Surgery for ulnar nerve compression at the elbow : Focusing on factors influencing outcome

Abstract

Ulnar nerve compression at the elbow (UNE) is a common peripheral nerve compression disorder in the upper limb. The literature regarding surgical outcome is inconclusive.This thesis aims to highlight various aspects of real-life settings for patients with UNE and to increase the understanding of underlying factors influencing the outcome of surgery.Patients undergoing surgery for UNE at a tertiary referral hospital were retrospectively evaluated (Linköping cohort; n=202). Comorbidity was extensive.Patients treated with simple decompression (SD) had a lower rate of complications than those with transposition surgery. Emerging neurogenic pain was the most common complication, with a two-fold risk for smokers. Scores from the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire revealed no differences between the surgical groups. Satisfaction with surgery was relatively low (53%), however only 8% stated that they would not go through the same surgical procedure again.Images from magnetic resonance imaging (MRI), performed in conjunction with surgery (Linköping cohort; 62 patients), were re-evaluated by a neuroradiologist.Spinal nerve root pathology contributing to the ulnar nerve (C8-Th1) was rare (1/62 patients), however, nerve root affections at other levels were common (26/62). No relation between cervical pathology and patient-reported outcome was seen.The Linköping cohort was combined with two cohorts from Region Skåne to evaluate time before return to work (RTW) after surgery for UNE (n=635 in total). RTW within 6 weeks was more common among older, SD and non-manual workers.Those who were unemployed were on sick leave longer than the rest of the population.Transposition of the ulnar nerve was the only predictor for prolonged RTW in the regression model. Paper V Experiences of living with chronic pain in conjunction with surgery for ulnar nerve compression at the elbowa qualitative studyAim: To explore experiences and consequences of living with chronic pain in conjunction with surgery for UNE.Methods: Purposeful sampling including patients with experience of chronic pain (lasting >3 months) in conjunction with UNE surgery/surgeries. In-depth interviews were carried out and transcribed. The transcripts were read and re-read and subjected to content analysis independently by two people.Results and conclusions: Chronic pain in conjunction with surgery for UNE affects most aspects of daily life and contributes to a heavy burden for the individual. The results clarify the need for a biopsychosocial approach among healthcare personnel when treating patients with UNE.