Purpose
Patients with severe ulnar neuropathy at the elbow frequently experience suboptimal
surgical outcomes. Clinical symptoms alone may not accurately represent the severity
of underlying nerve injury, calling for objective assessment tools, such as electrodiagnostic
studies. The goal of our study was to determine whether specific electrodiagnostic
parameters can be used to predict the outcomes after in situ decompression of the ulnar nerve.
Methods
This prospective study enrolled consecutive patients aged ≥18 years diagnosed with
ulnar neuropathy at the elbow. Patients completed a baseline battery of motor, sensory,
functional, and electrodiagnostic tests before undergoing in situ decompression of the ulnar nerve. They were reassessed at 6 weeks, 3 months, 6 months,
and 12 months after surgery. Forty-two patients completed at least 2 follow-up assessments
and were included in the study.
Results
When controlling for other electrodiagnostic measurements and demographic factors,
none of the electrodiagnostic parameters were predictive of outcomes at 12 months
after surgery. Patients with decreased compound muscle action potential amplitudes
demonstrated slower trends of recovery in grip strength, pinch strength, and overall
scores on the Michigan Hand Outcomes Questionnaire as well as its function, work,
and activities of daily living subscales, Disabilities of the Arm, Shoulder, and Hand
questionnaire, and the Carpal Tunnel Questionnaire. Decreased motor nerve conduction
velocity was predictive of slower recovery of 2-point discrimination and pinch strength.
Conclusions
Compound muscle action potential amplitude, but not other conventional electrodiagnostic
parameters, was predictive of functional outcomes after in situ decompression of the ulnar nerve. This parameter should play a role in determining
the timing and prognosis of treatment for ulnar neuropathy at the elbow.
Type of study/level of evidence
Prognostic II.
Key words
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Article info
Publication history
Published online: November 09, 2022
Accepted:
October 5,
2022
Received:
February 16,
2022
Footnotes
Dr Chung receives funding from the National Institutes of Health, book royalties from Wolters Kluwer and Elsevier, and a research grant from Sonex to study carpal tunnel outcomes. No benefits in any form have been received or will be received by the other authors related directly or indirectly to the subject of this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
