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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.
Front Clin Diabetes Healthc. 2022; 3:756022.FC

Abstract

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.

Authors+Show Affiliations

Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden. Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, Linköping, Sweden.Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden. Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.National Diabetes Register, Centre of Registers, Gothenburg, Sweden. Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.Department of Neurophysiology, Skåne University Hospital, Lund University, Lund, Sweden.Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden. Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden. Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

36992728

Citation

Anker, Ilka, et al. "Preoperative Electrophysiology in Patients With Ulnar Nerve Entrapment at the Elbow-Prediction of Surgical Outcome and Influence of Age, Sex and Diabetes." Frontiers in Clinical Diabetes and Healthcare, vol. 3, 2022, p. 756022.
Anker I, Nyman E, Zimmerman M, et al. Preoperative Electrophysiology in Patients With Ulnar Nerve Entrapment at the Elbow-Prediction of Surgical Outcome and Influence of Age, Sex and Diabetes. Front Clin Diabetes Healthc. 2022;3:756022.
Anker, I., Nyman, E., Zimmerman, M., Svensson, A. M., Andersson, G. S., & Dahlin, L. B. (2022). Preoperative Electrophysiology in Patients With Ulnar Nerve Entrapment at the Elbow-Prediction of Surgical Outcome and Influence of Age, Sex and Diabetes. Frontiers in Clinical Diabetes and Healthcare, 3, 756022. https://doi.org/10.3389/fcdhc.2022.756022
Anker I, et al. Preoperative Electrophysiology in Patients With Ulnar Nerve Entrapment at the Elbow-Prediction of Surgical Outcome and Influence of Age, Sex and Diabetes. Front Clin Diabetes Healthc. 2022;3:756022. PubMed PMID: 36992728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preoperative Electrophysiology in Patients With Ulnar Nerve Entrapment at the Elbow-Prediction of Surgical Outcome and Influence of Age, Sex and Diabetes. AU - Anker,Ilka, AU - Nyman,Erika, AU - Zimmerman,Malin, AU - Svensson,Ann-Marie, AU - Andersson,Gert S, AU - Dahlin,Lars B, Y1 - 2022/03/16/ PY - 2021/08/09/received PY - 2022/02/04/accepted PY - 2023/3/31/medline PY - 2023/3/30/entrez PY - 2023/3/31/pubmed KW - QuickDASH KW - axonal degeneration KW - diabetes KW - neuropathy KW - surgery outcome KW - ulnar nerve SP - 756022 EP - 756022 JF - Frontiers in clinical diabetes and healthcare JO - Front Clin Diabetes Healthc VL - 3 N2 - 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. SN - 2673-6616 UR - https://www.unboundmedicine.com/medline/citation/36992728/Preoperative_Electrophysiology_in_Patients_With_Ulnar_Nerve_Entrapment_at_the_Elbow_Prediction_of_Surgical_Outcome_and_Influence_of_Age_Sex_and_Diabetes_ DB - PRIME DP - Unbound Medicine ER -
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