Outcome of simple decompression of the compressed ulnar nerve at the elbow – influence of smoking, gender, and electrophysiological findings

Dahlin, Erik; Dahlin, Emma; Andersson, Gustav; Thomsen, Niels; Björkman, Anders; Dahlin, Lars B.

doi:10.1080/2000656x.2016.1210520

Cited by 11 publications

(19 citation statements)

References 21 publications

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“…Other relevant studies have populations with an age distribution similar to that in our study, with a mean age of around 50 years [14,[18][19][20][21]. Adelaar et al found no relationship between age and the postoperative result, while Leone et al stated that the result of primary anterior intramuscular transposition is less good in patients younger than 50 years [15,22].…”

Section: Discussionsupporting

confidence: 77%

Patient Characteristics in Ulnar Nerve Compression at the Elbow at a Tertiary Referral Hospital and Predictive Factors for Outcomes of Simple Decompression versus Subcutaneous Transposition of the Ulnar Nerve

Giöstad

Nyman

2019

BioMed Research International

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Patient characteristics and predictive factors for outcomes were analysed in 202 cases undergoing simple decompression, primary subcutaneous transposition, or secondary subcutaneous transposition for ulnar nerve compression at the elbow at a tertiary referral hospital. Data from medical charts and a survey were evaluated. The mean patient age was 49 years with revision surgery cases being significantly younger. Sixty-one percent of cases were female, and 31% were smokers. The comorbidity was extensive, including other nerve compression lesions as well as neck and shoulder problems. Overall, 53% reported being pleased with the result of surgery and 57% of the cases rated function as better or completely recovered after surgery. The median postoperative DASH (Disabilities of the Arm, Shoulder and Hand) score was 26 (IQR 11–49), which is in accordance with unpublished national data. No significant differences in DASH scores were found between surgical groups, but a higher preoperative McGowan grade was significantly associated with a poorer postoperative DASH score. Women scored greater disability postoperatively than men. There was a significantly increased risk of complications, which was doubled for smokers, following primary and secondary transposition compared to simple decompression. Surgical cases with ulnar nerve compression treated at a tertiary referral hospital constitute a heterogeneous group with great comorbidity and frequent concomitant nerve compression lesions. We suggest simple decompression as the procedure of first choice. Transposition can be used in selected cases or when simple decompression fails. All patients should be strongly recommended to stop smoking considering the remarkably increased risk for complications among smokers.

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Section: Discussionsupporting

confidence: 77%

Patient Characteristics in Ulnar Nerve Compression at the Elbow at a Tertiary Referral Hospital and Predictive Factors for Outcomes of Simple Decompression versus Subcutaneous Transposition of the Ulnar Nerve

Giöstad

Nyman

2019

BioMed Research International

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“…Smoking has been associated with a worse outcome and a risk of developing chronic pain after surgical procedures in several studies, 36 while other studies state that smoking does not affect outcome after surgery. 7 , 37 , 38 In the present study, a high proportion of the patients were smokers. Our previous study indicated that smoking doubled the risk of complications after surgery for ulnar nerve compression, with pain after surgery being the most common complication.…”

Section: Discussionsupporting

confidence: 41%

Enrollment in Treatment at a Specialized Pain Management Clinic at a Tertiary Referral Center after Surgery for Ulnar Nerve Compression: Patient Characteristics and Outcome

Giöstad

Räntfors

Nyman

et al. 2021

Journal of Hand Surgery Global Online

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To study patients who enroll in treatment at a specialized pain management clinic at a tertiary referral center following ulnar nerve decompression. Methods: Data from medical charts and postoperative questionnaires were collected for all patients after surgery for ulnar nerve compression at the elbow from 2011 to 2014 (n ¼ 173) at a tertiary referral center. Differences in characteristics between patients who enrolled in treatment at the pain management clinic (study group, n ¼ 26) and the rest of the patients (reference group, n ¼ 147) were analyzed. The study group was further evaluated using questionnaires from the Swedish Quality Registry for Pain Rehabilitation (SQRP) and regarding outcome of pain treatment. Results: The study group was characterized by prior pain conditions, earlier contact with a pain management clinic, and high degrees of kinesiophobia, depression/anxiety, low quality of life, and low life satisfaction. These patients had significantly higher postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores, were significantly younger, and had bilateral surgery significantly more often than the reference group. For patients with unilateral surgery, simple decompression was significantly more common in the reference group. The most common treatments at the clinic were antidepressants and anticonvulsants for neurogenic pain. In 5 of 26 patients, pain relief, or pain reduction was the documented reason for discharge. Conclusions: Pain is a relevant outcome measure for ulnar nerve decompression among complicated cases at a referral center. Severe postoperative pain is connected to higher disability, reduced life satisfaction, and overall low health status. This study maps out characteristics of patients who postoperatively enroll in treatment at a specialized pain management clinic following ulnar nerve decompression. Further studies are needed to define predictive factors for such pain.

