Is There an Association Between Ulnar Nerve Hypermobility and Neuropathy at the Elbow?

Abstract

Objective(s) To systematically review the association between ulnar nerve hypermobility at the elbow and ulnar neuropathy. Data Sources We searched the CINAHL, Embase, and Medline databases to July 4, 2020 for studies that evaluated the prevalence of ulnar nerve hypermobility in those with and without ulnar neuropathy. Study Selection Our inclusion criteria were: ulnar nerve hypermobility presence or absence determined by ulnar nerve examination at the elbow either A) under ultrasound or B) by clinical examination; ulnar neuropathy at the elbow presence or absence determined by either eletrophysiological or ultrasound measurements in addition to a physical examination and history; English language; case-control, cohort, or randomized controlled studies. 20 of 654 studies identified met inclusion criteria. Data Extraction We pooled data for ulnar nerve hypermobility subjects based on method of diagnosis and presence or absence of UNE. We reviewed these studies for ulnar nerve cross-sectional area measurements, and pooled data for cross sectional areas based on presence or absence of ulnar neuropathy at the elbow and ulnar nerve hypermobility. Data Synthesis The meta-analysis pooled rate of ulnar nerve hypermobility was 0.37 (95% CI: 0.20, 0.57) for those without ulnar neuropathy at the elbow and 0.33 (95% CI: 0.23, 0.45) for those with ulnar neuropathy at the elbow, which was not significantly different (p=0.73). We repeated the analysis for nerves examined under ultrasound, again, there was no significant difference between the pooled rates of ulnar nerve hypermobility between those with and without ulnar neuropathy at the elbow (p=0.80). Conclusions The clinical finding of ulnar nerve hypermobility is unhelpful when assessing for ulnar neuropathy at the elbow, as the presence of ulnar nerve hypermobility does not make the diagnosis of ulnar neuropathy at the elbow more likely. Author(s) Disclosures None To systematically review the association between ulnar nerve hypermobility at the elbow and ulnar neuropathy. We searched the CINAHL, Embase, and Medline databases to July 4, 2020 for studies that evaluated the prevalence of ulnar nerve hypermobility in those with and without ulnar neuropathy. Our inclusion criteria were: ulnar nerve hypermobility presence or absence determined by ulnar nerve examination at the elbow either A) under ultrasound or B) by clinical examination; ulnar neuropathy at the elbow presence or absence determined by either eletrophysiological or ultrasound measurements in addition to a physical examination and history; English language; case-control, cohort, or randomized controlled studies. 20 of 654 studies identified met inclusion criteria. We pooled data for ulnar nerve hypermobility subjects based on method of diagnosis and presence or absence of UNE. We reviewed these studies for ulnar nerve cross-sectional area measurements, and pooled data for cross sectional areas based on presence or absence of ulnar neuropathy at the elbow and ulnar nerve hypermobility. The meta-analysis pooled rate of ulnar nerve hypermobility was 0.37 (95% CI: 0.20, 0.57) for those without ulnar neuropathy at the elbow and 0.33 (95% CI: 0.23, 0.45) for those with ulnar neuropathy at the elbow, which was not significantly different (p=0.73). We repeated the analysis for nerves examined under ultrasound, again, there was no significant difference between the pooled rates of ulnar nerve hypermobility between those with and without ulnar neuropathy at the elbow (p=0.80). The clinical finding of ulnar nerve hypermobility is unhelpful when assessing for ulnar neuropathy at the elbow, as the presence of ulnar nerve hypermobility does not make the diagnosis of ulnar neuropathy at the elbow more likely.