ULNAR NEUROPATHY AT ELBOW (UNE): ITALIAN MULTICENTRE STUDY DESIGN AND PRELIMINARY DATA

The clinical picture of UNE, its relationship with neurophysiological impairment and natural history of the disease are yet undefined. The main objectives of Italian Multicentre Study are: 1) to better assess historical, physical and neurophysiological features using a multiperspective evaluation; 2) to evaluate the sensitivity of an electrodiagnostic protocol in a wide population of patients; 3) to develop a disease‐specific self‐administered questionnaire; 4) to assess the natural time course of clinical and electrophysiological parameters. Case recognition is based on clinical ground: symptoms and/or signs suggestive of ulnar nerve impairment. Personal and clinical data of each patient are properly scheduled with particular regard to duration, trend and anatomic distribution of symptoms, associated diseases, work and hobby related manual activities. A patient‐oriented evaluation is performed through three self‐administered questionnaires: the first one validated for unspecified upper limb diseases, a second validated for CTS and the third, newly proposed, specific for ulnar symptoms. Clinical severity is assessed with a 3‐stage scale proposed by Antoniadis et al. (1997) and a 4‐stage scale proposed by Giannini et al. (2001). Electrophysiological study is performed according to practice recommendations of AAEM/AAN (1999). Although minimal criteria for diagnosis are based on motor ulnar conduction abnormalities across the elbow, other motor and sensory conduction parameters of ulnar, radial and median nerves are measured to correctly detect most common co‐morbidities such as carpal tunnel syndrome. The electrophysiological impairment is quantified using a 5‐step neurophysiological classification proposed by Padua et al. (2001) and a 13‐point global severity score proposed by Mondelli et al. (2000) based on abnormalities of ulnar motor and sensory neural conduction and amplitude and EMG of ulnar‐supplied muscles. Each patient suffering from UNE, neurophysiologically confirmed, will be again assessed by the same protocol at one and six months after the first diagnosis. About 30 centres, widely distributed in the national country and consisting of an EMG‐Lab with proper medical staff and instrumental equipment, have joined the study and are enrolling consecutive UNE cases starting from November 1st, 2001. Data are being collected in Siena centre for statistical analysis.