Predictors of disease severity for ulnar neuropathy at the elbow, analysis from a randomized clinical trial

Abstract

Importance: 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 common occurrence and impacting lives, risk factors that predispose UNE and help understand disease severity are not investigated thoroughly.

Methods: Patients enrolled in the Surgery for Ulnar Neuropathy (SUN) at the elbow study were included. Data on patient demographics, distance traveled, disease duration and comorbidities collected at the time of enrollment prior to surgery were used for this analysis. Ordinal logistic regression was used to determine risk factors associated with three-level UNE severity.

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

Conclusion: In this NIH-funded clinical trial, distance traveled, and patient 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. Our results inform that distance traveled by patients is not a limitation for UNE treatment. Older individuals are at increased risk of severe disease and can benefit from early referral and treatment.

Level of evidence: Therapeutic, Level 1.

Trial registration: ClinicalTrials.gov ( https://clinicaltrials.gov/ ): NCT04254185, Date 1/31/2020.