| 1. |
- Andersson, Stina, et al.
(författare)
-
Presurgical management of ulnar nerve entrapment in patients with and without diabetes mellitus
- 2024
-
Ingår i: Scientific Reports. - : NATURE PORTFOLIO. - 2045-2322. ; 14:1, s. 1-8
-
Tidskriftsartikel (refereegranskat)abstract
- Diabetes mellitus (DM) is a risk factor for the development of ulnar nerve entrapment (UNE). Differences in surgical outcomes for UNE between patients with and without DM have been reported, but studies on presurgical management are scarce. This study aimed to evaluate the presurgical management of UNE in patients with (DM diagnosis < 2 years of UNE diagnosis) and without DM regarding the level of care for diagnosis and the proportion that proceeds to surgery. Data from 6600 patients with UNE between 2004 and 2019 were included from the Skåne Health Care Register (SHR) and cross-linked with data from the Swedish National Diabetes Register (NDR). The group with UNE and DM was compared to the group with UNE without DM and prevalence ratios were calculated using Cox regression analysis. Patients with DM more often got their first UNE diagnosis in secondary care than in primary care (643/667, 96% vs. 5361/5786; 93%). Patients with and without DM, regardless of the type of DM, presence of retinopathy, or HbA1c levels, were surgically treated for UNE to the same extent (258/667, 39% of patients with DM vs. 2131/5786, 37% of patients without DM). The proportion of surgically treated was significantly lower among patients diagnosed with UNE in primary care compared to secondary care (59/449, 13% vs. 2330/5786, 38%). Men were more often surgically treated than women (1228/3191, 38% vs.1161/3262 36%). Patients with UNE and DM are surgically treated to the same extent as patients with UNE but without DM and are more likely to be diagnosed in specialized care.
|
|
| 2. |
- Anker, Ilka, et al.
(författare)
-
Outcome and predictors in simple decompression of ulnar nerve entrapment at the elbow
- 2018
-
Ingår i: Hand & Microsurgery. - : ScopeMed. - 2458-7834. ; 7, s. 24-32
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: Simple decompression is an accepted surgical treatment of ulnar nerve entrapment at the elbow (UNE). Our purpose was to evaluate the outcome and potential predictors for the outcome after simple decompression in UNE.Methods: All surgically treated UNE cases (from 2004-2008) at our department were studied retrospectively. Out of 285 primary surgeries, 242 primary simple ulnar nerve decompressions were included. Medical records, including electrophysiologic protocols, were reviewed and postoperative outcome was graded: 1) cured/improved and 2) unchanged/worsened symptoms, based on surgeon-evaluated outcome.Results: Of the 242 simple decompressions (122 males and 120 females; median age 50.5 years), 101 cases were students, retired, un-employed, or on a long-term sick-leave and 112 had manual, blue-collar type of careers. 189 cases were cured or improved, while 53 cases had no change in, or even worsened, symptoms. Gender, presence of smoking, or associated diseases did not affect outcome, while a tendency was observed for higher age, a manual occupation and constant symptoms. Out of 196 cases electrophysiologically examined,155 cases showed signs of ulnar nerve affection (56 reduced conduction velocity; 19 conduction block; 80 axonal degeneration; latter two groups significantly worse outcome).Conclusion: Patients with a preoperatively electrophysiologically diagnosed nerve conduction block or axonal degeneration have higher risk of not being cured or improved after simple decompression in UNE. Older patients, those with a manual profession, and constant symptoms of UNE tend to be less improved after surgery.
|
|
| 3. |
- Anker, Ilka, et al.
(författare)
-
Preoperative Electrophysiology in Patients With Ulnar Nerve Entrapment at the Elbow-Prediction of Surgical Outcome and Influence of Age, Sex and Diabetes.
