title: Ulnar neuropathy at the elbow: follow-up and prognostic factors determining outcome.
abstract: OBJECTIVE
  To determine the outcome in patients with ulnar neuropathy at the elbow (UNE) treated surgically or conservatively, and the prognostic value of clinical, sonographic, and electrophysiologic features.
  
  
  METHODS
  After a median follow-up of 14 months, 69 of 84 patients initially included in a prospective blinded study on the diagnostic value of sonography in UNE were re-evaluated. The patients underwent renewed systematic clinical and sonographic examination. Patients were scored as having a poor (stable or progressive symptoms) or favorable (complete remission of symptoms or improvement) outcome.
  
  
  RESULTS
  Of the 74 initially affected arms, 12 (16%) had a complete remission, 21 (28%) improved, 25 (34%) remained stable, and 16 (22%) had progression. Surgically treated patients (28 arms) had a more favorable outcome than those treated conservatively (p = 0.03). After surgery, the mean ulnar nerve diameter decreased from 3.2 to 2.9 mm (p = 0.03), while this was not seen after conservative treatment. Multiple logistic regression analysis showed that more outspoken nerve enlargement found during sonography at the time of the diagnosis was associated with a poor outcome (OR: 2.9, p = 0.009). Furthermore, the presence of a motor conduction block (OR: 0.2, p = 0.03) and motor velocity slowing across the elbow (OR: 0.1, p = 0.01) were associated with a favorable outcome.
  
  
  CONCLUSIONS
  More pronounced ulnar nerve thickening at the time of the diagnosis is associated with poor outcome at follow-up, especially in conservatively treated cases, while electrodiagnostic signs of demyelination on testing indicate favorable outcome.
authors.affiliation: Department of Neurology, Atrium Medical Center, PO Box 4446, 6401 CX Heerlen, The Netherlands. r_beekman01@planet.nl
authors.forename: R
authors.initials: R
authors.lastname: Beekman
authors.forename: J H J
authors.initials: JH
authors.lastname: Wokke
authors.forename: M C
authors.initials: MC
authors.lastname: Schoemaker
authors.forename: M L
authors.initials: ML
authors.lastname: Lee
authors.forename: L H
authors.initials: LH
authors.lastname: Visser
mesh_terms: D000328:Adult; D004550:Elbow / Q000294:innervation*; D004568:Electrodiagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000000981:diagnostic imaging; D020424:Ulnar Neuropathies / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D014463:Ultrasonography