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Pardal-Fernández JM, Diaz-Maroto I, Segura T, de Cabo C. Ulnar nerve thickness at the elbow on longitudinal ultrasound view in control subjects. Neurol Res Pract 2023; 5:4. [PMID: 36698205 PMCID: PMC9878874 DOI: 10.1186/s42466-023-00230-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/03/2023] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Ulnar mononeuropathy at the elbow is the second most frequent neuropathy in humans. Diagnosis is based on clinical and electrophysiological criteria and, more recently, also on ultrasound. Cross-sectional ultrasound is currently the most valued, although longitudinal ultrasound allows assessment of the entire affected trajectory of the nerve in a single view, but always in a straight line with no changes in direction, as in the extended elbow. The main aim of this work is to propose normative values for longitudinal ultrasound of the ulnar nerve at the elbow. METHODS The neurological exploration of upper extremity, and electrophysiological and ultrasound parameters at the elbow of ulnar nerve were evaluated in 76 limbs from 38 asymptomatic subjects. RESULTS The diameters of the nerve as well as the distal and proximal areas were larger at the proximal region of the ulnar groove, and even more so in older individuals. In most of these elderly subjects, we found a small, non-significant slowdown in motor conduction velocity at the elbow with respect to the forearm (less than 5 m/s). CONCLUSIONS We observed a good correlation between the longitudinal and cross-sectional ultrasounds of the ulnar nerve at the elbow. Longitudinal ultrasound proved to be sensitive, reliable, simple and rapid, but its greatest contribution was allowing the visualization of the entire nerve trajectory in an integrated way, providing an image with good definition of the outline, proportions and intraneural characteristics of the nerve.
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Affiliation(s)
| | - Inmaculada Diaz-Maroto
- Unit of Neuromuscular Disorders, Department of Neurology, University General Hospital, Albacete, Spain
| | - Tomás Segura
- Department of Neurology, University General Hospital, Albacete, Spain
| | - Carlos de Cabo
- Neuropsychopharmacology Unit, University General Hospital of Albacete, Albacete, Spain
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Florczynski MM, Kong L, Burns PB, Wang L, Chung KC. Electrodiagnostic Predictors of Outcomes After In Situ Decompression of the Ulnar Nerve. J Hand Surg Am 2023; 48:28-36. [PMID: 36371353 PMCID: PMC10161202 DOI: 10.1016/j.jhsa.2022.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 09/15/2022] [Accepted: 10/05/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Patients with severe ulnar neuropathy at the elbow frequently experience suboptimal surgical outcomes. Clinical symptoms alone may not accurately represent the severity of underlying nerve injury, calling for objective assessment tools, such as electrodiagnostic studies. The goal of our study was to determine whether specific electrodiagnostic parameters can be used to predict the outcomes after in situ decompression of the ulnar nerve. METHODS This prospective study enrolled consecutive patients aged ≥18 years diagnosed with ulnar neuropathy at the elbow. Patients completed a baseline battery of motor, sensory, functional, and electrodiagnostic tests before undergoing in situ decompression of the ulnar nerve. They were reassessed at 6 weeks, 3 months, 6 months, and 12 months after surgery. Forty-two patients completed at least 2 follow-up assessments and were included in the study. RESULTS When controlling for other electrodiagnostic measurements and demographic factors, none of the electrodiagnostic parameters were predictive of outcomes at 12 months after surgery. Patients with decreased compound muscle action potential amplitudes demonstrated slower trends of recovery in grip strength, pinch strength, and overall scores on the Michigan Hand Outcomes Questionnaire as well as its function, work, and activities of daily living subscales, Disabilities of the Arm, Shoulder, and Hand questionnaire, and the Carpal Tunnel Questionnaire. Decreased motor nerve conduction velocity was predictive of slower recovery of 2-point discrimination and pinch strength. CONCLUSIONS Compound muscle action potential amplitude, but not other conventional electrodiagnostic parameters, was predictive of functional outcomes after in situ decompression of the ulnar nerve. This parameter should play a role in determining the timing and prognosis of treatment for ulnar neuropathy at the elbow. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Matthew M Florczynski
