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Gasemaltayeb R, Wannarong T, Ticku H, Preston DC. Neuromuscular ultrasound: Impact on diagnosis and management. Muscle Nerve 2024; 69:295-302. [PMID: 37818726 DOI: 10.1002/mus.27983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION/AIM High-resolution ultrasound (HRUS) is increasingly used in evaluating neuromuscular conditions. Its potential advantages include its ability to discern anatomic information and make specific etiological diagnoses. Although many studies have demonstrated HRUS effectiveness, especially in mononeuropathies, more information is needed to better determine how often and to what extent useful information is obtained; how it influences diagnosis, clinical decision-making, and patient management; and how it is used with electrodiagnostic (EDx) studies. METHODS A retrospective cohort study was performed on patients referred for HRUS at a university laboratory during 2021. Demographic information, referral diagnoses, clinical information, HRUS findings, and follow-up patient management were analyzed. For patients who had EDx, results were compared with HRUS. Determinations were made whether HRUS did or did not aid in the diagnosis. For patients in whom HRUS resulted in a diagnosis, determination was made whether it confirmed the diagnosis made clinically or by EDx but did not change management; added additional important information; and/or made a decisive impact on subsequent management. RESULTS Five hundred two patients were analyzed, most referred for mononeuropathy, brachial plexopathy, and polyneuropathy. HRUS was abnormal in 81.7% of patients. HRUS added additional useful information in 79.0% and was decisive in management in 62.7%. In patients who also had abnormal EDx, HRUS resulted in decisive management in 49.5%. DISCUSSION HRUS is an effective diagnostic tool that frequently adds localizing and structural information that is otherwise not obtainable by clinical and EDx evaluation. In a substantial number of patients selected for HRUS, it is decisive in guiding further management.
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Affiliation(s)
- Raed Gasemaltayeb
- Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Thapat Wannarong
- Neuromuscular Division, Department of Neurology, Duke University Hospital, Durham, North Carolina, USA
| | - Hemani Ticku
- Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - David C Preston
- Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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2
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Rubin DI, Lamb CJ. The role of electrodiagnosis in focal neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:43-59. [PMID: 38697746 DOI: 10.1016/b978-0-323-90108-6.00010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Electrodiagnostic (EDX) testing plays an important role in confirming a mononeuropathy, localizing the site of nerve injury, defining the pathophysiology, and assessing the severity and prognosis. The combination of nerve conduction studies (NCS) and needle electromyography findings provides the necessary information to fully assess a nerve. The pattern of NCS abnormalities reflects the underlying pathophysiology, with focal slowing or conduction block in neuropraxic injuries and reduced amplitudes in axonotmetic injuries. Needle electromyography findings, including spontaneous activity and voluntary motor unit potential changes, complement the NCS findings and further characterize chronicity and degree of axon loss and reinnervation. EDX is used as an objective marker to follow the progression of a mononeuropathy over time.
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Affiliation(s)
- Devon I Rubin
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States.
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3
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Hannaford A, Simon NG. Ulnar neuropathy. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:103-126. [PMID: 38697734 DOI: 10.1016/b978-0-323-90108-6.00006-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Ulnar neuropathy at the elbow is the second most common compressive neuropathy. Less common, although similarly disabling, are ulnar neuropathies above the elbow, at the forearm, and the wrist, which can present with different combinations of intrinsic hand muscle weakness and sensory loss. Electrodiagnostic studies are moderately sensitive in diagnosing ulnar neuropathy, although their ability to localize the site of nerve injury is often limited. Nerve imaging with ultrasound can provide greater localization of ulnar injury and identification of specific anatomical pathology causing nerve entrapment. Specifically, imaging can now reliably distinguish ulnar nerve entrapment under the humero-ulnar arcade (cubital tunnel) from nerve injury at the retro-epicondylar groove. Both these pathologies have historically been diagnosed as either "ulnar neuropathy at the elbow," which is non-specific, or "cubital tunnel syndrome," which is often erroneous. Natural history studies are few and limited, although many cases of mild-moderate ulnar neuropathy at the elbow appear to remit spontaneously. Conservative management, perineural steroid injections, and surgical release have all been studied in treating ulnar neuropathy at the elbow. Despite this, questions remain about the most appropriate management for many patients, which is reflected in the absence of management guidelines.
