Impact of Cervical Radiculopathy on the Risk of Cubital Tunnel Syndrome Following Distal Humerus Fracture: A Retrospective Cohort Analysis of 165 Million Patients

Abstract

Background:

Cubital tunnel syndrome (CuTS) is a common peripheral neuropathy often exacerbated by trauma or anatomical disruption. Cervical radiculopathy has been proposed as a proximal risk factor via the double crush mechanism, but its role in post-traumatic CuTS following distal humerus fracture (DHF) remains underexplored.

Methods:

A retrospective cohort study was conducted using the PearlDiver database (165 million patients). Patients with DHF were stratified by the presence of pre-existing cervical radiculopathy. Incidence rates of cubital tunnel syndrome diagnosis (CuTSD) and cubital tunnel release surgery (CuTRS) were compared using bivariate and multivariate logistic regression, adjusting for demographics, comorbidities, fracture type, and management approach.

Results:

Patients with cervical radiculopathy had a significantly higher incidence of CuTSD after DHF (9.6% vs 5.14%; odds ratio, 1.95, 95% confidence interval, 1.71-2.23) and modestly elevated CuTRS rates (3.75% vs 3.18%). Cervical radiculopathy remained an independent predictor of both outcomes after adjusting for confounders. Predictors such as rheumatoid arthritis and prior nerve injury were significant, whereas fibromyalgia, diabetic neuropathy, and systemic lupus erythematosus were not. The predictive effect was stronger for diagnosis than for surgical intervention.

Conclusion:

Cervical radiculopathy is an independent risk factor for developing CuTSD following DHF and may influence symptom perception more than surgical decision-making. These findings support the double crush hypothesis and highlight the need for heightened vigilance in managing DHF in patients with cervical radiculopathy. Prospective studies are warranted to validate these associations and refine treatment algorithms.