- 2022
-
Ingår i: Frontiers in clinical diabetes and healthcare. - : Frontiers Media S.A.. - 2673-6616. ; 3
-
Tidskriftsartikel (refereegranskat)abstract
- The impact of preoperative electrophysiology on outcome of surgical treatment in ulnar nerve entrapment at the elbow (UNE) is not clarified. Our aim was to evaluate influence of preoperative electrophysiologic grading on outcome and analyse how age, sex, and in particular diabetes affect such grading. Electrophysiologic protocols for 406 UNE cases, surgically treated at two hand surgery units reporting to the Swedish National Quality Register for Hand Surgery (HAKIR; 2010-2016), were retrospectively assessed, and graded as normal, reduced conduction velocity, conduction block or axonal degeneration. Outcome of surgery after primary and revision surgery was evaluated using QuickDASH and a doctor reported outcome measure (DROM) grading. No differences in QuickDASH or DROM were found between the four groups with different electrophysiologic grading preoperatively, or at three and 12 months or at follow up, respectively. When dichotomizing the electrophysiologic grading into normal and pathologic electrophysiology, cases with normal electrophysiology had worse QuickDASH than cases with pathologic electrophysiology preoperatively (p=0.046). Presence of a conduction block or axonal degeneration indicated a worse outcome by DROM grading (p=0.011). Primary surgeries had electrophysiologic more pronounced nerve pathology compared to revision surgeries (p=0.017). Cases of older age, men, and those with diabetes had more severe electrophysiologic nerve affection (p<0.0001). In the linear regression analysis, increasing age (unstandardized B=0.03, 95% CI 0.02-0.04; p<0.0001) and presence of diabetes (unstandardized B=0.60, 95% CI 0.25-0.95; p=0.001) were associated with a higher risk of a worse electrophysiologic classification. Female sex was associated with a better electrophysiologic grading (unstandardized B=-0.51, 95% CI -0.75- -0.27; p<0.0001). We conclude that older age, male sex, and concomitant diabetes are associated with more severe preoperative electrophysiologic nerve affection. Preoperative electrophysiologic grade of ulnar nerve affection may influence surgical outcome.
|
|
| 4. |
- Anker, Ilka, et al.
(författare)
-
Subcutaneous and submuscular transposition due to ulnar nerve entrapment at the elbow– Analyses of 43 primary and 44 revision cases
- 2018
-
Ingår i: Hand & Microsurgery. - : ScopeMed. - 2458-7834. ; 8:1, s. 9-18
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: Knowledge is scarce about the outcome of revision surgery for recurrent or persistent ulnar nerve entrapmentat the elbow (UNE). We studied the outcome of subcutaneous (SCT) and submuscular (SMT) ulnar nerve transpositionsdue to UNE, analyzing both primary and revision surgeries, aiming to identify predictors for revision surgery.Methods: All surgically treated UNE cases (2004-2008) at our department were studied retrospectively. The initial population of surgically treated patients included 285 primary and 52 revision surgeries. Forty-three of the former were transpositions (15 SCT and 28 SMT) and 44 (7 SCT and 37 SMT) of the latter, which were the ones included in the present study.Medical records, including electrophysiological protocols, were reviewed and the postoperative outcome was graded as 1)cured/improved, and 2) unchanged/exacerbated symptoms, based on the patient-reported and surgeon-evaluated outcome.Results: The frequency of concomitant systemic diseases (p<0.001), musculoskeletal conditions (p=0.029) and CTS(p=0.048) was higher in revision than in primary surgery cases. Both primary (79%) and revision SMT (76%) cases had ahigh frequency of ulnar nerve subluxation. Primary SMT cases had a higher frequency of ulnar nerve impact found throughelectrophysiological examination (p=0.045), while revision SMT cases had normal electrophysiological findings or reducedulnar nerve conduction velocity (not significant; p=0.10). The satisfaction rate was 79-93% of primary transposition surgeries and 73-86% of revision transposition surgeries.Conclusion: Patients with comorbidity with other systemic diseases, musculoskeletal conditions or concomitant CTS havea higher risk of UNE relapse and need revision surgery. Surgeons should assess any tendency for peroperative subluxationat primary surgery for UNE, proceeding with concomitant transposition of the nerve to minimize the need for revision surgery.Key words: Ulnar nerve, entrapment, submuscular ulnar nerve transposition, subcutaneous ulnar nerve transposition,electrophysiology, outcome
|
|
| 5. |
- Bergsten, Elin, et al.
