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Carroll TJ, Chirokikh A, Thon J, Jones CMC, Logigian E, Ketonis C. Diagnosis of Ulnar Neuropathy at the Elbow Using Ultrasound - A Comparison to Electrophysiologic Studies. J Hand Surg Am 2023; 48:1229-1235. [PMID: 37877916 DOI: 10.1016/j.jhsa.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 08/16/2023] [Accepted: 08/30/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE Given the relatively high false negative rate of electrodiagnostic studies (EDX) in patients with clinically diagnosed ulnar neuropathy at the elbow (UNE), we sought to determine whether an alternative objective test could more effectively detect UNE. Additionally, we proposed to determine the relationship between the cross-sectional area (CSA) of the ulnar nerve on ultrasound (US), EDX, and clinical symptoms. METHODS This was a retrospective study of patients presenting with symptomatic UNE. The performance characteristics of EDX versus ultrasound were calculated using the clinical diagnosis of UNE as the reference standard. Standard EDX studies and US of the ulnar nerve were analyzed. Maximal CSA of the ulnar nerve and EDX severity were analyzed for patients with each combination of US-positive/negative and EDX-positive/negative findings. RESULTS Analysis was performed on 89 patients and 115 nerves with signs and symptoms of cubital tunnel syndrome. In total, 56 (49%) nerves were diagnosed as mild UNE, 32 (28%) nerves were diagnosed as moderate UNE, 17 (15%) nerves were diagnosed as severe UNE, and 10 (8%) nerves were negative for UNE by EDX. Maximal-maximal CSA was highly correlated with disease severity as determined by nerve conduction studies/electromyography. Compared with EDX+/US+, patients with EDX-/US+ showed higher rates of ulnar sensory loss and elbow tenderness with similar rates of positive Tinel and intrinsic muscle atrophy. In this sample of patients with clinically diagnosed UNE, 91.3% of the patients demonstrated positive EDX studies, whereas 94.8% had a positive US. CONCLUSIONS Ultrasound is an alternative to EDX that could be incorporated clinically in the diagnosis and management of UNE. Ultrasound was able to consistently detect clinically positive cubital tunnel syndrome demonstrating its utility as a confirmatory or supplemental test to the clinical assessment if one is required. Ultrasound additionally may be able to better identify patients with early stages of UNE with negative EDX findings. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic IV.
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Affiliation(s)
- Thomas John Carroll
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY.
| | - Alexander Chirokikh
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY
| | - Julie Thon
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY
| | - Courtney Marie Cora Jones
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY
| | - Eric Logigian
- University of Rochester Department of Neurology, University of Rochester School, Rochester, NY
| | - Constantinos Ketonis
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY
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2
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Schulze DG, Nilsen KB, Clemm T, Grotle M, Zwart JA, Ulvestad B, Nordby KC. Influence of ergonomic factors on peripheral neuropathy under HAV exposure. Occup Med (Lond) 2023; 73:13-18. [PMID: 36480225 DOI: 10.1093/occmed/kqac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hand-arm vibration (HAV) is a risk factor for carpal tunnel syndrome (CTS) and ulnar neuropathy at the elbow (UNE). It is unclear how ergonomic factors influence the relationship between HAV exposure and CTS and UNE. AIMS We aimed to assess the relationship between cumulative HAV exposure and CTS and UNE in workers exposed to HAV from two tools with different ergonomic profiles. METHODS We performed nerve conduction studies (NCSs) of the sensory and motor median and ulnar nerves and recorded symptoms indicating CTS and UNE in workers exposed to HAV from impact wrenches or from rock drills. Exposure was measured as cumulative lifetime exposure. We used linear regression adjusted for age and body mass index to assess linear relationships. RESULTS Sixty-five workers participated (33 rock drill and 32 impact wrench operators). We found inverse linear associations between cumulative HAV exposure and median nerve sensory conduction velocity in impact wrench operators and ulnar nerve motor conduction velocity in rock drill operators (beta of 0.63 and 0.75). Based on NCS findings and symptoms, seven impact wrench operators had CTS and one UNE, and four rock drill operators had CTS and six UNE. CONCLUSIONS Our findings indicate that ergonomic factors influence the development of CTS and UNE under HAV exposure. The ergonomic profile seems to influence which type of neuropathy workers exposed to HAV will develop. Design of occupational exposure guidelines and future studies should be based on ergonomic profile and exposure characteristics for different tools and not merely HAV.
