Article

OBJECTIVE: To confirm that smoking increases the risk for ulnar neuropathy at the
elbow and to investigate potential mechanisms for that increased risk. DESIGN:
Prospective case-control study featuring the recruitment of 100 subjects with
upper-limb neurologic symptoms: 50 meeting (cases) and not meeting (controls)
electrodiagnostic criteria for ulnar neuropathy at the elbow. Known risk factors
for ulnar neuropathy at the elbow, preferred smoking hand, and upper-limb joint
angles during preferred smoking posture were recorded. RESULTS: Subjects with
ulnar neuropathy at the elbow reported increased smoking when compared with the
control group, but there was no agreement between ulnar neuropathy at the elbow
side and preferred smoking hand or group differences in joint angles during
preferred smoking posture. Ulnar neuropathy at the elbow occurred more frequently
on the left regardless of hand dominance (P = 0.007). Independent risk factors
included age, male sex, and smoking (in pack-years), demonstrating odds ratios
(95% confidence intervals) of 1.054 (1.015-1.095), 4.41 (1.75-11.16), and 1.035
(1.001-1.070), respectively. Smoking also correlated negatively with above-elbow
ulnar compound muscle action potential, across-elbow conduction velocity, and
conduction block. CONCLUSIONS: Smoking is associated with increased risk for
ulnar neuropathy at the elbow, and the dose-response effect between smoking and
electrophysiologic ulnar measures associated with ulnar neuropathy at the elbow
severity increases the likelihood that the relationship is one of cause and
effect. However, the data do not suggest that a mechanical explanation related to
repetitive elbow flexion is likely.

Langue : ANGLAIS