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Affiliation(s)
- Andrew Hannaford
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | - Neil G Simon
- Northern Beaches Clinical School, Macquarie University, Sydney, NSW, Australia.
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4
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Telleman JA, Sneag DB, Visser LH. The role of imaging in focal neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:19-42. [PMID: 38697740 DOI: 10.1016/b978-0-323-90108-6.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Electrodiagnostic testing (EDX) has been the diagnostic tool of choice in peripheral nerve disease for many years, but in recent years, peripheral nerve imaging has been used ever more frequently in daily clinical practice. Nerve ultrasound and magnetic resonance (MR) neurography are able to visualize nerve structures reliably. These techniques can aid in localizing nerve pathology and can reveal significant anatomical abnormalities underlying nerve pathology that may have been otherwise undetected by EDX. As such, nerve ultrasound and MR neurography can significantly improve diagnostic accuracy and can have a significant effect on treatment strategy. In this chapter, the basic principles and recent developments of these techniques will be discussed, as well as their potential application in several types of peripheral nerve disease, such as carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow (UNE), radial neuropathy, brachial and lumbosacral plexopathy, neuralgic amyotrophy (NA), fibular, tibial, sciatic, femoral neuropathy, meralgia paresthetica, peripheral nerve trauma, tumors, and inflammatory neuropathies.
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Affiliation(s)
- Johan A Telleman
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
| | - Leo H Visser
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
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5
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Chirokikh AA, Carroll TJ, Hoffman S, Speach D, Jones CMC, Ketonis C. Where Does Ultrasound Fit in the Diagnostic Algorithm for Cubital Tunnel Syndrome? Hand (N Y) 2023:15589447231200645. [PMID: 37746734 DOI: 10.1177/15589447231200645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Ultrasound (US) has emerged as a promising supplement to electrodiagnostic studies (EDX) in the diagnosis of cubital tunnel syndrome (CuTS) and has potential to be performed by novice operators. Our objective is to understand the discrepancies in assessment between the two modalities and to assess the utility of US in CuTS diagnosis by a novice operator. METHODS Patients who presented to a single tertiary academic medical center and clinically diagnosed with CuTS were prospectively enrolled. Electrodiagnostic studies were performed along with US measurements of the cross-sectional area (CSA) of the ulnar nerve by both a board-certified physiatrist and novice operator. Electrodiagnostic study and US outcomes were compared among four diagnostic impression groups: EDX-/US-, EDX+/US-, EDX-/US+, and EDX+/US+. RESULTS Sixteen patients were classified as abnormal by both EDX and US, 14 were classified abnormal by US only, 3 were classified abnormal by EDX only, and 6 were classified normal by both EDX and US (P = .008, K = 0.14). The EDX+/US+ group had a significantly reduced sensory amplitude compared with the EDX-/US+ (P = .04) group. Diagnostic classifications between a board-certified physiatrist and novice operator were in moderate agreement (K = 0.58, P = .08). CONCLUSIONS Ultrasound detected a greater proportion of patients as abnormal than EDX. A subset of patients with clinical diagnoses of CuTS had normal sensory amplitudes but increased maximum nerve CSAs. Competency in US may be easily acquired with minimal training, suggesting its potential to be extended for use by other members of the health care team.
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Reddy YM, K. Murthy J, Suresh L, Jaiswal S, Pidaparthi L, S. Kiran ES. Diagnosis and severity evaluation of ulnar neuropathy at the elbow by ultrasonography: A case-control study. J Med Ultrasound 2022; 30:189-195. [DOI: 10.4103/jmu.jmu_152_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/31/2021] [Accepted: 08/09/2021] [Indexed: 11/04/2022] Open
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7
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Campbell WW, Landau M. Treatment and Management of Segmental Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Zubair AS, Wang A, Roy B. Ulnar neuropathy from accessory epitrochlearis anconeus muscle. Neurol Sci 2021; 43:2165-2166. [PMID: 34786630 DOI: 10.1007/s10072-021-05713-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Adeel S Zubair
- Department of Neurology, Division of Neuromuscular Medicine, Yale University School of Medicine, CT, New Haven, USA
| | - Annie Wang
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Bhaskar Roy
- Department of Neurology, Division of Neuromuscular Medicine, Yale University School of Medicine, CT, New Haven, USA.
