Abstract
Aim. To evaluate the diagnostic value of ultrasonography and magnetic resonance imaging (MRI) in patients with ulnar neuropathy at the elbow (UNE). Methods. We prospectively performed electrodiagnostic, ultrasonographic, and MRI studies in UNE patients and healthy controls. Three cross-sectional area (CSA) measurements of the ulnar nerve at multiple levels along the arm and maximum CSA(-max) were recorded. Results. The ulnar nerve CSA measurements were different between the UNE severity grades (P < 0.05). CSA-max had the greatest sensitivity (93%) and specificity (68%). Moreover, CSA-max ≥10 mm2 defined the severe UNE cases (sensitivity/specificity: 82%/72%). In MRI, ulnar nerve hyperintensity had the greatest sensitivity (90%) and specificity (80%). Conclusion. Ultrasonography using CSA-max is sensitive and specific in UNE diagnosis and discriminating the severe UNE cases. Furthermore, MRI particularly targeting at increased signal of the ulnar nerve can be a useful diagnostic test of UNE.
Highlights
Ulnar neuropathy is the second most common cause of entrapment neuropathy after carpal tunnel syndrome [1]
We aimed at evaluating the diagnostic value of ultrasonography and magnetic resonance imaging (MRI) in patients with Ulnar neuropathy at the elbow (UNE) and comparing the ultrasonographic and MRI alterations of the ulnar nerve in patients with different grades of UNE severity determined by electrodiagnostic studies
The median ulnar nerve cross-sectional area (CSA) at all the four studied levels (-prox, -epi, -dist, and max) in the patient group was significantly different between the UNE severity grades (P < 0.05, Table 2)
Summary
Ulnar neuropathy is the second most common cause of entrapment neuropathy after carpal tunnel syndrome [1]. Ulnar neuropathy at the elbow (UNE) where the nerve passes through the cubital tunnel is the most common place of the ulnar nerve entrapment [2]. Due to false negative or nonlocalizing results of the electrodiagnostic studies, ultrasonography of the ulnar nerve has been recently recommended as an accurate noninvasive additional tool. Few investigations have targeted at assessing the diagnostic value of MRI in UNE with debatable results [5,6,7]. To the best of our knowledge, the diagnostic value of both ultrasonography and MRI in UNE has not been hitherto investigated in a single study. We aimed at evaluating the diagnostic value of ultrasonography and MRI in patients with UNE and comparing the ultrasonographic and MRI alterations of the ulnar nerve in patients with different grades of UNE severity determined by electrodiagnostic studies
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