Article

OBJECTIVE: To assess the effect of patient education, the simplest conservative
treatment of ulnar neuropathy at the elbow, and establish its indication. DESIGN:
Patients with ulnar neuropathy at the elbow were treated by education. Its
effects and factors affecting outcome were investigated. The length of the
treatment was at least 3 months. If the symptoms were improving, the follow-up
was lengthened. All of the improved patients were followed up at least for 1 year
after they reached a plateau of improvement to check recurrence. SETTING:
Patients were selected from an outpatient clinic of a general hospital.
PARTICIPANTS: Patients (N=77; 80 nerves) with ulnar neuropathy at the elbow
diagnosed clinically and electrophysiologically. INTERVENTIONS: Patient education
on the pathophysiology and activity modification to unload the ulnar nerve from
mechanical stress. MAIN OUTCOME MEASURES: Outcomes were graded as excellent,
good, fair, or poor with use of the modified Akahori's classification system.
Patient satisfaction was graded as 1 (low) to 5 (high). Repeat nerve conduction
studies were performed in those who gave consent, and results were graded as
excellent, good, fair, or poor. RESULTS: Fifty-three nerves (66%) had excellent
or good outcomes. Multivariate logistic regression analysis revealed that
degenerative change (graded as normal, mild, moderate, or severe) was associated
with the outcome, while age, sex, side, duration and severity of the disease,
diabetes, dislocation of the nerve, and smoking were not. Excellent or good
outcomes were obtained in 43 (80%) of 54 nerves with no or mild degeneration and
10 (38%) of 26 nerves with moderate or severe degeneration. Recurrence was less
frequent in the former (2 of 43 nerves, 5%) than the latter (4 of 10, 40%). The
outcomes strongly correlated with the satisfaction scores and repeat nerve
conduction study results. CONCLUSIONS: Patient education is effective for a
considerable number of patients with ulnar neuropathy at the elbow. Whether this
is indicated depends on the grade of elbow degeneration. Those who have no or
mild degeneration respond better to this treatment with a lower rate of
recurrence than those with more severe degeneration regardless of age, sex, side,
duration and severity of the disease, presence or absence of diabetes and
dislocation of the nerve, and smoking status.

Langue : ANGLAIS