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Affiliation(s)
- D G Schulze
- Department of Neurology, Oslo University Hospital and University of Oslo, 0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, 0424 Oslo, Norway
| | - K B Nilsen
- Department of Neurology, Oslo University Hospital and University of Oslo, 0424 Oslo, Norway
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, 0424 Oslo, Norway
| | - T Clemm
- National Institute of Occupational Health, 0304 Oslo, Norway
| | - M Grotle
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, 0424 Oslo, Norway
- Oslo Metropolitan University, 0130 Oslo, Norway
| | - J A Zwart
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, 0424 Oslo, Norway
| | - B Ulvestad
- National Institute of Occupational Health, 0304 Oslo, Norway
| | - K C Nordby
- National Institute of Occupational Health, 0304 Oslo, Norway
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3
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Patel K, Horak HA. Electrodiagnosis of Common Mononeuropathies: Median, Ulnar, and Fibular (Peroneal) Neuropathies. Neurol Clin 2021; 39:939-955. [PMID: 34602220 DOI: 10.1016/j.ncl.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This article addresses common mononeuropathies seen in the electrodiagnostic laboratory. The most common mononeuropathies-median neuropathy at the wrist (carpal tunnel syndrome), ulnar neuropathy at the elbow, and fibular (peroneal) neuropathy at the fibular head-are reviewed. The causes, clinical presentations, approached to the electrodiagnostic studies (including nerve conduction studies and needle electromyography), and the typical findings are discussed.
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Affiliation(s)
- Kamakshi Patel
- University of Texas Medical Branch (UTMB), 301 University Boulevard, JSA 9.128, Galveston, TX 77555, USA
| | - Holli A Horak
- University of Arizona College of Medicine- Tucson, 1501 North Campbell Avenue, Room 6212a, Tucson, AZ 87524, USA.
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Parkhurst DB, Andary MT, Powell JW. An Additional Electrodiagnostic Tool for Ulnar Neuropathy: Mixed across the Elbow. J Brachial Plex Peripher Nerve Inj 2020; 15:e16-e21. [PMID: 32863856 PMCID: PMC7449790 DOI: 10.1055/s-0040-1714742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background
Diagnosing ulnar neuropathy at the elbow (UNE) remains challenging despite guidelines from national organizations. Motor testing of hand intrinsic muscles remains a common diagnostic method fraught with challenges.
Objective
The aim of the study is to demonstrate utility of an uncommon nerve conduction study (NCS), mixed across the elbow, when diagnosing UNE.
Methods
Retrospective analysis of 135 patients, referred to an outpatient University-based electrodiagnostic laboratory with suspected UNE between January 2013 and June 2019 who had motor to abductor digiti minimi (ADM), motor to first dorsal interosseus (FDI), and mixed across the elbow NCS completed. To perform the mixed across the elbow NCS, the active bar electrode was placed 10-cm proximal to the medial epicondyle between the biceps and triceps muscle bellies. The median nerve was stimulated at the wrist followed by stimulation of the ulnar nerve at the ulnar styloid. The difference between peak latencies, labeled the ulnar-median mixed latency difference (U-MLD), was used to evaluate for correlation between the nerve conduction velocities (NCV) of ADM and FDI.
Results
Pearson
r
-values = −0.479 and −0.543 (
p
< 0.00001) when comparing U-MLD to ADM and FDI NCV across the elbow, respectively. The negative
r
-value describes the inverse relationship between ulnar velocity across the elbow and increasing U-MLD.
Conclusion
Mixed across the elbow has moderate–strong correlation with ADM and FDI NCV across the elbow. All three tests measure ulnar nerve function slightly differently. Without further prospective data, the most accurate test remains unclear. The authors propose some combination of the three tests may be most beneficial when diagnosing UNE.
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Affiliation(s)
- Drew B Parkhurst
- Department of Physical Medicine and Rehabilitation, Michigan State University, Lansing, Michigan, United States
| | - Michael T Andary
- Department of Physical Medicine and Rehabilitation, Michigan State University, Lansing, Michigan, United States
| | - John W Powell
- Department of Physical Medicine and Rehabilitation, Michigan State University, Lansing, Michigan, United States
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5
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Schulze DG, Nordby KC, Cvancarova Småstuen M, Clemm T, Grotle M, Zwart JA, Nilsen KB. Impact of technical variations on the ring-finger test for carpal tunnel syndrome. Clin Neurophysiol Pract 2019; 5:23-29. [PMID: 31909307 PMCID: PMC6940656 DOI: 10.1016/j.cnp.2019.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 11/19/2019] [Accepted: 11/23/2019] [Indexed: 11/15/2022] Open
Abstract
The median and ulnar nerves can be recorded consecutively or simultaneously to diagnose carpal tunnel syndrome. Simultaneous and consecutive recording of the median and ulnar nerves sensory latency have a poor agreement. Technical variations can have diagnostic consequences.