(författare)
-
Carpal Tunnel Syndrome and Ulnar Nerve Entrapment at the Elbow Are Not Associated With Plasma Levels of Caspase-3, Caspase-8 or HSP27
- 2022
-
Ingår i: Frontiers in Neuroscience. - : Frontiers Media SA. - 1662-4548 .- 1662-453X. ; 16
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Nerve compression disorders, such as carpal tunnel syndrome (CTS) and ulnar entrapment at the elbow (UNE), may be associated with apoptosis and neuroprotective mechanisms in the peripheral nerve that may be detected by biomarkers in the blood. The relationships between CTS and UNE and two biomarkers of apoptosis, i.e., caspase-3 and caspase-8, and the neuroprotective factor Heat Shock Protein 27 (HSP27) in plasma were examined in a population-based cohort. Method: The biomarkers caspase-3, caspase-8 and HSP27 were measured in plasma at inclusion of 4,284 study participants aged 46–68 years in the population-based Malmö Diet and Cancer study (MDCS). End-point retrieval was made from national registers concerning CTS and UNE. Independent t-test was used to examine the association between caspase-3, caspase-8 and HSP27 plasma levels and incidence of CTS and UNE. Cox proportional hazards regression was used to investigate if plasma levels of caspase-3, caspase-8 and HSP27 affected time to diagnosis of CTS or UNE. Results: During the mean follow-up time of 22 years, 189/4,284 (4%) participants were diagnosed with CTS and 42/4,284 (1%) were diagnosed with UNE. No associations were found between incident CTS or UNE and the biomarkers caspase-3, caspase-8 and HSP27 in plasma. Conclusion: The apoptotic biomarkers caspase-3 and caspase-8 and the neuroprotective factor HSP27 in plasma, factors conceivably related to a nerve injury, are not associated with the nerve compression disorders CTS and UNE in a general population.
|
|
| 6. |
- Dahlin, Emma, et al.
(författare)
-
Patient reported symptoms and disabilities before and after neuroma surgery: a register-based study
- 2023
-
Ingår i: Scientific Reports. - : NATURE PORTFOLIO. - 2045-2322. ; 13:1
-
Tidskriftsartikel (refereegranskat)abstract
- Residual problems may occur from neuroma despite surgery. In a 12-month follow-up study using national register data, symptoms, and disabilities related to surgical methods and sex were evaluated in patients surgically treated for a neuroma. Among 196 identified patients (55% men; lower age; preoperative response rate 20%), neurolysis for nerve tethering/scar formation was the most used surgical method (41%; more frequent in women) irrespective of affected nerve. Similar preoperative symptoms were seen in patients, where different surgical methods were performed. Pain on load was the dominating symptom preoperatively. Women scored higher preoperatively at pain on motion without load, weakness and QuickDASH. Pain on load and numbness/tingling in fingers transiently improved. The ability to perform daily activities was better after nerve repair/reconstruction/transposition than after neurolysis. Regression analysis, adjusted for age, sex, and affected nerve, showed no association between surgical method and pain on load, tingling/numbness in fingers, or ability to perform daily activities. Neuroma, despite surgery, causes residual problems, affecting daily life. Choice of surgical method is not strongly related to pre- or postoperative symptoms. Neurolysis has similar outcome as other surgical methods. Women have more preoperative symptoms and disabilities than men. Future research would benefit from a neuroma-specific ICD-code, leading to a more precise identification of patients.
|
|
| 7. |
- Dahlin, Lars B., et al.
(författare)
-
Carpal Tunnel Syndrome and Ulnar Nerve Entrapment Are Associated with Impaired Psychological Health in Adults as Appraised by Their Increased Use of Psychotropic Medication
- 2022
-
Ingår i: Journal of Clinical Medicine. - : MDPI AG. - 2077-0383. ; 11:13
-
Tidskriftsartikel (refereegranskat)abstract
- We aimed to study psychological health, as approximated by the use of psychotropic drugs, in a population diagnosed and surgically treated for carpal tunnel syndrome (CTS) or ulnar nerve entrapment (UNE), or both, also considering the demographic and socioeconomic factors of the individuals. Linking data from five large national registers, use of psychotropics (at least one dispensation during the first year after the surgery or the baseline date) was examined in around 5.8 million people 25–80 years old residing in Sweden 2010. Among these individuals, 9728 (0.17%), 890 (0.02%) and 149 (0.00%) were identified as diagnosed and surgically treated for CTS, UNE, or both, respectively. As much as 28%, 34% and 36% in each group, respectively, used psychotropic drugs, compared with 19% in the general population. Regression analyses showed a general higher risk for use of psychotropics related to these nerve compression disorders, to higher age, being a woman, and having low income or low occupational qualification level. Individuals born outside of Sweden had a lower risk. We conclude that surgically treated individuals with a nerve compression disorder have an increased risk of impaired psychological health. Caregivers should be aware of the risk and provide necessary attention.
|
|
| 8. |
- Dahlin, Lars, et al.