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI; Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Lingxuan Kong
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Patricia B Burns
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Lu Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
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Raeissadat SA, Youseffam P, Bagherzadeh L, Rayegani SM, Bahrami MH, Eliaspour D. Electrodiagnostic Findings in 441 Patients with Ulnar Neuropathy - a Retrospective Study. Orthop Res Rev 2019; 11:191-198. [PMID: 31819676 PMCID: PMC6897064 DOI: 10.2147/orr.s230116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/11/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Ulnar neuropathy (UN) is the second most common focal neuropathy in the upper extremities. Electrodiagnostic studies (EDx), including nerve conduction study (NCS) and electromyography (EMG), are reliable tools for the diagnosis of ulnar neuropathy. We aimed to retrospectively analyze the medical records of patients diagnosed with ulnar neuropathy in a seven-year period and report our findings. Patients and methods In this retrospective study, documents of the patients whose ulnar nerve injury was confirmed through electrodiagnostic study in two departments of Physical Medicine and Rehabilitation were collected and demographic data, subjective complaints of the patient, the cause, and electrodiagnostic findings were extracted from each patient’s file. The following points were specifically evaluated in the electrodiagnostic records; type of injury, location, accompanying injuries, sensory nerve action potentials (SNAP) of the fifth finger, SNAP of dorsal ulnar cutaneous nerve (DUCN), compound muscle action potential (CMAP) of abductor digiti minimi (ADM) muscle, nerve conduction velocity (NCV) across elbow, patterns of muscle involvement, and the severity of insult. Results Out of 441 records, 305 (69.2%) were male and 68.1% were non-traumatic. Based on our clinical criteria, the intensity of the injury was mild in most cases. The elbow and forearm were the most involved regions in non-traumatic and traumatic cases respectively. Across elbow nerve conduction velocity showed decreased velocity in 71% of records. In non-traumatic cases, the most affected muscle was ADM (97%) and then FDI (85%). Conclusion In focal entrapments such as ulnar neuropathy, electrodiagnostic findings are very helpful in assessing location, severity, and type of injury. If a consensus is achieved for the diagnosis of UN, even retrospective studies can become valuable sources for studying UN.
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Affiliation(s)
- Seyed Ahmad Raeissadat
- Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Department and Research Center, Shahid Beheshti University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Parisa Youseffam
- Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Bagherzadeh
- Department of Orthopedics, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Seyed Mansoor Rayegani
- Physical Medicine and Rehabilitation Research Center, Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hasan Bahrami
- Physical Medicine and Rehabilitation Research Center, Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Dariush Eliaspour
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Aird C, Thoirs K, Maranna S, Massy-Westropp N. Ultrasound Measurements and Assessments of the Ulnar Nerve at the Elbow and Cubital Tunnel: A Scoping Review. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319870467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Ulnar neuropathy at the elbow (UNE) is the second most frequent peripheral nerve entrapment neuropathy in the upper extremity. The diagnosis is determined through a combination of history, physical examination, and electrodiagnostic testing. However, the use of high-resolution sonography is increasing, with sonographic measurements of ulnar nerve dimension established as a reliable diagnostic criterion for UNE. Sonographic imaging can describe anatomical features beyond ulnar nerve size, and therefore additional observations could potentially be used in UNE diagnosis and treatment follow-up. This review was a scoping of the literature on different sonographic measurements and assessments that have been reported to evaluate the ulnar nerve and cubital tunnel. This should provide a guide to scanning protocols for sonographers.
