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Brogan DM, Landau AJ, Olsen MA, Nickel KB, Buss JL, Dy CJ. Direct Economic Burden of Cubital Tunnel Surgery in the United States: Total Payments and Components of Cost. J Hand Surg Am 2024:S0363-5023(24)00337-X. [PMID: 39230553 DOI: 10.1016/j.jhsa.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 07/09/2024] [Accepted: 07/24/2024] [Indexed: 09/05/2024]
Abstract
PURPOSE Despite its widespread prevalence, the cost of cubital tunnel syndrome (CuTS) in the United States to patients and insurers is not well understood. The purpose of this study was to quantify the direct payments associated with operative treatment of CuTS. We hypothesized that CuTS represents a substantial cost to the payer in facility fees, surgeon fees and other expenses. METHODS Utilizing the MarketScan database of insured patients (commercial and Medicaid), we identified a cohort of 41,777 patients aged 18-64 years with surgically treated CuTS from 2006 to 2018. We estimated the median 90-day payments from encounters associated with cubital tunnel release (CuTR) and/or ulnar nerve transposition surgery by summing all payments for claims within 90 days after the index surgery. Published estimates of the annual number of cubital tunnel surgeries were used to calculate the annual expenditure. RESULTS Of 41,777 patients, the median (interquartile range [IQR]) values of total direct payments were $5,522 [$3,426, $9,541]. With an estimated 94,645 cases/year, this leads to an annual payment of more than $522 million. Index facility payments (median[IQR] $2,555 [$1,359, $4,708] were the highest, followed by index provider payments ($1,691 [$1,328, $2,217]). The median index surgeon payment (median[IQR] $905 [$707, $1,184]) represented just over half of the provider payments. Post-operative care had a median [IQR] payment of $377 ($424, $1,987). Limitations of claims databases prevented assessment of other indirect costs associated with cubital tunnel surgery. CONCLUSIONS Payments for the surgical treatment of CuTS from the index surgery to 90 days post-operatively have an estimated median of $5,522 per patient, totaling $52 million annually. Index facility fees are responsible for more than 46% of payments, while index payments to surgeons represent approximately 16%. Defining this data is critical to understanding one component of the economic impact of CuTS. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- David M Brogan
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO.
| | - Andrew J Landau
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO
| | - Margaret A Olsen
- Institute for Informatics, Data Science and Biostatistics, Washington University, St. Louis, MO
| | - Katelin B Nickel
- Institute for Informatics, Data Science and Biostatistics, Washington University, St. Louis, MO
| | - Joanna L Buss
- Institute for Informatics, Data Science and Biostatistics, Washington University, St. Louis, MO
| | - Christopher J Dy
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO
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Andersson S, Zimmerman M, Perez R, Rydberg M, Dahlin LB. Presurgical management of ulnar nerve entrapment in patients with and without diabetes mellitus. Sci Rep 2024; 14:15595. [PMID: 38971864 PMCID: PMC11227510 DOI: 10.1038/s41598-024-66592-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/02/2024] [Indexed: 07/08/2024] Open
Abstract
Diabetes mellitus (DM) is a risk factor for the development of ulnar nerve entrapment (UNE). Differences in surgical outcomes for UNE between patients with and without DM have been reported, but studies on presurgical management are scarce. This study aimed to evaluate the presurgical management of UNE in patients with (DM diagnosis < 2 years of UNE diagnosis) and without DM regarding the level of care for diagnosis and the proportion that proceeds to surgery. Data from 6600 patients with UNE between 2004 and 2019 were included from the Skåne Health Care Register (SHR) and cross-linked with data from the Swedish National Diabetes Register (NDR). The group with UNE and DM was compared to the group with UNE without DM and prevalence ratios were calculated using Cox regression analysis. Patients with DM more often got their first UNE diagnosis in secondary care than in primary care (643/667, 96% vs. 5361/5786; 93%). Patients with and without DM, regardless of the type of DM, presence of retinopathy, or HbA1c levels, were surgically treated for UNE to the same extent (258/667, 39% of patients with DM vs. 2131/5786, 37% of patients without DM). The proportion of surgically treated was significantly lower among patients diagnosed with UNE in primary care compared to secondary care (59/449, 13% vs. 2330/5786, 38%). Men were more often surgically treated than women (1228/3191, 38% vs.1161/3262 36%). Patients with UNE and DM are surgically treated to the same extent as patients with UNE but without DM and are more likely to be diagnosed in specialized care.
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Affiliation(s)
- Stina Andersson
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Malin Zimmerman
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden.
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden.
| | - Raquel Perez
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
- Unit for Social Epidemiology, Department of Clinical Sciences (Malmö), Faculty of Medicine, Lund University, 20502, Malmö, Sweden
| | - Mattias Rydberg
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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3
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Olson SN, Harbaugh TD, Stoltzfus MT, Majid SS, Mrowczynski OD. First Case of Combined Carpal and Cubital Tunnel Syndromes in an Adolescent: A Case Report and Literature Review. Cureus 2024; 16:e65650. [PMID: 39205771 PMCID: PMC11357709 DOI: 10.7759/cureus.65650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 07/22/2024] [Indexed: 09/04/2024] Open
Abstract
Carpal and cubital tunnel syndromes are the two most common compressive neuropathies, but both carpal and cubital tunnel syndromes are extremely rare in children. Therefore, the combination of carpal and cubital tunnel syndrome in the pediatric population is even more uncommon. These neuropathies have multiple causes, with the three main categories being mechanical injury, metabolic, and idiopathic. Here, we present the unique case of a 15-year-old female with no known genetic or physical risk factors who was diagnosed with atraumatic combined carpal and cubital tunnel syndrome with severe, chronic nerve entrapment and damage. After nearly two years of conservative management, the patient had a cubital tunnel and carpal tunnel release simultaneously. The transverse carpal ligament was grossly thickened intraoperatively, leading to difficulty in the identification of the median nerve. The ulnar nerve was severely compressed and flattened. Following decompression, both nerves continued to be erythematous and inflamed. After surgery, the patient had barriers to getting appropriate postoperative care. Specifically, the patient was unable to attend physical and hand therapy appointments, possibly leading to continued weakness, numbness, and intermittent pain. In our patient, the preoperative workup did not illuminate the severity of the median and ulnar nerve damage, possibly delaying surgical intervention. In addition to our case, we utilized the TriNetX database (TriNetX, Inc., Cambridge, Massachusetts, United States) to investigate the rate and treatment of compressive neuropathies in the pediatric population. The database was queried for pediatric patients who underwent carpal tunnel release, cubital tunnel release, and pediatric patients with both carpal and cubital tunnel syndrome diagnoses in childhood. We found that there were 20,819,207 pediatric patients on the TriNetX database, of whom 503 (0.002%) were diagnosed with both carpal and cubital tunnel syndrome. Based on our case and the current literature, a thorough history of pediatric patients with suspected carpal or cubital tunnel syndrome should include an evaluation of family history and activity level for pertinent risk factors. Widening the scope of the patient history could allow for more timely surgical intervention and improve long-term outcomes for the pediatric population. When evaluating children for either carpal tunnel or cubital tunnel syndrome, we recommend that healthcare providers evaluate both neuropathies simultaneously.
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Affiliation(s)
- Samantha N Olson
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Thaddeus D Harbaugh
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Mason T Stoltzfus
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Sonia S Majid
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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Abourisha E, Srinivasan AS, Barakat A, Chong HH, Singh HP. Surgical management of cubital tunnel syndrome: A systematic review and meta-analysis of randomised trials. J Orthop 2024; 53:41-48. [PMID: 38456175 PMCID: PMC10915370 DOI: 10.1016/j.jor.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024] Open
Abstract
Background Cubital tunnel syndrome (CUTS) is a common upper limb compression neuropathy with significant consequences when left untreated. Surgical decompression remains gold-standard treatment for moderate to severe disease, however the optimal operative technique remains unclear. This network meta-analysis (NMA) of Level I and II randomised prospective studies aims to discern superiority between open in-situ, endoscopic and anterior transposition (subcutaneous or submuscular techniques) with respect to the primary outcome of response-to-treatment and secondary outcomes which include complications, post-operative chronic pain VAS scale, return to work and re-operation. Methods This NMA adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed, Web of Science, Cochrane Central, Science direct and Embase were searched. The MESH database was further searched with the terms 'cubital tunnel' to improve sensitivity of the search. Data pertaining to the primary and secondary outcomes were pooled for NMA. Results Following abstract and full-text screening, 10 randomised prospective trials were included. There was no statistical difference in the response-to-treatment between the four studied techniques. Endoscopic decompression conferred a significantly higher complication rate compared to open decompression (Odds Ratio [OR], 4.21; 95% CI, 1.22-14.59). Endoscopic decompression had a statistically significant lower risk of post-operative chronic pain compared to open in-situ decompression (OR, 0.03, 95% CI, 0.00-0.32). There were no differences between techniques with respect to return to work or re-operation rates. Conclusion Response-to-treatment was similar between the four operative techniques for CUTS. Endoscopic decompression was found to be more hazardous when compared to open-in situ decompression but conferred significantly less post-operative chronic pain. There was significant heterogeneity in reported outcomes between the included articles. The authors suggest conducting more high-quality research with standardised outcome reporting to facilitate comparison. Level of evidence ii Systematic Review and Meta-analysis of Randomised Prospective Trials- Therapeutic study.
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Affiliation(s)
- Eslam Abourisha
- Trauma and Orthopaedic Department, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Ananth S. Srinivasan
- Trauma and Orthopaedic Department, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Ahmed Barakat
- Trauma and Orthopaedic Department, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Han Hong Chong
- Trauma and Orthopaedic Department, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Harvinder P. Singh
- Trauma and Orthopaedic Department, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
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van der Heijden B, Dailiana ZH, Giele HP. State of the art review. Upper extremity revision nerve compression surgery. J Hand Surg Eur Vol 2024; 49:687-697. [PMID: 38488612 DOI: 10.1177/17531934241238533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Although surgical release of upper extremity nerve compression syndromes is highly effective, persistence or recurrence of symptoms and signs may occur. Thorough investigation is necessary in this situation before treatment is recommended. If the symptoms cannot be explained by other pathology than compression of the affected nerve and if conservative management has not provided improvement, reoperation may be considered. This review provides an overview of the diagnostic and surgical considerations in the revision of carpal tunnel syndrome, cubital tunnel syndrome and thoracic outlet syndrome.Level of evidence: V.
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Affiliation(s)
- Brigitte van der Heijden
- Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Hospital's-Hertogenbosch, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Henk P Giele
- Department of Plastic, Reconstructive and Hand Surgery, John Radcliffe Hospital, Oxford, UK
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Abstract
BACKGROUND Although the literature supports not using preoperative antibiotic prophylaxis for clean soft tissue procedures around the hand, there is limited data for soft tissue procedures around the elbow, such as cubital tunnel release. Complications of postoperative infection include scarring, stiffness, and rarely, amputation. The purpose of this study is to determine if preoperative antibiotic prophylaxis decreases the risk of surgical site infection for cubital tunnel release. METHODS A retrospective review of 919 in situ, subcutaneous transposition, and submuscular transposition cubital tunnel surgery at a tertiary care center was performed. Patient records were searched to determine preoperative antibiotic status and infection within 30 days of surgery. In addition, comorbidities and demographics such as age, race, sex, and past medical history were also identified. Comorbidities with qualitative variables were analyzed with odds ratio, Chi-squared, and Fisher's Exact test, linear variables analyzed with t-test. RESULTS There were 5/296 (1.7%) infections in patients without preoperative antibiotics, and 17/623 (2.7%) infections in patients with preoperative antibiotics. Patients who had received preoperative antibiotics had no significant change in infection rate (95% odds ratio: 0.597-1.633). Other variables, such as age, body mass index, race, surgeon, insurance type, diabetes, depression, anxiety, arthritis, concurrent surgeries, and hyperlipidemia were also not significant for risk of infection. CONCLUSIONS Preoperative antibiotics do not demonstrate benefit for patients undergoing uncomplicated ulnar nerve releases at the elbow. Preoperative antibiotics do not significantly decrease the risk for postoperative infections in patients, regardless of patient comorbidities.Type of Evidence: Level 4-retrospective study.
