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Trend of Recovery after Simple Decompression for Treatment of Ulnar Neuropathy at the Elbow

Giladi, Aviram M. M.D.; Gaston, R. Glenn M.D.; Haase, Steven C. M.D.; Hammert, Warren C. M.D., D.D.S.; Lawton, Jeffrey N. M.D.; Merrell, Greg A. M.D.; Nassab, Paul F. M.D.; Song, Jae W. M.D., M.S.; Yang, Lynda J. S. M.D., Ph.D.; Chung, Kevin C. M.D., M.S.; For the Surgery of the Ulnar Nerve Study Group

Plastic & Reconstructive Surgery: April 2013 - Volume 131 - Issue 4 - p 563e–573e
doi: 10.1097/PRS.0b013e318282764f
Hand/Peripheral Nerve: Outcomes Articles
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Background: Although numerous studies have investigated long-term outcomes after surgical treatment of ulnar neuropathy at the elbow with simple decompression, no study has evaluated the trend of postoperative recovery. The authors assessed timing of recovery after simple decompression for ulnar neuropathy at the elbow.

Methods: The five-center Surgery of the Ulnar Nerve Study Group prospectively recruited 58 consecutive subjects with ulnar neuropathy at the elbow and treated them with simple decompression. Patients were evaluated preoperatively and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Patient-rated outcomes questionnaires included the Michigan Hand Questionnaire; the Disabilities of the Arm, Shoulder and Hand questionnaire; and the Carpal Tunnel Questionnaire. Functional tests used were grip strength, key pinch strength, two-point discrimination, and Semmes-Weinstein monofilament testing. Postoperative improvement was assessed at each time point to establish the trend of recovery in reaching a plateau.

Results: Significant patient-reported symptomatic and functional recovery occurred over the first 6 weeks postoperatively as represented by improvements in questionnaire scores. Symptomatic recovery occurred earlier than functional recovery as measured by sensory and strength testing and the work domain of the Michigan Hand Questionnaire. Improvement in patient-reported outcomes continued and reached a plateau at 3 months, whereas measured strength and sensory recovery continued over 12 months.

Conclusion: The greatest clinical improvement after simple decompression for ulnar neuropathy at the elbow, according to questionnaire scores, occurs in the first 6 weeks postoperatively and reaches a plateau by 3 months.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Ann Arbor, Mich.; Charlotte, N.C.; Rochester, N.Y.; Indianapolis, Ind.; North Kansas City, Mo.; and Philadelphia, Pa.

From the Department of Surgery, Section of Plastic Surgery, the Department of Orthopedic Surgery, and the Department of Neurosurgery, University of Michigan Health System; the Department of Orthopedic Surgery, OrthoCarolina Hand Center; the Department of Orthopedic Surgery, University of Rochester Medical Center; the Indiana Hand to Shoulder Center; Drisko, Fee, and Parkins Orthopedics; and the Department of Radiology, Drexel University College of Medicine.

Received for publication August 30, 2012; accepted October 31, 2012.

Disclosure: The authors have no financial interest to declare in any of the products or devices mentioned in this article.

Kevin C. Chung, M.D., M.S.; Section of Plastic Surgery, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109-5340, kecchung@umich.edu

©2013American Society of Plastic Surgeons