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9
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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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10
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Pelosi L, Arányi Z, Beekman R, Bland J, Coraci D, Hobson-Webb LD, Padua L, Podnar S, Simon N, van Alfen N, Verhamme C, Visser L, Walker FO, Yoon JS, Cartwright MS. Expert consensus on the combined investigation of ulnar neuropathy at the elbow using electrodiagnostic tests and nerve ultrasound. Clin Neurophysiol 2021; 132:2274-2281. [PMID: 34229959 DOI: 10.1016/j.clinph.2021.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/16/2021] [Accepted: 04/30/2021] [Indexed: 12/20/2022]
Abstract
The addition of ultrasound (US) to electrodiagnostic (EDX) tests can significantly enhance the accuracy of testing for ulnar neuropathy at the elbow (UNE). We aimed to obtain expert consensus to guide clinicians on the combined use of EDX and US in UNE investigation. Consensus was achieved using the Delphi method. Two consecutive anonymised questionnaires were submitted to 15 experts, who were asked to choose their level of agreement with each statement. Consensus was pre-defined as ≥ 80% rating agreement. The experts concluded that all investigations of UNE should include both nerve conduction studies and US. There was consensus that US should include cross-sectional area measurement and assessment of nerve mobility at the elbow, and that the entire ulnar nerve should be imaged. This study defined expert opinion on the 'core' techniques that should be used routinely in the UNE investigation using EDX and US. Areas with lack of consensus highlighted some controversial issues in the current use of these diagnostic modalities and the need for future research. This document is an initial step to guide clinicians on the combined investigation of UNE using EDX and US, to be regularly updated as new research emerges.
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Affiliation(s)
- Luciana Pelosi
- Departments of Neurology and Neurophysiology, Bay Of Plenty District Health Board, Tauranga Hospital, Tauranga, New Zealand.
| | - Zsuzsanna Arányi
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Roy Beekman
- Zuyderland Medical Centre, Departement of Neurology, Heerlen, the Netherlands
| | - Jeremy Bland
- Department of Neurophysiology, East Kent Hospitals University NHS Trust, UK
| | - Daniele Coraci
- IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Lisa D Hobson-Webb
- Duke University, Department of Neurology/Neuromuscular Division, Durham, NC, USA
| | - Luca Padua
- IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Simon Podnar
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Centre Ljubljana, Slovenia
| | - Neil Simon
- Northern Clinical School, the University of Sydney, NSW, Australia
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Camiel Verhamme
- Department of Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Leo Visser
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Francis O Walker
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joon Shik Yoon
- Department of Rehabilitation Medicine, Korea University Hospital at Guro, Korea University Medical College, Seoul, Republic of Korea
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11
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Ultrasound: A Useful Tool in the Diagnosis and Localization of Ulnar Neuropathy at the Elbow. Ochsner J 2021; 21:3-5. [PMID: 33828418 PMCID: PMC7993428 DOI: 10.31486/toj.21.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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12
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Zhao H, Nepal P, Alam SI. Sonographic evaluation of leprosy of ulnar nerve. Radiol Case Rep 2021; 16:1057-1060. [PMID: 33680276 PMCID: PMC7917452 DOI: 10.1016/j.radcr.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/18/2022] Open
Abstract
Leprosy is a chronic granulomatous infection caused by Mycobacterium Leprae that predominantly affects the skin and peripheral nerves. The disease is prevalent in developing countries of Asia and Africa, with occasional cases reported from United States. In this case report we highlight a 33-year-old man from Qatar, who presented with symptoms of progressive weakness in his left wrist and hand for six months and was later found to have a granuloma of the ulnar nerve secondary to leprosy. We will discuss the etiopathogenesis, clinical features, role of imaging, and management of neuropathy due to leprosy. Our case provides an excellent learning example of the utility of ultrasonography to characterize leprosy granulomas of the ulnar nerve.
