Electrodiagnostic Predictors Of Disease Severity And Treatment Outcomes In Ulnar Neuropathy At The Elbow
Matthew Florczynski, MD, MS, Lingxuan Kong, MS, Lu Wang, PhD, Patricia Burns, MPH, Kevin C. Chung, MD, MS.
University of Michigan, Ann Arbor, MI, USA.
PURPOSE: Treatment outcomes for patients with severe ulnar neuropathy at the elbow (UNE) are suboptimal, calling for a need to identify and treat patients before extensive nerve damage has occurred. Electrodiagnostic tests (EDX) are objective tools that may more accurately reflect the severity of disease than clinical assessment. We aimed to identify the best electrodiagnostic predictors of outcomes in UNE.
METHODS: Our prospective study recruited 52 patients with UNE in the collaborative multi-center Surgery of the Ulnar Nerve (SUN) project. Patients completed baseline EDX, motor and sensory testing, and patient-reported outcome (PRO) questionnaires and underwent in-situ decompression of the ulnar nerve. They were re-assessed at 6 weeks, 3 months, 6 months and 12 months post-operatively. Multivariable regression analyses were used to evaluate the relationships between electrodiagnostic parameters and outcomes.
RESULTS: At baseline, only compound muscle action potential (CMAP) amplitude was predictive of disease severity as measured by PROs. At final follow-up, decreased CMAP amplitudes were predictive of worse motor outcomes. Patients with decreased CMAP amplitudes also demonstrated a slower trend of recovery of motor function and PROs measuring upper extremity function. CMAP amplitudes were not predictive of sensory function or PROs measuring pain or aesthetics, but decreased motor nerve conduction velocities were associated with slower sensory recovery.
CONCLUSION: CMAP amplitude is predictive of disease severity at the time of diagnosis and improvement in motor function and PROs after in-situ decompression of the ulnar nerve. This parameter warrants attention in establishing the treatment prognosis of patients with UNE
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