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Kong G, Brutus JP, Vo TT, Hagert E. The prevalence of double- and multiple crush syndromes in patients surgically treated for peripheral nerve compression in the upper limb. HAND SURGERY & REHABILITATION 2023; 42:475-481. [PMID: 37714514 DOI: 10.1016/j.hansur.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/04/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE The double crush syndrome describes a condition characterized by multifocal entrapment of a nerve. In the upper limb, the high prevalence of carpal tunnel syndrome makes it a common diagnosis of assumption in the setting of median neuropathy. More proximal compressions may tend to be overlooked, under-diagnosed and under-treated in the population. This study aims to map the prevalence of peripheral upper limb nerve compressions among patients undergoing peripheral nerve decompression. METHODS A prospective case series was conducted on 183 patients undergoing peripheral nerve decompression in a private hand surgery clinic. Level(s) of nerve compression in the median, ulnar and radial nerves were determined by history and physical examination. The prevalence of each nerve compression syndrome or combination of syndromes was analyzed. RESULTS A total of 320 upper limbs in 183 patients were analyzed. A double crush of the median nerve at the levels of the lacertus fibrosus and carpal tunnel was identified in 78% of upper limbs with median neuropathy, whereas isolated lacertus syndrome and carpal tunnel syndrome were present in only 5% and 17% of affected limbs respectively. Cubital tunnel syndrome affected 12.5% of upper limbs, and 80% of these had concomitant lacertus and carpal tunnel syndromes, compared to only 7.5% with isolated cubital tunnel syndrome. CONCLUSION A high prevalence should prompt clinicians towards more routine assessment for double crush syndrome to avoid misdiagnosis, inadequate treatment, recurrence, and revision surgeries.
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Affiliation(s)
- Geraldine Kong
- Hamad Medical Corporation, Dept. of Orthopedic Surgery, Doha, Qatar
| | | | | | - Elisabet Hagert
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Karolinska Institutet, Dept. of Clinical Science and Education, Sodersjukhuset, Stockholm, Sweden
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Mansoori K, Raissi GR, Madani SP, Ameri M, ZoghAli M, Sajadi S. A Three months Electrodiagnostic Follow-Up of Patients Suspected of having Ulnar Nerve Involvement at Elbow Level with Normal Conventional Electrodiagnostic Study at First Evaluation. Neurol India 2022; 70:1920-1924. [PMID: 36352588 DOI: 10.4103/0028-3886.359279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Compression of ulnar nerve at the elbow is the second most common peripheral neuropathy of the upper extremity. OBJECTIVE Due to the lack of the gold diagnostic standard for ulnar nerve involvement at elbow level (UNE) and the lack of sufficient study in this field, we decided to evaluate patients with symptoms of this disease who have normal conventional electrodiagnostic study (EDX) in first evaluation. MATERIALS AND METHODS In this cross-sectional study, 18 persons were selected from patients who were referred to the clinic of Physical Medicine and Rehabilitation. If conventional EDX was normal, compound nerve action potential (CNAP) test (peak latency and amplitude) was carried out. Patients with normal conventional EDX but abnormal ulnar CNAP included to our study. After 3 months, if they had not been treated for ulnar neuropathy, they were reexamined by conventional EDX plus ulnar CNAP measurement. RESULTS In total, 18 patients (11 females, 7 males) aged 28-58 years old (mean = 40.11) were analyzed in this study. After 3 months, 14 patients (77.8%) demonstrated parameter changes consistent with UNE in conventional EDX. CONCLUSION Based on the results of this study, ulnar CNAP has diagnostic value in patients with symptoms of UNE who have normal routine EDX. Therefore, ulnar CNAP should be taken into account for early diagnosis of ulnar neuropathy when routine electrodiagnostic tests are normal.
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Affiliation(s)
- Korosh Mansoori
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Gholam Reza Raissi
- Department of Physical Medicine and Rehabilitation, Neuromusculoskeletal Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Pezhman Madani
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran; ALS Clinical and Research Fellow, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Milad Ameri
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masoume ZoghAli
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Simin Sajadi
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
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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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Di Virgilio G, Grapperon AM, Fayerstein J, Goudot M, Nollet S, Ochsner F, Théaudin M, Truffert A, Tsouni P, Vial C, Wang FC, Pasquier J, Tatu L, Attarian S, Kuntzer T. Ulnar neuropathy at the elbow: Reappraisal of the wrist-upper arm latency difference between ulnar and median nerves. Clin Neurophysiol 2019; 131:372-376. [PMID: 31865138 DOI: 10.1016/j.clinph.2019.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the sensitivity and specificity of the latency difference (DLat) between ulnar and median nerves of the arm after stimulation at the wrist; one of the easiest techniques proposed for recognizing ulnar neuropathy at the elbow (UNE). As latency difference is not a standardized technique, we set up a multicenter study to recruit large numbers of normal subjects and patients with UNE or generalized neuropathy. METHODS Six centers participated in the study with data obtained from three groups of participants, controls (CTRLs), patients with UNE and patients with generalized neuropathy (GNP). We first verified the anatomical superposition of the ulnar and median nerves in cadaver examination. The optimal recording site for these two nerves was found to be 10 cm above the medial epicondyle. We then standardized the position of the arm with full extension of the elbow and stimulated first the median and then the ulnar nerves at the wrist. CTRLs were examined on both arms at two consecutive visits. RESULTS We recorded 32 idiopathic UNE cases, 44 GNP patients and 62 controls. We demonstrated that a DLat cut-off value of 0.69 ms brings a sensitivity of 0.86 and specificity of 0.89 to discriminate CTRLs from UNE. We also validated that intra-examiner reproducibility was good. CONCLUSION We report a lower normal value for DLat than reported in several non-standardized studies and CTRL and UNE groups have clearly separated DLat values. SIGNIFICANCE Due to its high sensitivity, our standardized technique could be used as a first-line diagnostic tool when UNE is suspected.
