Postsurgical Electrical Stimulation Enhances Recovery Following Surgery for Severe Cubital Tunnel Syndrome: A Double-Blind Randomized Controlled Trial.

BACKGROUND: Patients with severe cubital tunnel syndrome often have poor functional recovery with conventional surgical treatment. Postsurgical electrical stimulation (PES) has been shown to enhance axonal regeneration in animal and human studies. OBJECTIVE: To determine if PES following surgery for severe cubital tunnel syndrome would result in better outcomes compared to surgery alone. METHODS: Patients with severe cubital tunnel syndrome in this randomized, double-blind, placebo-controlled trial were randomized in a 1:2 ratio to the control or stimulation groups. Control patients received cubital tunnel surgery and sham stimulation, whereas patients in the stimulation group received 1-h of 20 Hz PES following surgery. Patients were assessed by a blinded evaluator annually for 3 yr. The primary outcome was motor unit number estimation (MUNE) and secondary outcomes were grip and key pinch strength and McGowan grade and compound muscle action potential. RESULTS: A total of 31 patients were enrolled: 11 received surgery alone and 20 received surgery and PES. Three years following surgery, MUNE was significantly higher in the PES group (176 ± 23, mean + SE) compared to controls (88 ± 11, P < .05). The mean gain in key pinch strength in the PES group was almost 3 times greater than in the controls (P < .05). Similarly, other functional and physiological outcomes showed significantly greater improvements in the PES group. CONCLUSION: PES enhanced muscle reinnervation and functional recovery following surgery for severe cubital tunnel syndrome. It may be a clinically useful adjunct to surgery for severe ulnar neuropathy, in which functional recovery with conventional treatment is often suboptimal.

Ulnar collateral ligament insufficiency affects cubital tunnel syndrome during throwing motion: a cadaveric biomechanical study.

BACKGROUND: In throwing athletes, cubital tunnel syndrome and insufficiency of the ulnar collateral ligament (UCL) are common pathologic processes of the elbow. The objective of this study was to investigate the effect of UCL tears on ulnar nerve elongation in the simulated throwing position. METHODS: Eight fresh frozen cadaveric upper limbs were tested at the simulated late cocking to acceleration phase in the throwing motion using an elbow testing system. Elbow valgus laxity and ulnar nerve length and strain under 2 Nm of applied valgus torque (maximum torque in cadaveric elbow) were evaluated. Paired t-tests were used to compare all data between intact UCLs and UCLs after complete transection of the anterior oblique ligament. Linear regression analysis was used to investigate relationships between elbow valgus laxity and ulnar nerve strain. RESULTS: Elbow valgus laxity significantly increased after transection of the UCL. Ulnar nerve length after UCL transection was significantly greater than that in the intact condition at 60° (P = .006) and 90° of elbow flexion (P < .0001). In addition, ulnar nerve strain was positive (increased) at 60° and 90° of elbow flexion. Maximum ulnar nerve strain at 90° of elbow flexion was 3.9% ± 0.9% when the UCL was intact and 6.8% ± 0.7% after transection. UCL transection yielded significant positive correlation between elbow valgus laxity and ulnar nerve strain (P = .006; r = .4714). CONCLUSION: Increased elbow valgus laxity due to UCL insufficiency may cause elongation of the ulnar nerve and exacerbate cubital tunnel syndrome during the throwing motion.

Compound Muscle Action Potential Amplitude Predicts the Severity of Cubital Tunnel Syndrome.

