Abstract
BackgroundThis study aimed to explore the value of extended motor nerve conduction studies in patients with ulnar nerve entrapment at the elbow (UNE) in order to find the most sensitive and least time-consuming method. We wanted to evaluate the utility of examining both the sensory branch from the fifth finger and the dorsal branch of the ulnar nerve. Further we intended to study the clinical symptoms and findings, and a possible correlation between the neurophysiological findings and pain.MethodsThe study was prospective, and 127 UNE patients who were selected consecutively from the list of patients, had a clinical and electrodiagnostic examination. Data from the most symptomatic arm were analysed and compared to the department's reference limits. Student's t - test, chi-square tests and multiple regression models were used. Two-side p-values < 0.05 were considered as significant.ResultsUlnar paresthesias (96%) were more common than pain (60%). Reduced ulnar sensitivity (86%) and muscle strength (48%) were the most common clinical findings. Adding a third stimulation site in the elbow mid-sulcus for motor conduction velocity (MCV) to abductor digiti minimi (ADM) increased the electrodiagnostic sensitivity from 80% to 96%. Additional recording of ulnar MCV to the first dorsal interosseus muscle (FDI) increased the sensitivity from 96% to 98%. The ulnar fifth finger and dorsal branch sensory studies were abnormal in 39% and 30% of patients, respectively. Abnormal electromyography in FDI was found in 49% of the patients. Patients with and without pain had generally similar conduction velocity parameter means.ConclusionWe recommend three stimulation sites at the elbow for MCV to ADM. Recording from FDI is not routinely indicated. Sensory studies and electromyography do not contribute much to the sensitivity of the electrodiagnostic evaluation, but they are useful to document axonal degeneration. Most conduction parameters are unrelated to the presence of pain.
Highlights
This study aimed to explore the value of extended motor nerve conduction studies in patients with ulnar nerve entrapment at the elbow (UNE) in order to find the most sensitive and least time-consuming method
In the present study we reported that three stimulation sites in the elbow for motor conduction velocity (MCV) to abductor digiti minimi (ADM) was the most effective method
Electrodiagnosis The results from the electrodiagnostic (ED) studies showed that 16% of patients with electroclinical UNE were not diagnosed by the use of only two stimulation sites below and above the ulnar groove
Summary
This study aimed to explore the value of extended motor nerve conduction studies in patients with ulnar nerve entrapment at the elbow (UNE) in order to find the most sensitive and least time-consuming method. Ulnar nerve neuropathy at the elbow (UNE) was described in 1922 by Buzzard [1] who had had personal experience with UNE. Lesions at the ulnar groove account for most cases [3]. A standardized incidence rate of 20.9 cases per 100 000 persons per year has been found [4]. In 1956 Simpson [5] described a neurophysiological method for the diagnosis of UNE, and new methods have often been proposed and discussed. Extended protocols like inching, recording from multiple muscles, and conduction block evaluation have been evaluated [6,7,8], but there is no general agreement about the optimal diagnostic procedure
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