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Affiliation(s)
| | - John R. Fowler
- Department of Orthopaedics, University of Pittsburgh Medical Center, PA, USA
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7
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Rocks MC, Donnelly MR, Li A, Glickel SZ, Catalano LW, Posner M, Hacquebord JH. Demographics of Common Compressive Neuropathies in the Upper Extremity. Hand (N Y) 2024; 19:217-223. [PMID: 35815639 PMCID: PMC10953515 DOI: 10.1177/15589447221107701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND The purpose of this study was to compare the demographic differences of the most common peripheral nerve compressions in the upper extremity-carpal tunnel syndrome (CTS), ulnar nerve compression (UNC) at the elbow, combined CTS and UNC, radial tunnel syndrome (RTS), and posterior interosseous nerve syndrome (PINS)-as a means to better understand the etiologies of each. METHODS A retrospective chart review was performed of all patients over the age of 18 years seen at our institution in the 2018 calendar year. International Classification of Diseases, Tenth Revision codes were used to identify patients with diagnoses of upper extremity peripheral nerve compressions. Demographic details and relevant comorbidities were recorded for each patient and compared with controls, who were seen the same calendar year with no neuropathies. χ2 analyses, independent-samples t tests, and multivariate logistic regressions were performed (P < .05). RESULTS A total of 7448 patients were identified. Those with CTS were mainly women, former smokers, and diabetic (all P < .001) and with a greater average body mass index (BMI) (P = .006) than controls. Patients with UNC were more often men and younger when compared with controls (both P < .001). A history of smoking, diabetes, and average BMI were similar between patients with UNC and controls (all P > .05). Those patients with combined CTS/UNC were mainly men, former smokers, and diabetic (all P < .001) when compared with controls. Patients with RTS/PINS were also mostly men (P = .007), diabetic (P = .042), and were more often current smokers (P < .001). CONCLUSIONS The demographics of patients with various compressive neuropathies were not homogeneous, suggesting different etiologies.
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8
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Nyman E, Dahlin LB. The Unpredictable Ulnar Nerve-Ulnar Nerve Entrapment from Anatomical, Pathophysiological, and Biopsychosocial Aspects. Diagnostics (Basel) 2024; 14:489. [PMID: 38472962 DOI: 10.3390/diagnostics14050489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Peripheral nerves consist of delicate structures, including a rich microvascular system, that protect and nourish axons and associated Schwann cells. Nerves are sensitive to internal and external trauma, such as compression and stretching. Ulnar nerve entrapment, the second most prevalent nerve entrapment disorder after carpal tunnel syndrome, appears frequently at the elbow. Although often idiopathic, known risk factors, including obesity, smoking, diabetes, and vibration exposure, occur. It exists in all adult ages (mean age 40-50 years), but seldom affects individuals in their adolescence or younger. The patient population is heterogeneous with great co-morbidity, including other nerve entrapment disorders. Typical early symptoms are paresthesia and numbness in the ulnar fingers, followed by decreased sensory function and muscle weakness. Pre- and postoperative neuropathic pain is relatively common, independent of other symptom severity, with a risk for serious consequences. A multimodal treatment strategy is necessary. Mild to moderate symptoms are usually treated conservatively, while surgery is an option when conservative treatment fails or in severe cases. The decision to perform surgery might be difficult, and the outcome is unpredictable with the risk of complications. There is no consensus on the choice of surgical method, but simple decompression is relatively effective with a lower complication rate than transposition.
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Affiliation(s)
- Erika Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, 581 85 Linköping, Sweden
| | - Lars B Dahlin
- Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
- Department of Hand Surgery, Skåne University Hospital, 205 02 Malmö, Sweden
- Department of Translational Medicine-Hand Surgery, Lund University, 205 02 Malmö, Sweden
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9
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Akhmadeeva LR, Davydov OS, Danilov AB, Dukhanin AS, Evzikov GY, Zhivolupov SA, Kukushkin ML, Nikitin SS, Strokov IA, Suponeva NA, Churyukanov MV, Shirokov VA. [A diagnostic algorithm for tunnel mononeuropathies management (consensus of experts)]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:80-88. [PMID: 39072571 DOI: 10.17116/jnevro202412406180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
The expert consensus is aimed to develop an algorithm for the diagnosis and treatment of mononeuropathies for outpatient neurologists. Leading experts in the field of neurology have suggested workup options for certain types of tunnel mononeuropathies based on current data on the effectiveness and safety of various types of conservative and surgical treatment.
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Affiliation(s)
| | - O S Davydov
- Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - A B Danilov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A S Dukhanin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - G Yu Evzikov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - M L Kukushkin
- Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - S S Nikitin
- Research Centre for Medical Genetics, Moscow, Russia
| | - I A Strokov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - N A Suponeva
- Research Center of Neurology Moscow, Russi, Research Center of Neurology Moscow, Russia
| | - M V Churyukanov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - V A Shirokov
- Erisman Federal Scientific Center of Hygiene, Mytishchi, Russia
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Hannaford A, Simon NG. Ulnar neuropathy. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:103-126. [PMID: 38697734 DOI: 10.1016/b978-0-323-90108-6.00006-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Ulnar neuropathy at the elbow is the second most common compressive neuropathy. Less common, although similarly disabling, are ulnar neuropathies above the elbow, at the forearm, and the wrist, which can present with different combinations of intrinsic hand muscle weakness and sensory loss. Electrodiagnostic studies are moderately sensitive in diagnosing ulnar neuropathy, although their ability to localize the site of nerve injury is often limited. Nerve imaging with ultrasound can provide greater localization of ulnar injury and identification of specific anatomical pathology causing nerve entrapment. Specifically, imaging can now reliably distinguish ulnar nerve entrapment under the humero-ulnar arcade (cubital tunnel) from nerve injury at the retro-epicondylar groove. Both these pathologies have historically been diagnosed as either "ulnar neuropathy at the elbow," which is non-specific, or "cubital tunnel syndrome," which is often erroneous. Natural history studies are few and limited, although many cases of mild-moderate ulnar neuropathy at the elbow appear to remit spontaneously. Conservative management, perineural steroid injections, and surgical release have all been studied in treating ulnar neuropathy at the elbow. Despite this, questions remain about the most appropriate management for many patients, which is reflected in the absence of management guidelines.
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Affiliation(s)
- Andrew Hannaford
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | - Neil G Simon
- Northern Beaches Clinical School, Macquarie University, Sydney, NSW, Australia.
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11
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Zhang JY, Manirajan A, Wolf JM. The Epidemiology of Radial Tunnel Syndrome and Its Overlap With Lateral Epicondylitis. J Hand Surg Am 2023; 48:1172.e1-1172.e7. [PMID: 37923487 DOI: 10.1016/j.jhsa.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/19/2023] [Accepted: 03/09/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Radial tunnel syndrome (RTS) is characterized by nerve compression affecting the posterior interosseous nerve branch in the forearm, and its symptoms often overlap with those of lateral epicondylitis (LE). The purpose of this study was to examine the epidemiology of RTS, frequency of injections and surgical release, and overlap of RTS with LE. METHODS We queried the PearlDiver database to identify RTS in patients older than 18 years. Demographic data, diagnostic or therapeutic injection within 30 days of diagnosis, surgical release within 1 year of diagnosis, and 90-day postoperative complication rates were evaluated. Using International Classification of Diseases, 10th Revision, laterality codes, we also determined the number of patients who had same-side RTS and LE and the proportion of patients who subsequently underwent simultaneous RT release and LE debridement. RESULTS The prevalence of RTS in a representative United States insurance database was 0.091%, and the annual incidence was 0.0091%. There were 75,459 patients identified with an active RTS diagnosis. The mean age at the time of diagnosis was 52 years (range, 18-81 years), 55% were women, and 1,833 patients (2.4%) underwent RT release within 1 year. Fewer than 3% of the patients received an injection within 30 days of RTS diagnosis. The 90-day postoperative complication rates were low: 5% of the patients required hospital readmission and 2.1% underwent revision surgery. Approximately 5.7% of the patients with RTS also had a diagnosis of LE on the same side within 6 months of RTS diagnosis. In patients with ipsilateral RTS and LE who underwent surgery, 59.1% underwent simultaneous RT release and LE debridement, whereas 40.9% underwent isolated radial tunnel release. CONCLUSIONS The analysis of a large insurance database showed that the diagnosis of RTS is rarely assigned, suggesting that the incidence of this nerve compression is low. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
| | | | - Jennifer Moriatis Wolf
- Department of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL
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12
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Vojtěch K, David K, Ivan H. Ulnar nerve neuropathy caused by pathologic ossification: a case report. Surg Radiol Anat 2023; 45:1107-1110. [PMID: 37566256 DOI: 10.1007/s00276-023-03217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Cubital tunnel syndrome is a well-described entity with many reported etiologies and anatomical compression sites. Accessory ossicles of either traumatic or congenital origin might occur around the elbow joint. Only one case reporting such ossicles compressing the ulnar nerve exists in previous literature. We aim to present this entity with a detailed description of the patient history and treatment. CASE REPORT We report a case of 30-year-old female presenting with classical signs of cubital tunnel syndrome-positive Wartenberg's and Froment's signs, hypoesthesia in the fourth and fifth finger with decreased finger duction strength but without gross hypotrophy of interosseous and hypothenar muscles. Tinel's sign was positive over the ulnar sulcus and an accessory ossicle was found on the elbow radiograph within the ulnar sulcus. The first signs of calcification in this patient were reported 6 years prior in a follow-up after the dislocation of her elbow joint following a bike accident. The EMG confirmed ulnar nerve neuropathy in the elbow area. The ossicle was extirpated, the ulnar nerve was decompressed in the ulnar sulcus in a standard manner and the symptoms quickly resolved. The patient has been regularly visiting our outpatient clinic for the next 12 years without any complaints considering her elbow and the ulnar nerve. CONCLUSION This is a rare case of cubital tunnel syndrome caused by an accessory ossicle of traumatic origin. Simple bone extirpation with ulnar nerve release followed by anterior subcutaneous transposition is the recommended method of treatment. No report of congenital accessory bones causing ulnar nerve compression in the elbow exists in the literature.
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Affiliation(s)
- Kunc Vojtěch
- Clinic of Trauma Surgery, Masaryk Hospital, Usti nad Labem, Czech Republic
| | - Kachlík David
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Humhej Ivan
- Clinic of Neurosurgery, Masaryk Hospital, Sociální péče 3316/12A, 400 111, Usti nad Labem, Czech Republic.
