Abstract
Nakamichi K, Tachibana S, Ida M, Yamamoto S. Patient education for the treatment of
ulnar neuropathy at the elbow.
Objective
To assess the effect of patient education, the simplest conservative treatment of
ulnar neuropathy at the elbow, and establish its indication.
Design
Patients with ulnar neuropathy at the elbow were treated by education. Its effects
and factors affecting outcome were investigated. The length of the treatment was at
least 3 months. If the symptoms were improving, the follow-up was lengthened. All
of the improved patients were followed up at least for 1 year after they reached a
plateau of improvement to check recurrence.
Setting
Patients were selected from an outpatient clinic of a general hospital.
Participants
Patients (N=77; 80 nerves) with ulnar neuropathy at the elbow diagnosed clinically
and electrophysiologically.
Interventions
Patient education on the pathophysiology and activity modification to unload the ulnar
nerve from mechanical stress.
Main Outcome Measures
Outcomes were graded as excellent, good, fair, or poor with use of the modified Akahori's
classification system. Patient satisfaction was graded as 1 (low) to 5 (high). Repeat
nerve conduction studies were performed in those who gave consent, and results were
graded as excellent, good, fair, or poor.
Results
Fifty-three nerves (66%) had excellent or good outcomes. Multivariate logistic regression
analysis revealed that degenerative change (graded as normal, mild, moderate, or severe)
was associated with the outcome, while age, sex, side, duration and severity of the
disease, diabetes, dislocation of the nerve, and smoking were not. Excellent or good
outcomes were obtained in 43 (80%) of 54 nerves with no or mild degeneration and 10
(38%) of 26 nerves with moderate or severe degeneration. Recurrence was less frequent
in the former (2 of 43 nerves, 5%) than the latter (4 of 10, 40%). The outcomes strongly
correlated with the satisfaction scores and repeat nerve conduction study results.
Conclusions
Patient education is effective for a considerable number of patients with ulnar neuropathy
at the elbow. Whether this is indicated depends on the grade of elbow degeneration.
Those who have no or mild degeneration respond better to this treatment with a lower
rate of recurrence than those with more severe degeneration regardless of age, sex,
side, duration and severity of the disease, presence or absence of diabetes and dislocation
of the nerve, and smoking status.
Key Words
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References
- Proximal ulnar nerve compression.Hand Clin. 1992; 8: 325-336
- Review of treatment results for ulnar nerve entrapment at the elbow.J Hand Surg [Am]. 1989; 14: 688-700
- General principles of patient evaluation and nonoperative management of cubital tunnel syndrome.Hand Clin. 1996; 12: 397-403
- Compressive neuropathies of the ulnar nerve at the elbow and wrist.AAOS Instr Course Lect. 2000; 49: 305-317
- Natural history and conservative management of cubital tunnel syndrome.Hand Clin. 2007; 23: 311-318
- Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement.Muscle Nerve. 1999; 22: 408-411
- Electrophysiological localization of ulnar nerve lesions.J Neurol Neurosurg Psychiatry. 1969; 32: 208-220
- An electrophysiological quantitation of the cubital tunnel syndrome.Can J Neurol Sci. 1979; 6: 403-410
- The pressure measurements in the ulnar nerve: a contribution to the pathophysiology of the cubital tunnel syndrome.J Biomech. 1975; 8: 75-79
- Treatment of cubital tunnel syndrome: perspectives for the therapist.J Hand Ther. 2006; 19: 170-178
- Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow.J Bone Joint Surg Am. 1998; 80: 492-501
- Nonoperative management of cubital tunnel syndrome: an 8-year prospective study.Neurology. 1993; 43: 1673-1677
- The role of splinting and rehabilitation in the treatment of carpal and cubital tunnel syndrome.Hand Clin. 1996; 12: 223-241
- Cubital tunnel syndrome: grade of palsy and prognosis, and selection of operation.Orthop Surg Traumatol. 1986; 29: 1745-1751
- Treatment of ulnar nerve palsy at the elbow with a night splint.J Bone Joint Surg Br. 1993; 75: 322-327
- Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation.Arch Phys Med Rehabil. 1996; 77: 573-577
- Natural history of ulnar entrapment at the elbow.Clin Neurophysiol. 2002; 113: 1980-1984
- The aetiology and outcome of 170 ulnar nerve lesions confirmed with electrophysiological testing.Acta Orthop Belg. 2003; 69: 405-411
- Ulnar neuropathy at the elbow: follow-up and prognostic factors determining outcome.Neurology. 2004; 63: 1675-1680
- Cigarette smoking and ulnar mononeuropathy at the elbow.Am J Phys Med Rehabil. 2004; 83: 730-734
- Risk factors for ulnar nerve compression at the elbow: a case control study.Acta Neurochir. 2007; 149: 669-674
- Management of work-related upper-extremity nerve entrapments.Hand Clin. 1996; 27: 783-793
- Patient self-reported outcome after ulnar nerve transposition.Ann Plast Surg. 2002; 48: 274-280
- Extraneural pressures affecting the ulnar nerve at the elbow.Hand. 1982; 14: 5-11
- Pressures recorded in ulnar neuropathy.Acta Orthop Scand. 1985; 56: 404-406
- Intraneural ulnar nerve pressure changes related to operative techniques for cubital tunnel decompression.J Hand Surg [Am]. 1994; 19: 923-930
- The cubital tunnel: anatomic, histologic, and biomechanical study.J Shoulder Elbow Surg. 1999; 8: 466-470
- Intraoperative measurement of pressure adjacent to the ulnar nerve in patients with cubital tunnel syndrome.J Hand Surg [Am]. 2006; 31: 553-558
- The relationship between the pressure adjacent to the ulnar nerve and the disease causing cubital tunnel syndrome.J Shoulder Elbow Surg. 2008; 17: 585-588
Article info
Footnotes
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2009 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
