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Prospective Analysis of Relationships of Outcome Measures for Ulnar Neuropathy at the Elbow

Published online by Cambridge University Press:  02 December 2014

Catherine A. Munro ,
Rajiv Midha ,
Peter H. Ho ,
John Paul Szalai ,
Jason Noble  and
Vivek Patel
Catherine A. Munro
Affiliation:
Division of Neurosurgery, Department of Surgery and Trauma Research, Program, Sunnybrook & Women's College Health, Sciences Centre, University of Toronto, Toronto, ON Canada
Rajiv Midha
Affiliation:
Division of Neurosurgery, Department of Surgery and Trauma Research, Program, Sunnybrook & Women's College Health, Sciences Centre, University of Toronto, Toronto, ON Canada
Peter H. Ho
Affiliation:
Department of Physiotherapy, Sunnybrook & Women's College Health, Sciences Centre, University of Toronto, Toronto, ON Canada
John Paul Szalai
Affiliation:
Department of, Research Design and Biostatistics, Sunnybrook & Women's College Health, Sciences Centre, University of Toronto, Toronto, ON Canada Supported by the Foundation Baxter et Alma Ricard Chair, Division of Neurosurgery, University of Toronto, Toronto, ON Canada
Jason Noble
Affiliation:
Supported by the Foundation Baxter et Alma Ricard Chair, Division of Neurosurgery, University of Toronto, Toronto, ON Canada
Vivek Patel
Affiliation:
Supported by the Foundation Baxter et Alma Ricard Chair, Division of Neurosurgery, University of Toronto, Toronto, ON Canada
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Abstract

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Background:

We undertook a prospective study to investigate relationships between outcome measures of ulnar neuropathy at the elbow.

Methods:

Thirty-one patients (mean age 52.6, range 20-80), with clinically and electrically verified ulnar neuropathy at the elbow, were seen independently by a neurosurgeon and a physiotherapist. All tests were administered to all patients on each visit. Data collected included measures of sensory (monofilament, two-point discrimination, vibration) and motor function (grip, key-pinch, muscle atrophy), pain (visual analogue scale (VAS)) and impact on lifestyle (Levine's questionnaires (function status score - FSS, symptom severity score - SSS)), disability of the arm, shoulder and hand module (DASH) and patient-specific measures (PSM). Parametric and non-parametric correlation and factor analysis were done.

Results:

Outcome analysis was available for 63 patient visits, with follow-up obtained for 20 patients (mean 8.5 months). Lifestyle and pain instruments (FSS, SSS, DASH, PSM and VAS) all correlated well with each other (r> 0.6, p< .01). DASH was moderately to highly correlated to nine of the 11 measures. Some tests correlated poorly, for example, Semmes-Weinstein monofilament with other sensory measures and muscle atrophy with almost all measures. Factor analysis revealed that there are two principal factors, accounting for 77% of the variance. Factor 1 relates to impact on lifestyle and pain while Factor 2 relates to strength and function.

Discussion/Conclusions:

Intraclass measures, particularly ones assessing lifestyle and pain instruments are strongly correlated. Factor analysis revealed two principal factors that account for the majority of the variance; future studies with a larger sample size are needed to validate this analysis.

Résumé:

RÉSUMÉ:Introduction:

Nous avons effectué une étude prospective afin d'étudier les relations entre les mesures des résultats dans la neuropathie cubitale au niveau du coude.

Méthodes:

Trente et un patients (âge moyen 52.6 ans, écart de 20 à 80 ans), atteints de neuropathie cubitale au niveau du coude, vérifiée cliniquement et électriquement, ont été examinés indépendamment par un neurochirurgien et un physiothérapeute. Tous les tests ont été administrés à tous les patients à chaque visite. Les données incluent des mesures de la fonction sensitive (monofilament, discrimination spatiale, vibrations) et motrice (préhension, atrophie musculaire), de la douleur (échelle analogique visuelle (VAS)) et impact sur le style de vie (questionnaires de Levine (score de statut fonctionnel - FSS, score de sévérité des symptômes - SSS)), invalidité du bras, du module épaule et main (DASH) et mesures spécifiques du patient (PSM). On a procédé à une analyse de corrélation et à des analyses factorielles paramétriques et non paramétriques.