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Affiliation(s)
- Courtney Aird
- The University of South Australia, Adelaide, South Australia, Australia
| | - Kerry Thoirs
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, South Australia, Australia
| | - Sandhya Maranna
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Nicola Massy-Westropp
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, South Australia, Australia
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Jariwala A, Bansal N, Nicol GM, Shelton J, Wigderowitz CA. Outcome analysis of cubital tunnel decompression. Scott Med J 2015; 60:136-40. [DOI: 10.1177/0036933015589487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cubital tunnel decompression is a commonly undertaken upper limb procedure. Most studies compare the different techniques of decompression; however, only a few have specifically investigated the outcome of ulnar nerve decompression. Aim The aim of this study was to investigate the outcome of ulnar nerve decompression following cubital tunnel syndrome. Methods and results A total of 174 ulnar nerve decompression cases were identified from the upper limb surgery database with complete data available for 136 cases. Simple decompression was performed in 110 (80.88%) cases, and in 26 (19.12%), anterior subcutaneous transposition was also supplemented. These operations were performed at three different hospitals by surgeons of different levels of experience. The most common cause of cubital tunnel syndrome was idiopathic. The outcome was satisfactory in 86% of cases. No obvious association was demonstrated between the outcome of surgery and duration of symptoms, presence of co-morbidities or the type of surgery performed. Conclusion This is the largest outcome analysis of the results of ulnar nerve decompression at the elbow. Good results following nerve decompression were attained in 86% of cases without any significant effect of duration of symptoms or co-morbidities on the outcome of surgery. It is hoped that the findings of the current study will help general practitioners, junior doctors and surgeons in their management and pre-operative consultation with patients having cubital tunnel syndrome.
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Affiliation(s)
- A Jariwala
- Consultant Upper Limb and Trauma Surgeon Ninewells Hospital and Medical School, UK
| | - N Bansal
- Research Fellow, University Department of Orthopaedic and Trauma Surgery, TORT Centre, Ninewells Hospital and Medical School, UK
| | - GM Nicol
- Speciality Registrar, Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, UK
| | - J Shelton
- CT2, Department of Trauma & Orthopaedics, Macclesfield District General Hospital, UK
| | - CA Wigderowitz
- Senior Clinical Lecturer, University Department of Orthopaedic and Trauma Surgery, TORT Centre, Ninewells Hospital and Medical School
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Seok HY, Jang JH, Won SJ, Yoon JS, Park KS, Kim BJ. Cross-sectional area reference values of nerves in the lower extremities using ultrasonography. Muscle Nerve 2014; 50:564-70. [PMID: 24639103 DOI: 10.1002/mus.24209] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 01/31/2014] [Accepted: 02/10/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Cross-sectional area (CSA) reference values of lower extremity nerves using ultrasonography have only been reported in a few studies and have been limited to white populations. METHODS For this study, 94 healthy Korean volunteers were recruited for measurement of the CSA at 7 sites of lower extremity nerves. The side-to-side difference in CSA was calculated for each nerve, and reference ranges were derived. External validity evaluation for the reference values was performed with 10 newly recruited volunteers at a different institution. RESULTS Nerve CSA was correlated significantly with body mass index, weight, and height; however, the absolute value of the side-to-side difference had no significant correlation with demographic factors. The external validity was adequate for all sites, ranging from 80% to 100%. CONCLUSIONS The lower extremity nerve CSA values obtained in this study may provide normal reference values for the Asian population.
