Abstract
ObjectivesThe primary aim of this study was to verify if shear-wave elastography (SWE) can be used to diagnose ulnar neuropathy at the elbow (UNE). The secondary objective was to compare the cross-sectional areas (CSA) of the ulnar nerve in the cubital tunnel and to determine a cut-off value for this parameter accurately identifying persons with UNE.MethodsThe study included 34 patients with UNE (mean age, 59.35 years) and 38 healthy controls (mean age, 57.42 years). Each participant was subjected to SWE of the ulnar nerve at three levels: in the cubital tunnel (CT) and at the distal arm (DA) and mid-arm (MA). The CSA of the ulnar nerve in the cubital tunnel was estimated by means of ultrasonographic imaging.ResultsPatients with UNE presented with significantly greater ulnar nerve stiffness in the cubital tunnel than the controls (mean, 96.38 kPa vs. 33.08 kPa, p < 0.001). Ulnar nerve stiffness of 61 kPa, CT to DA stiffness ratio equal 1.68, and CT to MA stiffness ratio of 1.75 provided 100% specificity, sensitivity, positive and negative predictive value in the detection of UNE. Mean CSA of the ulnar nerve in the cubital tunnel turned out to be significantly larger in patients with UNE than in healthy controls (p < 0.001). A weak positive correlation was found in the UNE group between the ulnar nerve CSA and stiffness (R = 0.31, p = 0.008).ConclusionsSWE seems to be a promising, reliable and simple quantitative adjunct test to support the diagnosis of UNE.Key Points• SWE enables reliable detection of cubital tunnel syndrome• Significant increase of entrapped ulnar nerve stiffness is observed in UNE• SWE is a perspective screening tool for early detection of compressive neuropathies
Highlights
Cubital tunnel syndrome, referred to as ulnar neuropathy at the elbow (UNE), is the second most common peripheral entrapment neuropathy after carpal tunnel syndrome
The cross-sectional areas (CSA) of the ulnar nerve at the cubital tunnel level turned out to be significantly larger in patients with UNE than in the controls
The cut-off value for the CSA of the ulnar nerve at the cubital tunnel level, which most accurately distinguished between the individuals with the entrapment neuropathy and without was 10 mm2; receiver operating characteristic (ROC) analysis demonstrated that this value provided 38.2% sensitivity, 100% specificity, 100% PPV and 64.4% NPV in the detection of UNE (Fig. 3)
Summary
Referred to as ulnar neuropathy at the elbow (UNE), is the second most common peripheral entrapment neuropathy after carpal tunnel syndrome. It can be defined as a compression of the ulnar nerve at the level of the elbow or in its direct proximity [1,2,3,4]. The ulnar nerve may be compressed at the cubital tunnel inlet by the medial intermuscular septum and an aponeurotic band referred to as the arcade of Struthers. Idiopathic neuropathy seems to be the most common cause of UNE among many potential aetiological factors of this condition [7, 8]. The list of intrinsic aetiological factors includes diseases of the thyroid, diabetes mellitus, alcohol abuse, rheumatoid arthritis and other systemic inflammatory diseases, to mention a few [5, 7, 9,10,11]
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