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13
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Javeed S, Birenbaum N, Xu Y, Dibble CF, Greenberg JK, Zhang JK, Benedict B, Sydnor K, Dy CJ, Brogan DM, Faraji AH, Spinner RJ, Ray WZ. Mechanomyography as a Surgical Adjunct for Treatment of Chronic Entrapment Neuropathy: A Case Series. Oper Neurosurg (Hagerstown) 2023; 25:242-250. [PMID: 37441801 DOI: 10.1227/ons.0000000000000812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 04/11/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Chronic entrapment neuropathy results in a clinical syndrome ranging from mild pain to debilitating atrophy. There remains a lack of objective metrics that quantify nerve dysfunction and guide surgical decision-making. Mechanomyography (MMG) reflects mechanical motor activity after stimulation of neuromuscular tissue and may indicate underlying nerve dysfunction. OBJECTIVE To evaluate the role of MMG as a surgical adjunct in treating chronic entrapment neuropathies. METHODS Patients 18 years or older with cubital tunnel syndrome (n = 8) and common peroneal neuropathy (n = 15) were enrolled. Surgical decompression of entrapped nerves was performed with intraoperative MMG of the hypothenar and tibialis anterior muscles. MMG stimulus thresholds (MMG-st) were correlated with compound muscle action potential (CMAP), motor nerve conduction velocity, baseline functional status, and clinical outcomes. RESULTS After nerve decompression, MMG-st significantly reduced, the mean reduction of 0.5 mA (95% CI: 0.3-0.7, P < .001). On bivariate analysis, MMG-st exhibited significant negative correlation with common peroneal nerve CMAP ( P < .05), but no association with ulnar nerve CMAP and motor nerve conduction velocity. On preoperative electrodiagnosis, 60% of nerves had axonal loss and 40% had conduction block. The MMG-st was higher in the nerves with axonal loss as compared with the nerves with conduction block. MMG-st was negatively correlated with preoperative hand strength (grip/pinch) and foot-dorsiflexion/toe-extension strength ( P < .05). At the final visit, MMG-st significantly correlated with pain, PROMIS-10 physical function, and Oswestry Disability Index ( P < .05). CONCLUSION MMG-st may serve as a surgical adjunct indicating axonal integrity in chronic entrapment neuropathies which may aid in clinical decision-making and prognostication of functional outcomes.
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Affiliation(s)
- Saad Javeed
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Nathan Birenbaum
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Yameng Xu
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Christopher F Dibble
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Jacob K Greenberg
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Justin K Zhang
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Braeden Benedict
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Kiersten Sydnor
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher J Dy
- Department of Orthopedic Surgery, Washington University, St. Louis, Missouri, USA
| | - David M Brogan
- Department of Orthopedic Surgery, Washington University, St. Louis, Missouri, USA
| | - Amir H Faraji
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Robert J Spinner
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Wilson Z Ray
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
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14
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Costello MC, Errante EL, Tigre JY, Burks SS. Commentary: Mechanomyography as a Surgical Adjunct for Treatment of Chronic Entrapment Neuropathy: A Prospective Case Series. Oper Neurosurg (Hagerstown) 2023; 25:e124-e125. [PMID: 37499241 DOI: 10.1227/ons.0000000000000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 07/29/2023] Open
Affiliation(s)
- Meredith C Costello
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Emily L Errante
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joseph Yunga Tigre
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - S Shelby Burks
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA
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15
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McGurk K, Tracey JA, Daley DN, Daly CA. Diagnostic Considerations in Compressive Neuropathies. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:525-535. [PMID: 37521550 PMCID: PMC10382896 DOI: 10.1016/j.jhsg.2022.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 10/14/2022] [Indexed: 12/23/2022] Open
Abstract
Peripheral nerve compression of the upper extremity is a common pathology often necessitating surgical intervention, much is known, but much more is left to understand. For the more common pathologies, carpal tunnel syndrome, cubital tunnel syndrome, and ulnar tunnel syndrome, research and clinical efforts directed toward standardization and reduction of resource use have been attempted with varied success. Diagnosis of many of these syndromes is largely based on a proper history and physical examination. Electrodiagnostic studies continue to have value, but proportionally less than previous decades. In addition, emerging technologies, including magnetic resonance neurography, novel ultrasound evaluation techniques, and ultrasound-guided diagnostic injections, are beginning to demonstrate their ability to add value to the diagnostic algorithm, particularly when less common compressive neuropathies are present and/or the diagnosis is in question.
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Affiliation(s)
- Katherine McGurk
- Department of Orthopedic Surgery, Medical University of South Carolina Charleston, SC
| | - Joseph Anthony Tracey
- Department of Orthopedic Surgery, Medical University of South Carolina Charleston, SC
| | - Dane N. Daley
- Department of Orthopedic Surgery, Medical University of South Carolina Charleston, SC
| | - Charles Andrew Daly
- Department of Orthopedic Surgery, Medical University of South Carolina Charleston, SC
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16
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Hannula A, Miettinen L, Lampainen K, Ryhänen J, Torkki P, Hulkkonen S. Cost of surgical treatment for ulnar nerve entrapment in Finland, 2011-2015: a registry-based cost description study. BMJ Open 2023; 13:e068964. [PMID: 37263693 DOI: 10.1136/bmjopen-2022-068964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the cost of surgical treatment for primary ulnar nerve entrapment (UNE) borne by the public sector in Finland. DESIGN Registry-based cost description study. SETTING Primary and secondary care throughout Finland. PARTICIPANTS We identified all the patients diagnosed with primary UNE in the whole population of Finland from 2011 to 2015 from the Care Register for Health Care. From these patients, we identified those who had undergone ulnar nerve release during the year they were diagnosed or the following year. INTERVENTIONS Open ulnar nerve release. OUTCOME MEASURES The primary outcome measure was cost borne by the public sector in 2015 euros. The cost of surgery was based on the diagnosis-related group prices. We calculated the cost of a single visit to a primary care physician, an electroneuromyography examination, a preoperative visit to a hand surgeon and a follow-up appointment by telephone in specialised care for each patient. These unit costs were provided by the Finnish Institute for Health and Welfare and the same costs were used for each patient. We obtained the number of reimbursed sick days and the total amount reimbursed to each patient in euros within the 2 years after diagnosis from the Social Insurance Institution of Finland. RESULTS During our study period, approximately 1786 primary UNE diagnoses were made yearly, and on average, 876 (49%) of patients received surgical treatment annually. The surgery-related cost per patient averaged at EUR 1341 (43%) and reimbursed sick leaves at EUR 952 (30%) during this period. The annual cost of surgical treatment for UNE borne by the public sector in Finland varied between EUR 3082 and EUR 3213 per patient. CONCLUSIONS The average cost of surgical treatment for UNE in Finland was EUR 3140 per patient between 2011 and 2015.
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Affiliation(s)
- Aarni Hannula
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Laura Miettinen
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaisa Lampainen
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jorma Ryhänen
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Paulus Torkki
- Department of Public Health, Helsingin Yliopisto, Helsinki, Finland
| | - Sina Hulkkonen
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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17
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Mendelaar NHA, Hundepool CA, Hoogendam L, Duraku LS, Zöphel OT, Selles RW, Zuidam JM. Multiple Compression Syndromes of the Same Upper Extremity: Prevalence, Risk Factors, and Treatment Outcomes of Concomitant Treatment. J Hand Surg Am 2023; 48:479-488. [PMID: 37003953 DOI: 10.1016/j.jhsa.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/29/2022] [Accepted: 01/25/2023] [Indexed: 04/03/2023]
Abstract
PURPOSE Multiple nerve compression syndromes can co-occur. Little is known about this coexistence, especially about risk factors and surgical outcomes. Therefore, this study aimed to describe the prevalence of multiple nerve compression syndromes in the same arm in a surgical cohort and determine risk factors. Additionally, the surgical outcomes of concomitant treatment were studied. METHODS The prevalence of surgically treated multiple nerve compression syndromes within one year was assessed using a review of patients' electronic records. Patient characteristics, comorbidities, and baseline scores of the Boston Carpal Tunnel Questionnaire were considered as risk factors. To determine the treatment outcomes of simultaneous treatment, patients who underwent concomitant carpal tunnel release (CTR) and cubital tunnel release (CubTR) were selected. The treatment outcomes were Boston Carpal Tunnel Questionnaire scores at intake and at 3 and 6 months after the surgery, satisfaction 6 months after the surgery, and return to work within the first year. RESULTS A total of 7,867 patients underwent at least one nerve decompression between 2011 and 2021. Of these patients, 2.9% underwent multiple decompressions for the same upper extremity within one year. The risk factors for this were severe symptoms, younger age, and smoking. Furthermore, the treatment outcomes of concomitant CTR and CubTR did not differ from those of CubTR alone. The median time to return to work after concomitant treatment was 6 weeks. Patients who underwent CTR or CubTR alone returned to work after 4 weeks. CONCLUSIONS Approximately 3% of the patients who underwent surgical treatment for nerve compression syndrome underwent decompression for another nerve within 1 year. Patients who report severe symptoms at intake, are younger, or smoke are at a greater risk. Patients with carpal and cubital tunnel syndrome may benefit from simultaneous decompression. The time to return to work may be less than if they underwent decompressions in separate procedures, whereas their surgical outcomes are comparable with those of CubTR alone. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Nienke H A Mendelaar
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands; Hand and Wrist Centre, Xpert Clinic, Eindhoven, The Netherlands.
| | - Caroline A Hundepool
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Lisa Hoogendam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands; Hand and Wrist Centre, Xpert Clinic, Eindhoven, The Netherlands
| | - Liron S Duraku
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Oliver T Zöphel
- Hand and Wrist Centre, Xpert Clinic, Eindhoven, The Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J Michiel Zuidam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
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18
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Avive Soft Tissue Membrane Improves Outcomes of Revision Upper-extremity Nerve Decompression Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4842. [PMID: 36891562 PMCID: PMC9988274 DOI: 10.1097/gox.0000000000004842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/18/2023] [Indexed: 03/08/2023]
Abstract
Revision nerve decompression remains a challenge for surgeons. Avive Soft Tissue Membrane is processed human umbilical cord membrane that may reduce inflammation and scarring, thereby improving tissue gliding. Although synthetic conduits have been reported in revision nerve decompression, the use of Avive has not. Methods Prospective study of revision nerve decompression with Avive application. VAS pain, two-point discrimination, Semmes-Weinstein, pinch and grip strength, range of motion, Quick Disability of Arm, Shoulder & Hand (QuickDASH), and satisfaction were recorded. Using a propensity-matched cohort, VAS pain and satisfaction were retrospectively collected to compare with cohort outcomes. Results In the Avive cohort, 77 patients (97 nerves) were included. Mean follow-up was 9.0 months. Avive was applied to the median nerve in 47.4%, ulnar nerve in 39.2%, and radial nerve in 13.4%. VAS pain was 4.5 preoperatively and 1.3 postoperatively. S4 sensory recovery was achieved in 58% of patients, S3+ in 33%, S3 in 7%, S0 in 2%, and improvement from baseline in 87%. Strength improved in 92%. Mean total active motion was 94.8%. Mean QuickDASH score was 36.1, and 96% reported improved or resolved symptoms. Preoperative pain was not significantly different between Avive cohort and controls (P = 0.618). Postoperative pain was significantly lower in cohort patients (1.3 ± 2.2 versus 2.7 ± 3.0, P = 0.001). In the Avive cohort, more had improved or resolved symptoms (P < 0.0001). Clinically important improvement in pain was reported in 64.9% of Avive group patients versus 40.8% of controls (P = 0.002). Conclusion Avive contributes to improved outcomes in revision nerve decompression.
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19
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Vinciguerra C, Iacono S, Bevilacqua L, Landolfi A, Piscosquito G, Ginanneschi F, Schirò G, Di Stefano V, Brighina F, Barone P, Balistreri CR. Sex differences in neuromuscular disorders. Mech Ageing Dev 2023; 211:111793. [PMID: 36806604 DOI: 10.1016/j.mad.2023.111793] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
The prevalence, onset, pathophysiology, and clinical course of many neuromuscular disorders (NMDs) may significantly differ between males and females. Some NMDs are more frequently observed in females, and characterized to show a higher grade of severity during or after the pregnancy. Meanwhile, others tend to have an earlier onset in males and exhibit a more variable progression. Prevalently, sex differences in NMDs have a familiar character given from genetic inheritance. However, they may also influence clinical presentation and disease severity of acquired NMD forms, and are represented by both hormonal and genetic factors. Consequently, to shed light on the distinctive role of biological factors in the different clinical phenotypes, we summarize in this review the sex related differences and their distinctive biological roles emerging from the current literature in both acquired and inherited NMDs.
