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Predictors of functional outcomes after simple decompression for ulnar neuropathy at the elbow: a multicenter study
Patricia B Burns1, H Myra Kim2, R Glenn Gaston3
1Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
Objective:
To identify predictors of surgical outcome for ulnar neuropathy at the elbow (UNE).
Design:
Prospective cohort followed for 1 year.
Setting:
Clinics.
Participants:
Patients diagnosed with UNE (N=55).
Intervention:
All subjects had simple decompression surgery.
Main Outcome Measures:
The primary outcome measure was patient-reported outcomes, such as overall hand function through the Michigan Hand Outcomes Questionnaire (MHQ). Predictors included age, duration of symptoms, disease severity, and motor conduction velocity across the elbow.
Results:
Multiple regression models with change in the overall MHQ score as the dependent variable showed that at 3 months postoperative time, patients with <3 months duration of symptoms showed 12 points (95% confidence interval [CI], 0.9-23.5) greater improvement in MHQ scores than those with ≥3 months symptom duration. Less than 3 months of symptoms was again associated with 13 points (95% CI, 2.9-24) greater improvement in MHQ scores at 6 months postoperative, but it was no longer associated with better outcomes at 12 months. A worse baseline MHQ score was associated with significant improvement in MHQ scores at 3 months (coefficient, -0.38; 95% CI, -.67 to -.09), and baseline MHQ score was the only significant predictor of 12 month MHQ scores (coefficient, -.40; 95% CI, -.79 to -.01).
Conclusions:
Subjects with <3 months of symptoms and worse baseline MHQ scores showed significantly greater improvement in functional outcomes as reported by the MHQ. However, duration of symptoms was only predictive at 3 or 6 months because most patients recovered within 3 to 6 months after surgery.
