Journal CME, October 2023: Preoperative electrodiagnostic studies and postoperative outcomes for ulnar mononeuropathy at the elbow: A systematic review-Journal CME, October 2023: Preoperative electrodiagnostic studies and postoperative outcomes for ulnar mononeuropathy at the elbow: A systematic review

Journal CME, October 2023: Preoperative electrodiagnostic studies and postoperative outcomes for ulnar mononeuropathy at the elbow: A systematic review

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This systematic review by Meiling et al. examines the association between preoperative electrodiagnostic (EDX) studies and postoperative outcomes in patients with ulnar neuropathy at the elbow (UNE), also known as cubital tunnel syndrome. Conducted by researchers from the Mayo Clinic and the University of Utah, the study involves a comprehensive literature search and analysis of studies from 1990 to June 2022.<br /><br />The review includes eight retrospective cohort studies comprising 762 patients. Its primary objective is to evaluate whether preoperative EDX findings can predict postoperative pain and functional outcomes following ulnar nerve decompression and/or transposition surgeries for UNE. Key EDX measurements analyzed include sensory nerve action potential (SNAP), sensory and motor conduction velocities (SNCV/MNCV), compound muscle action potential (CMAP), and electromyography (EMG) data.<br /><br />Significant findings show that a decreased or absent preoperative SNAP and the presence of conduction block at the elbow are predictive of worse postoperative outcomes. These outcomes are measured using various scales such as the Disabilities of the Arm, Shoulder, and Hand (DASH) score, Visual Analog Pain Score (VAS), and others. However, slower preoperative motor conduction velocities or electromyography abnormalities did not show a consistent predictive value for postoperative outcomes. Two studies were of "good" quality, four were "fair," and two were "poor," with the overall certainty in evidence rated as "low" due to potential biases and methodological deficiencies.<br /><br />The review underscores the need for careful interpretation of these results, considering the limited evidence and low certainty. It highlights the requisite for prospective studies to better understand the predictive value of preoperative EDX in UNE outcomes. The authors also suggest that an update to the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) practice parameters for UNE diagnosis could be beneficial, given advancements in surgical techniques.

Keywords

preoperative electrodiagnostic

ulnar neuropathy

cubital tunnel syndrome

postoperative outcomes

ulnar nerve decompression

sensory nerve action potential

conduction velocities

electromyography

predictive value

systematic review