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Affiliation(s)
- Claudia Vinciguerra
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy.
| | - Salvatore Iacono
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Liliana Bevilacqua
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Annamaria Landolfi
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Giuseppe Piscosquito
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Giuseppe Schirò
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Vincenzo Di Stefano
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Filippo Brighina
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Paolo Barone
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Carmela Rita Balistreri
- Cellular and Molecular Laboratory, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90134 Palermo
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20
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Córdoba-Mosqueda ME, Rasulić L, Savić A, Grujić J, Vitošević F, Lepić M, Mićić A, Radojević S, Mandić-Rajčević S, Jovanović I, Rodríguez-Aceves CA. Quality of life and satisfaction in patients surgically treated for cubital tunnel syndrome. Neurol Res 2023; 45:138-151. [PMID: 36130919 DOI: 10.1080/01616412.2022.2126163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Cubital tunnel syndrome (CuTS) results from compression of the ulnar nerve at the elbow, resulting in pain, weakness, and numbness of the hand and forearm. This work describes the Quality of Life (QoL) and satisfaction after CuTS surgery and identifies the factors associated with those outcomes. METHODS This cross-sectional study included patients surgically treated for CuTS from January 2011 to September 2021 at the Neurosurgery Clinic of the Clinic Center in Serbia. The questionnaires applied were the Short Form 36 (SF-36), EuroQol instrument (EQ-5D-5 L), Bishop's score and Patient-Rated Ulnar Nerve Evaluation (PRUNE). RESULTS Sixty-two patients met the inclusion criteria. Bishop's score: The median score was 10 (7.75-11), 54.8% of the cases presented excellent results. PRUNE: The median score for symptoms was 19 (6-38.5); for functional, was 14 (0.75-38); and the total was 18.25 (5.87-34.12). SF-36: The subscale with the best result was social functioning (84.68 ± 22.79). The scale with the worst value was emotional well-being (49.35 ± 7.87). EQ-5D-5L: Over 50% patients did not present problems with mobility, self-care, activity, and anxiety. The average EQ-VAS was 72.77 ± 18.70; and 0.72 ± 0.21 of the EQ-index, revealing a good QoL. Models for QoL and satisfaction: Ten models showed statistical significance. The variables with major involvement were body mass index and time evolution of the symptoms. CONCLUSION Surgical decompression has proved to diminish the symptoms, improving QoL and satisfaction. Many fixed and changeable factors can affect the satisfaction levels after surgery.
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Affiliation(s)
- María Elena Córdoba-Mosqueda
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Lukas Rasulić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Andrija Savić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jovan Grujić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Filip Vitošević
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Neuroradiology Department, Center for Radiology and MRI, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Lepić
- Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Aleksa Mićić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Stefan Mandić-Rajčević
- School of Public Health and Health Management and Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Jovanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
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21
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Kortlever JT, Brandsema B, Gradl-Dietsch G, Zhao M, Ring D. Electrodiagnostic test results in people with a working diagnosis of cubital tunnel syndrome. J Orthop 2023; 36:114-119. [PMID: 36691440 PMCID: PMC9860396 DOI: 10.1016/j.jor.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 11/19/2022] [Accepted: 01/06/2023] [Indexed: 01/08/2023] Open
Abstract
Background Electrodiagnostic tests (EDx) can determine when symptoms and signs suggestive of idiopathic ulnar neuropathy at the elbow (cubital tunnel syndrome; CubTS) is due to measurable ulnar neuropathy at the elbow (UNE), cervical radiculopathy, or median neuropathy at the carpal tunnel, and when there is no measurable neuropathology associated with the symptoms. The role of EDx in management of CubTS is debated. Questions (1) What is the percentage of patients with CubTS (both including and excluding patients with a previous electrodiagnosis of idiopathic UNE) that have EDx results consistent with idiopathic UNE, other neuropathology, and no detectable neuropathology (2) What factors (e.g. age and gender); are independently associated with electrodiagnosis of UNE. Methods We retrospectively reviewed all medical records of 133 patients with a working diagnosis of CubTS sent for EDx over a 5-year period in one large urban medical center. We recorded data on patient demographics, comorbidities, non-specialist or specialist referring physician, and EDx results. Results Among 133 patients, 61% (N = 81) of EDx identified idiopathic UNE, 14% (N = 18) identified other neuropathology, and for 26% (N = 34) there was no measurable neuropathology. Among the 14 patients with a previous ipsilateral or contralateral electrodiagnosis of UNE, all 14 had electrodiagnosis of UNE. Older age and men were independently associated with an increased likelihood of UNE. Conclusions The observation that people diagnosed with CubTS often do not have UNE, particularly if they are relatively young, suggests that the diagnosis of CubTS may benefit from a more stringent clinical prediction rule. Level of Evidence Diagnostic; Retrospective cohort study; Level III.
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Affiliation(s)
- Joost T.P. Kortlever
- Department of Surgery and Perioperative Care Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | | | - Gertraud Gradl-Dietsch
- Department of Orthopaedic and Trauma Surgery Klinikum Essen, The University of Duisburg, Essen, Germany
| | - Meijuan Zhao
- Department of Physical Medicine and Rehabilitation Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Ring
- Department of Surgery and Perioperative Care Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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22
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Liu C, Grisdela P, Liu D, Model Z, Steele A, Blazar P, Earp BE, Zhang D. Does the Surgical Assistant Influence Perioperative Outcomes Surrounding Cubital Tunnel Surgery? J Hand Surg Asian Pac Vol 2023; 28:84-90. [PMID: 36803476 DOI: 10.1142/s2424835523500133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background: Ulnar neuropathy at the elbow is the second most common upper extremity compressive neuropathy and surgical treatment often involves surgical trainee involvement. The primary aim of this study is to determine the effect of trainees and surgical assistants on outcomes surrounding cubital tunnel surgery. Methods: This retrospective study included 274 patients with cubital tunnel syndrome who underwent primary cubital tunnel surgery at two academic medical centres between 1 June 2015 and 1 March 2020. The patients were divided into four main cohorts based on primary surgical assistant: physician associates (PA, n = 38), orthopaedic or plastic surgery residents (n = 91), hand surgery fellows (n = 132), or both residents and fellows (n = 13). Exclusion criteria included patient age <18 years, revision surgery as the index procedure, prior traumatic ulnar nerve injury and concurrent procedures not related to cubital tunnel surgery. Demographics, clinical variables and perioperative findings were collected through chart reviews. Univariate and bivariate analyses were performed, and p < 0.05 was considered significant. Results: Patients in all cohorts had similar demographic and clinical characteristics. There was a significantly higher rate of subcutaneous transposition in the PA cohort (39.5% PA vs. 13.2% Resident vs. 19.7% Fellow vs. 15.4% Resident + Fellow). Presence of surgical assistants and trainees had no association with length of surgery, complications and reoperation rates. Although male sex and ulnar nerve transposition were associated with longer operative times, no explanatory variables were associated with complications or reoperation rates. Conclusions: Surgical trainee involvement in cubital tunnel surgery is safe and has no effect on operative time, complications or reoperation rates. Understanding the role of trainees and measuring the effect of graduated responsibility in surgery is important for medical training and safe patient care. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Christina Liu
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Phillip Grisdela
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - David Liu
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Zina Model
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Amy Steele
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Philip Blazar
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Brandon E Earp
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Dafang Zhang
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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23
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Hones KM, Nichols DS, Barker H, Cox E, Hones JA, Chim H. Outcomes following use of VersaWrap nerve protector in treatment of patients with recurrent compressive neuropathies. Front Surg 2023; 10:1123375. [PMID: 37025263 PMCID: PMC10071003 DOI: 10.3389/fsurg.2023.1123375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Epineural scarring following previous carpal or cubital tunnel release can lead to pain and permanent dysfunction. To prevent this cascade, nerve wraps are an option. The purpose of this study was to evaluate outcomes following use of VersaWrap nerve protector during surgical decompression and neurolysis in patients with recurrent compressive neuropathies in the upper extremity. Twenty patients comprised the patient cohort, with a mean postoperative follow-up time of 139 days (range: 42-356 days). There were 13 females and 7 males, with a mean age of 43.4 years. Fourteen surgeries were performed for revision cubital tunnel, 5 for revision carpal tunnel, and 1 for revision radial tunnel syndrome. Average duration of symptoms prior to revision surgery with VersaWrap was 2 years (range 9 months to 6 years). Postoperatively, the mean DASH score was 57.7 and VAS 3.1. Mean s2PD median distribution was 7.3, s2PD ulnar distribution 8.9, m2PD median distribution 6.9 and m2PD ulnar distribution 7.3. All patients had subjective improvement of symptoms and were satisfied with their result. No patients in our cohort required further revisional surgery. In conclusion, the use of VersaWrap as a nerve protector following revision surgery for recurrent compressive neuropathies in the upper extremity was safe and effective. Level of Evidence: IV; retrospective case series.
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Affiliation(s)
- Keegan M. Hones
- University of Florida Collage of Medicine, Gainesville, FL, United States
| | | | - Haley Barker
- Department of Plastic and Reconstructive Surgery, University of Florida, Gainesville, FL, United States
| | - Elizabeth Cox
- University of Florida Collage of Medicine, Gainesville, FL, United States
| | - Jaime A. Hones
- Department of Plastic and Reconstructive Surgery, University of Florida, Gainesville, FL, United States
| | - Harvey Chim
- Department of Plastic and Reconstructive Surgery, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
- Correspondence: Harvey Chim
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Anterior interosseous nerve neuropathy in a patient with spinal cord injury: case report and literature review. Spinal Cord Ser Cases 2022; 8:61. [DOI: 10.1038/s41394-022-00527-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/09/2022] Open
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Dabbagh A, Saeidi S, MacDermid JC. Psychometric Properties of the Patient-Reported Outcome Measures for People With Ulnar Nerve Entrapment at the Elbow: A Systematic Review. Phys Ther 2022; 102:6650972. [PMID: 35899759 DOI: 10.1093/ptj/pzac103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/23/2022] [Accepted: 05/06/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of this study was to systematically review, critically appraise, and synthesize evidence on the measurement properties of patient-reported outcome measures (PROMs) for people with ulnar nerve entrapment at the elbow (UNE). METHODS CINAHL, MEDLINE, Embase, and Scopus were searched for studies reporting on the psychometric properties of the PROMs used to assess pain, disability, and quality of life of people with UNE. Relevant data were extracted based on the Consensus-Based Standards for the Selection of Health Measurement Instruments 2018 checklist. Two authors independently rated the quality and risk of bias of the studies. A qualitative synthesis was performed according to the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines. The results were categorized based on the identified PROMs, and all the psychometric properties were summarized and presented. RESULTS Eight included studies had a quality score of very good or higher. Among all the included PROMs, the Patient-Rated Ulnar Nerve Evaluation (PRUNE) was comprehensively evaluated in 4 studies and had high reliability, appropriate correlation to the physical component summary score of the 36-Item Short-Form Health Survey (r = -0.68), excellent content (cognitive interviews), structural (factor analysis) and discriminative validities, and high responsiveness. The Disabilities of the Arm, Shoulder and Hand Questionnaire was assessed in 5 studies and had appropriate properties, showing a high correlation with the 8-Item Short-Form Health Survey (r = 0.77) and PRUNE (r = 0.75) and moderate responsiveness. CONCLUSIONS The PRUNE was the most specific to UNE, had the most supporting studies and evidence of excellent reliability, validity, and responsiveness and therefore was the preferred PROM. The Disabilities of the Arm, Shoulder and Hand Questionnaire demonstrated more limited validation across 5 studies and had moderate responsiveness. Information on other included PROMs was limited in terms of psychometric properties. IMPACT This study provides insight into which PROM is potentially more suitable for measuring outcomes related to UNE.
