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Preoperative Electrophysiology in Patients With Ulnar Nerve Entrapment at the Elbow-Prediction of Surgical Outcome and Influence of Age, Sex and Diabetes.
Department of Translational Medicine – Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden; Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.ORCID iD: 0000-0003-2792-9525
Department of Translational Medicine – Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden; Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
5 National Diabetes Register, Centre of Registers, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
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2022 (English)In: Frontiers in clinical diabetes and healthcare, ISSN 2673-6616, Vol. 3, article id 756022Article in journal (Refereed) Published
Abstract [en]

The impact of preoperative electrophysiology on outcome of surgical treatment in ulnar nerve entrapment at the elbow (UNE) is not clarified. Our aim was to evaluate influence of preoperative electrophysiologic grading on outcome and analyse how age, sex, and in particular diabetes affect such grading. Electrophysiologic protocols for 406 UNE cases, surgically treated at two hand surgery units reporting to the Swedish National Quality Register for Hand Surgery (HAKIR; 2010-2016), were retrospectively assessed, and graded as normal, reduced conduction velocity, conduction block or axonal degeneration. Outcome of surgery after primary and revision surgery was evaluated using QuickDASH and a doctor reported outcome measure (DROM) grading. No differences in QuickDASH or DROM were found between the four groups with different electrophysiologic grading preoperatively, or at three and 12 months or at follow up, respectively. When dichotomizing the electrophysiologic grading into normal and pathologic electrophysiology, cases with normal electrophysiology had worse QuickDASH than cases with pathologic electrophysiology preoperatively (p=0.046). Presence of a conduction block or axonal degeneration indicated a worse outcome by DROM grading (p=0.011). Primary surgeries had electrophysiologic more pronounced nerve pathology compared to revision surgeries (p=0.017). Cases of older age, men, and those with diabetes had more severe electrophysiologic nerve affection (p<0.0001). In the linear regression analysis, increasing age (unstandardized B=0.03, 95% CI 0.02-0.04; p<0.0001) and presence of diabetes (unstandardized B=0.60, 95% CI 0.25-0.95; p=0.001) were associated with a higher risk of a worse electrophysiologic classification. Female sex was associated with a better electrophysiologic grading (unstandardized B=-0.51, 95% CI -0.75- -0.27; p<0.0001). We conclude that older age, male sex, and concomitant diabetes are associated with more severe preoperative electrophysiologic nerve affection. Preoperative electrophysiologic grade of ulnar nerve affection may influence surgical outcome.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022. Vol. 3, article id 756022
Keywords [en]
QuickDASH, axonal degeneration, diabetes, neuropathy, surgery outcome, ulnar nerve
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-193341DOI: 10.3389/fcdhc.2022.756022PubMedID: 36992728OAI: oai:DiVA.org:liu-193341DiVA, id: diva2:1754003
Note

Funding agencies: Lund University, ALF[grant number 2018-Project 0104], Region Skåne (Funds from Skåne University Hospital Malmö-Lund), the Swedish Diabetes Foundation [grant number DIA2016-117 and DIA2020-492], the Swedish Research Council [grant number 2021-01942], Sydvästra Skånes Diabetesförening, Sweden, and ALF Grants [grant numberLIO-823361], Region Östergötland, Sweden

Available from: 2023-05-02 Created: 2023-05-02 Last updated: 2023-08-24

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Nyman, ErikaDahlin, Lars

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Division of Surgery, Orthopedics and OncologyFaculty of Medicine and Health SciencesDepartment of Hand and Plastic Surgery
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