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Affiliation(s)
- Helen Zhao
- Frank H Netter School of Medicine, Quinnipiac University, CT 06473, USA
- Corresponding author.
| | - Pankaj Nepal
- Frank H Netter School of Medicine, Quinnipiac University, CT 06473, USA
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13
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Abstract
PURPOSE Although there are many case reports on the role of ultrasonography (US) in distal ulnar nerve neuropathy (Guyon canal syndrome), there is a paucity of large series in the literature because of its rarity. During an 8-year period, 33 instances of electrodiagnostically confirmed cases underwent US imaging. These cases were analyzed to determine the role of US in uncovering the cause of distal ulnar nerve neuropathy and its contribution to further management. METHODS This was a retrospective study of patients diagnosed with distal ulnar nerve neuropathy based on electrodiagnostic criteria, who also had undergone US (measurement of the cross-sectional area and documentation of causes such as cysts and neuromas). RESULTS US showed normal ulnar nerve in 5, cysts in 10, neuromas in 2, and nonspecific enlargement in 16 patients. Surgery was performed in 15 patients, and the US findings were corroborated in those with cysts and neuromas; 1 patient had an aberrant muscle, and two had fibrous bands constricting the ulnar nerve in the Guyon canal (not detected preoperatively by US imaging). CONCLUSIONS US imaging detected the underlying cause of distal ulnar nerve neuropathy in a significant percentage of patients, potentially contributing to effective treatment.
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14
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Pelosi L, Yong V, Blumhardt LD. Utility of nerve ultrasound in ulnar neuropathy with abnormal non-localizing electrophysiology in diabetes mellitus. Neurophysiol Clin 2020; 50:387-390. [PMID: 32994094 DOI: 10.1016/j.neucli.2020.09.001] [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] [Received: 07/01/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022] Open
Abstract
We studied the utility of ultrasound in the diagnostic workup of ulnar neuropathy with abnormal non-localizing electrophysiology (NL-UN) in patients with diabetes. Eighteen ulnar nerves (15 patients) were scanned from wrist to mid-upper arm. Ultrasound showed: (a) focal nerve enlargement at the elbow (8/18 nerves), either alone (6) or superimposed upon diffuse nerve abnormality (2); (b) diffuse nerve enlargement without focal abnormality (8/18); (c) segmental abnormality in upper-arm or forearm without extrinsic nerve compression (2/18). This study shows a pivotal role for ultrasound in the classification of NL-UN in patients with diabetes, which can facilitate critical therapeutic decisions.
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Affiliation(s)
- Luciana Pelosi
- Departments of Neurology and Neurophysiology, Bay Of Plenty District Health Board, Tauranga Hospital, Tauranga, New Zealand.
| | - Vivien Yong
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand
| | - Lance D Blumhardt
- University Department of Clinical Neurology, Nottingham, United Kingdom
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15
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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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16
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Is ultrasound better than electrodiagnosis for the diagnosis of compressive neuropathy? Clin Neurophysiol 2020; 131:1657-1659. [PMID: 32362459 DOI: 10.1016/j.clinph.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023]
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17
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Abstract
Nerve imaging is an important component in the assessment of patients presenting with suspected peripheral nerve pathology. Although magnetic resonance neurography and ultrasound are the most commonly utilized techniques, several promising new modalities are on the horizon. Nerve imaging is useful in localizing the nerve injury, determining the severity, providing prognostic information, helping establish the diagnosis, and helping guide surgical decision making. The focus of this article is imaging of damaged nerves, focusing on nerve injuries and entrapment neuropathies.
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Affiliation(s)
- David A Purger
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sarada Sakamuri
- Department of Neurology and Neurological Sciences, 213 Quarry Road, MC 5979, Palo Alto, CA 94304, USA
| | - Nicholas F Hug
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sandip Biswal
- Department of Radiology, Stanford University, 300 Pasteur Drive, S-068B, Stanford, CA 94305, USA
| | - Thomas J Wilson
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, R293, Stanford, CA 94305, USA.