BACKGROUND: Cubital tunnel syndrome has a spectrum of presentations ranging from mild paresthesias to debilitating numbness and intrinsic atrophy. Commonly, the classification of severity relies on clinical symptoms and slowing of conduction velocity across the elbow. However, changes in compound muscle action potential (CMAP) amplitude more accurately reflect axonal loss. We hypothesized that CMAP amplitude would better predict functional impairment than conduction velocity alone. METHODS: A retrospective cohort of patients who underwent a surgical procedure for cubital tunnel syndrome over a 5-year period were included in the study. All patients had electrodiagnostic testing performed at our institution. Clinical and electrodiagnostic variables were recorded. The primary outcome was preoperative functional impairment, defined by grip and key pinch strength ratios. Multivariable regression identified which clinical and electrodiagnostic variables predicted preoperative functional impairment. RESULTS: Eighty-three patients with a mean age of 57 years (75% male) were included in the study. The majority of patients (88%) had abnormal electrodiagnostic studies. Fifty-four percent had reduced CMAP amplitude, and 79% had slowing of conduction velocity across the elbow (recorded from the first dorsal interosseous). On bivariate analysis, older age and longer symptom duration were significantly associated (p < 0.05) with reduced CMAP amplitude and slowing of conduction velocity across the elbow, whereas body mass index (BMI), laterality, a primary surgical procedure compared with revision surgical procedure, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores, and visual analog scale (VAS) scores for pain were not. Multivariable regression analysis demonstrated that reduced first dorsal interosseous CMAP amplitude independently predicted the loss of preoperative grip and key pinch strength and that slowed conduction velocity across the elbow did not. CONCLUSIONS: Reduced first dorsal interosseous amplitude predicted preoperative weakness in grip and key pinch strength, and isolated slowing of conduction velocity across the elbow did not. CMAP amplitude is a sensitive indicator of axonal loss and an important marker of the severity of cubital tunnel syndrome. It should be considered when counseling patients with regard to their prognosis and determining the necessity and timing of operative intervention. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Prospective evaluation of sleep improvement after cubital tunnel decompression surgery.

BACKGROUND: Compromised sleep is a known phenomenon with compressive neuropathies such as carpal tunnel syndrome. However, the prevalence of sleep disturbance with cubital tunnel syndrome (CuTS) and the effect on sleep after ulnar nerve decompression are not well understood. We hypothesized that CuTS results in sleep disturbances and that decompression surgery would result in improvement in overall sleep quality. METHODS: Consecutive patients with electrodiagnostic-proven CuTS indicated for decompression were prospectively enrolled. Demographic data, McGowan grade, electrodiagnostic (electromyography) severity, visual analog scale pain score, the 11-item version of the Disabilities of the Arm, Shoulder and Hand questionnaire, and the Insomnia Severity Index scale data were collected preoperatively and at 2 weeks and 3 months postoperatively. RESULTS: There were 145 patients enrolled, with 97% available at 2 weeks and 72% available at the final 3-month follow-up. Surgical decompression procedures consisted of 102 in situ releases and 43 transpositions. The average preoperative Insomnia Severity Index score for the entire cohort was 10.7, above the threshold for a diagnosis of insomnia, which subsequently improved to 4.1 by final follow-up postoperatively, consistent with resolution of the insomnia. There was no difference in the extent of sleep improvement between in situ decompression and transposition. Similarly, electromyography severity and McGowan grade also did not appear to significantly affect the extent of sleep improvement. CONCLUSION: CuTS decompression surgery, irrespective of surgical type and preoperative severity, resulted in improvement in sleep by the 3 month postoperative visit.

Effect of dry needling on cubital tunnel syndrome: Three case reports.

This case series describes three patients who presented with right medial elbow pain managed unsuccessfully with conservative treatment that included medication, massage, exercise therapy, ultrasound therapy, neurodynamic mobilization, and taping. Diagnosis of cubital tunnel syndrome was based on palpatory findings, a positive elbow flexion test, and a positive Tinel's sign. Conventionally, the intervention for this entrapment has been surgical decompression, with successful outcomes. This is potentially a first-time description of the successful management of cubital tunnel syndrome with dry needling (DN) using a recently published DN grading system. The patients were seen twice a week for 2 weeks with immediate improvements noted in all the outcome measures after the first treatment session. At discharge, they were pain-free and fully functional, which was maintained up to a 6-month follow-up.

Polish version of the Patient-Rated Ulnar Nerve Evaluation in preoperative patients: Translation and psychometric testing.