Résultats:

L'analyse des résultats était disponible concernant 63 visites de patients, dont des visites de suivi chez 20 patients (moyenne de 8.5 mois). Les mesures se rapportant au style de vie et à la douleur (FSS, SS, DASH, PSM et VAS) étaient bien corrélées entre elles (r > 0.6, p < 0.01). Le DASH était de modérément à fortement corrélé à neuf des 11 mesures. Certains tests étaient peu corrélés, tels le test du monofilament de Semmes-Weinstein aux autres mesures sensitives et l'atrophie musculaire à presque toutes les mesures. L'analyse factorielle a montré qu'il y a deux facteurs principaux qui expliquent 77% de la variance. Le premier facteur est associé à l'impact sur le style de vie et la douleur, alors que le deuxième facteur est associé à la force et à la fonction. Discussion /

Conclusions:

les mesures intraclasses, particulièrement celles qui évaluent le style de vie et les mesures de la douleur sont fortement corrélées. L'analyse factorielle a montré deux facteurs principaux qui expliquent la plus grande partie de la variance; d'autres études portant sur un échantillon plus considérable seront nécessaires pour valider les résultats de cette analyse.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 28 , Issue 3 , August 2001 , pp. 239 - 244
Copyright
Copyright © The Canadian Journal of Neurological 2001

