Patient-reported outcomes after in situ cubital tunnel decompression: a report in 77 patients

Yeoman, Thomas; Stirling, Paul; Lowdon, A. G. R.; Jenkins, Paul J.; McEachan, Jane E.

doi:10.1177/1753193419882853

Cited by 12 publications

(14 citation statements)

References 20 publications

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“…17,31 Postoperative DASH scores have also been shown to correlate with patient satisfaction, and patients with muscle weakness and atrophy before surgery had poorer scores. 32 Moreover, it is increasingly recognized that PROs may more accurately reflect a patient’s level of disability from disease than clinical or radiographic measurements for a variety of problems in hand surgery. 33,34…”

Section: Discussionmentioning

confidence: 99%

“…22,25,40 This type of irreversible injury appears to occur more commonly in UNE than carpal tunnel syndrome and is associated with poorer surgical outcomes, residual symptoms, and decreased patient satisfaction. 12,16,32,41 Although abnormal thresholds for CMAP amplitude have been established, these measurements are not routinely used in conventional evaluation of UNE. 20,25,42 Although many authors have argued that EDXs add little value in the workup of carpal tunnel syndrome, [43][44][45][46] we would posit the contrary in the context of UNE.…”

Section: Discussionmentioning

confidence: 99%

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Compound Muscle Action Potential Amplitude as a Predictor of Functional and Patient-Reported Outcomes in Ulnar Neuropathy at the Elbow

Florczynski

Kong

Burns

et al. 2023

Plastic &Amp; Reconstructive Surgery

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lnar neuropathy at the elbow (UNE) is the second most common compression neuropathy after carpal tunnel syndrome, with an estimated incidence of 22 to 32 per 100,000 person-years. [1][2][3] Initial symptoms generally consist of pain and paresthesias in the ring and small fingers, eventually progressing to irreversible intrinsic muscle weakness and atrophy. 4,5 Although mild disease can be treated nonoperatively, progressive or moderate to severe cases are best managed surgically. [6][7][8][9] Regardless of the treatment chosen, patients with advanced disease often experience incomplete symptom relief after surgery. [10][11][12][13][14][15][16] Longer duration of symptoms has been associated with worse surgical outcomes, 16,17 suggesting that prompt surgical treatment is important for optimizing results. However, the early symptoms of UNE are better tolerated than in other compression neuropathies, such as carpal tunnel syndrome, 18,19 possibly causing clinicians to underestimate the severity of disease based on clinical assessment alone. Background: Ulnar neuropathy at the elbow (UNE) is a debilitating upper extremity condition that often leaves patients with residual symptoms even after surgical treatment. The role of electrodiagnostic studies in guiding the treatment of UNE is not well established, and conventional electrodiagnostic parameters may not reflect the severity of disease. Compound muscle action potential (CMAP) amplitude is a parameter that corresponds with axonal injury and motor symptoms and may more accurately predict the severity of neurologic injury. Methods: This prospective multicenter study recruited 78 patients in the Surgery of the Ulnar Nerve project. Patients underwent electrodiagnostic testing and clinical assessment of motor and sensory function, and completed patientreported outcome questionnaires, including the Michigan Hand Outcome Questionnaire; the Disabilities of the Arm, Shoulder and Hand questionnaire; and the Carpal Tunnel Questionnaire (CTQ). Correlations were measured among each of the electrodiagnostic parameters and outcomes and predictive models for each outcome were subsequently developed. Results: Of all the electrodiagnostic parameters measured, only CMAP amplitude was predictive of scores on the Michigan Hand Outcome Questionnaire; Disabilities of the Arm, Shoulder and Hand questionnaire; CTQ function scale, and motor impairment in grip and pinch strength. None of the parameters were predictive of scores on the CTQ symptom scale or sensory impairments as measured with two-point discrimination or Semmes-Weinstein monofilament testing. Conclusions: CMAP amplitude, but not other conventional electrodiagnostic parameters, is predictive of functional outcomes in UNE. This electrodiagnostic measurement can alert the clinician to severe cases of UNE and inform surgical decision-making.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Compound Muscle Action Potential Amplitude as a Predictor of Functional and Patient-Reported Outcomes in Ulnar Neuropathy at the Elbow

Florczynski

Kong

Burns

et al. 2023

Plastic &Amp; Reconstructive Surgery

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“…Despite the high frequency of surgical treatment for CuTS, comparison of outcomes of cubital tunnel release remains difficult due to the heterogeneity of PROMs used. 17,18 A recent systematic review of 101 studies reported that 30 different patient or clinician reported instruments were used to assess surgical treatment for CuTS within the literature. 7 Popular existing questionnaires used for hand conditions include Michigan Hand Questionnaire (MHQ); Disabilities of the Arm, Shoulder, and Hand (DASH); and the Carpal Tunnel Questionnaire (CTQ).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of PROMIS Outcomes for Surgical Treatment of Cubital Tunnel Syndrome With and Without Carpal Tunnel Syndrome

Phan

Hammert

2021

Hand (New York, N,Y.)