STUDY DESIGN: Cross-sectional design. INTRODUCTION: This study examined the translated English to Polish version of the Patient-Rated Ulnar Nerve Evaluation (PRUNE) for its internal consistency, test-retest reliability, and construct validity. METHODS: During the first assessment validity testing, a total of 39 consecutive patients with cubital tunnel syndrome completed the PRUNE, Michigan Hand Outcome Questionnaire, Disabilities of the Arm, Shoulder, and Hand questionnaire, and Patient Evaluation Measure in conjunction with the grip and key pinch tests and pain score (by Visual Analogue Scale). Cronbach's alpha (CA), intraclass correlation coefficient (ICC), and the Bland-Altman plot were used to evaluate internal consistency, test-retest reliability, and agreement, respectively. Analysis of variance compared the PRUNE score with the McGowan clinical stages. RESULTS: After a 1-day interval, 19 patients completed the PRUNE for the second time. The total PRUNE score was 44.4 ± 20.4, CA = 0.93, and ICC = 0.921. The total PRUNE score limits of agreement varied from -9.87 to 7.55 points. PRUNE subscale CA ranged from 0.79 to 092; the ICC varied from 0.738 to 0.911. The construct validity revealed a strong association with Michigan Hand Outcome Questionnaire (R = -0.83; P < .000), and moderate with Disabilities of the Arm, Shoulder, and Hand (R = 0.75; P < .000), Patient Evaluation Measure (R = 0.75; P < .000), and Visual Analogue Scale (R = 0.69; P < .000). The grip and pinch tests had low and no correlation with the total PRUNE score, respectively. CONCLUSION: The Polish version of PRUNE showed good psychometric properties for use in both clinical and research practice in patients with cubital tunnel syndrome of varying intensity.

Little finger abduction and adduction testing in ulnar nerve lesions.

We aimed to evaluate the abduction and adduction of the little finger based on a new clinical test in the context of ulnar nerve lesions. We tested little finger abduction and adduction in 34 patients with an isolated ulnar nerve injury and 20 patients with cubital tunnel syndrome. With their forearms supinated, patients were asked to fully abduct their little finger. Then, the examiner held the patients' index, middle, and ring fingers in extension and maximal radial deviation, and then asked the patients to touch their little finger to their radially deviated ring finger. In patients with ulnar nerve injuries, either above or below the elbow, little finger abduction and adduction were impossible. In the patients with cubital tunnel syndrome, 19 had partial paralysis of little finger adduction and one patient had complete paralysis. Abduction and adduction of the little finger is not possible when the ulnar nerve is transected. In cubital tunnel syndrome, this little finger adduction test was able to identify decreased range of motion, possibly indicating muscle weakness.

V-Y Lengthening Technique of the Flexor-Pronator Mass for Anterior Submuscular Transposition of the Ulnar Nerve in Severe Cubital Tunnel Syndrome: A Long-Term Follow-Up Study.

PURPOSE: This study aimed to retrospectively analyze the clinical results of anterior submuscular transposition of the ulnar nerve using a flexor-pronator V-Y lengthening technique in patients with severe cubital tunnel syndrome (CTS). MATERIALS AND METHODS: From January 2007 to May 2015, 36 patients with grade III CTS based on McGowan's classification were enrolled. All patients were treated with anterior submuscular transposition of the ulnar nerve using a flexor-pronator V-Y lengthening technique. To evaluate clinical outcomes, all patients underwent preoperative and final follow-up assessments of disabilities of the arm, shoulder, and hand scores, nerve conduction velocity, 2-point discrimination, and pinch and grip strength. Overall functional outcomes were evaluated after a mean follow-up of 53 months using the Modified Bishop rating system. We analyzed the statistical correlation of patients' duration of symptom and age with clinical results. RESULTS: At the final follow-up, the average disabilities of the arm, shoulder, and hand, nerve conduction velocity, 2-point discrimination, and grip and pinch strengths significantly improved in all patients. At least a 1-McGowan grade improvement was achieved in 34 extremities (94.4%). According to the modified Bishop scores, 30 patients (83.3%) achieved good or excellent outcomes and 2 extremities (5.5%) had poor outcomes. There was a significant negative correlation between prolonged symptom duration and the Modified Bishop score at the final follow-up, but age did not affect the functional outcome. CONCLUSIONS: In McGowan grade III severe CTS, anterior submuscular transposition of the ulnar nerve using a flexor-pronator V-Y lengthening technique leads to satisfactory outcomes. Longer symptom duration is associated with poorer results, and the outcome is not correlated with age. Therefore, active surgical treatment should be considered regardless of age before severe disease occurs.

