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      Risk factors for ulnar nerve compression at the elbow: a case control study

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          Summary

          Background. Ulnar nerve compression at the elbow is frequently encountered as the second most common compression neuropathy in the arm. As dexterity may be severely affected, the disease entity can seriously interfere with daily life and work. However, epidemiological research considering the risk factors is rarely performed.

          This study intended to investigate whether potential risk factors based on historical belief contribute to the development of ulnar nerve compression at the elbow.

          Method. A hospital based case control study was performed of patients that underwent surgical treatment for ulnar nerve compression at the elbow at the neurosurgical department from June 2004 until June 2005. Controls were those patients treated for a cervical or lumbar herniated disc.

          The main outcome measure was the presence of ulnar nerve compression at the elbow proven clinically, and electrodiagnostically.

          Results. 110 patients with ulnar nerve lesions and 192 controls were identified. Smoking, education level and related working experience were identified as risk factors. Conversely, gender, BMI, alcohol consumption, trauma to the elbow, diabetes mellitus, and hypertension are not risk factors for the development of ulnar nerve compression at the elbow.

          Conclusion. Risk factors are clearly defined. In the past many factors have been described, but mostly in surgical series. This study concludes that gender, previous fracture of the elbow and BMI are not predictive factors for ulnar entrapment neuropathy. However, education and working experience are closely correlated with this entity.

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          Most cited references13

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          Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy).

          Although ulnar neuropathy at the elbow (UNE) is the second most frequent focal peripheral neuropathy of the upper limb after carpal tunnel syndrome (CTS), no figures on its prevalence or incidence in the general population have been reported. To determine the incidence of UNE in a general population. Retrospective study to identify newly diagnosed cases on the basis of clinical symptoms or signs and slowing of motor conduction velocity of the ulnar nerve across the elbow or surgical evidence of nerve compression in the elbow region. In the 5-year period from 1995 to 1999, cases among residents in Siena Province (Italy) were identified from medical records of electromyographic services of Local Health District no. 7 and from hospital medical records coded ICD 354.2, 04.49 and 04.6. Siena province has a population of 251,930. In the 5-year period, 311 cases (112 women and 199 men, mean age 56 years, range 15-86) were identified. The mean annual crude incidence was 24.7 cases per 100,000 person-years, and the standardized incidence was 20.9. The sex-specific incidences were 32.7 for men and 17.2 for women. The mean annual crude and sex-specific incidences remained constant during the study period. The age-specific incidences of whole population and both genders showed an increasing trend with decade of age. The incidence of "possible", "probable" and "definite" UNE cases, classified according to level of motor conduction velocity anomalies and evidence of surgical compression of the ulnar nerve at the elbow, was 4.3, 10.6, and 9.8, respectively. The residents of a health subdistrict where manual work is dominant had a higher male-specific incidence (57.1) than other areas. This is the first published study on the incidence of UNE. The incidence was higher in males than females and about one-thirteenth that reported for CTS in part of the present geographic area.
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            Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: Part 1.

            The main objective of this study was to compare the clinical outcome of participants treated by simple decompression (SD) of the ulnar nerve versus anterior subcutaneous transposition (AST). A prospective randomized controlled study was performed. Three hundred forty participants were referred to our institution between March 1999 and July 2002. One hundred fifty-two patients met the inclusion criteria and were randomized into two surgical groups: 75 were assigned to SD, and 77 were assigned to AST. Participants were followed for 1 year after surgery. The main outcome measure was clinical outcome 1 year after surgery. An excellent or good result was obtained in 49 of 75 participants who underwent SD and in 54 of 77 participants undergoing AST. The difference was not statistically significant. However, the complication rate was statistically lower in the SD group (9.6%) compared with the AST group (31.1%) (risk ratio, 0.32; 95% confidence interval, 0.14-0.69). Duration of symptoms, (sub)luxation of the ulnar nerve, and severity of the complaints did not influence outcome. Surgery for ulnar neuropathy at the elbow is effective. The outcomes of SD and AST are equivalent, except for the complication rate. Because the intervention is simpler and associated with fewer complications, SD is advised, even in the presence of (sub)luxation.
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              Surgical management of ulnar nerve compression at the elbow: an analysis of the literature.

              Surgical treatment for cubital ulnar nerve compression includes medial epicondylectomy, simple decompression, or anterior transposition (subcutaneous, intramuscular, or submuscular). There is a dearth of prospective randomized studies on which to base guidelines for choosing one operative treatment over another. The authors review the literature on this subject and present their findings. The authors reviewed the literature from January 1970 to July 1997. Two authors decided independently whether an article should be included for review based on previously formulated inclusion and exclusion criteria. In addition to demographic information, data concerning preoperative status and outcome were extracted. For statistical analyses chi-square and Kruskal-Wallis tests were performed. Irrespective of their preoperative status, patients with simple decompression had the best outcome, whereas those with anterior subcutaneous and submuscular transposition had the worst. If outcome was related to the patient's preoperative status, a significant difference was not found among the various groups for those patients with a preoperative McGowan Grade 2. However, for those with McGowan Grade 3 (severe) symptoms, patients with anterior intramuscular transposition had the best outcome followed by those with simple decompression and anterior submuscular transposition. Statistical analysis was not possible for patients with McGowan Grade 1 because of the small numbers of patients in several treatment modality groups. Formulating a uniform guideline for operative treatment is not possible based on the results of this study. However, the authors believe that support is given to their policy, which is primarily to perform a simple decompression. Its surgical simplicity with preservation of the anatomy, especially the vascularization, and the possibility of rapid postoperative rehabilitation are also taken into consideration. If subluxation is found intraoperatively, anterior transposition is proposed.
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                Author and article information

                Journal
                Acta Neurochir (Wien)
                Acta Neurochirurgica
                Springer-Verlag (Vienna )
                0001-6268
                0942-0940
                16 May 2007
                July 2007
                : 149
                : 7
                : 669-674
                Affiliations
                [ ]Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
                [ ]Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
                Article
                1166
                10.1007/s00701-007-1166-5
                2779416
                17502986
                2b4b7cab-28c8-4fab-bed7-cc73f2755095
                © Springer-Verlag 2007
                History
                : 5 January 2007
                : 30 March 2007
                Categories
                Clinical Article
                Custom metadata
                © Springer-Verlag 2007

                Surgery
                keywords: ulnar nerve compression; ulnar neuropathy; risk factors.
                Surgery
                keywords: ulnar nerve compression; ulnar neuropathy; risk factors.

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