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Affiliation(s)
- Armaghan Dabbagh
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Sahar Saeidi
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Joy C MacDermid
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada.,Department of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada
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Mansour J, Ghanimeh J, Ghersi A, Moutinot B, Coulomb R, Kouyoumdjian P, Mares O. Percutaneous ultrasound-guided ulnar nerve release technique compared to open technique: A cadaveric study. SICOT J 2022; 8:40. [PMID: 36155647 PMCID: PMC9511962 DOI: 10.1051/sicotj/2022041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/08/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the outcomes of a novel percutaneous ultrasound-guided technique for release of ulnar nerve entrapment at the elbow when compared to standard open release Methods: One single surgeon performed an ultrasound-guided percutaneous release of the cubital tunnel on a group of five cadaveric elbows and open release on five others. All procedures were timed, and incision lengths were recorded. Meticulous anatomic dissection was then performed to assess the complete release of the carpal tunnel and iatrogenic injuries. RESULTS No significant difference was found between the two groups in terms of complete release and iatrogenic injury, whereas Operative time was significantly shorter for the US-guided technique. Incomplete releases of the nerve were found only during the first two trials in each group, while the third, fourth, and fifth trials showed a complete ulnar nerve release in both series, highlighting a fast learning curve for both techniques. All of this through a significantly smaller incision in the US-guided technique. CONCLUSIONS This study highlights the similar effects of these two techniques in terms of complete release of the ulnar nerve, with no clear superiority of one over the other in terms of morbidity rate. Both have a fast learning curve for an ultrasound-trained surgeon, with the US-guided technique being a less traumatic and quicker alternative procedure.
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Affiliation(s)
- Jad Mansour
- Centre Hospitalier Universitaire Nîmes-Caremeau place du professeur Robert-Debré 30029 Nîmes France
| | - Joe Ghanimeh
- Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Lebanese American University, School of Medicine Beirut Lebanon
| | - Abdelhamid Ghersi
- Centre Hospitalier Universitaire Nîmes-Caremeau place du professeur Robert-Debré 30029 Nîmes France
| | - Berenice Moutinot
- Centre Hospitalier Universitaire Nîmes-Caremeau place du professeur Robert-Debré 30029 Nîmes France
| | - Remy Coulomb
- Centre Hospitalier Universitaire Nîmes-Caremeau place du professeur Robert-Debré 30029 Nîmes France
| | - Pascal Kouyoumdjian
- Centre Hospitalier Universitaire Nîmes-Caremeau place du professeur Robert-Debré 30029 Nîmes France
| | - Olivier Mares
- Centre Hospitalier Universitaire Nîmes-Caremeau place du professeur Robert-Debré 30029 Nîmes France
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Socioeconomic Differences between Sexes in Surgically Treated Carpal Tunnel Syndrome and Ulnar Nerve Entrapment. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2022; 3:353-362. [PMID: 36417243 PMCID: PMC9620911 DOI: 10.3390/epidemiologia3030027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 12/14/2022]
Abstract
We aimed to investigate socioeconomic differences between sexes and the influence on outcome following surgery for carpal tunnel syndrome (CTS) or ulnar nerve entrapment (UNE) at the elbow. Patients with CTS (n = 9000) or UNE (n = 1266) registered in the Swedish National Register for Hand Surgery (HAKIR) 2010-2016 were included and evaluated using QuickDASH 12 months postoperatively. Statistics Sweden (SCB) provided socioeconomic data. In women with CTS, being born outside Sweden, having received social assistance, and more sick leave days predicted worse outcomes. Higher earnings and the highest level of education predicted better outcomes. In men with CTS, more sick leave days and having received social assistance predicted worse outcomes. Higher earnings predicted better outcomes. For women with UNE, higher earnings predicted better outcomes. In men with UNE, only sick leave days predicted worse outcomes. In long-term follow up, socioeconomic status affects outcomes differently in women and men with CTS or UNE.
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Daeschler SC, Wienbruch R, Bursacovschi C, Zimmermann KS, Nemariam SB, Harhaus L, Kneser U, Dehé A, Bittner A. Sensor-Based Nerve Compression Measurement: A Scoping Review of Current Concepts and a Preclinical Evaluation of Commercial Microsensors. Front Bioeng Biotechnol 2022; 10:868396. [PMID: 35898643 PMCID: PMC9309797 DOI: 10.3389/fbioe.2022.868396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Chronic nerve compression is the most common indication for nerve surgery. However, the clinical diagnosis still relies on surrogate parameters since devices for direct nerve compression pressure measurement (DNCPM) are clinically unavailable yet. Objectives: To review previous approaches to DNCPM and evaluate presently available microsensor systems for their feasibility and reliability in preclinical nerve compression models. Methods: A scoping literature review was conducted in accordance with the PRISMA-ScR guidelines. A subsequent market research aimed at identifying commercially available sensor systems potentially suitable for DNCPM. Sensors were evaluated for feasibility and safety of perineural sensor positioning, tissue compatibility and measurement reliability in a synthetic nerve compression model and an ex-vivo chicken leg model. Results: A scoping literature review identified 197 potentially eligible studies of which 65 were included in the analysis. Previous approaches to DNCPM predominantly used pressure sensing catheters designed for fluid- or intra-compartmental pressure measurement. A market research identified two piezoresistive sensor systems (IntraSense, SMi, United States; Mikro-Cath, Millar, United States) as potentially suitable for intraoperative DNCPM. In both preclinical models, the detected compression pressure differed significantly between sensors and systems showed substantial measurement variability with a median percent coefficient of variation between 15.5% and 32%. Sensor position was accountable for up to 99.1% of the variance. Conclusion: Measurement variability caused by unreliable sensor positioning is a key limitation of presently available sensors when applied for nerve compression measurements. Redesigned systems with small, flat-shaped and longitudinally oriented sensors and dedicated introducers would facilitate sensor positioning and therefore may allow for reliable measurements.
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Affiliation(s)
- Simeon C. Daeschler
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, University of Heidelberg, BG Trauma Hospital, Ludwigshafen, Germany
- Department of Plastic and Hand Surgery, University of Heidelberg, BG Trauma Hospital, Ludwigshafen, Germany
- SickKids Research Institute, Neuroscience and Mental Health Program, Toronto, ON, Canada
| | - Rebecca Wienbruch
- Hahn-Schickard-Society for Applied Research, Villingen-Schwenningen, Germany
| | - Catalina Bursacovschi
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, University of Heidelberg, BG Trauma Hospital, Ludwigshafen, Germany
- Department of Plastic and Hand Surgery, University of Heidelberg, BG Trauma Hospital, Ludwigshafen, Germany
| | - Kim Sophie Zimmermann
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, University of Heidelberg, BG Trauma Hospital, Ludwigshafen, Germany
- Department of Plastic and Hand Surgery, University of Heidelberg, BG Trauma Hospital, Ludwigshafen, Germany
| | - Selam Bekure Nemariam
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, University of Heidelberg, BG Trauma Hospital, Ludwigshafen, Germany
- Department of Plastic and Hand Surgery, University of Heidelberg, BG Trauma Hospital, Ludwigshafen, Germany
| | - Leila Harhaus
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, University of Heidelberg, BG Trauma Hospital, Ludwigshafen, Germany
- Department of Plastic and Hand Surgery, University of Heidelberg, BG Trauma Hospital, Ludwigshafen, Germany
- *Correspondence: Leila Harhaus,
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, University of Heidelberg, BG Trauma Hospital, Ludwigshafen, Germany
- Department of Plastic and Hand Surgery, University of Heidelberg, BG Trauma Hospital, Ludwigshafen, Germany
| | - Alfons Dehé
- Hahn-Schickard-Society for Applied Research, Villingen-Schwenningen, Germany
- University of Freiburg, Freiburg, Germany
| | - Achim Bittner
- Hahn-Schickard-Society for Applied Research, Villingen-Schwenningen, Germany
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Ferguson DP, Grewal R. Cubital Tunnel Syndrome: Review of Diagnosis and Management. HANDCHIR MIKROCHIR P 2022; 54:253-262. [PMID: 35688432 DOI: 10.1055/a-1808-6973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cubital tunnel syndrome is one of the most common upper extremity nerve entrapment conditions. Clinical examination and electrodiagnostic studies assist in the diagnosis. Mild cases can be successfully treated conservatively, aiming to reduce traction and compression on the nerve. Surgical management of cubital tunnel syndrome is increasing in frequency. Multiple surgical options exist ranging from simple decompression to decompression and anterior transposition of the nerve. There is no preferred surgical technique. It is critical to reduce the risk of recurrent cubital tunnel syndrome. Revision surgical procedures have worse outcomes than primary surgical procedures.
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Affiliation(s)
| | - Ruby Grewal
- University of Western Ontario Roth
- McFarlane Hand and Upper Limb Center
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Anker I, Nyman E, Zimmerman M, Svensson AM, Andersson G, Dahlin LB. Preoperative Electrophysiology in Patients With Ulnar Nerve Entrapment at the Elbow-Prediction of Surgical Outcome and Influence of Age, Sex and Diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:756022. [PMID: 36992728 PMCID: PMC10012145 DOI: 10.3389/fcdhc.2022.756022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022]
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.
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Affiliation(s)
- Ilka Anker
- Department of Translational Medicine – Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Erika Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, Linköping, Sweden
| | - Malin Zimmerman
- Department of Translational Medicine – Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Ann-Marie Svensson
- National Diabetes Register, Centre of Registers, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Gert S. Andersson
- Department of Neurophysiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lars B. Dahlin
- Department of Translational Medicine – Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- *Correspondence: Lars B. Dahlin,
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Patient Expectations for Symptomatic Improvement before Cubital Tunnel Release. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4174. [PMID: 35265448 PMCID: PMC8901200 DOI: 10.1097/gox.0000000000004174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
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Bergsten E, Rydberg M, Dahlin LB, Zimmerman M. Carpal Tunnel Syndrome and Ulnar Nerve Entrapment at the Elbow Are Not Associated With Plasma Levels of Caspase-3, Caspase-8 or HSP27. Front Neurosci 2022; 16:809537. [PMID: 35310100 PMCID: PMC8931660 DOI: 10.3389/fnins.2022.809537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Nerve compression disorders, such as carpal tunnel syndrome (CTS) and ulnar entrapment at the elbow (UNE), may be associated with apoptosis and neuroprotective mechanisms in the peripheral nerve that may be detected by biomarkers in the blood. The relationships between CTS and UNE and two biomarkers of apoptosis, i.e., caspase-3 and caspase-8, and the neuroprotective factor Heat Shock Protein 27 (HSP27) in plasma were examined in a population-based cohort. Method The biomarkers caspase-3, caspase-8 and HSP27 were measured in plasma at inclusion of 4,284 study participants aged 46-68 years in the population-based Malmö Diet and Cancer study (MDCS). End-point retrieval was made from national registers concerning CTS and UNE. Independent t-test was used to examine the association between caspase-3, caspase-8 and HSP27 plasma levels and incidence of CTS and UNE. Cox proportional hazards regression was used to investigate if plasma levels of caspase-3, caspase-8 and HSP27 affected time to diagnosis of CTS or UNE. Results During the mean follow-up time of 22 years, 189/4,284 (4%) participants were diagnosed with CTS and 42/4,284 (1%) were diagnosed with UNE. No associations were found between incident CTS or UNE and the biomarkers caspase-3, caspase-8 and HSP27 in plasma. Conclusion The apoptotic biomarkers caspase-3 and caspase-8 and the neuroprotective factor HSP27 in plasma, factors conceivably related to a nerve injury, are not associated with the nerve compression disorders CTS and UNE in a general population.