Anterior Subcutaneous Transposition of the Ulnar Nerve Affects Elbow Range of Motion: A Mean 13.5 Years of Follow-up.

BACKGROUND: Surgical decompression of the ulnar nerve is effective for cubital tunnel syndrome. However, deep approaches may result in iatrogenic elbow stiffness. This long-term study was to evaluate the range of motion (ROM) of the elbow and functional outcomes after anterior subcutaneous transposition. METHODS: A total of 115 patients (78 male and 37 female; mean age: 46.6 years) who underwent anterior subcutaneous transposition of the ulnar nerve between 2001 and 2005 were evaluated retrospectively; mean follow-up was 13.5 years. Elbow ROM was measured as flexion arc, flexion, and extension preoperatively and at the final follow-up, and compared via a mixed analysis of variance adjusting for age. Neuropathy was assessed preoperatively using a modified McGowan neuropathy grade and postoperatively using modified Wilson-Krout criteria. An ordinal logistic regression analysis used postoperative modified Wilson-Krout criteria as the outcome and preoperative factors as predictors. RESULTS: Preoperative McGowan grades were Grade 1 in 14 patients (12.2%), Grade 2A in 28 (24.3%), Grade 2B in 53 (46.1%), and Grade 3 in 20 (17.4%) patients. Postoperatively, 66 patients (57.4%) had excellent results, 26 (22.6%) had good results, 16 (13.9%) had fair results, and 7 (6.1%) had poor results at the final follow-up, as per the Wilson-Krout criteria. There were no complications. Pre- and postoperative elbow ROM was significantly decreased in patients with previous trauma or surgery of the elbow compared with those without (P < 0.05). Anterior subcutaneous transposition of the ulnar nerve did not significantly affect elbow ROM regardless of previous trauma or surgical history nor preoperative ROM (P > 0.05), after adjusting for age. Patients with prolonged symptoms prior to surgery and worse neuropathy tended to have less satisfactory functional outcomes (P < 0.05), after adjusting for covariates. CONCLUSIONS: Anterior subcutaneous transposition of the ulnar nerve is an effective and reliable treatment of cubital tunnel syndrome with satisfactory outcomes and minimal effect on elbow ROM.

Prevalence of cold sensitivity in upper extremity nerve compression syndromes.

This prospective observational study assessed the prevalence of cold sensitivity in patients with nerve compression using the Cold Intolerance Symptom Severity (CISS) questionnaire. One hundred patients (72 women, 28 men; mean age 59 years) with carpal tunnel syndrome ( n = 95) or cubital tunnel syndrome ( n = 5) were studied. Fifty-two patients reported symptoms of cold sensitivity with a mean CISS score of 50. Overall, significantly more women (58% vs. 36%) reported cold sensitivity with significantly worse CISS scores than men. LEVEL OF EVIDENCE: IV.

Predictors of surgical outcomes for severe cubital tunnel syndrome: a review of 146 patients.

BACKGROUND: Full recovery is unlikely for severe cubital tunnel syndrome, and prognostic factors remain uncertain. We aimed to identify predictors of surgical outcome for these patients. METHODS: One hundred forty-six patients with McGowan grade III cubital tunnel syndrome were evaluated retrospectively with a minimum follow-up of 2 years. All patients underwent either in situ decompression or subcutaneous transposition. The primary outcome measure was postoperative McGowan grade. Predictors included age, sex, dominant hand, disease duration, diabetes mellitus, smoking, alcohol, surgical procedure, follow-up time and preoperative electrophysiological data. Spearman's rank correlation and ordinal logistic regression model were used to assess the effect of independent variables on the postoperative McGowan grade. RESULTS: At the last follow-up, improvement by at least one McGowan grade was reached in 118 cases (80.8%), and complete recovery was achieved in 40 hands (27.4%), while 28 extremities (19.2%) remained at grade III. Older age [per 10-year increase, odds ratio (OR) 2.10; 95% confidence interval (95% CI) 1.55-2.84, p < 0.001], longer disease duration (per 1-year increase, OR 1.31; 95% CI 1.16-1.49, p < 0.001), absent sensory nerve conduction (OR 2.55; 95% CI 1.25-5.21, p = 0.010) and shorter postoperative follow-up (per 1-year increase, OR 0.76; 95% CI 0.65-0.90, p = 0.001) were associated with a higher postoperative McGowan grade. CONCLUSION: Significant improvement but not complete recovery could be expected following in situ decompression or subcutaneous transposition for severe cubital tunnel syndrome. Older age, longer disease duration, absent sensory nerve conduction and shorter postoperative follow-up are independent predictors of worse outcomes.

