Cigarette Smoking and Ulnar Mononeuropathy at the Elbow

Richardson JK, Jamieson SC: Cigarette smoking and ulnar mononeuropathy at the elbow. Am J Phys Med Rehabil 2004;83:730–734. Objective:To identify lifestyle risk factors for electrodiagnostically confirmed ulnar mononeuropathy at the elbow (UME). Design:A case-control study involving 101 subjects (12 with definite UME, 42 with probable UME, and 47 controls) who responded to a questionnaire requesting information on subject vocation, repetitive upper limb activity, and alcohol and cigarette use. Results:Subjects with definite UME reported greater tobacco usage as defined by cigarettes per day (mean ± standard error; 20.1 ± 5.2, 9.3 ± 1.9, 8.6 ± 1.5 cigarettes/day for definite, probable UME, and controls, respectively; P = 0.014) and pack-years (27.3 ± 9.7, 12.5 ± 3.0, 9.9 ± 2.3, for definite, probable UME, and controls, respectively; P = 0.029). The association between cigarettes and definite UME persisted after adjustment for age, sex, and body mass index and was not confounded by alcohol use. Significant negative correlations between tobacco use and ulnar conduction velocities across the elbow and amplitudes above the elbow were identified. Conclusions:Cigarette smoking and UME seem to be associated. The presence of a plausible mechanism for injury and a dose-response effect suggests that this association may be causative.