Predictors of Disease Severity for Ulnar Neuropathy at the Elbow: Analysis from a Randomized Clinical Trial

Ulnar neuropathy at the elbow (UNE) is the second most common nerve compression in the upper extremity. Painful paresthesias in fingers progress to muscle weakness and atrophy, impairing activities of daily living. Despite the common occurrence and effects on quality of life, risk factors that predispose to UNE and contribute to disease severity have not been thoroughly investigated.

Patients enrolled in the Clinical Trial for Surgery of the Ulnar Nerve at the Elbow (SUN) were included. Data on patient demographics, distance traveled, disease duration, and comorbidities collected at the time of enrollment before surgery were used for this analysis. Ordinal logistic regression was used to determine risk factors associated with 3-level UNE severity.

The 225 study participants included in this analysis had an average age of 51 years. Age (odds ratio, 1.05 [95% CI, 1.03, 1.08]; P < 0.001) and disease duration (odds ratio, 0.71 [95% CI, 0.54, 0.93]; P = 0.01) were significantly associated with disease severity. Patients with longer disease duration before surgery were less likely to have severe disease.

In this National Institutes of Health-funded clinical trial, distance traveled and comorbidities were not associated with severity of UNE. Patients with longer disease duration were less inclined to seek treatment sooner, likely owing to mild disease severity. The results show that distance from a treatment center is not a limitation for UNE treatment. Older individuals are at increased risk of severe disease and can benefit from early referral and treatment.