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Affiliation(s)
- Elin Bergsten
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden
- Department of Translational Medicine—Hand Surgery, Lund University, Lund, Sweden
| | - Mattias Rydberg
- Department of Translational Medicine—Hand Surgery, Lund University, Lund, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Lars B. Dahlin
- Department of Translational Medicine—Hand Surgery, Lund University, Lund, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Malin Zimmerman
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden
- Department of Translational Medicine—Hand Surgery, Lund University, Lund, Sweden
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Liu Z, Zhang D. Clinical efficacy of decompression and anterior transposition of the ulnar nerve in osteoarthritis-induced cubital tunnel syndrome and influencing factors. HAND SURGERY & REHABILITATION 2022; 41:370-376. [DOI: 10.1016/j.hansur.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
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Mendelaar NHA, Hundepool CA, Hoogendam L, Duraku LS, Power DM, Walbeehm ET, Selles RW, Zuidam JM. Outcome of Simple Decompression of Primary Cubital Tunnel Syndrome Based on Patient-Reported Outcome Measurements. J Hand Surg Am 2022; 47:247-256.e1. [PMID: 35000814 DOI: 10.1016/j.jhsa.2021.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 10/06/2021] [Accepted: 11/17/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the patient-reported outcome measures of patients with primary cubital tunnel syndrome and to assess whether they are affected by preoperative symptom severity. METHODS Patients who underwent simple decompression for primary cubital tunnel syndrome were selected from a prospectively maintained database. Outcome measurements consisted of the Boston Carpal Tunnel Questionnaire at intake and at 3 and 6 months after surgery. Also, 6 months after surgery, the patients received a question about their satisfaction with the treatment result. To determine a possible influence of preoperative symptom severity on postoperative outcomes, the sample was divided into quartiles based on symptom severity at intake. RESULTS One hundred and forty-five patients were included in the final analysis. On average, all patients improved on the Boston Carpal Tunnel Questionnaire. The subgroup of patients with the mildest symptoms at intake did not improve significantly on symptom severity but did improve significantly on their functional status. In addition, the patients with the most severe symptoms at intake did improve on both aspects. Moreover, no difference in satisfaction with treatment result between the severity of symptoms at intake was found. CONCLUSIONS The patients with the mildest symptoms at intake may not improve on symptom severity, but they do improve on functional status after simple decompression for cubital tunnel syndrome. In addition, patients with the most severe symptoms at intake do improve on both symptom severity and functional status. Moreover, all patients reported to be equally satisfied with the treatment result, which suggests that satisfaction is not dependent on the symptom severity at intake. Even those patients with both the mildest symptoms before surgery and the least improvement still seem to benefit from simple decompression. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Nienke H A Mendelaar
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC - University Medical Centre Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC - University Medical Centre Rotterdam, the Netherlands; Hand and Wrist Centre, Xpert Clinic, the Netherlands
| | - Caroline A Hundepool
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC - University Medical Centre Rotterdam, the Netherlands
| | - Lisa Hoogendam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC - University Medical Centre Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC - University Medical Centre Rotterdam, the Netherlands; Hand and Wrist Centre, Xpert Clinic, the Netherlands
| | - Liron S Duraku
- Hand and Wrist Centre, Xpert Clinic, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Dominic M Power
- Birmingham Hand Centre, University Hospitals Birmingham, NHS Foundation Trust
| | - Erik T Walbeehm
- Hand and Wrist Centre, Xpert Clinic, the Netherlands; Peripheral Nerve Centre, Radboudumc, Nijmegen, the Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC - University Medical Centre Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC - University Medical Centre Rotterdam, the Netherlands
| | - J Michiel Zuidam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC - University Medical Centre Rotterdam, the Netherlands.
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Shook SJ, Ginsberg M, Narayanaswami P, Beekman R, Dubin AH, Katirji B, Swaminathan B, Werner RA, Cartwright MS. Evidence-based guideline: Neuromuscular ultrasound for the diagnosis of ulnar neuropathy at the elbow. Muscle Nerve 2021; 65:147-153. [PMID: 34921428 DOI: 10.1002/mus.27460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION/AIMS The purpose of this literature review is to develop an evidence-based guideline for the use of neuromuscular ultrasound in the diagnosis of ulnar neuropathy at the elbow (UNE). The proposed research question was: "In patients with suspected UNE, does ulnar nerve enlargement as measured with ultrasound accurately identify those patients with UNE?" METHODS A systematic review and meta-analysis was performed, and studies were classified according to American Academy of Neurology criteria for rating articles for diagnostic accuracy. RESULTS Based on Class I evidence in four studies, it is probable that neuromuscular ultrasound measurement of the ulnar nerve at the elbow, either of diameter or cross-sectional area (CSA), is accurate for the diagnosis of UNE. RECOMMENDATION For patients with symptoms and signs suggestive of ulnar neuropathy, clinicians should offer ultrasonographic measurement of ulnar nerve cross-sectional area or diameter to confirm the diagnosis and localize the site of compression (Level B).
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Affiliation(s)
- Steven J Shook
- American Association of Neuromuscular & Electrodiagnostic Medicine, Rochester, Minnesota, USA.,Department of Neurology, Neuromuscular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew Ginsberg
- Department of Neurology, Akron Children's Hospital, Akron, Ohio, USA
| | - Pushpa Narayanaswami
- Department of Neurology, Neuromuscular Division, Beth Israel Deaconess Medical Center, Boston, Ohio, USA
| | - Roy Beekman
- Department of Neurology, Zuyderland Medisch Centrum, Sittard-Geleen, The Netherlands
| | - Andrew H Dubin
- Department of Physical Medicine & Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - Bashar Katirji
- Neurological Institute, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Bharathi Swaminathan
- Department of Physical Medicine and Rehabilitation, Chicago Medical School, North Chicago, Illinois, USA
| | - Robert A Werner
- Michigan Medicine, Ann Arbor VA Health System, Ann Arbor, Michigan, USA
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Patel K, Horak HA. Electrodiagnosis of Common Mononeuropathies: Median, Ulnar, and Fibular (Peroneal) Neuropathies. Neurol Clin 2021; 39:939-955. [PMID: 34602220 DOI: 10.1016/j.ncl.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This article addresses common mononeuropathies seen in the electrodiagnostic laboratory. The most common mononeuropathies-median neuropathy at the wrist (carpal tunnel syndrome), ulnar neuropathy at the elbow, and fibular (peroneal) neuropathy at the fibular head-are reviewed. The causes, clinical presentations, approached to the electrodiagnostic studies (including nerve conduction studies and needle electromyography), and the typical findings are discussed.
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Affiliation(s)
- Kamakshi Patel
- University of Texas Medical Branch (UTMB), 301 University Boulevard, JSA 9.128, Galveston, TX 77555, USA
| | - Holli A Horak
- University of Arizona College of Medicine- Tucson, 1501 North Campbell Avenue, Room 6212a, Tucson, AZ 87524, USA.
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Risk factors of asymptomatic reduction of motor conduction velocity of the ulnar nerve across the elbow. Neurol Sci 2021; 43:2065-2072. [PMID: 34499243 DOI: 10.1007/s10072-021-05584-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The aim of the study was to check the risk factors for subjects with motor conduction velocity (MCV) reduction of the ulnar nerve across the elbow without symptoms/signs of ulnar neuropathy at the elbow (UNE) using a database of a previous multicenter case-control study on UNE patients. METHODS From the previous database, we extracted all asymptomatic UNE (A-UNE) and matched for age and sex with a control and UNE groups with a ratio of 1:2. Anthropometric factors were measured and all participants filled in a questionnaire on demographic, lifestyle factors, and medical history. One-sample proportion test and univariate and multivariate logistic regression analyses were performed. RESULTS We enrolled 64 A-UNE, 124 UNE, and 124 controls (mean age 53 years). There were more males with A-UNE than females (74.2%). The predominantly or exclusively concerned side of A-UNE was the right. Logistic regression showed that A-UNE was associated with diabetes (OR = 2.99, 95% CI = 1.21-7.39) and width of cubital groove (CGW) (OR = 0.89, 95% CI = 0.81-0.97). DISCUSSION Risk factors for A-UNE are different from UNE. The prevalence of right side in A-UNE was not due to particular elbow postures. Diabetes is a risk factor, probably because MCV reduction of the ulnar nerve across the elbow was an early manifestation of asymptomatic polyneuropathy in diabetes. A-UNE is associated with narrow CGW as already demonstrated in UNE, even if the OR was higher in UNE than in A-UNE. Only future longitudinal studies will be able to check whether the A-UNE subjects develop symptoms and signs of true mononeuropathy with time.
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Hwang JS, Lee Y, Bae KJ, Kim J, Baek GH. In Situ Neurolysis of Ulnar Nerve for Patients With Failed Anterior Subcutaneous Transposition - A Case Series. Oper Neurosurg (Hagerstown) 2021; 21:111-117. [PMID: 34100080 PMCID: PMC8521744 DOI: 10.1093/ons/opab171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/19/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Various surgical techniques have been attempted to treat patients with failed anterior subcutaneous transposition performed for cubital tunnel syndrome. OBJECTIVE To analyze intraoperative findings of failed anterior subcutaneous transposition and to report the outcome of in Situ neurolysis of ulnar nerve. METHODS Patients who, under diagnosis of failed anterior subcutaneous transposition of ulnar nerve, underwent in Situ neurolysis between 2001 and 2018 were included in this study. We excluded patients with follow-up of less than one year, records of traumatic ulnar nerve injury, and concomitant double crush syndrome such as cervical spondylosis causing radicular pain, ulnar tunnel syndrome, or thoracic outlet syndrome. Surgical outcomes were evaluated using visual analog scale (VAS) pain score and Disabilities of the Arm, Shoulder, and Hand (DASH) score, which were assessed before and after surgery. A total of 28 elbows in 27 patients whose average age was 58.5 (range, 31-76) yr were enrolled, and the duration of follow-up was 5.8 (range, 1.0-14.9) yr. RESULTS The most common pathologic finding identified during operation was severe adhesion of the transposed nerve in all elbows, followed by incomplete decompression of deep flexor-pronator aponeurosis in 26 elbows (93%). The average VAS pain score improved from 4.9 (range, 2-7) to 1.3 (range, 0-5), and the average DASH score from 31.7 (range, 18.1-66.7) to 14.1 (range, 5.0-46.6). Of the 28 elbows, 27 (96.4%) showed improvement of preoperative symptoms. CONCLUSION In Situ neurolysis of ulnar nerve for patients with failed anterior subcutaneous transposition resulted in satisfactory outcome.
