Clinical Findings and Electrodiagnostic Testing in Ulnar Neuropathy at the Elbow and Differences According to Site and Type of Nerve Damage

Vinciguerra, Claudia; Curti, Stefania; Aretini, Alessandro; Sicurelli, Francesco; Greco, Giovanna; Mattioli, Stefano; Mondelli, Mauro

doi:10.1097/phm.0000000000001286

Cited by 8 publications

(8 citation statements)

References 48 publications

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“…A recent paper showed differences in UNE regarding side, age and job between the two sites of injury of ulnar nerve at the retroepicondylar groove or at the humeroulnar arcade 9 . Even if our EDX protocol included inching MCV test across the elbow (2 cm short‐segment MCV) 25,50 and we were able to localize the site of the nerve injury, we did not elaborate the data according to the site of nerve damage; this will be the object of another study.…”

Section: Discussionmentioning

confidence: 99%

“…To confirm the clinical diagnosis of UNE we performed EDX according to a protocol inspired by AANEM, including the conduction velocity of the ulnar and median nerves and standard needle EMG of the first dorsal interosseous (FDI), abductor digiti minimi (ADM), flexor carpi ulnaris, abductor pollicis brevis, and at least one extensor muscle 20 . The details of EDX methods were reported elsewhere 25 . Our minimum electrodiagnostic criteria to include UNE cases were one of the following “localizing” EDX anomalies recording from FDI and ADM muscles: slowing of MCV across elbow or “conduction drop” (significant difference between MCV across elbow vs MCV below elbow‐wrist segments) or “conduction block” (abnormal percentage decrease in compound muscle action potential amplitude from below elbow to above elbow).…”

Section: Methodsmentioning

confidence: 99%

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Comorbidities, anthropometric, demographic, and lifestyle risk factors for ulnar neuropathy at the elbow: A case control study

Mondelli

Mattioli

Vinciguerra

et al. 2020

J Peripheral Nervous Sys

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We performed a prospective multicenter case-control study to explore the association between ulnar neuropathy at elbow (UNE) and body and elbow anthropometric measures, demographic and lifestyle factors, and comorbidities. Cases and controls were consecutively enrolled among subjects admitted to four electromyography labs. UNE diagnosis was made on clinical and neurographic findings. The control group included all other subjects without signs/symptoms of ulnar neuropathy and with normal ulnar nerve neurography. Anthropometric measurements included weight, height, waist, hip circumferences, and external measures of elbow using a caliper. The participants filled in a self-administered questionnaire on personal characteristics, lifestyle factors, and medical history. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) by fitting unconditional logistic regression models adjusted by center and education level. We enrolled 220 cases (males 61.8%; mean age 51.7 years) and 460 controls (47.4% males; mean age 47.8 years). At multivariable analysis, UNE was associated to male gender (OR = 2.4, 95%CI = 1.6-3.7), smoking habits (>25 pack-years (OR = 2.3, 95% CI = 1.3-4.1), body mass index (OR = 1.05, 95%CI 1.01-1.10), polyneuropathies (OR = 4.1, 95%CI 1.5-11.5), and leaning with flexed elbow on a table/desk (OR = 1.5, 95%CI 1.0-2.2). Cubital groove width (CGW) turned out to be negatively associated with UNE (OR = 0.80, 95%CI = 0.74-0.85). Our study suggests that some personal factors especially anthropometric measures of the elbow may play a role in UNE pathogenesis as the measures of wrist in CTS. We demonstrated that for each millimeter of smaller CGW the risk of idiopathic UNE increases of 25%.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Comorbidities, anthropometric, demographic, and lifestyle risk factors for ulnar neuropathy at the elbow: A case control study

Mondelli

Mattioli

Vinciguerra

et al. 2020

J Peripheral Nervous Sys

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“…Patients with primarily axonal lesions were older than those with primarily demyelinating findings, but there were no other differences with respect to demographic findings, side, and localization of UNE. 4 In a study of UNE associated with ulnar nerve dislocation/subluxation, Kang reported a higher rate of axonal injury to the ulnar nerve in those with subluxation or dislocation, as seen on ultrasound. 8 There are limitations to our study.…”

Section: Resultsmentioning

confidence: 97%

“…Due to the nature of the injury, one might expect that chronic compressive neuropathies, including ulnar neuropathies, would be primarily demyelinating and an acute traumatic injury might be primarily axonal 4,5 . However, there is limited evidence in the literature to either support or refute this conclusion regarding UNE.…”