The cubital tunnel syndrome caused by the intraneural or extraneural ganglion cysts: Case report and review of the literature.

Cubital tunnel syndrome is the second most common nerve compression syndrome in peripheral nerve compression disease. Although potential ulnar nerve entrapment can occur at multiple points along its course, such as the arcade of struthers, the medial intermuscular septum, the medial epicondyle, the cubital tunnel, and the deep flexor pronator aponeurosis, the most common site of entrapment is the cubital tunnel. However, cubital tunnel syndrome could also be caused by the occupying masses along the course of ulnar nerve, such as intraneural or extraneural ganglia. The cubital tunnel syndrome caused by intraneural or extraneural ganglion cysts has been rarely reported. In our hospital, there were 184 patients with cubital tunnel syndrome who underwent surgical treatment from January 2010 to January 2014. Of these patients, 16 had extraneural cysts and 3 had intraneural ganglion cysts. The incidence rate of cysts in the cubital tunnel was 10.33%. Electromyography was used as routine examination. Ultrasound was used only in some patients in whom elbow mass was suspected. In the surgery of the cubital tunnel syndrome combined with cyst, if any other cysts were found, we should be remove completely the cyts and decompress the ulnar nerve thoroughly with the ulnar nerve being anterior transposition. These cysts were confirmed by histopathological examination. Finally, we compared the clinical features of patients who had a medial elbow ganglion with those of patients who had only cubital tunnel syndrome. B ultrasound can significantly improve the diagnosis. All patients were followed up for 4 months to 2 years, and the curative effect was good.

Comparison of two medial epicondylectomy techniques in cubital tunnel syndrome.

OBJECTIVES: This study aims to compare partial medial epicondylectomy (PMe) and distal medial epicondylectomy (DMe) techniques in terms of sensory and motor improvements, functional results and complications. PATIENTS AND METHODS: The study included a total of 59 cubital tunnel syndrome patients (37 males, 22 females; mean age 42.3 years; range 23 to 80 years). Of the patients, DMe was applied on 30 and PMe was applied on 29. Patients were evaluated with Wilson Krout scores, Semmes-Weinstein Monofilament (SWM) test, and grip and pinch strength measurements preoperatively and at postoperative third, sixth, and 12th months. Both groups' pre- and postoperative intragroup and intergroup results were compared. RESULTS: Wilson Krout scores in postoperative checks were better with DMe compared to PMe. The improvement in SWM test scores was statistically significant for only DMe. The improvement in grip strength, lateral pinch and terminal pinch measurements in DMe group was significant at postoperative third month. In PMe group, significant improvement for these measurements was obtained at postoperative sixth month. The only complication observed with DMe was tenderness developing over the medial epicondyle. Painful subluxation of the nerve associated with paresthesia was detected in four patients in PMe group. CONCLUSION: Compared to PMe, DMe offers more satisfactory subjective results. Motor functional recovery occurs earlier with DMe. DMe appears to have lower complication rates.

Results of endoscopically-assisted cubital tunnel release without using any specific instrument.

BACKGROUND: We aimed to report the clinical and electrophysiological results of patients who were treated with an endoscopically assisted in situ release technique for cubital tunnel syndrome and to show safety and efficacy of this procedure. MATERIALS AND METHODS: Twenty nine patients were included into the study. 13 patients (44.8%) were female, 16 patients (55.2%) were male. The mean age was 44.4 years (range; 22-66 years). Mean follow up period was 16.0 months (range; 7-42 months). We used Dellon classification for preoperative staging, and modified Bishop rating system for the evaluation of postoperative clinical results. Dynamometric and electromyographic measurements were obtained preoperatively and at final control. RESULTS: Preoperative Dellon's classification revealed 3 patients grade 1, 14 grade 2, and 12 grade 3. Modified Bishop score was very good for 21 patients (72.4%), good for 4 patients (13.8%), fair for 3 patient (10.3%), and poor for 1 patient (3.4%). At final control; the mean proportion of grip power and pinch strength of the affected hand to the contralateral normal hand was improved, and also nerve conduction velocity were improved in all patients. As complication, hematoma formation developed in two cases. CONCLUSION: Our study showed that endoscopically assisted decompression technique without using any special instruments can be performed successfully with a low complication rate. It is a safe and effective method in the treatment of cubital tunnel syndrome. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Endoscopic neurolysis of the ulnar nerve: retrospective evaluation of the first 60 cases.