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“…This type of simple clinical outcome assessment by the treating surgeon has been shown to correlate well to improvement in the patient-rated outcome questionnaire QuickDASH at one year post-surgery [19]. The QuickDASH is suitable for evaluation of outcome in clinical studies [19,20].…”

Section: Discussionmentioning

confidence: 99%

“…Due to the retrospective nature of the study postoperative outcome based on validated, standardized questionnaires could not be re- produced. The outcomes were, therefore, based on patient-reported and surgeon-evaluated outcome registered in the patient files at the last out-patient visit and then divided into two groups for comparison and due to clinical reasons: cured/improved or unchanged/worsened [19]. During the study's timeframe, there were no standardized follow-up at our department, but it was done according to the decision of the treating surgeon.…”

Section: Methodsmentioning

confidence: 99%

“…Due to this factor, preoperative examinations as well as postoperative outcome have been assessed retrospectively and are not standardized. Validated questionnaires had not been used, therefore, the presently used outcome data are based on the patients' subjective opinion of how successful the treatment was, but such judgment correlate well with validated questionnaires as QuickDASH [19,20].…”

Section: Study Limitationsmentioning

confidence: 99%

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Outcome and predictors in simple decompression of ulnar nerve entrapment at the elbow

Anker¹,

Zimmerman²,

Andersson³

et al. 2018

Hand Microsurg

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Objectives:Simple decompression is an accepted surgical treatment of ulnar nerve entrapment at the elbow (UNE). Our purpose was to evaluate the outcome and potential predictors for the outcome after simple decompression in UNE. Methods: All surgically treated UNE cases (from 2004-2008) at our department were studied retrospectively. Out of 285 primary surgeries, 242 primary simple ulnar nerve decompressions were included. Medical records, including electrophysiologic protocols, were reviewed and postoperative outcome was graded: 1) cured/improved and 2) unchanged/worsened symptoms, based on surgeon-evaluated outcome. Results: Of the 242 simple decompressions (122 males and 120 females; median age 50.5 years), 101 cases were students, retired, un-employed, or on a long-term sick-leave and 112 had manual, blue-collar type of work. 189 cases were cured or improved, while 53 cases had no change in, or even worsened, symptoms. Gender, presence of smoking, or associated diseases did not affect outcome, while a tendency was observed for higher age, a manual occupation and constant symptoms. Out of 196 cases electrophysiologically examined, 155 cases showed signs of ulnar nerve affection (56 reduced conduction velocity; 19 conduction block; 80 axonal degeneration; latter two groups significantly worse outcome). Conclusion: Patients with a preoperatively electrophysiologically diagnosed nerve conduction block or axonal degeneration have higher risk of not being cured or improved after simple decompression in UNE. Older patients, those with a manual profession, and constant symptoms of UNE tend to be less improved after surgery.

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Outcome of simple decompression of the compressed ulnar nerve at the elbow – influence of smoking, gender, and electrophysiological findings

Cited by 11 publications

References 21 publications

Patient Characteristics in Ulnar Nerve Compression at the Elbow at a Tertiary Referral Hospital and Predictive Factors for Outcomes of Simple Decompression versus Subcutaneous Transposition of the Ulnar Nerve

Patient Characteristics in Ulnar Nerve Compression at the Elbow at a Tertiary Referral Hospital and Predictive Factors for Outcomes of Simple Decompression versus Subcutaneous Transposition of the Ulnar Nerve

Enrollment in Treatment at a Specialized Pain Management Clinic at a Tertiary Referral Center after Surgery for Ulnar Nerve Compression: Patient Characteristics and Outcome

Outcome and predictors in simple decompression of ulnar nerve entrapment at the elbow

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