Stimulus electrodiagnosis and motor and functional evaluations during ulnar nerve recovery

Abstract

BACKGROUND: Distal ulnar nerve injury leads to impairment of hand function due to motor and sensorial changes. Stimulus electrodiagnosis (SE) is a method of assessing and monitoring the development of this type of injury. OBJECTIVE: To identify the most sensitive electrodiagnostic parameters to evaluate ulnar nerve recovery and to correlate these parameters (Rheobase, Chronaxie, and Accommodation) with motor function evaluations. METHOD: A prospective cohort study of ten patients submitted to ulnar neurorrhaphy and evaluated using electrodiagnosis and motor assessment at two moments of neural recovery. A functional evaluation using the DASH questionnaire (Disability of the Arm, Shoulder, and Hand) was conducted at the end to establish the functional status of the upper limb. RESULTS: There was significant reduction only in the Chronaxie values in relation to time of injury and side (with and without lesion), as well as significant correlation of Chronaxie with the motor domain score. CONCLUSION: Chronaxie was the most sensitive SE parameter for detecting differences in neuromuscular responses during the ulnar nerve recovery process and it was the only parameter correlated with the motor assessment.

Reply to “Stimulus electrodiagnosis and motor and functional evaluations during ulnar nerve recovery”

“…We thank the authors (Coraci and colleagues) for your interest in our paper and for the great contribution to this important research topic. The authors of the letter demonstrate a good perception of the relevance of our study (Fernandes et al 1 ), which aims to retrieve the use of stimulus electrodiagnosis. Another objective of this paper is to encourage the new generation of physical therapists to study, explore, and use this instrument in clinical practice.…”

“…We have read with great attention the paper by Fernandes and colleagues about electrodiagnosis as a monitoring tool in ulnar nerve recovery after surgical treatment of nerve lesion 1 . The study is very interesting and aims to demonstrate that, among the electrodiagnostic parameters, Chronaxie may be the one that best detects the evolution of neuromuscular responses in ulnar nerve recovery.…”

Intra- and inter-rater reliability and agreement of stimulus electrodiagnostic tests in post-COVID-19 patients

“…In clinical practice, needle electromyography is considered to be the standard method for diagnosing neuromuscular electrophysiological disorders (NED), allowing quantitative grading, type, and localization of the neurogenic lesions (Paternostro-Sluga et al 2002). One surrogate method to detect NED is the stimulus electrodiagnosis test (SET), which evaluates neuromuscular excitability and the nerve recovery process, using a transcutaneous electrical stimulus (Paternostro-Sluga et al 2002, Fernandes et al 2016, Silva et al 2018, de Araujo et al 2019, Santana et al 2022. The SET could be more advantageous than needle electromyography since it is a non-invasive assessment, that is low-cost, and more comfortable for the patient (Paternostro-Sluga et al 2002, Fernandes et al 2016.…”

“…One surrogate method to detect NED is the stimulus electrodiagnosis test (SET), which evaluates neuromuscular excitability and the nerve recovery process, using a transcutaneous electrical stimulus (Paternostro-Sluga et al 2002, Fernandes et al 2016, Silva et al 2018, de Araujo et al 2019, Santana et al 2022. The SET could be more advantageous than needle electromyography since it is a non-invasive assessment, that is low-cost, and more comfortable for the patient (Paternostro-Sluga et al 2002, Fernandes et al 2016.…”

Aplicação da técnica de eletrodiagnóstico em pacientes críticos: uma revisão sistemática

“…Portanto, observou-se por parte dos profissionais, a necessidade de avaliar as alterações neuromusculares apresentadas, sendo o exame de eletrodiagnóstico uma possibilidade, por ser de baixo custo e não invasivo. Este teste de estímulo permite a aquisição de motor limiares de excitabilidade (reóbase e cronaxia) 8,9 . Dentro dos parâmetros determinados através do exame de eletrodiagnóstico, os principais são: a construção das curvas de intensidade-duração do pulso (através de correntes de pulso retangulares e exponenciais), a determinação da reóbase, que é a intensidade mínima da corrente para promover uma contração muscular com tempo de pulso muito largo (que em termos fisiológicos é 1 segundo), a determinação da cronaxia, que é o tempo de pulso para promover uma contração muscular usando-se uma intensidade duas vezes o valor da reóbase, a determinação da capacidade que os músculos Têm de se acomodarem a pulsos largos de subida lenta (acomodação) 10,11 .…”