Available online 5 December 2023, 108078

Author links open overlay panel, , , ABSTRACTBackground

Ulnar nerve entrapment at the elbow (UNE) is the second most prevalent entrapment neuropathy after carpal tunnel syndrome. The objective of this study was to evaluate the expert opinion of different surgical disciplines regarding the need for electrodiagnostic or ultrasound confirmation of UNE and, if so, which test was preferred for confirmation.

Methods

A questionnaire was sent to all neurosurgeons and plastic or hand surgeons in the Netherlands to evaluate the current practice in planning surgical treatment of UNE.

Results

The response rate was 36.4% (134 out of 368). 94% of surgeons reported that >95% of their patients had EDX or ultrasound studies before surgery. 80.6% of all surgeons who responded reported that they seldom operated on UNE without electrodiagnostic confirmation. Hand surgeons (25.9%) were more willing to operate on clinically diagnosed UNE without EDX than neurosurgeons (9.4%)

Conclusions

Dutch surgeons prefer diagnostic confirmation of UNE either by ultrasound or EDX, with a preference for EDX and the vast majority of operated patients do have either EDX or ultrasound or both before surgery. Compared to neurosurgeons, hand surgeons are more willing to operate on patients with clinically defined UNE but normal electrodiagnostic studies.

Section snippetsINTRODUCTION

Ulnar nerve entrapment at the elbow (UNE) is the second most prevalent entrapment neuropathy, surpassed only by carpal tunnel syndrome (CTS).

Clinical diagnosis of UNE is based on a history of pain, numbness and reduced muscle strength in muscles innervated by the ulnar nerve. Clinical signs include ulnar paresthesia and reduced ulnar sensitivity and strength. Pain may or may not be present [1]. Provocative tests are not reliable or useful in the diagnosis of UNE [2].

In the Netherlands, patients

MATERIALS AND METHODS

A questionnaire (Table 1) was sent to neurosurgeons and plastic or hand surgeons in the Netherlands to evaluate the current practice in planning surgical treatment of UNE. The Dutch society of neurosurgeons and the Dutch society of hand surgeons sent the online questionnaire to their members, and a reminder was sent to all members of both societies after three months. Membership of professional scientific society is obliged in the Netherlands for all types of mentioned surgeons to work in the

RESULTS

Less than half (134) of the 368 questionnaires were returned (36.4%) (Table 2), 53 from the 138 neurosurgeons (38.4%) and 81 from the 230 PRC surgeons (35.2%).

Of the surgeons, 94% stated that >95% of their patients have had EDX or US. This percentage was higher for neurosurgeons (100%) than for hand surgeons (90.1%), but there was no significant difference between the two different subdisciplines of surgeons.

A vast majority (80.6%) of surgeons never or rarely operated on patients with typical

DISCUSSION

Our study presents an overview of the use of EDX and US in ulnar nerve entrapment treatment decision by surgeons in the Netherlands. Dutch surgeons highly prefer confirmation of the clinical diagnosis of UNE either by EDX or US. These findings are in line with a study which showed that most Dutch surgeons rarely operate on patients with carpal tunnel syndrome without EDX confirmation [4]. This resemblance in method might be explained by the large overlap between the two groups of surgeons

CRediT authorship contribution statement

Anne Kurver: Conceptualization, Methodology, Formal Analysis, Investigation; Resources, Data Curation, Writing - Original Draft. Suzanne M. Scherf: Resources, Data Curation, Writing - Original Draft Dr. Jan Meulstee: Conceptualization, Methodology, Writing - Review & Editing, Supervision. Dr. Wim I.M. Verhagen: Conceptualization, Methodology, Writing - Review & Editing, Supervision

CRediT authorship contribution statement

Meulstee Jan: Writing – review & editing, Writing – original draft, Supervision, Methodology, Conceptualization. Scherf Suzanne M.: Writing – review & editing, Writing – original draft, Project administration, Methodology, Investigation. Verhagen Wim I.M.: Writing – review & editing, Writing – original draft, Supervision, Methodology, Conceptualization. Kurver Anne: Writing – review & editing, Writing – original draft, Project administration, Methodology, Investigation, Data curation,

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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