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Tawfik EA, Cartwright MS, Grimm A, Boon AJ, Kerasnoudis A, Preston DC, Wilder‐Smith E, Axer H, Hobson‐Webb LD, Alfen N, Crump N, Shahrizaila N, Inkpen P, Mandeville R, Sakamuri S, Shook SJ, Shin S, Walker FO. Guidelines for neuromuscular ultrasound training. Muscle Nerve 2019; 60:361-366. [DOI: 10.1002/mus.26642] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Eman A. Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of MedicineAin Shams University Cairo Egypt
| | | | - Alexander Grimm
- Department of NeurologyUniversity Hospital Tuebingen Tuebingen Germany
| | - Andrea J. Boon
- Department of Physical Medicine and RehabilitationMayo Clinic Rochester Minnesota
| | | | - David C. Preston
- Neurological Institute, University Hospitals, Cleveland Medical CenterCase Western Reserve University Cleveland Ohio
| | - Einar Wilder‐Smith
- Department of NeurologyYong Loo Lin School of Medicine, National University Singapore Singapore
| | - Hubertus Axer
- Hans Berger Department of NeurologyJena University Hospital Jena Germany
| | - Lisa D. Hobson‐Webb
- Department of Neurology, Neuromuscular DivisionDuke University School of Medicine Durham North Carolina
| | - Nens Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition, and BehaviorRadboud University Medical Center Nijmegen The Netherlands
| | - Nicholas Crump
- Department of NeurologyAustin Health and University of Melbourne Heidelberg Victoria Australia
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
| | - Peter Inkpen
- Division of Physical Medicine and RehabilitationUniversity of British Columbia Vancouver British Columbia Canada
| | - Ross Mandeville
- Department of NeurosciencesUniversity of California San Diego School of Medicine La Jolla California
| | - Sarada Sakamuri
- Department of Neurology and Neurological SciencesStanford University Stanford California
| | - Steven J. Shook
- Department of NeurologyNeuromuscular Center, Cleveland Clinic Cleveland Ohio
| | - Susan Shin
- Department of Neurology, Mount Sinai School of Medicine New York New York
| | - Francis O. Walker
- Department of NeurologyWake Forest School of Medicine Winston‐Salem North Carolina
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19
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Gonzalez NL, Hobson-Webb LD. Neuromuscular ultrasound in clinical practice: A review. Clin Neurophysiol Pract 2019; 4:148-163. [PMID: 31886438 PMCID: PMC6921231 DOI: 10.1016/j.cnp.2019.04.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022] Open
Abstract
Neuromuscular ultrasound (NMUS) is becoming a standard element in the evaluation of peripheral nerve and muscle disease. When obtained simultaneously to electrodiagnostic studies, it provides dynamic, structural information that can refine a diagnosis or identify a structural etiology. NMUS can improve patient care for those with mononeuropathies, polyneuropathy, motor neuron disease and muscle disorders. In this article, we present a practical guide to the basics of NMUS and its clinical application. Basic ultrasound physics, scanning techniques and clinical applications are reviewed, along with current challenges.
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Affiliation(s)
- Natalia L. Gonzalez
- Department of Neurology/Neuromuscular Division, Duke University Hospital, DUMC 3403, Durham, NC 27710, USA
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20
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Karvelas KR, Walker FO. Clinical and Ultrasonographic Features of Distal Ulnar Neuropathy: A Review. Front Neurol 2019; 10:632. [PMID: 31293494 PMCID: PMC6601364 DOI: 10.3389/fneur.2019.00632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/29/2019] [Indexed: 01/04/2023] Open
Abstract
Focal ulnar neuropathy at the wrist is a rare but problematic disorder often associated with the unique anatomy of this nerve as it courses through Guyon's canal, a superficial fibro-osseous tunnel in the proximal ulnar palm. The electrophysiologic features of this disorder have been well-characterized, but the sonographic anatomy of the nerve across the wrist and palm has yet to be systematically described in normal and abnormal states. In this review, we describe the basic anatomy and the sonographic appearance of the nerve in the wrist and palm in normals and individuals with pathology. The value of using US in conjunction with electrodiagnostic testing is emphasized as the two tests together provide critical information regarding etiology, predisposing factors, and functional significance. Furthermore, ultrasound is useful as a patient educational tool to promote behavioral changes that assist in nerve recovery when pathology is related to repetitive stress.
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Affiliation(s)
- Kristopher R Karvelas
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Francis O Walker
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States
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