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Affiliation(s)
- Ji Sup Hwang
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yohan Lee
- Department of Orthopaedic Surgery, Seoul National University Boramae Hospital, Seoul, Republic of Korea
| | - Kee Jeong Bae
- Department of Orthopaedic Surgery, Seoul National University Boramae Hospital, Seoul, Republic of Korea
| | - Jihyeung Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
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Zimmerman M, Peyron H, Svensson AM, Eeg-Olofsson K, Nyman E, Dahlin LB. Cold Sensitivity in Ulnar Neuropathy at the Elbow - Relation to Symptoms and Disability, Influence of Diabetes and Impact on Surgical Outcome. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:719104. [PMID: 36994349 PMCID: PMC10012061 DOI: 10.3389/fcdhc.2021.719104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022]
Abstract
Cold sensitivity, an abnormal response to exposure to cold, is debilitating. It often affects people with nerve injuries and diabetes. Knowledge about the occurrence and prognostic impact of cold sensitivity in people with ulnar neuropathy at the elbow (UNE) is limited. We aimed to investigate the occurrence of cold sensitivity in UNE in relation to disability, the influence of diabetes and impact on surgical outcome. Data concerning 1270 persons operated on for UNE from 2010-2016 from the Swedish National Register for Hand Surgery (HAKIR) were matched with data from the Swedish National Diabetes Register (NDR). Disability and symptoms were assessed preoperatively, and at three and 12 months postoperatively using QuickDASH and a symptom-specific survey (HQ-8) containing one item regarding cold sensitivity. Differences regarding grade of cold sensitivity, occurrence of diabetes, QuickDASH scores and HQ-8 scores were studied. A linear regression analysis was performed to predict surgical outcome based on preoperative cold sensitivity. The mean age of the cases was 52 ± SD 14 years and 48% were women. Preoperatively, 427 answered the questionnaire. Severe cold sensitivity was present in 140/427 (33%) cases, moderate in 164/427 (38%) and mild in 123/427 (29%) cases. Cases with severe preoperative cold sensitivity reported higher QuickDASH scores at all times compared to cases with mild cold sensitivity. Relative change in QuickDASH scores over time did not differ between the groups. Cases with diabetes reported worse cold sensitivity preoperatively, but not postoperatively. All HQ-8 items improved with surgery, but cases with severe cold sensitivity reported worse persisting symptoms. Cold sensitivity is a major problem among those with UNE and an even greater preoperative problem among people with diabetes. It is associated with more symptoms and disability pre- and post-operatively. All cases, regardless of preoperative degree of cold sensitivity improve with surgery.
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Affiliation(s)
- Malin Zimmerman
- Department of Orthopaedics, Helsingborg Hospital, Helsingborg, Sweden
- Department of Translational Medicine – Hand Surgery, Lund University, Malmö, Sweden
- *Correspondence: Malin Zimmerman,
| | - Hanna Peyron
- Department of Orthopaedics, Helsingborg Hospital, Helsingborg, Sweden
- Department of Translational Medicine – Hand Surgery, Lund University, Malmö, Sweden
| | - Ann-Marie Svensson
- National Diabetes Register, Centre of Registers, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Eeg-Olofsson
- Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Erika Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, Linköping, Sweden
| | - Lars B. Dahlin
- Department of Translational Medicine – Hand Surgery, Lund University, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
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Management of Recalcitrant Cubital Tunnel Syndrome. J Am Acad Orthop Surg 2021; 29:635-647. [PMID: 33999876 DOI: 10.5435/jaaos-d-20-01381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/02/2021] [Indexed: 02/01/2023] Open
Abstract
Cubital tunnel syndrome is a common upper extremity compressive neuropathy. Recalcitrant cubital tunnel syndrome poses diagnostic and treatment challenges. Potential etiologies of persistent or recurrent symptoms after surgical treatment include an inaccurate preoperative diagnosis, incomplete nerve decompression, iatrogenic injury, postsurgical perineural adhesions, irreversible nerve pathology, or conditions associated with secondary nerve compression. Confirmation of recalcitrant ulnar nerve pathology relies on a thorough history to consider symptoms and chronology, careful examination to quantify nerve function and to assess for focal nerve provocation, and objective testing to highlight a possible nerve lesion such as ultrasonography and electrodiagnostic testing. Conservative treatment may provide symptomatic relief; however, surgical management such as revision neuroplasty, neurolysis, nerve reconstruction, and/or anterior transposition may be indicated. Optimizing the biology of the local nerve environment is critical. No surgical treatment procedure has shown superiority over another; however, individualized treatment is emphasized to improve symptoms and maximize nerve recovery potential.
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Griffiths TT, Flather R, Teh I, Haroon HA, Shelley D, Plein S, Bourke G, Wade RG. Diffusion tensor imaging in cubital tunnel syndrome. Sci Rep 2021; 11:14982. [PMID: 34294771 PMCID: PMC8298404 DOI: 10.1038/s41598-021-94211-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/25/2021] [Indexed: 11/09/2022] Open
Abstract
Cubital tunnel syndrome (CuTS) is the 2nd most common compressive neuropathy. To improve both diagnosis and the selection of patients for surgery, there is a pressing need to develop a reliable and objective test of ulnar nerve 'health'. Diffusion tensor imaging (DTI) characterises tissue microstructure and may identify differences in the normal ulnar from those affected by CuTS. The aim of this study was to compare the DTI metrics from the ulnar nerves of healthy (asymptomatic) adults and patients with CuTS awaiting surgery. DTI was acquired at 3.0 T using single-shot echo-planar imaging (55 axial slices, 3 mm thick, 1.5 mm2 in-plane) with 30 diffusion sensitising gradient directions, a b-value of 800 s/mm2 and 4 signal averages. The sequence was repeated with the phase-encoding direction reversed. Data were combined and corrected using the FMRIB Software Library (FSL) and reconstructed using generalized q-sampling imaging in DSI Studio. Throughout the length of the ulnar nerve, the fractional anisotropy (FA), quantitative anisotropy (QA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were extracted, then compared using mixed-effects linear regression. Thirteen healthy controls (8 males, 5 females) and 8 patients with CuTS (6 males, 2 females) completed the study. Throughout the length of the ulnar nerve, diffusion was more isotropic in patients with CuTS. Overall, patients with CuTS had a 6% lower FA than controls, with the largest difference observed proximal to the cubital tunnel (mean difference 0.087 [95% CI 0.035, 0.141]). Patients with CuTS also had a higher RD than controls, with the largest disparity observed within the forearm (mean difference 0.252 × 10-4 mm2/s [95% CI 0.085 × 10-4, 0.419 × 10-4]). There were no significant differences between patients and controls in QA, MD or AD. Throughout the length of the ulnar nerve, the fractional anisotropy and radial diffusivity in patients with CuTS are different to healthy controls. These findings suggest that DTI may provide an objective assessment of the ulnar nerve and potentially, improve the management of CuTS.
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Affiliation(s)
- Timothy T Griffiths
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic, Reconstructive and Hand Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Robert Flather
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic, Reconstructive and Hand Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Irvin Teh
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Hamied A Haroon
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - David Shelley
- The Advanced Imaging Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Sven Plein
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Grainne Bourke
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic, Reconstructive and Hand Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Ryckie G Wade
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK.
- Department of Plastic, Reconstructive and Hand Surgery, Leeds Teaching Hospitals Trust, Leeds, UK.
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Thomas M, Hinton A, Heywood A, Shirley R, Chan JKK. Peripheral nerve decompression in the upper limb in spinal cord injury: experiences at the National Spinal Injuries Centre, UK. Spinal Cord Ser Cases 2021; 7:56. [PMID: 34234101 DOI: 10.1038/s41394-021-00423-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study of consecutive upper limb peripheral nerve decompressions in SCI patients. All procedures were performed at a single National Spinal Injuries Centre between 2015 and 2019. OBJECTIVES Entrapment neuropathies in the upper limb are underdiagnosed and undertreated in patients with spinal cord injury (SCI). This cohort study represents the first published outcomes of upper limb peripheral nerve decompression in patients with SCI. SETTING National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire, UK. METHODS Data collected from electronic medical records included patient demographics, procedures performed, length of inpatient stay, nerve conduction studies, and patient satisfaction. Patients were also contacted by telephone to complete a questionnaire that included patient satisfaction, the NHS 'Friends & Family Test' and validated patient-reported outcome measures (PROMs). RESULTS Thirty-four decompression procedures (24 carpal tunnel, 10 cubital tunnel) were performed in 24 patients (14 with paraplegia, 10 tetraplegia). 71% of patients had pre-operative nerve conduction studies: 71% of these were graded as severe. Mean length of stay was 14 nights. 91% of patients were satisfied with their procedure at clinic follow-up. Mean Boston Carpal Tunnel Questionnaire (BCTQ) symptom scores were reduced from 3.7 to 1.3 pre- vs. post-operatively (p < 0.001). Patient Reported Ulnar Nerve Evaluation (PRUNE) scores reduced from 49.4 to 23.0 (p = 0.01). CONCLUSION In our experience, SCI patients tend to present with severe upper limb nerve entrapment syndromes. Operative management is well tolerated with low risk of complications and can result in marked improvements in symptoms and function.
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Affiliation(s)
- Matthew Thomas
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare Trust, Aylesbury, UK.
| | - Alex Hinton
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare Trust, Aylesbury, UK
| | - Anthony Heywood
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare Trust, Aylesbury, UK
| | - Rebecca Shirley
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare Trust, Aylesbury, UK
| | - James K K Chan
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare Trust, Aylesbury, UK
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Miettinen L, Ryhänen J, Shiri R, Karppinen J, Miettunen J, Auvinen J, Hulkkonen S. Work-related risk factors for ulnar nerve entrapment in the Northern Finland Birth Cohort of 1966. Sci Rep 2021; 11:10010. [PMID: 33976337 PMCID: PMC8113547 DOI: 10.1038/s41598-021-89577-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/28/2021] [Indexed: 12/01/2022] Open
Abstract
Ulnar nerve entrapment (UNE) is the second most common entrapment neuropathy in the upper extremity. The aetiology of UNE is multifactorial and is still not fully understood. The aim of the study was to identify occupational risk factors for UNE and to determine whether smoking modifies the effects of work-related factors on UNE. The study population consisted of the Northern Finland Birth Cohort of 1966 (NFBC1966). In total, 6325 individuals active in working life participated at baseline in 1997. Occupational risk factors were evaluated by a questionnaire at baseline. The data on hospitalizations due to UNE were obtained from the Care Register for Health Care between 1997 and 2018. The incidence rate of hospitalization due to UNE was 47.6 cases per 100,000 person-years. After adjusting for confounders, entrepreneurs (Hazard ratio (HR) = 3.68, 95% CI 1.20–11.27), smokers (HR = 2.51, 95% CI 1.43–4.41), workers exposed to temperature changes (HR = 1.72, 95% CI 1.00–2.93), workers with physically demanding jobs (HR = 3.02, 95% CI 1.39–6.58), and workers exposed to hand vibration (HR = 1.94, 95% CI 1.00–3.77) were at an increased risk of hospitalization for UNE. Exposure to work requiring arm elevation increased the risk of hospitalization due to UNE among smokers (HR = 2.62, 95% CI 1.13–6.07), but not among non-smokers. Work-related exposure to vibration and temperature changes, and physically demanding work increase the risk of hospitalization for UNE. Smoking may potentiate the adverse effects of work-related factors on UNE.
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Affiliation(s)
- Laura Miettinen
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Jorma Ryhänen
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
| | - Jouko Miettunen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Juha Auvinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Sina Hulkkonen
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Johnson NA, Darwin O, Chasiouras D, Selby A, Bainbridge C. The association between surgery for carpal and cubital tunnel syndrome: analysis of incidence and risk factors within a geographical area. J Hand Surg Eur Vol 2021; 46:260-264. [PMID: 33423582 DOI: 10.1177/1753193420980983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The relationship between surgery for cubital tunnel and carpal tunnel syndrome was examined in this retrospective study. Between 1997 and 2018, data from consecutive patients who underwent carpal tunnel release (8352 patients), cubital tunnel release (1681 patients) or both procedures (692 patients) were analysed. The relative risk of undergoing cubital tunnel release in the population who had carpal tunnel release compared with those with no carpal tunnel release was 15.3 (male 20.3; female 12.5). The relative risk of undergoing carpal tunnel release in the population who had cubital tunnel release compared with those who did not undergo carpal tunnel release was 11.5 (male 16.5; female 9.1). Our study showed that men and women who undergo carpal tunnel release are over 20 times and 10 times more likely to have cubital tunnel release than those who did not undergo carpal tunnel release, respectively. These findings suggest that the two conditions may share a similar aetiology.Level of evidence: IV.
