Mateusz Gładysz FESSH prep

FESSH prep Compressive neuropathies Cubital tunnel syndrome — clinical, electrodiagnostic and sonographic prognostic markers

Prognostic Factors for Ulnar Neuropathy Recovery

Last reviewed v1.0

FESSH-020Compressive neuropathies●●○ intermediate

Prognostic Factors for Ulnar Neuropathy Recovery

  1. 1.A longer duration of symptoms before surgery is associated with poorer outcomes.

  2. 2.Older age is associated with more severe electrophysiological findings at presentation in cubital tunnel syndrome.

  3. 3.Electrodiagnostic evidence of motor axonal loss, including low distal CMAP amplitude, can indicate slower or less predictable recovery after decompression.

  4. 4.The presence of diabetes does not affect the surgical outcomes of ulnar neuropathy.

  5. 5.More pronounced ulnar nerve enlargement on ultrasonography at diagnosis predicts a poorer outcome of conservative treatment of ulnar neuropathy at the elbow.

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Question ID
FESSH-020
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. A longer duration of symptoms before surgery is associated with poorer outcomes.

    True

    Pooled data and individual cohorts find that longer symptom duration before surgery correlates with reduced rate of complete recovery, particularly in McGowan grade III disease, where Tong and colleagues identified disease duration as an independent predictor of higher postoperative McGowan grade.

    • Tong J, Dong Z, Xu B, Zhang C, Gu Y. Predictors of surgical outcomes for severe cubital tunnel syndrome: a review of 146 patients. Acta Neurochir (Wien). 2018;160(3):645-650. PMID 29214401
    • Mowlavi A, Andrews K, Lille S, Verhulst S, Zook EG, Milner S. The management of cubital tunnel syndrome: a meta-analysis of clinical studies. Plast Reconstr Surg. 2000;106(2):327-334. PMID 10946931

  2. 2. Older age is associated with more severe electrophysiological findings at presentation in cubital tunnel syndrome.

    True

    On bivariate analysis Power and colleagues showed that older age and longer symptom duration were significantly associated with reduced first-dorsal-interosseous CMAP amplitude and slowing of conduction velocity across the elbow. In severe disease, Tong and colleagues identified older age as an independent predictor of worse postoperative McGowan grade.

    • Power HA, Sharma K, El-Haj M, Moore AM, Patterson MM, Mackinnon SE. Compound muscle action potential amplitude predicts the severity of cubital tunnel syndrome. J Bone Joint Surg Am. 2019;101(8):730-738. PMID 30994591
    • Tong J, Dong Z, Xu B, Zhang C, Gu Y. Predictors of surgical outcomes for severe cubital tunnel syndrome: a review of 146 patients. Acta Neurochir (Wien). 2018;160(3):645-650. PMID 29214401

  3. 3. Electrodiagnostic evidence of motor axonal loss, including low distal CMAP amplitude, can indicate slower or less predictable recovery after decompression.

    True

    Reduced distal CMAP amplitude supports a loss of functioning motor axons. A prospective surgical cohort found slower functional recovery with lower CMAP amplitude, but no electrodiagnostic parameter independently predicted the 12-month outcome. Severe cubital tunnel syndrome can still improve after surgery, although complete recovery is less likely.

    • Florczynski MM, Kong L, Burns PB, Wang L, Chung KC. Electrodiagnostic Predictors of Outcomes After In Situ Decompression of the Ulnar Nerve. The Journal of hand surgery. 2023;48(1):28-36. PMID 36371353
    • Tong J, Dong Z, Xu B, Zhang C, Gu Y. Predictors of surgical outcomes for severe cubital tunnel syndrome: a review of 146 patients. Acta Neurochir (Wien). 2018;160(3):645-650. PMID 29214401

  4. 4. The presence of diabetes does not affect the surgical outcomes of ulnar neuropathy.

    False

    In the prospective single-centre series by Stirling and colleagues, diabetic patients did not show significant QuickDASH improvement after cubital tunnel surgery (preoperative 46.5 versus postoperative 43.2), whereas non-diabetic patients did (34.1 to 20.5).

    • Stirling PHC, Harrison SJ, McEachan JE. The effect of diabetes mellitus on the outcome of surgery for cubital tunnel syndrome. J Hand Surg Eur Vol. 2023;48(4):316-320. PMID 36524277
    • Zimmerman M, Anker I, Karlsson A, Arner M, Svensson AM, Eeg-Olofsson K, et al.. Ulnar nerve entrapment in diabetes: patient-reported outcome after surgery in national quality registries. Plast Reconstr Surg Glob Open. 2020;8(4):e2740. PMID 32440410

  5. 5. More pronounced ulnar nerve enlargement on ultrasonography at diagnosis predicts a poorer outcome of conservative treatment of ulnar neuropathy at the elbow.

    True

    In the Beekman cohort, greater ulnar nerve cross-sectional enlargement on ultrasound at presentation was independently associated with a poor outcome (odds ratio 2.9, p = 0.009), particularly among conservatively treated patients, while electrodiagnostic signs of demyelination predicted favourable outcome.

    • Beekman R, Wokke JHJ, Schoemaker MC, Lee ML, Visser LH. Ulnar neuropathy at the elbow: follow-up and prognostic factors determining outcome. Neurology. 2004;63(9):1675-1680. PMID 15534254
    • Beekman R, Zijlstra W, Visser LH. A novel points system to predict the prognosis of ulnar neuropathy at the elbow. Muscle Nerve. 2017;55(5):698-705. PMID 27623990