Ulnar Nerve Motor Conduction to the First Dorsal Interosseous Muscle

Abstract

The ulnar motor study to the abductor digiti minimi (ADM) is commonly performed, but does not test the terminal deep palmar branch of the ulnar nerve. Although damage to the ulnar nerve most often occurs at the elbow, the damage may occur elsewhere along the course of the nerve, including damage to the deep palmar branch. Ulnar conduction studies of the deep branch have been performed with recording from the first dorsal interosseous (FDI) muscle. These studies have used differing methodologies and were mostly limited by small sample size. The aim of this study was to develop a normative database for ulnar nerve conduction to the FDI. A new method of recording from the FDI was developed for this study. It utilizes recording with the active electrode over the dorsal first web space, with the reference electrode placed at the fifth metacarpophalangeal joint. This technique reliably yields negative takeoff measurements. An additional comparison was made between ulnar motor latency with recording at the ADM and with recording at the FDI. For this study, 199 subjects with no risk factors for neuropathy were tested. The latency, amplitude, area, and duration were recorded. The upper limit of normal (ULN) was defined as the 97th percentile of observed values. The lower limit of normal (LLN) was defined as the 3rd percentile of observed values. For the FDI, mean latency was 3.8 +/- 0.5 ms, with a ULN of 4.7 ms for males, 4.4 ms for females, and 4.6 ms for all subjects. Mean amplitude was 15.8 +/- 4.9 mV, with a LLN of 5.1 for all subjects. Side-to-side differences in latency to the FDI, from dominant to nondominant hands, was -0.1 +/- 0.4 ms, with a ULN of 0.8 ms. For the amplitude, up to a 52% decrease from side to side was normal. For the same-limb comparison of the FDI and ADM, the mean latency difference was 0.6 +/- 0.4 ms, with a ULN increase of 1.3 ms for latency to the ADM versus the FDI.