BACKGROUND: The aim of this study was to determine the clinical efficacy of minimally invasive endoscopic ulnar nerve release at midterm follow-up. METHODS: This was a retrospective, consecutive, single-center study. The inclusion criterion was presentation of the patient with isolated and stable cubital tunnel syndrome. The surgical technique described by Hoffmann and Siemionow in 2006 was used for all patients. The cubital tunnel syndrome was graded by Dellon's classification and scored as described by MacDermid and Grewal in 2013. RESULTS: Sixty patients underwent surgery (62 cubital tunnel operations). Fifty-three patients were included in the study. The mean follow-up was 17 months (6-34). In the preoperative period, according to Dellon's classification, 8 patients were grade 1, 29 patients were grade 2, and 16 patients were grade 3. After surgery, according to the MacDermid score, 45 patients (84.9%) had good or excellent results, 6 (11.3%) had moderate results, and 2 (3.8%) had poor results. The mean preoperative score was 103.1 (25-181), and the mean postoperative score was 26.3 (0-135). By comparison with standard surgical technique, the endoscopic technique appears to be reliable with a similar success rate and functional improvement. The advantages are the minimally invasive portion of the surgical technique. Endoscopic control allowed complete release of the ulnar nerve with few complications. CONCLUSION: The endoscopic technique as described by Hoffman et al had similar efficacy to open surgical techniques with the advantage of being minimally invasive.

A Clinical Scoring System for Distinguishing Patients With Coincident Cubital Tunnel Syndrome Among Patients With Carpal Tunnel Syndrome.

Background: Coincident carpal and cubital tunnel syndromes present a diagnostic challenge, exacerbated by the limitations of nerve conduction study (NCS) for confirming cubital tunnel syndrome. This study develops a diagnostic scoring system, the Koh-Benhaim (KB) score, to identify patients with coincident compression neuropathies. Methods: A retrospective review of 515 patients was performed from patients surgically treated for carpal and/or cubital tunnel release. These patients were divided as patients with isolated carpal tunnel syndrome (n = 337) or coincident carpal and cubital tunnel syndromes (n = 178), then characterized according to demographics, medical history, physical examination, and NCS results. Univariate and multivariate logistic regression identified predictors of coincident neuropathy. A clinical score was constructed by integerizing regression coefficients of predictive factors. Receiver operating characteristic (ROC) curves were generated for each iteration of the score. Sensitivities, specificities, and positive and negative predictive values were calculated to identify the best cutoff value. Results: Decreased intrinsic muscle strength, decreased ulnar sensation, positive elbow flexion test, positive cubital tunnel Tinel's sign, and abnormal NCS result were selected. The cutoff value for high risk of coincident compression was 3 points: positive predictive value, 82.9% and specificity, 93.4%. Model performance was very good-ROC area under the curve of 0.917. Conclusions: A KB score of 3 or greater represents high risk of coincident cubital tunnel compression. The variables involved are routinely used to assess the cubital tunnel, and all component factors of the KB score were of equivalent clinical weight in assessing patients with potential coincident compression neuropathy.

Postoperative improvement in DASH score, clinical findings, and nerve conduction velocity in patients with cubital tunnel syndrome.