(författare)
-
Carpal tunnel syndrome
- 2024
-
Ingår i: NATURE REVIEWS DISEASE PRIMERS. - : NATURE PORTFOLIO. - 2056-676X. ; 10:1
-
Forskningsöversikt (refereegranskat)abstract
- Carpal tunnel syndrome (CTS) is the most common nerve entrapment disorder worldwide. The epidemiology and risk factors, including family burden, for developing CTS are multi-factorial. Despite much research, its intricate pathophysiological mechanism(s) are not fully understood. An underlying subclinical neuropathy may indicate an increased susceptibility to developing CTS. Although surgery is often performed for CTS, clear international guidelines to indicate when to perform non-surgical or surgical treatment, based on stage and severity of CTS, remain to be elucidated. Neurophysiological examination, using electrophysiology or ultrasonography, performed in certain circumstances, should correlate with the history and findings in clinical examination of the person with CTS. History and clinical examination are particularly relevant globally owing to lack of other equipment. Various instruments are used to assess CTS and treatment outcomes as well as the effect of the disorder on quality of life. The surgical treatment options of CTS - open or endoscopic - offer an effective solution to mitigate functional impairments and pain. However, there are risks of post-operative persistent or recurrent symptoms, requiring meticulous diagnostic re-evaluation before any additional surgery. Health-care professionals should have increased awareness about CTS and all its implications. Future considerations of CTS include use of linked national registries to understand risk factors, explore possible screening methods, and evaluate diagnosis and treatment with a broader perspective beyond surgery, including psychological well-being. Carpal tunnel syndrome (CTS) is one of the most common hand conditions caused by an increased pressure on the median nerve in the carpal tunnel in the wrist. In this Primer, Dahlin et al. review the epidemiology, pathophysiology, diagnosis, management and quality of life of people with CTS; they also highlight occupational risk factors for this condition.
|
|
| 9. |
- Dahlin, Lars, et al.
(författare)
-
Impact of smoking and preoperative electrophysiology on outcome after open carpal tunnel release
- 2017
-
Ingår i: Journal of Plastic Surgery and Hand Surgery. - 2000-656X. ; 51:5, s. 329-335
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The aim was to evaluate the influence of smoking and preoperative electrophysiology on the outcome of open carpal tunnel release. Methods: This retrospective observational study evaluated the outcome in 493 patients (531 hands) primary operated for carpal tunnel syndrome. Data were collected from medical records, health evaluations, and QuickDASH questionnaires before surgery and 1 year after. Results: Smokers had a higher QuickDASH score preoperatively as well as postoperatively, but the change in total score did not differ. The odds of having a postoperative QuickDASH score >10 were 2.5 times higher in smoking patients than in non-smoking patients. In 124/493 patients (25%), no clinically significant improvement was seen. Normal and extreme preoperative electrophysiology values were associated with higher postoperative scores. No correlation was found between preoperative QuickDASH scores and preoperative electrophysiology values. Conclusions: Smokers with carpal tunnel syndrome experience more symptoms preoperatively. Smokers have remaining symptoms after surgery. There is no correlation between preoperative QuickDASH scores and preoperative electrophysiology values. Patients with normal or near to normal preoperative electrophysiology results have limited improvement after surgery.
|
|
| 10. |
- Dahlin, Lars, et al.
(författare)
-
Low myelinated nerve-fibre density may lead to symptoms associated with nerve entrapment in vibration-induced neuropathy.
- 2014
-
Ingår i: Journal of Occupational Medicine and Toxicology. - : Springer Science and Business Media LLC. - 1745-6673. ; 9:1
-
Forskningsöversikt (refereegranskat)abstract
- Prolonged exposure to hand-held vibrating tools may cause a hand-arm vibration syndrome (HAVS), sometimes with individual susceptibility. The neurological symptoms seen in HAVS are similar to symptoms seen in patients with carpal tunnel syndrome (CTS) and there is a strong relationship between CTS and the use of vibrating tools. Vibration exposure to the hand is known to induce demyelination of nerve fibres and to reduce the density of myelinated nerve fibres in the nerve trunks. In view of current knowledge regarding the clinical effects of low nerve-fibre density in patients with neuropathies of varying aetiologies, such as diabetes, and that such a low density may lead to nerve entrapment symptoms, a reduction in myelinated nerve fibres may be a key factor behind the symptoms also seen in patients with HAVS and CTS. Furthermore, a reduced nerve-fibre density may result in a changed afferent signal pattern, resulting in turn in alterations in the brain, further prompting the symptoms seen in patients with HAVS and CTS. We conclude that a low nerve-fibre density lead to symptoms associated with nerve entrapment, such as CTS, in some patients with HAVS.
|
|
