Preoperative Electrophysiology in Patients With Ulnar Nerve Entrapment at the Elbow-Prediction of Surgical Outcome and Influence of Age, Sex and Diabetes

Overview

Journal Front Clin Diabetes Healthc

Specialty Endocrinology

Date 2023 Mar 30

PMID 36992728

Authors

Ilka Anker

Erika Nyman

Malin Zimmerman

Ann-Marie Svensson

Gert S Andersson

Lars B Dahlin

Affiliations

Soon will be listed here.

Abstract

The impact of preoperative electrophysiology on outcome of surgical treatment in ulnar nerve entrapment at the elbow (UNE) is not clarified. Our aim was to evaluate influence of preoperative electrophysiologic grading on outcome and analyse how age, sex, and in particular diabetes affect such grading. Electrophysiologic protocols for 406 UNE cases, surgically treated at two hand surgery units reporting to the Swedish National Quality Register for Hand Surgery (HAKIR; 2010-2016), were retrospectively assessed, and graded as normal, reduced conduction velocity, conduction block or axonal degeneration. Outcome of surgery after primary and revision surgery was evaluated using QuickDASH and a doctor reported outcome measure (DROM) grading. No differences in QuickDASH or DROM were found between the four groups with different electrophysiologic grading preoperatively, or at three and 12 months or at follow up, respectively. When dichotomizing the electrophysiologic grading into normal and pathologic electrophysiology, cases with normal electrophysiology had worse QuickDASH than cases with pathologic electrophysiology preoperatively (p=0.046). Presence of a conduction block or axonal degeneration indicated a worse outcome by DROM grading (p=0.011). Primary surgeries had electrophysiologic more pronounced nerve pathology compared to revision surgeries (p=0.017). Cases of older age, men, and those with diabetes had more severe electrophysiologic nerve affection (p<0.0001). In the linear regression analysis, increasing age (unstandardized B=0.03, 95% CI 0.02-0.04; p<0.0001) and presence of diabetes (unstandardized B=0.60, 95% CI 0.25-0.95; p=0.001) were associated with a higher risk of a worse electrophysiologic classification. Female sex was associated with a better electrophysiologic grading (unstandardized B=-0.51, 95% CI -0.75- -0.27; p<0.0001). We conclude that older age, male sex, and concomitant diabetes are associated with more severe preoperative electrophysiologic nerve affection. Preoperative electrophysiologic grade of ulnar nerve affection may influence surgical outcome.

Citing Articles

Presurgical management of ulnar nerve entrapment in patients with and without diabetes mellitus.

Andersson S, Zimmerman M, Perez R, Rydberg M, Dahlin L Sci Rep. 2024; 14(1):15595.

PMID: 38971864 PMC: 11227510. DOI: 10.1038/s41598-024-66592-y.

The Unpredictable Ulnar Nerve-Ulnar Nerve Entrapment from Anatomical, Pathophysiological, and Biopsychosocial Aspects.

Nyman E, Dahlin L Diagnostics (Basel). 2024; 14(5).

PMID: 38472962 PMC: 10931116. DOI: 10.3390/diagnostics14050489.

References

Camp C, Ryan C, Degen R, Dines J, Altchek D, Werner B . Risk factors for revision surgery following isolated ulnar nerve release at the cubital tunnel: a study of 25,977 cases. J Shoulder Elbow Surg. 2017; 26(4):710-715. DOI: 10.1016/j.jse.2016.10.028. View

Osei D, Groves A, Bommarito K, Ray W . Cubital Tunnel Syndrome: Incidence and Demographics in a National Administrative Database. Neurosurgery. 2017; 80(3):417-420. DOI: 10.1093/neuros/nyw061. View

Shi Q, MacDermid J, Grewal R, King G, Faber K, Miller T . Predictors of functional outcome change 18 months after anterior ulnar nerve transposition. Arch Phys Med Rehabil. 2012; 93(2):307-12. DOI: 10.1016/j.apmr.2011.08.040. View

Beekman R, Wokke J, Schoemaker M, Lee M, Visser L . Ulnar neuropathy at the elbow: follow-up and prognostic factors determining outcome. Neurology. 2004; 63(9):1675-80. DOI: 10.1212/01.wnl.0000142535.24626.90. View