Objective To assess if recording the sensory latencies of the median and ulnar nerves one-by-one (consecutive) or at the same time (simultaneous) in the ring-finger test for carpal tunnel syndrome (CTS) will show equivalent results or if it will lead to a different clinical classification of patients. Methods We assessed the limits of agreement between the simultaneous and the consecutive method based on the median- ulnar sensory latency difference derived by both methods in 80 subjects and compared the number of minimal CTS cases identified by the two methods. Results Limits of agreement ranged from −0.23 to 0.29 ms. A significantly higher proportion of subjects with minimal CTS (only detectable by using the comparison test) was found using the simultaneous method (n = 8 and 2, respectively; p = 0.03). Conclusion The two methods have a poor to moderate agreement as indicated by the range of the limits of agreement (0.5 ms). Significance Even small methodological changes to the ring-finger test can lead to results with different clinical meaning in the same individual and one should be aware of which method was used when interpreting results.
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Affiliation(s)
- Daniel Gregor Schulze
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Norway
| | | | - Milada Cvancarova Småstuen
- Oslo and Akershus University College, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Thomas Clemm
- National Institute of Occupational Health, Oslo, Norway
| | - Margreth Grotle
- Oslo and Akershus University College, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Norway
| | - John Anker Zwart
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Norway
| | - Kristian Bernhard Nilsen
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Norway
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Abstract
This chapter covers the electrodiagnostic (EDX) evaluation of upper extremity nerves and the brachial plexus. Carpal tunnel syndrome is the most common peripheral nerve disorder of the upper extremity. A number of techniques are used but there is no gold standard approach for its diagnosis. Needle EMG aids in the differentiation of proximal and distal median neuropathies. Ulnar neuropathy at the elbow and ulnar neuropathy at or distal to the wrist can be distinguished by EDX techniques. Radial neuropathy at the spiral groove has a specific EDX pattern. EDX assessment of proximal upper extremity nerve lesions such as brachial plexopathy is a valuable tool for exploring the diagnosis and differential diagnosis of this complex disorder.
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Affiliation(s)
- John C Kincaid
- Department of Neurology, Indiana University, Indianapolis, IN, United States.
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7
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Kurver A, Smolders J, Verhagen WIM, Meulstee J, Nijhuis FAP. The Diagnostic Sensitivity for Ulnar Neuropathy at the Elbow Is Not Increased by Addition of Needle EMG of ADM and FDI When Nerve Conduction Studies Are Normal. Front Neurol 2019; 10:196. [PMID: 30915020 PMCID: PMC6421266 DOI: 10.3389/fneur.2019.00196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/15/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: The main objective of this study was to investigate whether electromyography (EMG) has additional value in the confirmation of the clinical diagnosis of ulnar nerve entrapment at the elbow (UNE) if nerve conduction studies (NCS) are normal. Methods: A prospective cross-sectional cohort observational study was conducted among patients with the clinical suspicion of UNE. A total of 199 arms were included, who were examined according to a standard neurophysiological protocol, i.e., NCS and EMG relevant to the ulnar nerve. Results: NCS were normal in 76 (38.2%) arms. No abnormal spontaneous muscle fiber activity was found with EMG in any of these cases. In 9 arms with normal NCS (11.8%), isolated abnormal MUAP configurations were found with EMG. Of these nine arms one UNE was diagnosed clinically, in which additional ultrasound and repeated NCS/EMG were negative. One had already been diagnosed with neuralgic amyotrophy and one with CTS. The other 6 arms had additional diagnostics which did not reveal an UNE. Conclusion: EMG as part of the standard neurophysiological protocol exclusively in the confirmation of the clinical diagnosis of UNE has limited added value if NCS are normal in a high prior-odds setting. However, removing EMG may prevent detecting concomitant and/or additional differential diagnoses.
