Ulnar Neuropathy at Elbow (U.N.E) in people with haemophilia, attending aMulti specialty clinic in a tertiary care centre in South India: An observational study.

Hemophilia is a genetic disease caused by single gene mutation in X chromosome in which production of clotting factor VIII and factor IX is affected leading to recurrent joint bleeds. According to WHO, the prevalence of hemophilia globally is 1 in 10000. Elbow is the second most common joint to bleed in patients with hemophilia after the knee joint. Recurrent bleeds lead to destruction of joint cartilage and reduced range of motion of the elbow joint. The Ulnar nerve is a peripheral nerve arising from C8 and T1 segments of the cervical spinal cord. Its anatomical course behind the elbow joint axis places it at a risk of developing compression neuropathy. During day to day activities with normal motion of the elbow, the ulnar nerve is subjected to frictional injuries and compression which can occur at 5 anatomical points, which are: the Arcade of Struthers (a tunnel formed by fascia), just proximal to the medial epicondyle, the ulnar groove, the point between the humeral and ulnar heads of the Flexor Carpi Ulnaris (F.C.U) muscle and the point where the ulnar nerve leaves the F.C. U . Compression of ulnar nerve in this area leads to a nerve entrapment syndrome called Ulnar Neuropathy at Elbow (U.N.E) more commonly known, as cubital tunnel syndrome. U.N.E is the second most common nerve entrapment syndrome after carpal tunnel syndrome. It is seen commonly in people like drivers, musicians and those in packaging in garment industries where prolonged elbow flexion attitude is required. It is also seen to occur in people with anatomical anomalies, post trauma (tardy ulnar nerve palsy), people with habitual leaning on the elbow, habitual excessive elbow flexion while sleeping, diseases affecting elbow ROM like rheumatoid arthritis and those causing swelling of the nerve like diabetes mellitus and Hansen’s disease. OBJECTIVES: To find the point prevalence of UNE in hemophilia patients attending a multidisciplinary clinic in a tertiary care centre in South India and its correlation with various parametres. METHODS: 50 patients satisfying the inclusion and exclusion criteria were included in the study. History reagrding their disease severity, frequency of joint bleeds, symptoms of UNE were taken. All were examined clinically and electrophysiologically for signs of UNE. UNE was diagnosed based on criteria by AAEM. Elbow Xrays taken as a part of treatment, were analysed for joint involvement. Descriptive statistics - mean, standard deviation and range were done for continuous data. Univariate analysis of the variables from data and their association with UNE was done by using ChiSquare test and Chi Squre for trend test. RESULTS: The prevalence of UNE in haemophilia patients attending our hospital was 42/100haemophilia patients. There was no association between stage of haemophilic arthropathy andUNE (OR<1, p value <0.05). Statistically significant association (p value<0.05) was found between UNEand Elbow joint being a target joint (OR 3.69) and between X ray involvement of ulnohumeral joint (OR 1.36) and UNE.