References

1. Norkus, SA, Meyers, MC. Ulnar neuropathy of the elbow. SportsMed 1994;17:189–199.Google ScholarPubMed
2. Kimura, J. Electrodiagnosis in Diseases of Nerve and Muscles:Principles and Practice. Philadelphia: FA Davis, 1983: 505.Google Scholar
3. Dellon, AL. Review of treatment results for ulnar nerve entrapmentat the elbow. J Hand Surg (Am) 1989;14:688–700.CrossRefGoogle ScholarPubMed
4. McGowan, AJ. The results of transposition of the ulnar nerve fortraumatic ulnar neuritis. J Bone Joint Surg 1950; 32:293–301.CrossRefGoogle ScholarPubMed
5. Elleman, K, Nielsen, KD, Poulsgaard, L, Smith, T. Vibrotactilometryas a diagnostic tool in ulnar nerve entrapment at the elbow. Scand J Plast Reconstr Hand Surg 1999; 33:93–97.CrossRefGoogle Scholar
6. Chassard, M, Pham, E, Comtet, JJ. Two-point discrimination testsversus functional sensory recovery in both median and ulnar nerve complete transections. J Hand Surg (Br) 1993; 18:790–796.CrossRefGoogle ScholarPubMed
7. Levine, DW, Simmons, BP, Koris, MJ, et al. A self-administeredquestionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg 1993; 75:1585–1592.CrossRefGoogle ScholarPubMed
8. Trumble, TE, Kahn, U, Vanderhooft, E, Bach, AW. A technique toquantitate motor recovery following nerve grafting. J Hand Surg(Am) 1995; 20:367–372.CrossRefGoogle ScholarPubMed
9. Bell-Krotoski, JA. Sensibility testing: current concepts. In: Hunter, JM, Mackin, EJ, Callahan, AD, eds. Rehabilitation of the Hand: Surgery and Therapy. St. Louis, Missouri: Mosby-Year Book, Inc., 1995: 109–128.Google Scholar
10. Hudak, PL, Amadio, PC, Bombardier, C. Development of an upperextremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group. Am J Ind Med 1996; 29:602–608.3.0.CO;2-L>CrossRefGoogle Scholar
11. Stratford, P, Gill, C, Westaway, M, Binkley, J. Assessing disability andchange on individual patients: a report of a patient specific measure. Physiother Can 1995; 47:258–262.CrossRefGoogle Scholar
12. Dellon, AL. Threshold versus innervation density. In: Stamm, D, ed. Somatosensory Testing and Rehabilitation. Bethesda, Maryland: The American Occupational Therapy Association Inc., 1997: 82–96.Google Scholar
13. Mackinnon, SE, Dellon, AL. Diagnosis Of Nerve Injury. Surgery OfThe Peripheral Nerve. New York: Thieme Medical Publishers,Inc, 1988: 65–88.Google Scholar
14. Sprent, P. Applied Nonparametric Statistical Methods. 2nd Ed. London: Chapman & Hall, 1993.Google Scholar
15. Carmines, EG, Zeller, RA. Reliability and validity assessment. Beverly Hills: Sage Publications, 1979.CrossRefGoogle Scholar
16. Tabachnick, BG, Fidell, L. Principal Components And FactorAnalysis. Using Multivariate Statistics. New York, New York: Harper Collins Publishers Inc., 1996: 635–707.Google Scholar
17. Hair, JF, Anderson, RE, Tatham, RL, Grablousky, BJ. MultivariateData Analysis with Readings. New York: Macmillian, 1984.Google Scholar
18. Wilson, DH, Krout, R. Surgery of ulnar neuropathy at the elbow: 16cases treated by decompression without transposition. JNeurosurg 1973; 38:780–785.Google Scholar
19. Laing, RJ. Measuring outcome in neurosurgery. Br J Neurosurg 2000; 14:181–184.CrossRefGoogle ScholarPubMed
20. Kerlinger, FN. Foundations of Behavioral Research. 3rd ed. NewYork: Holt, Rinehart and Winston, 1986.Google Scholar
21. Almquist, E, Eeg-Olofsson, O. Sensory-nerve-conduction velocityand two-point discrimination in sutured nerves. J Bone Joint Surg (Am) 1970; 52:791–796.CrossRefGoogle Scholar
22. Jabaley, ME, Burns, JE, Orcutt, BS, Bryant, WM. Comparison ofhistologic and functional recovery after peripheral nerve repair. J Hand Surg (Am) 1976; 1:119–130.CrossRefGoogle Scholar
23. Munro, CA, Szalai, JP, Mackinnon, SE, Midha, R. Lack of associationbetween outcome measures of nerve regeneration. Muscle Nerve 1998; 21:1095–1097.3.0.CO;2-S>CrossRefGoogle Scholar
24. Rosén, B, Dahlin, LB, Lundborg, G. Assessment of functionaloutcome after nerve repair in a longitudinal cohort. Scand J Plast Reconstr Hand Surg 2000; 34:71–78.Google Scholar
25. Foster, RJ, Edshage, S. Factors related to the outcome of surgicallymanaged compressive ulnar neuropathy at the elbow level. J Hand Surg (Am) 1981; 6:181–192.CrossRefGoogle Scholar
26. Nathan, PA, Kennedy, AM, Meadows, KD. Outcome study of ulnarnerve compression at the elbow treated with simple decompression and an early programme of physcial therapy. J Hand Surg (Br) 1995; 20:628–637.CrossRefGoogle Scholar
27. Greenwald, D, Moffitt, M, Cooper, B. Effective surgical treatment ofcubital tunnel syndrome based on provocative clinical testing without electrodiagnostics. Plast Reconstr Surg 1999; 104:215–218.CrossRefGoogle ScholarPubMed
28. Rosen, B. Recovery of sensory and motor function after nerve repair.A rationale for evaluation. J Hand Ther 1996; 9:315–327.CrossRefGoogle ScholarPubMed
29. Rosen, B, Lundborg, G. Amodel instrument for the documentation ofoutcome after nerve repair. J Hand Surg (Am) 2000; 25:535–543.CrossRefGoogle Scholar
30. Wright, JG, Young, NL. The patient-specific index: asking patientswhat they want. J Bone Joint Surg 1997; 79:974–983.CrossRefGoogle Scholar
31. Chatman, AB, Hyams, SP, Neel, JM, et al. The patient-specificfunctional scale: measurement properties in patients with kneedysfunction. Phys Ther 1997; 77:820–829.CrossRefGoogle Scholar