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Affiliation(s)
- Anne Kurver
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Joost Smolders
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Wim I M Verhagen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Jan Meulstee
- Department of Clinical Neurophysiology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Frouke A P Nijhuis
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands.,Department of Clinical Neurophysiology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
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8
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Shapiro BE, Preston DC. Looking for periodic paralysis: Optimizing the long exercise test. Muscle Nerve 2019; 59:8-9. [PMID: 30071152 DOI: 10.1002/mus.26314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 07/24/2018] [Accepted: 07/28/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Barbara E Shapiro
- Neurological Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, Ohio, 44106-5098, USA
| | - David C Preston
- Neurological Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, Ohio, 44106-5098, USA
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9
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Simmons DB, Lanning J, Cleland JC, Puwanant A, Twydell PT, Griggs RC, Tawil R, Logigian EL. Long Exercise Test in Periodic Paralysis: A Bayesian Analysis. Muscle Nerve 2019; 59:47-54. [PMID: 29752813 DOI: 10.1002/mus.26157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 04/30/2018] [Accepted: 05/05/2018] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The long exercise test (LET) is used to assess the diagnosis of periodic paralysis (PP), but LET methodology and normal "cutoff" values vary. METHODS To determine optimal LET methodology and cutoffs, we reviewed LET data (abductor digiti minimi motor response amplitude, area) from 55 patients with PP (32 genetically definite) and 125 controls. Receiver operating characteristic curves were constructed, and area under the curve (AUC) was calculated to compare (1) peak-to-nadir versus baseline-to-nadir methodologies and (2) amplitude versus area decrements. Using bayesian principles, we calculated optimal cutoff decrements that achieved 95% posttest probability of PP for various pretest probabilities (PreTPs). RESULTS AUC was highest for peak-to-nadir methodology and equal for amplitude and area decrements. For PreTP ≤ 50%, optimal decrement cutoffs (peak-to-nadir) were > 40% (amplitude) or > 50% (area). DISCUSSION For confirmation of PP, our data endorse the diagnostic utility of peak-to-nadir LET methodology using 40% amplitude or 50% area decrement cutoffs for PreTP ≤50%. Muscle Nerve 59:47-54, 2019.
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Affiliation(s)
- Daniel B Simmons
- Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York, 14642, USA.,Department of Neurology, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | - Julie Lanning
- Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York, 14642, USA
| | - James C Cleland
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Araya Puwanant
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Robert C Griggs
- Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York, 14642, USA
| | - Rabi Tawil
- Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York, 14642, USA
| | - Eric L Logigian
- Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York, 14642, USA
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10
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Tong JS, Dong Z, Xu B, Zhang CG, Gu YD. Surgical treatment for severe cubital tunnel syndrome with absent sensory nerve conduction. Neural Regen Res 2019; 14:519-524. [PMID: 30539822 PMCID: PMC6334593 DOI: 10.4103/1673-5374.245479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
For severe cubital tunnel syndrome, patients with absent sensory nerve action potential tend to have more severe nerve damage than those without. Thus, it is speculated that such patients generally have a poor prognosis. How absent sensory nerve action potential affects surgical outcomes remains uncertain owing to a scarcity of reports and conflicting results. This retrospective study recruited one hundred and fourteen cases (88 patients with absent sensory nerve action potential and 26 patients with present sensory nerve action potential) undergoing either subcutaneous transposition or in situ decompression. The minimum follow-up was set at 2 years. Primary outcome measures of overall hand function included their McGowan grade, modified Bishop score, and Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) score. For patients with absent sensory nerve action potential, 71 cases (80.7%) achieved at least one McGowan grade improvement, 76 hands (86.4%) got good or excellent results according to the Bishop score, and the average DASH score improved 49.5 points preoperatively to 13.1 points postoperatively. When compared with the present sensory nerve action potential group, they showed higher postoperative McGowan grades and DASH scores, but there was no statistical difference between the modified Bishop scores of the two groups. Following in situ decompression or subcutaneous transposition, great improvement in hand function was achieved for severe cubital tunnel syndrome patients with absent sensory nerve action potential. The functional outcomes after surgery for severe cubital tunnel syndrome are worse in patients with absent sensory nerve action potential than those without. This study was approved by the Ethical Committee of Huashan Hospital, Fudan University, China (approval No. 2017142).