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Background: Assessment of outcomes for cubital tunnel syndrome (CuTS) surgeries has been difficult due to heterogeneity in outcome reporting. Our objective was to evaluate the outcomes for 2 cohorts treated surgically for isolated CuTS and for combined CuTS and carpal tunnel syndrome (CTS) using Patient Reported Outcomes Measurement Information System (PROMIS). Methods: There were 29 patients in the isolated CuTS cohort and 30 patients in the combined CuTS and CTS cohort. PROMIS Physical Function (PF), Pain Interference (PI), Depression, and Upper Extremity (UE) were completed preoperatively and 1-week, 6-weeks, and 3-months postoperatively. Responsiveness was evaluated by standardized response means (SRM). Results: Significant improvements from the 1-week to 6-week postoperative period are shown in the isolated CuTS cohort for PROMIS PF ( P = .002), PI ( P = .0002), and UE ( P = .02), but scores plateau after 6-weeks postoperatively. A similar pattern for the same time points was seen for the combined CuTS and CTS group for PROMIS PF ( P = .001), PI ( P = .02), and UE ( P = .04), with a plateau of scores beyond 6 weeks postoperatively. PROMIS UE was more responsive (SRM range: 0.11-1.03) than the PF (SRM range: 0.02-0.52) and PI (SRM range: 0.11-0.40), which were both mildly responsive for both cohorts. Conclusions: PROMIS lacks the sensitivity to show improvement beyond 6-weeks postoperatively for both isolated CuTS and combined CuTS and CTS. Patients with combined nerve compressions follow similar trajectories in the postoperative period as those with isolated CuTS. Level of Evidence: Level IV.

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“…All procedures were done under the care of a single consultant hand surgeon with level V experience (Tang and Giddins, 2015). An open in-situ decompression was performed without transposition of the ulnar nerve in accordance with a previously published technique (Yeoman et al., 2020). Some of the patients in this study had been included in a previous smaller study that did not address the same research question (Yeoman et al., 2020).…”

Section: Methodsmentioning

confidence: 99%

“…An open in-situ decompression was performed without transposition of the ulnar nerve in accordance with a previously published technique (Yeoman et al., 2020). Some of the patients in this study had been included in a previous smaller study that did not address the same research question (Yeoman et al., 2020). We have reported the demographic details of the patients who were not included in the previous study (Supplementary Table S1).…”

Section: Methodsmentioning

confidence: 99%

The effect of diabetes mellitus on the outcome of surgery for cubital tunnel syndrome

Stirling

Harrison

McEachan

2022

J Hand Surg Eur Vol

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The aims of this study were to investigate the effect of diabetes mellitus (DM) on patient-reported outcome measures (PROMs) and satisfaction after surgery for cubital tunnel syndrome (CuTS). Pre- and 1-year postoperative QuickDASH, normal hand, and satisfaction scores were prospectively collected from 107 patients over a 6-year period. Patients without DM reported a significant QuickDASH improvement after surgery (preoperative 34.1 versus postoperative 20.5; p < 0.001), but patients with DM did not (preoperative 46.5 versus postoperative 43.2; p = 0.554). Postoperative QuickDASH (43.2 versus 20.5) and normal hand (65 versus 80) scores were significantly worse in patients with DM. Satisfaction rates were excellent in both groups (88% versus 82%; p = 0.480). Our study showed that surgery for CuTS did not lead to an improvement in QuickDASH score in patients with DM and consequently patients with DM reported worse postoperative PROMs compared with those without. However, lack of improvement in PROMs does not affect patient satisfaction. Level of evidence: IV

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Patient-reported outcomes after in situ cubital tunnel decompression: a report in 77 patients

Cited by 12 publications

References 20 publications

Compound Muscle Action Potential Amplitude as a Predictor of Functional and Patient-Reported Outcomes in Ulnar Neuropathy at the Elbow

Compound Muscle Action Potential Amplitude as a Predictor of Functional and Patient-Reported Outcomes in Ulnar Neuropathy at the Elbow

Evaluation of PROMIS Outcomes for Surgical Treatment of Cubital Tunnel Syndrome With and Without Carpal Tunnel Syndrome

The effect of diabetes mellitus on the outcome of surgery for cubital tunnel syndrome

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