Neurophysiological localisation of ulnar neuropathy at the elbow: Validation of diagnostic criteria developed by a taskforce of the Danish Society of clinical neurophysiology

Pugdahl, Kirsten; Beniczky, Sándor; Wanscher, Benedikte; Johnsen, Birger; Qerama, Erisela; Ballegaard, Martin; Benedek, Krisztina; Juhl, Anne; Ööpik, M.-L.; Selmar, P.; Sønderborg, J.; Terney, Daniella; Fuglsang‐Frederiksen, Anders

doi:10.1016/j.clinph.2017.08.018

Cited by 9 publications

(6 citation statements)

References 22 publications

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“…In patients with abnormal median and ulnar NCS, palm recordings of the median nerve were performed. For ulnar nerve entrapment neuropathy, NCS both at the forearm and at the elbow were performed and the published criteria developed by the Danish Consensus Group were used (Pugdahl et al, 2017).…”

Section: Methodsmentioning

confidence: 99%

Evidence-based recommendations for examination and diagnostic strategies of polyneuropathy electrodiagnosis

Tankisi

Pugdahl

Beniczky

et al. 2019

Clinical Neurophysiology Practice

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Section: Methodsmentioning

confidence: 99%

Evidence-based recommendations for examination and diagnostic strategies of polyneuropathy electrodiagnosis

Tankisi

Pugdahl

Beniczky

et al. 2019

Clinical Neurophysiology Practice

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“…6 Scores were assigned based on degree of NCV across elbow and forearm, presence or absence of a difference exceeding 20 m/s for across elbow NCV compared with forearm, and presence or absence of conduction block across the elbow. 6 To improve clinical certainty, additional ulnar motor conduction studies were recommended including adductor pollicis, FDI, and sensory near nerve needle technique. Neither the Danish task force nor the AANEM appear to have considered using the mixed across the elbow NCS to enhance diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 99%

“…Neither the Danish task force nor the AANEM appear to have considered using the mixed across the elbow NCS to enhance diagnostic accuracy. 6 10 Given that patients with mainly sensory symptoms are more difficult to diagnose with electrodiagnostic testing 1 8 ; further tests to evaluate sensory and motor function should be useful.…”

Section: Discussionmentioning

confidence: 99%

“…Such aspects that limit utility include, measurement error, selective fascicular involvement, challenging data interpretation, and inability to adequately localize the lesion. 1 4 5 6 Measurement variability (standard deviation) of the across elbow distance increases when the elbow is flexed. 7 The absence of weakness or atrophy in muscles innervated by the ulnar nerve is another important factor that potentially limits the functionality of electrodiagnostic testing as these patients have more subtle abnormalities.…”

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An Additional Electrodiagnostic Tool for Ulnar Neuropathy: Mixed across the Elbow

Parkhurst

Andary

Powell

2020

J Brachial Plex Peripher Nerve Inj

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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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“…When axonal damage is present, the amplitude of the sensory nerve action potential (SNAP) is reduced or absent. 19 Non-ulnar muscles of the C8 myotome (abductor pollicis brevis, extensor indicis proprius) should be tested to exclude C8 radiculopathy or lower trunk/brachial plexopathy of the medial cord. 13 Fig.…”

Section: Ulnar Neuropathy In the Elbowmentioning

confidence: 99%

Most Frequent Compressive Limb Neuropathies: A Literature Review

Silva

Cronemberger

Moura

et al. 2022

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Peripheral nerve injuries vary in length and severity, and they can occur secondary to trauma, compression and ischemia, leading to both motor and sensory neurological deficits. Nerve compression can occur in both the upper and lower limbs. These injuries can affect the quality of life, including the total or partial loss of the individual's productive capacity. The diagnostic methods are based on clinical criteria, but they may also include imaging and electroneurophysiological studies. A clinical examination using the Tinel and Phalen tests, for example, may suggest carpal tunnel syndrome. Complementary exams are used to confirm the diagnosis and rule out other possibilities, and the most used are electroneuromyography (ENMG), computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US). Depending on the type of injury, recovery may be spontaneous or may require conservative or surgical treatment.

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Neurophysiological localisation of ulnar neuropathy at the elbow: Validation of diagnostic criteria developed by a taskforce of the Danish Society of clinical neurophysiology

Cited by 9 publications

References 22 publications

Evidence-based recommendations for examination and diagnostic strategies of polyneuropathy electrodiagnosis

Evidence-based recommendations for examination and diagnostic strategies of polyneuropathy electrodiagnosis

An Additional Electrodiagnostic Tool for Ulnar Neuropathy: Mixed across the Elbow

Most Frequent Compressive Limb Neuropathies: A Literature Review

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