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Affiliation(s)
- Hung Youl Seok
- Department of Neurology, Korea University College of Medicine, Seoul, #73, Inchon-ro, Seongbuk-gu, Seoul, 136-705, South Korea
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Granata G, Padua L, Celletti C, Castori M, Saraceni V, Camerota F. Entrapment neuropathies and polyneuropathies in joint hypermobility syndrome/Ehlers–Danlos syndrome. Clin Neurophysiol 2013; 124:1689-94. [DOI: 10.1016/j.clinph.2012.12.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 12/04/2012] [Accepted: 12/19/2012] [Indexed: 11/25/2022]
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Won SJ, Kim BJ, Park KS, Yoon JS, Choi H. Reference values for nerve ultrasonography in the upper extremity. Muscle Nerve 2013; 47:864-71. [DOI: 10.1002/mus.23691] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2012] [Indexed: 12/24/2022]
Affiliation(s)
- Sun Jae Won
- Department of Rehabilitation Medicine; Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Seoul; South Korea
| | - Byung-Jo Kim
- Department of Neurology; Korea University College of Medicine; Seoul; South Korea
| | - Kyung Seok Park
- Department of Neurology; Seoul National University Bundang Hospital, Seoul National University, College of Medicine; Seoul; South Korea
| | - Joon Shik Yoon
- Department of Rehabilitation Medicine; Korea University College of Medicine; 80 Guro Gu, Guro Dong; Seoul; South Korea
| | - Hyuk Choi
- Department of Medical Sciences; Graduate School of Medicine, Korea University; Seoul; South Korea
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Location, location, dislocation. Clin Neurophysiol 2013; 124:1490. [PMID: 23523113 DOI: 10.1016/j.clinph.2013.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 01/31/2013] [Accepted: 02/05/2013] [Indexed: 11/21/2022]
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Ehler E, Ridzoň P, Urban P, Mazanec R, Nakládalová M, Procházka B, Matulová H, Latta J, Otruba P. Ulnar nerve at the elbow - normative nerve conduction study. J Brachial Plex Peripher Nerve Inj 2013; 8:2. [PMID: 23398737 PMCID: PMC3653784 DOI: 10.1186/1749-7221-8-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 01/20/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction A goal of our work was to perform nerve conduction studies (NCSs) of the ulnar nerve focused on the nerve conduction across the elbow on a sufficiently large cohort of healthy subjects in order to generate reliable reference data. Methods We examined the ulnar nerve in a position with the elbow flexion of 90o from horizontal. Motor response was recorded from the abductor digiti minimi muscle (ADM) and the first dorsal interosseous muscle (FDI). Results In our sample of 227 healthy volunteers we have examined 380 upper arms with the following results: amplitude (Amp)-CMAP(wrist) for ADM 9.6 ± 2.3 mV, MNCV at the forearm 60.4 ± 5.2 m/s, MNCV across the elbow 57.1 ± 5.9 m/s. Discussion Our study showed that motor NCSs of the ulnar nerve above elbow (AE) and below elbow (BE) in a sufficiently large cohort using methodology recommended by AANEM gave results well comparable for registration from FDI and ADM.
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Affiliation(s)
- Edvard Ehler
- Department of Neurology, Regional Hospital and Faculty of Health Studies, University of Pardubice, 44 Kyjevská, 532 03, Pardubice, Czech Republic.
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Landau ME, Campbell WW. Clinical Features and Electrodiagnosis of Ulnar Neuropathies. Phys Med Rehabil Clin N Am 2013. [DOI: 10.1016/j.pmr.2012.08.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Won SJ, Kim BJ, Park KS, Kim SH, Yoon JS. Measurement of cross-sectional area of cervical roots and brachial plexus trunks. Muscle Nerve 2012; 46:711-6. [PMID: 23055312 DOI: 10.1002/mus.23503] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The aim of this study was to determine normal reference values for cross-sectional area (CSA) and the correlation between demographic factors and CSA in the cervical roots and brachial plexus trunks using ultrasonography. METHODS Ninety-five age-matched healthy individuals were studied. Ultrasonographic tests were performed via nerve tracing from the cervical root to the brachial plexus trunk. The CSA of each nerve was measured in the C5-8 ventral roots and brachial plexus (trunk level). RESULTS Normal values of each cervical root were: C5, 5.66 ± 1.02 mm(2); C6, 8.98 ± 1.65 mm(2); C7, 10.43 ± 1.86 mm(2); and C8, 10.76 ± 2.02 mm(2). Values for the brachial plexus were: upper trunk, 16.70 ± 2.88 mm(2); middle trunk, 14.01 ± 2.70 mm(2); and lower trunk, 13.75 ± 2.57 mm(2). The side-to-side discrepancy was 11.91 ± 11.11%. Body mass index (BMI) and height correlated frequently with nerve CSA. CONCLUSIONS These reference values may be helpful in investigating pathologies involving the cervical area.
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Affiliation(s)
- Sun Jae Won
- Department of Rehabilitation Medicine, Yeouido St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Ulnar nerve measurements in healthy individuals to obtain reference values. Rheumatol Int 2012; 33:1143-7. [DOI: 10.1007/s00296-012-2527-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
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