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From the Department of Neurology (Dr. Beekman), Atrium Medical Center, Heerlen; Rudolf Magnus Institute for Neuroscience (Dr. Wokke), University Medical Center, Utrecht; Departments of Radiology (Dr. Schoemaker) and Neurology and Clinical Neurophysiology (Dr. Visser), St. Elisabeth Hospital, Tilburg, The Netherlands; and Department of Biostatistics (Dr. Lee), University of California, Los Angeles.
Address correspondence and reprint requests to Dr. Roy Beekman, Department of Neurology, Atrium Medical Center, PO Box 4446, 6401 CX Heerlen, The Netherlands; e-mail: r_beekman01{at}planet.nl
Objective: To determine the outcome in patients with ulnar neuropathy at the elbow (UNE) treated surgically or conservatively, and the prognostic value of clinical, sonographic, and electrophysiologic features.
Methods: After a median follow-up of 14 months, 69 of 84 patients initially included in a prospective blinded study on the diagnostic value of sonography in UNE were re-evaluated. The patients underwent renewed systematic clinical and sonographic examination. Patients were scored as having a poor (stable or progressive symptoms) or favorable (complete remission of symptoms or improvement) outcome.
Results: Of the 74 initially affected arms, 12 (16%) had a complete remission, 21 (28%) improved, 25 (34%) remained stable, and 16 (22%) had progression. Surgically treated patients (28 arms) had a more favorable outcome than those treated conservatively (p = 0.03). After surgery, the mean ulnar nerve diameter decreased from 3.2 to 2.9 mm (p = 0.03), while this was not seen after conservative treatment. Multiple logistic regression analysis showed that more outspoken nerve enlargement found during sonography at the time of the diagnosis was associated with a poor outcome (OR: 2.9, p = 0.009). Furthermore, the presence of a motor conduction block (OR: 0.2, p = 0.03) and motor velocity slowing across the elbow (OR: 0.1, p = 0.01) were associated with a favorable outcome.
Conclusion: More pronounced ulnar nerve thickening at the time of the diagnosis is associated with poor outcome at follow-up, especially in conservatively treated cases, while electrodiagnostic signs of demyelination on testing indicate favorable outcome.
Received March 22, 2004. Accepted in final form July 8, 2004.
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