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Affiliation(s)
- G Di Virgilio
- Unité Nerf-Muscle, Service de Neurologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - A M Grapperon
- Reference Center for Neuromuscular Disorders and ALS, CHU La Timone, Aix-Marseille University, Marseille, France
| | - J Fayerstein
- Reference Center for Neuromuscular Disorders and ALS, CHU La Timone, Aix-Marseille University, Marseille, France
| | - M Goudot
- Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - S Nollet
- Service de Neurologie-Électrophysiologie clinique, University Hospital (CHRU), Besançon, France
| | - F Ochsner
- Unité Nerf-Muscle, Service de Neurologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - M Théaudin
- Unité Nerf-Muscle, Service de Neurologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - A Truffert
- Unité de Neuroimmunologie et des maladies Neuromusculaires, Hôpitaux Universitaires de Genève (HUG), Switzerland
| | - P Tsouni
- Unité Nerf-Muscle, Service de Neurologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Unité de Neuroimmunologie et des maladies Neuromusculaires, Hôpitaux Universitaires de Genève (HUG), Switzerland
| | - C Vial
- Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - F C Wang
- Neurophysiology Department, CHU Sart Tilman, Liège, Belgium
| | - J Pasquier
- Département Formation, Recherche et Innovation, Centre universitaire de médecine générale et santé publique, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - L Tatu
- Service de Neurologie-Électrophysiologie clinique, University Hospital (CHRU), Besançon, France
| | - S Attarian
- Reference Center for Neuromuscular Disorders and ALS, CHU La Timone, Aix-Marseille University, Marseille, France
| | - T Kuntzer
- Unité Nerf-Muscle, Service de Neurologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
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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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Clinical Findings and Electrodiagnostic Testing in Ulnar Neuropathy at the Elbow and Differences According to Site and Type of Nerve Damage. Am J Phys Med Rehabil 2019; 99:116-123. [PMID: 31369403 DOI: 10.1097/phm.0000000000001286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the clinical and electrodiagnostic testing in ulnar neuropathy at the elbow and differences according to site (humeroulnar arcade vs. retroepicondylar groove) and injury physiopathology (axonal vs. demyelinating), through prospective multicenter case-control study. DESIGN Cases and controls were matched by age and sex. Ulnar neuropathy at the elbow diagnosis was made on symptoms. Statistical analysis was performed using Mann-Whitney, χ, and analysis of variance tests. RESULTS One hundred forty-four cases and 144 controls were enrolled. Sensory loss in the fifth finger had the highest sensitivity (70.8%) compared with clinical findings. Motor conduction velocity across elbow reached the highest sensitivity (84.7%) in localizing ulnar neuropathy at the elbow recording from at least one of the two hand muscles (first dorsal interosseous and abductor digiti minimi). Abnormal sensory action potential amplitude from the fifth finger occurred more frequently in axonal than in demyelinating forms. Differences between retroepicondylar groove and humeroulnar arcade regarded conduction block and job type. CONCLUSIONS Clinical findings have less usefulness than electrodiagnostic testing in ulnar neuropathy at the elbow diagnosis. Motor conduction velocity across elbow recorded from both abductor digiti minimi and first dorsal interosseous increases diagnostic accuracy. Axonal forms have greater clinical and electrodiagnostic testing severity than demyelinating forms, which are more frequent in retroepicondylar groove. Manual workers prevailed in humeroulnar arcade. These findings may be helpful in prognostic and therapeutic approaches.
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Speach DP, Lee DJ, Reed JD, Palmer BA, Abt P, Elfar JC. Is medial elbow pain correlated with cubital tunnel syndrome? An electrodiagnostic study. Muscle Nerve 2015; 53:252-4. [PMID: 26032904 DOI: 10.1002/mus.24719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 05/20/2015] [Accepted: 05/28/2015] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Medial elbow pain is often considered to be a symptom associated with ulnar neuropathy at the elbow (UNE). We examined the relationship between medial elbow pain and a positive electrodiagnostic (EDx) test result for UNE. METHODS We performed a retrospective review of 884 patients referred for EDx evaluation of UNE. Regression models were used to determine the odds ratios between clinical findings and a positive EDx result for UNE. RESULTS Patients reported medial elbow pain in 44.3% of cases. Clinical factors that correlated with a positive EDx study result for UNE included male gender, small and ring finger numbness, ulnar intrinsic weakness, and age. Medial elbow pain was negatively correlated with a positive EDx result. CONCLUSIONS This study demonstrates a negative correlation between medial elbow pain and a positive EDx result for UNE. Medial elbow pain should not be considered a clear diagnostic symptom of UNE.
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Affiliation(s)
- David P Speach
- Department of Orthopaedic Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, New York, 14642, USA
| | - Daniel J Lee
- Department of Orthopaedic Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, New York, 14642, USA
| | - Jeffrey D Reed
- Department of Orthopaedic Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, New York, 14642, USA
| | - Bradley A Palmer
- Center for Orthopedics, St. Clair Hospital, Pittsburgh, Pennsylvania, USA
| | - Patrick Abt
- Department of Orthopaedic Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, New York, 14642, USA
| | - John C Elfar
- Department of Orthopaedic Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, New York, 14642, USA
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