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Affiliation(s)
- Jin-Song Tong
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Zhen Dong
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Bin Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Cheng-Gang Zhang
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yu-Dong Gu
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
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11
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Xu G, Zhou C, Liu S, Li W, Tang W. Electrophysiological characteristics of the frontal nerve in patients with herpetic ophthalmic neuralgia. Muscle Nerve 2018; 57:973-980. [PMID: 29314073 DOI: 10.1002/mus.26057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2017] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The aim of this study was to explore a method for obtaining sensory nerve action potentials (SNAPs) of the supratrochlear (STN) and supraorbital (SON) nerves and evaluate the function of affected nerves in patients with herpetic ophthalmic neuralgia (HON). METHODS Thirty healthy volunteers and 40 subjects with subacute HON participated in this study. RESULTS The amplitudes and sensory conduction velocities (SCVs) that predicted HON were identified. The corresponding cutoff values for the amplitudes ranged from 11.10 μV to 12.45 μV. The corresponding cutoff values for the SCVs ranged from 43.14 m/s to 44.64 m/s. SCVs were markedly lower on the affected side compared with healthy volunteers (P < 0.05), and the amplitudes of SNAPs on the affected side were decreased by 36% compared with healthy volunteers (P < 0.05). DISCUSSION SCVs of STN and SONs can be obtained with the 3-channel method and used to evaluate myelinated fibers in patients with HON. Muscle Nerve 57: 973-980, 2018.
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Affiliation(s)
- Gang Xu
- Department of Rehabilitation Medicine, Affiliated Tenth People's Hospital of Tongji University, Shanghai Tenth People's Hospital, 301 Middle Yanchang Road Shanghai, 200072, China
| | - Chaosheng Zhou
- Department of Rehabilitation Medicine, Affiliated Tenth People's Hospital of Tongji University, Shanghai Tenth People's Hospital, 301 Middle Yanchang Road Shanghai, 200072, China
| | - Shasha Liu
- Department of Rehabilitation Medicine, Affiliated Tenth People's Hospital of Tongji University, Shanghai Tenth People's Hospital, 301 Middle Yanchang Road Shanghai, 200072, China
| | - Wen Li
- Department of Rehabilitation Medicine, Affiliated Tenth People's Hospital of Tongji University, Shanghai Tenth People's Hospital, 301 Middle Yanchang Road Shanghai, 200072, China
| | - Weizhen Tang
- Department of Rehabilitation Medicine, Affiliated Tenth People's Hospital of Tongji University, Shanghai Tenth People's Hospital, 301 Middle Yanchang Road Shanghai, 200072, China
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12
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Carroll CG, Landau ME, Rouhanian M, Campbell WW. Inter-rater reliability determination for two tests of ulnar nerve conduction across the elbow. Muscle Nerve 2016; 55:664-668. [PMID: 27571443 DOI: 10.1002/mus.25390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 08/10/2016] [Accepted: 08/23/2016] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The inter-rater variability in determination of ulnar nerve conduction across the elbow compromises test accuracy. The extent of this variability is unknown. The objective of this study was to determine and compare inter-rater reliability of variables derived from 2 different ulnar nerve conduction studies (NCSs) across the elbow. METHODS Two investigators performed a standard ulnar NCS and a 6-cm conduction time (Six-Centimeter Conduction Time test, SCCT) on 60 extremities of asymptomatic subjects. In the standard test, below-elbow (BE) and above-elbow (AE) stimulation points were ≥ 10 cm apart, measured along a curved path, to calculate across-elbow NCV. In SCCT, BE and AE were precisely 6 cm apart measured linearly to calculate CTE (conduction time elbow). Inter-rater reliability was assessed by means of intraclass correlation coefficients (ICC). RESULTS ICC for across-elbow NCV and CTE were 0.726 and 0.801, respectively. CONCLUSIONS Reliability of CTE and across-elbow NCV are similar. Shorter distances, if measured linearly, can be used to determine across-elbow ulnar nerve conduction. Muscle Nerve 55: 664-668, 2017.