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Affiliation(s)
| | - Oliver Darwin
- Pulvertaft Hand Centre, Derby, UK.,University of Nottingham, Nottingham, UK
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Johnson NA, Darwin O, Chasiouras D, Selby A, Bainbridge C. The effect of social deprivation on the incidence rate of carpal and cubital tunnel syndrome surgery. J Hand Surg Eur Vol 2021; 46:265-269. [PMID: 32677495 DOI: 10.1177/1753193420939384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We sought to establish whether carpal and cubital tunnel syndrome requiring surgery is associated with deprivation in England. Data from 10,496 adult patients who were treated in our hand unit over a 20-year period were reviewed. The Index of Multiple Deprivation was used to measure deprivation from the patients' postcode. The mean age at surgery in the most deprived three quintiles was significantly lower than in the least deprived two quintiles for carpal tunnel release (55 vs 59 years, respectively) and cubital tunnel release (52 vs 57 years, respectively). The incidence rate was significantly lower for the three least deprived quintiles when compared with the most deprived quintile for both conditions. The incidence rate ratio of the least deprived quintile compared with the most deprived quintile for carpal tunnel release was 0.70 for men and 0.76 for women. The incidence rate ratio of the least deprived quintile compared with the most deprived quintile for cubital tunnel release was 0.79 for men and 0.49 for women. Carpal tunnel and cubital tunnel syndrome requiring surgery is more common in deprived patients and occurs at an earlier age.Level of evidence: IV.
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Affiliation(s)
| | - Oliver Darwin
- Pulvertaft Hand Centre, Derby, UK.,University of Nottingham, Nottingham, UK
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Ultrasound Ulnar Nerve Measurement in a Healthy Population. Rheumatol Ther 2021; 8:457-466. [PMID: 33543416 PMCID: PMC7991055 DOI: 10.1007/s40744-021-00283-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/20/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Ulnar tunnel syndrome at the elbow is a common pathology. The ultrasound cross-sectional area is a well-known metric widely accepted in radiology for the description of nerve entrapment. However, the pathological cut-off value remains challenging. The objectives of this study were to (1) describe the ultrasound cross-sectional area measurement of the ulnar nerve at three locations, and (2) to evaluate the inter-observer reliability by two independent ultrasonographers. Methods One-hundred ulnar nerves of 50 asymptomatic individuals were scanned using B-mode and power Doppler ultrasonography. The ultrasound cross-sectional area measurements of the ulnar nerve were performed at three different levels: 2 cm proximal to the epicondyle, at the level of the epicondyle, and 2 cm distal to the epicondyle. Results In our healthy population, we found 21, 24 and 7% of ultrasound cross-sectional area ulnar nerve > 8 mm2, respectively, at three different levels of measurement and 4, 7, and 0% US-CSA ulnar nerve > 10 mm2. The intraclass correlation coefficient measured at three different site levels were good (0.7943, 0.7509) to moderate (0.5701). Conclusions Almost one-quarter of our healthy population had an ultrasound cross-sectional area ulnar nerve more than 8 mm2 and few more than 10 mm2. A cut-off of ultrasound cross-sectional area ulnar nerve measurement more than 10 mm2 could be considered as pathological. No abnormal elbow ulnar nerve vascularization has been seen. This is the first step towards normal B-mode ulnar nerve values at the elbow to further detect pathological US findings as ulnar nerve entrapment.
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Kuijer PPFM, van der Pas J, van der Molen HF. Work Disabling Nerve Injury at Both Elbows Due to Laptop Use at Flexible Workplaces inside an Office: Case-Report of a Bilateral Ulnar Neuropathy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249529. [PMID: 33352652 PMCID: PMC7766745 DOI: 10.3390/ijerph17249529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022]
Abstract
Background: This case report describes whether a female civil servant who developed bilateral ulnar neuropathy can be classified as having an occupational disease. Methods: The Dutch six-step protocol for the assessment and prevention of occupational diseases is used. Results: Based on the six-step protocol, we propose that pressure on the ulnar nerve in the elbow region precipitated the neuropathy for this employee while working prolonged periods in elbow flexion with a laptop. Conclusion: Despite the low incidence laptop use might be a risk factor for the occurrence of ulnar neuropathy due to prolonged pressure on the elbow. Employers and workers need to be educated about this disabling occupational injury due to laptop use and about protective work practices such as support for the upper arm and elbow. This seems especially relevant given the trend of more flexible workspaces inside and outside offices, and given the seemingly safe appearance of laptop use.
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Affiliation(s)
- P. Paul F. M. Kuijer
- Department of Public and Occupational Health, Netherlands Centre for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, 1105 Amsterdam, The Netherlands;
- Correspondence: ; Tel.: +31-20-566-5339
| | - Joris van der Pas
- Self-Employed Occupational Physician, 5221 Den Bosch, The Netherlands;
| | - Henk F. van der Molen
- Department of Public and Occupational Health, Netherlands Centre for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, 1105 Amsterdam, The Netherlands;
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Zimmerman M, Nyman E, Steen Carlsson K, Dahlin LB. Socioeconomic Factors in Patients with Ulnar Nerve Compression at the Elbow: A National Registry-Based Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5928649. [PMID: 33381560 PMCID: PMC7762664 DOI: 10.1155/2020/5928649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022]
Abstract
AIMS To investigate demographics and socioeconomic status in patients with ulnar nerve compression and the influence of socioeconomic factors on patient-reported outcome measurements (PROM) as evaluated by QuickDASH (short version of Disabilities of Arm, Shoulder and Hand) after surgery for ulnar nerve compression at the elbow. METHODS Patients operated for primary ulnar nerve compression from 2010 to 2016 were identified in the National Quality Registry for Hand Surgery Procedures (HAKIR). Patients filled out questionnaires before and at three and 12 months after surgery. A total of 1346 surgically treated cases were included. Data from HAKIR were linked to data from Statistics Sweden (SCB) on socioeconomic status (i.e., education level, earnings, social assistance, immigrant status, sick leave, unemployment, and marital status). RESULTS Patients surgically treated for ulnar nerve compression at the elbow differed from the general population with lower levels of education, higher social assistance dependence, a high proportion of unemployment, and lower earnings. However, the results were not clear concerning the influence of socioeconomic factors on the outcome of surgery, except for long-term sick leave. CONCLUSION Patients surgically treated for ulnar nerve compression at the elbow are socioeconomically deprived, but only a history of long-term sick leave influences the outcome of surgery. This information is crucial in the diagnosis and treatment of these patients.
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Affiliation(s)
- Malin Zimmerman
- Department of Translational Medicine-Hand Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 5, S-205 02 Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Jan Waldenströms gata 5, S-205 02 Malmö, Sweden
| | - Erika Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, 581 85 Linköping, Sweden
| | | | - Lars B. Dahlin
- Department of Translational Medicine-Hand Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 5, S-205 02 Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Jan Waldenströms gata 5, S-205 02 Malmö, Sweden
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49
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Abstract
PURPOSE OF REVIEW Cubital tunnel syndrome is the second most common compressive neuropathy, next to only carpal tunnel syndrome in its incidence. Severe states of disease do not respond to nonoperative management. Likewise, functional outcomes of cubital tunnel surgery decline as the disease becomes more severe. The relatively long distance from site of nerve compression at the elbow to the hand intrinsic muscles distally makes it a race between reinnervation of the muscle and irreversible motor endplate degeneration with muscle atrophy. Loss of intrinsic function can lead to severe functional impairment with poor dexterity and clawing of the hand. While decompressing the nerve at the site of compression is important to prevent further axonal injury, until recently, the only option to restore intrinsic function was tendon transfers. Tendon transfers aim to restore thumb side pinch and control clawing with addition surgery. They also require the sacrifice of wrist extensors or finger flexors. In the past decade, nerve transfers to the distal portion of the ulnar nerve innervating these intrinsic muscles, originally described for proximal ulnar nerve injury or transections, have become increasingly popular as an adjunct procedure in severe cubital tunnel syndrome. Physicians treating severe ulnar neuropathy must be aware of these nerve transfers, as well as their indications and expected outcomes. RECENT FINDINGS The so-called supercharged anterior interosseous nerve (AIN)-to-ulnar motor nerve transfer has become a mainstay for distal nerve transfers for ulnar neuropathy and/or injury. Ideal patients to undergo such a procedure demonstrate severe ulnar neuropathy on nerve conduction and electromyography studies, with reduced compound muscle action potential (CMAP) amplitude and fibrillations at rest. Recent studies demonstrate nerve transfers to be superior in intrinsic muscle reinnervation compared with nerve graft in the setting of large segmental nerve defects. Likewise, compared with decompression alone, patients undergoing the supercharge procedure are more likely to regain intrinsic function and less likely to need secondary tendon transfer surgeries. Finally, initial results for sensory nerve transfer to recover sensation in the ulnar-sided digits in severe cubital tunnel are more advantageous than for decompression alone. Distal nerve transfers offer a reliable, reproducible treatment option for the restoration of intrinsic hand function and protective sensation in the setting of severe cubital tunnel syndrome.
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Affiliation(s)
- Andrew Baron
- Department of Orthopedic Surgery, The Philadelphia Hand to Shoulder Center, P.C., Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA 19107 USA
| | - Adam Strohl
- Department of Orthopedic Surgery, The Philadelphia Hand to Shoulder Center, P.C., Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA 19107 USA
- Department of Surgery – Plastic Surgery, The Philadelphia Hand to Shoulder Center, P.C., Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA 19107 USA
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50
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Jia S, Shi X, Liu G, Wang L, Zhang X, Ma X, Li J, Shao X. Determinants of anxiety and depression in patients with cubital tunnel syndrome. BMC Psychiatry 2020; 20:540. [PMID: 33203413 PMCID: PMC7673081 DOI: 10.1186/s12888-020-02934-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/27/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The aim of this cross-sectional study to assess the proportions of anxiety and depression in patients with CuTS, and to explore the associated demographic and clinical features. METHODS From May 2011 to January 2017, 246 patients diagnosed with CuTS were recruited. The Hospital Anxiety and Depression Scale was used to assess the proportions of depression and anxiety. Patient demographic and clinical data were collected. Univariate analysis and multivariate regression were carried out to identify the variables that were independently associated with anxiety and depression. RESULTS The proportions of depression and anxiety were 17.9% (n = 44) and 14.2% (n = 35), respectively. Five patients had both possible/probable anxiety and depression. Logistic regression analysis revealed that diabetes mellitus was independently associated with depression; and the modified McGowan grade was independently associated with anxiety. CONCLUSIONS In patients with CuTS, the proportions of depression and anxiety were 17.9% and 14.2%, respectively. Early screening for anxiety and depression is beneficial for patients with CuTS.
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Affiliation(s)
- Siming Jia
- grid.452209.8Department of Hand Surgery, The Third hospital of Hebei Medical University, Shijiazhuang, 050000 Hebei China ,grid.256883.20000 0004 1760 8442Graduate School, Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - Xiaoying Shi
- grid.256883.20000 0004 1760 8442Graduate School, Hebei Medical University, Shijiazhuang, 050000 Hebei China ,grid.440208.aDepartment of Neurology, Hebei General Hospital, Shijiazhuang, 050000 Hebei China
| | - Guanglian Liu
- Department of Bone Surgery, Hebei Pingshan General Hospital, Shijiazhuang, 050000 Hebei China
| | - Li Wang
- grid.452209.8Department of Hand Surgery, The Third hospital of Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - Xiaoran Zhang
- grid.452209.8Department of Hand Surgery, The Third hospital of Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - Xuelin Ma
- grid.452209.8Department of Hand Surgery, The Third hospital of Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - Jia Li
- Department of Hand Surgery, Xuzhou Renci Hospital, Xuzhou, 221000 Jiangsu China
| | - Xinzhong Shao
- Department of Hand Surgery, The Third hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.
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