Section: Introductionmentioning

confidence: 99%

Comparison of electrodiagnostic findings in acute traumatic versus chronic non‐traumatic ulnar neuropathy at the elbow

Robinson,

Broadhurst,

Wasserman

2023

Muscle and Nerve

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Introduction/AimsA common concept is that traumatic nerve injuries are more likely axonal, and that compressive neuropathies are more likely demyelinating. The purpose of this study was to compare traumatic versus non‐traumatic ulnar neuropathy at the elbow (UNE) to look for electrodiagnostic differences between the two groups.MethodsA retrospective 3 year review of UNE patients at two academic health science centers was conducted. Patients were grouped into acute traumatic UNE versus chronic non‐traumatic UNE based on clinical history. Electrodiagnostic measurements were compared between the two groups.ResultsThere were 50 subjects with acute traumatic UNE and 41 with chronic non‐traumatic UNE. Mean age and sex distribution were similar but those with traumatic UNE had a 7 month duration of symptoms, while those with chronic UNE had 29 month duration (p < .001). All electrodiagnostic measurements were similar between the two groups including compound muscle action potential amplitudes, motor conduction velocities, frequency of conduction block, sensory nerve studies, and needle electromyography.DiscussionWe did not find a difference between the two groups. One should not make inferences regarding acuity or etiology based on electrodiagnostic features alone.

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“…The details of the NCS and EMG have been reported elsewhere. [14][15][16] Based on the type of electrophysiological damage, the UNE patients were categorized as axonal damage forms if they demonstrated mNCV slowing across the elbow, neurogenic EMG pattern, and/or reduction of the CMAP amplitude at the wrist and no significant percentage of CMAP amplitude decrease across the elbow, and as demyelinating forms if they demonstrated a sufficient percentage CMAP amplitude decrease across the elbow, and/or mNCV slowing across the elbow according to the cut-off values in our electrodiagnostic laboratory, without abnormalities of CMAP amplitude with stimulation at the wrist and no EMG denervation activity at rest. The abnormalities of U5 SNAPs were not used to differentiate the two forms because this does not necessarily imply an axonal damage.…”

Section: Ncs and Emgmentioning

confidence: 99%

Cutaneous silent period in ulnar neuropathy at the elbow

Mondelli

Aretini

2021

Muscle and Nerve

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Introduction/Aims: The cutaneous silent period (CSP) reflects the function of A-delta sensory fibers. There are few studies on CSP in nerve entrapment syndromes. This study aims to evaluate the neurophysiological abnormalities of small-diameter sensory fibers in ulnar neuropathy at the elbow (UNE) by means of CSP.Methods: We consecutively evaluated UNE patients at one electrodiagnostic laboratory. The CSP was obtained upon stimulating the fifth (D5) and third digits, recording from the first dorsal interosseous (FDI) and abductor pollicis brevis (APB) muscles.Results: We enrolled 37 UNE patients (mean age 55.4 ± 11.2 y) and 30 controls (mean age 51.2 ± 11.1 y). The combinations of the D5-APB and D5-FDI mean onset latencies of CSP were significantly more prolonged in patients (83.7 ± 6.8 and 84.5 ± 8 ms, respectively) than in controls (78.2 ± 8.1 and 79.4 ± 7.6 ms, respectively).The D5-FDI duration of CSP was shorter in patients (52.2 ± 8.3 ms) than in controls (55.8 ± 7 ms). The mean of the onset latencies of D5-FDI and D5-APB was related to the clinical severity (P = .013 and .0025, respectively). D5-APB and D5-FDI onset latencies were more prolonged and the duration was shorter in the UNE group with absent ulnar sensory nerve action potentials (SNAPs) and axonal motor damage than in patients with preserved SNAPs and with demyelinating damage.Discussion: CSP was able to demonstrate abnormalities of small-diameter myelinated sensory fibers. This damage was directly related to UNE severity and to axonal damage of motor fibers. Absence of a sensory large-diameter fiber response did not exclude preserved residual small fiber conduction.

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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

Abstract: The authors state that there are no conflicts of interest and that they have not received any financial support. This research has never been presented previously as a full manuscript, nor as an abstract for scientific congresses.

Cited by 8 publications

References 48 publications

Comorbidities, anthropometric, demographic, and lifestyle risk factors for ulnar neuropathy at the elbow: A case control study

Comorbidities, anthropometric, demographic, and lifestyle risk factors for ulnar neuropathy at the elbow: A case control study

Comparison of electrodiagnostic findings in acute traumatic versus chronic non‐traumatic ulnar neuropathy at the elbow

Cutaneous silent period in ulnar neuropathy at the elbow

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