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Affiliation(s)
- Craig G Carroll
- Department of Neurology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, Maryland, 20815
| | - Mark E Landau
- Department of Neurology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, Maryland, 20815
| | - Minoo Rouhanian
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - William W Campbell
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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13
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Padua L, Coraci D, Erra C, Doneddu PE, Granata G, Rossini PM. Prolonged phone-call posture causes changes of ulnar motor nerve conduction across elbow. Clin Neurophysiol 2016; 127:2728-2732. [PMID: 27417044 DOI: 10.1016/j.clinph.2016.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 05/02/2016] [Accepted: 05/09/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Postures and work-hobby activities may play a role in the origin and progression of ulnar neuropathy at the elbow (UNE), whose occurrence appears to be increasing. The time spent on mobile-phone has increased in the last decades leading to an increased time spent with flexed elbow (prolonged-phone-posture, PPP). We aimed to assess the effect of PPP both in patients with symptoms of UNE and in symptom-free subjects. METHODS Patients with pure sensory symptoms of UNE and negative neurophysiological tests (MIN-UNE) and symptom-free subjects were enrolled. We evaluated ulnar motor nerve conduction velocity across elbow at baseline and after 6, 9, 12, 15, and 18min of PPP in both groups. Fifty-six symptom-free subjects and fifty-eight patients were enrolled. Globally 186 ulnar nerves from 114 subjects were studied. RESULTS Conduction velocity of ulnar nerve across the elbow significantly changed over PPP time in patients with MIN-UNE, showing a different evolution between the two groups. CONCLUSIONS PPP causes a modification of ulnar nerve functionality in patients with MIN-UNE. SIGNIFICANCE PPP may cause transient stress of ulnar nerve at elbow.
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Affiliation(s)
- Luca Padua
- Don Carlo Gnocchi Onlus Foundation, Piazzale Morandi 6, 20100 Milan, Italy; Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy.
| | - Daniele Coraci
- Don Carlo Gnocchi Onlus Foundation, Piazzale Morandi 6, 20100 Milan, Italy; Board of Physical Medicine and Rehabilitation, Department of Orthopaedic Science, "Sapienza" University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Carmen Erra
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy
| | - Pietro Emiliano Doneddu
- Department of Clinical and Experimental Medicine, Unit of Clinical Neurology, University of Sassari, viale san Pietro, 07100 Sassari, Italy
| | - Giuseppe Granata
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy
| | - Paolo Maria Rossini
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy; IRCCS San Raffaele-Pisana, Rome, Italy
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Schuhfried O, Herceg M, Pieber K, Paternostro-Sluga T. Interrater Repeatability of Motor Nerve Conduction Velocity of the Ulnar Nerve. Am J Phys Med Rehabil 2016; 96:45-49. [PMID: 27149598 DOI: 10.1097/phm.0000000000000530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to obtain data on interrater repeatability of the motor nerve conduction velocity (NCV) of the ulnar nerve of different segments, ulnar distal motor latency (DML), and compound muscle action potential (CMAP) amplitudes. DESIGN Twenty-four healthy volunteers were examined in consecutive order. Ulnar motor NCV of different segments, ulnar DML, and CMAP amplitudes were determined. Based on a randomization list of various combinations and sequences, 1 of 3 examiners performed the first measurement. A second examiner repeated the evaluation within half an hour. RESULTS There were no significant differences between the first and second measurements for all parameters. For the ulnar motor NCV of the different segments, the intraclass correlation coefficient (ICC) ranged from 0.38 to 0.51, and the coefficient of repeatability (CR) ranged from 8.0 to 11.6 m/s. For the ulnar DML, the ICC was 0.44, and the CR was 0.49 millisecond. For the CMAP amplitudes at the different stimulation sites, the ICC ranged from 0.53 to 0.76, and the CR ranged from 1.5 to 2.3 mV. CONCLUSIONS A moderate amount of interrater variability of the ulnar motor NCV must be taken into account. Compared with the CMAP amplitudes, the interrater repeatability of the ulnar motor NCV is poorer.
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Affiliation(s)
- Othmar Schuhfried
- From the Department of Physical Medicine and Rehabilitation, Medical University of Vienna General Hospital of Vienna (OS, MH, KP); and Institute of Physical Medicine and Rehabilitation, Donauspital (TP-S), Vienna, Austria
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Diagnostic accuracy of ultrasonographic and nerve conduction studies in ulnar neuropathy at the elbow. Clin Neurophysiol 2015; 126:1797-804. [DOI: 10.1016/j.clinph.2014.12.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/18/2014] [Accepted: 12/01/2014] [Indexed: 01/29/2023]
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Omejec G, Podnar S. Normative values for short-segment nerve conduction studies and ultrasonography of the ulnar nerve at the elbow. Muscle Nerve 2015; 51:370-7. [DOI: 10.1002/mus.24328] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Gregor Omejec
- Institute of Clinical Neurophysiology; Division of Neurology; University Medical Center; SI-1525 Ljubljana Slovenia
| | - Simon Podnar
- Institute of Clinical Neurophysiology; Division of Neurology; University Medical Center; SI-1525 Ljubljana Slovenia
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