extremity surgeries and postoperative upper-extremity neuropathies.

Findings

3.05% of patients who had neck surgery developed upper limb nerve issues, the highest rate among the surgeries studied.

Neck surgery patients had higher rates of combined carpal tunnel and cubital neuropathies compared to hip or knee surgery patients.

Most patients who underwent surgical decompression saw symptom resolution, while conservative treatment had a lower success rate.

Abstract

Carpal tunnel syndrome (CTS) and cubital syndrome (CuTS) are common neuropathies typically associated with upper-extremity surgeries or systemic risk factors. This study investigates the incidence of CTS and CuTS following anterior cervical discectomy and fusion (ACDF), total hip arthroplasty (THA), and total knee arthroplasty (TKA) to evaluate whether postoperative upper-extremity neuropathy is linked to perioperative systemic responses, patient-specific risk factors, or a combination of the above.

Patients who underwent ACDF, primary THA, or primary TKA at a single institution between 2015 and 2025 were retrospectively reviewed. Cases of postoperative CTS or CuTS were identified based on clinical presentation and electrodiagnostic testing when available. Each chart was reviewed to confirm the diagnosis, timing, and extract clinical details. Demographic, diagnostic, surgical, and clinical outcomes were compared between cohorts.

Among 49,752 patients, 463 (0.93%) developed postoperative CTS and/or CuTS. The observed incidence was highest in the ACDF cohort (3.05%) compared to TKA (0.88%) and THA (0.82%). CTS accounted for 78% of cases, CuTS for 11%, and combined CTS/CuTS for 11%. Neuropathy distribution varied considerably by surgical group, with ACDF patients having higher rates of CuTS and combined CTS/CuTS diagnoses. Time to diagnosis was shorter in the ACDF group compared to other groups. Surgical decompression was performed in 69.5% of cases, with symptom resolution in 90.4%. Of the 30.5% managed conservatively, 34.8% reported persistent symptoms.

Upper-extremity neuropathy can develop following nonupper extremity surgeries, particularly ACDF. The timing and pattern suggest that perioperative systemic and patient-level factors may contribute more substantially toward neuropathy development than local surgical effects.

Prognostic III.