Wade R, Griffiths T, Flather R, Burr N, Teo M, Bourke G . Safety and Outcomes of Different Surgical Techniques for Cubital Tunnel Decompression: A Systematic Review and Network Meta-analysis. JAMA Netw Open. 2020; 3(11):e2024352. PMC: 7686867. DOI: 10.1001/jamanetworkopen.2020.24352. View

Zimmerman M, Anker I, Karlsson A, Arner M, Svensson A, Eeg-Olofsson K . Ulnar Nerve Entrapment in Diabetes: Patient-reported Outcome after Surgery in National Quality Registries. Plast Reconstr Surg Glob Open. 2020; 8(4):e2740. PMC: 7209826. DOI: 10.1097/GOX.0000000000002740. View

Rydberg M, Zimmerman M, Gottsater A, Nilsson P, Melander O, Dahlin L . Diabetes mellitus as a risk factor for compression neuropathy: a longitudinal cohort study from southern Sweden. BMJ Open Diabetes Res Care. 2020; 8(1). PMC: 7199181. DOI: 10.1136/bmjdrc-2020-001298. View

Anker I, Zimmerman M, Nyman E, Dahlin L . Ulnar nerve dislocation in ulnar nerve entrapment at the elbow. Influence on surgical outcome. Hand Surg Rehabil. 2021; 41(1):96-102. DOI: 10.1016/j.hansur.2021.09.003. View

Pelosi L, Mulroy E . Diagnostic sensitivity of electrophysiology and ultrasonography in ulnar neuropathies of different severity. Clin Neurophysiol. 2018; 130(2):297-302. DOI: 10.1016/j.clinph.2018.11.018. View

10.

Aaberg M, Burch D, Hud Z, Zacharias M . Gender differences in the onset of diabetic neuropathy. J Diabetes Complications. 2008; 22(2):83-7. DOI: 10.1016/j.jdiacomp.2007.06.009. View

11.

Arner M . Developing a national quality registry for hand surgery: challenges and opportunities. EFORT Open Rev. 2017; 1(4):100-106. PMC: 5367535. DOI: 10.1302/2058-5241.1.000045. View

12.

Liu C, Wu S, Ke X, Wang H, Chen C, Lai Z . Subcutaneous Versus Submuscular Anterior Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies. Medicine (Baltimore). 2015; 94(29):e1207. PMC: 4602994. DOI: 10.1097/MD.0000000000001207. View

13.

Mondelli M, Aretini A, Rossi S . Ulnar neuropathy at the elbow in diabetes. Am J Phys Med Rehabil. 2008; 88(4):278-85. DOI: 10.1097/PHM.0b013e318190b89d. View

14.

Todnem K, Michler R, Wader T, Engstrom M, Sand T . The impact of extended electrodiagnostic studies in ulnar neuropathy at the elbow. BMC Neurol. 2009; 9:52. PMC: 2767342. DOI: 10.1186/1471-2377-9-52. View

15.

Krogue J, Aleem A, Osei D, Goldfarb C, Calfee R . Predictors of surgical revision after in situ decompression of the ulnar nerve. J Shoulder Elbow Surg. 2015; 24(4):634-9. DOI: 10.1016/j.jse.2014.12.015. View

16.

Gaspar M, Kane P, Putthiwara D, Jacoby S, Osterman A . Predicting Revision Following In Situ Ulnar Nerve Decompression for Patients With Idiopathic Cubital Tunnel Syndrome. J Hand Surg Am. 2016; 41(3):427-35. DOI: 10.1016/j.jhsa.2015.12.012. View

17.

Barrell K, Smith A . Peripheral Neuropathy. Med Clin North Am. 2019; 103(2):383-397. DOI: 10.1016/j.mcna.2018.10.006. View

18.

Lind M, Bounias I, Olsson M, Gudbjornsdottir S, Svensson A, Rosengren A . Glycaemic control and incidence of heart failure in 20,985 patients with type 1 diabetes: an observational study. Lancet. 2011; 378(9786):140-6. DOI: 10.1016/S0140-6736(11)60471-6. View

19.

Omejec G, Podnar S . What causes ulnar neuropathy at the elbow?. Clin Neurophysiol. 2015; 127(1):919-924. DOI: 10.1016/j.clinph.2015.05.027. View

20.

Visser L, Beekman R, Franssen H . Short-segment nerve conduction studies in ulnar neuropathy at the elbow. Muscle Nerve. 2005; 31(3):331-8. DOI: 10.1002/mus.20248. View