We investigated a recovery pattern in subjective and objective measures among 52 patients with cubital tunnel syndrome after anterior subcutaneous transposition of the ulnar nerve. Disabilities of the Arm, Shoulder and Hand (DASH) score (primary outcome), numbness score, grip and pinch strength, Semmes-Weinstein (SW) score, static 2-point discrimination (2PD) score, and motor conduction velocity (MCV) stage were examined preoperatively and 1, 3, 6, 12, and ≥24 months postoperatively. Statistical analyses were conducted to evaluate how each variable improved after surgery. A linear mixed-effects model was used for continuous variables (DASH score, numbness, grip and pinch strength), and a proportional odds model was used for categorical variables (SW and 2PD tests and MCV stages). DASH score significantly improved by 6 months. Significant recovery in numbness and SW test scores occurred at 1 month. Grip and pinch strength, 2PD test scores, and MCV stage improved by 3 months. DASH scores and numbness recovered regardless of age, sex, or disease severity. It was still unclear if both subjective and objective measures improved beyond 1-year postoperatively. These data are helpful for predicting postoperative recovery patterns and tend to be most important for patients prior to surgery.

Association Between Gender, Body Mass Index, and Ulnar Nerve Entrapment at the Elbow: A Retrospective Study.

INTRODUCTION: Entrapment of the ulnar nerve is the second most common compression neuropathy in the upper extremity, but the etiology is multifactorial and still not clearly understood. The authors aimed to determine whether gender and body mass index (BMI) are risk factors for ulnar nerve entrapment (UNE) at the elbow. METHODS: Results of electrodiagnostic studies performed on patients with UNE between January 2008 and February 2013 were examined retrospectively. Patients with BMI ≤22 were considered slender, those with a BMI between 22 and 29, normal, and those with a BMI >29, overweight. The authors compared the data for patients with and without UNE. RESULTS: A total of 622 subjects were studied; 295 were UNE cases (154 men, 141 women) and 327 were controls (110 men, 217 women). There was no difference between control and UNE groups in terms of BMI. In univariate analysis, age and gender are independent risk factors for UNE, but when included in a stepwise Cox regression model, only gender was a significant factor. Male gender was found to be a risk factor for UNE. CONCLUSIONS: Male gender is a risk factor for developing UNE, but age and BMI are not significant risk factors. Further studies which examine BMI and gender differences with data about occupational risk factors are required.

Effect of Elbow Position on Short-segment Nerve Conduction Study in Cubital Tunnel Syndrome.

BACKGROUND: The appropriate elbow position of short-segment nerve conduction study (SSNCS) to diagnose cubital tunnel syndrome (CubTS) is still controversial. The goal of this study was to determine the effect of different elbow positions at full extension and 70° flexion on SSNCS in CubTS. METHODS: In this cross-sectional study, the clinical data of seventy elbows from 59 CubTS patients between September, 2011 and December, 2014 in the Peking University First Hospital were included as CubTS group. Moreover, thirty healthy volunteers were included as the healthy group. SSNCS were conducted in all subjects at elbow full extension and 70° elbow flexion. Paired nonparametric test, bivariate correlation, Bland-Altman, and Chi-squared test analysis were used to compare the effectiveness of elbow full extension and 70° flexion elbow positions on SSNCS in CubTS patients. RESULTS: Data of upper limit was calculated from healthy group, and abnormal latency was judged accordingly. CubTS group's latency and compound muscle action potential (CMAP) of each segment at 70° elbow flexion by SSNCS was compared with full extension position, no statistically significant difference were found (all P > 0.05). Latency and CMAP of each segment at elbow full extension and 70° flexion were correlated (all P < 0.01), except the latency of segment of 4 cm to 6 cm above elbow (P = 0.43), and the latency (P = 0.15) and the CMAP (P = 0.06) of segment of 2 cm to 4 cm below elbow. Bivariate correlation and Bland-Altman analysis proved the correlation between elbow full extension and 70° flexion. Especially in segments across the elbow (2 cm above the elbow and 2 cm below it), latency at elbow full extension and 70° flexion were strong direct associated (r = 0.83, P < 0.01; r = 0.55, P < 0.01), and so did the CMAP (r = 0.49, P < 0.01; r = 0.72, P < 0.01). There was no statistically significant difference in abnormality of each segment at full extension as measured by SSNCS compared with that at 70° flexion (P > 0.05, respectively). CONCLUSIONS: There was no statistically significant difference in the diagnosis of CubTS with the elbow at full extension compared with that at 70° flexion during SSNCS. We suggest that elbow positon at full extension can also be used during SSNCS.