Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy)

doi:10.1016/j.jns.2005.02.010

Journal of the Neurological Sciences

Volume 234, Issues 1–2, 15 July 2005, Pages 5-10

https://doi.org/10.1016/j.jns.2005.02.010 Get rights and content

Abstract

Background

Although ulnar neuropathy at the elbow (UNE) is the second most frequent focal peripheral neuropathy of the upper limb after carpal tunnel syndrome (CTS), no figures on its prevalence or incidence in the general population have been reported.

Objective

To determine the incidence of UNE in a general population.

Methods

Retrospective study to identify newly diagnosed cases on the basis of clinical symptoms or signs and slowing of motor conduction velocity of the ulnar nerve across the elbow or surgical evidence of nerve compression in the elbow region. In the 5-year period from 1995 to 1999, cases among residents in Siena Province (Italy) were identified from medical records of electromyographic services of Local Health District no. 7 and from hospital medical records coded ICD 354.2, 04.49 and 04.6. Siena province has a population of 251,930.

Results

In the 5-year period, 311 cases (112 women and 199 men, mean age 56 years, range 15–86) were identified. The mean annual crude incidence was 24.7 cases per 100,000 person-years, and the standardized incidence was 20.9. The sex-specific incidences were 32.7 for men and 17.2 for women. The mean annual crude and sex-specific incidences remained constant during the study period. The age-specific incidences of whole population and both genders showed an increasing trend with decade of age. The incidence of “possible”, “probable” and “definite” UNE cases, classified according to level of motor conduction velocity anomalies and evidence of surgical compression of the ulnar nerve at the elbow, was 4.3, 10.6, and 9.8, respectively. The residents of a health subdistrict where manual work is dominant had a higher male-specific incidence (57.1) than other areas.

Conclusions

This is the first published study on the incidence of UNE. The incidence was higher in males than females and about one-thirteenth that reported for CTS in part of the present geographic area.

Introduction

Ulnar nerve neuropathy at the elbow (UNE) is commonly regarded as the second most frequent mononeuropathy of the upper limb after carpal tunnel syndrome (CTS). However, there are no epidemiological reports in the literature regarding its incidence and prevalence in a general population. The aim of our paper was to calculate the incidence of UNE in the province of Siena (Tuscany, Italy) in the years 1995–1999.

Section snippets

Study area

The population at risk was that of the province of Siena, corresponding to Local Health District no. 7 (LHD7) of Tuscany, which includes four health subdistricts (Siena, Val di Chiana, Val d'Elsa and Amiata). The province of Siena is in central Italy and has an area 3821 km² consisting of prevalently hilly country. The study period was from 1 January 1995 to 31 December 1999. The total population on 31 December 1994 was 250,898 and on 31 December 1999, 252,860 (mean 251,930). The total annual

Results

During the study period, 311 new cases of UNE were identified: 112 were women (36%) and 199 men (64%); mean age at diagnosis was 56 ± 16.3 years (range 15–86 years). The mean age of women at diagnosis (55.6 ± 16.4 years) was similar to that of men (56.3 ± 16.4 years). The distribution of the population of cases in decade classes was normal with the peak in the seventh decade.

The clinical features of UNE cases included ulnar nerve paraesthesia without objective findings (51.1%), ulnar sensory loss

Discussion

Ulnar neuropathy at the elbow is a heterogeneous group of focal neuropathies of the ulnar nerve in the region of the elbow [5], [6], [7], [8], [9], [10]. Since electrophysiological diagnosis of UNE may not be easy, the AAEM has published recommendations and guidelines for electrodiagnostic studies based on a critical review of the literature [3]. In line with these guidelines, the lower limit of across-elbow MCV used to recognize UNE cases in the present study was < 50 m/s. This limit was very

Acknowledgment

We are grateful to Dr. Riccardo Cioni for reviewing the medical records.

References (19)

A.M. Tetro et al.
Cubital tunnel syndrome and the painful upper extremity
Hand Clin
(1996)
M.M. Tomaino et al.
The rationale for and efficacy of surgical intervention for electrodiagnostic-negative cubital tunnel syndrome
J Hand Surg
(2001)
P. Seror et al.
Relative frequency of nerve conduction abnormalities at carpal tunnel and cubital tunnel in France and the United States: importance of silent neuropathies and role of ulnar neuropathy after unsuccessful carpal tunnel syndrome release
Ann Hand Surg
(1993)
A. Yassi
Repetitive strain injuries
Lancet
(1997)
S. Pellieux et al.
Ulnar nerve tunnel syndrome of the elbow and an occupational disorder. Analysis of socio-professional and physical parameters
Ann Readapt Med Phys
(2001)
M. Mondelli et al.
Carpal tunnel syndrome in a general population
Neurology
(2002)
L.R. Robinson et al.
Effect of statistical methodology of normal limits in nerve conduction studies
Muscle Nerve
(1991)
W.W. Campbell et al.
Practice parameter. Electrodiagnostic studies in ulnar neuropathy at the elbow
Neurology
(1999)
Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJL, Lozano R, Inoue M. Age standardization of rates: a New WHO standard....

There are more references available in the full text version of this article.

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Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy)

Abstract

Background

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Study area

Results

Discussion

Acknowledgment

Hand Clin

J Hand Surg

Ann Hand Surg

Lancet

Ann Readapt Med Phys

Carpal tunnel syndrome in a general population

Neurology

Effect of statistical methodology of normal limits in nerve conduction studies

Muscle Nerve

Practice parameter. Electrodiagnostic studies in ulnar neuropathy at the elbow

Neurology