Neurophysiological Diagnosis of the Ulnar Nerve Damage at the Elbow


Authors: E. Ehler 1;  P. Ridzoňihash2ihash4 2,3 3,5 3,5;  H. Matulová 7;  P. Otruba 8;  J. Latta 1
Authors‘ workplace: Neurologická klinika FZS UPa a Pardubická krajská nemocnice, a. s. 1;  Neurologická klinika IPVZ a Thomayerova nemocnice, Praha 2;  Klinika pracovního lékařství 1. LF UK a VFN v Praze 3;  Klinika pracovního lékařství LF UP a FN Olomouc 4;  Státní zdravotní ústav, Praha 5;  Neurologická klinika 2. LF UK a FN v Motole, Praha 6;  Neurologická klinika LF UK a FN Hradec Králové 7;  Neurologická klinika LF UP a FN Olomouc 8
Published in: Cesk Slov Neurol N 2012; 75/108(3): 320-325
Category: Original Paper

Overview

Damage to the ulnar nerve most frequently develops around the elbow region. Some occupations are associated with a chronic trauma to the ulnar nerve at the elbow and the resulting damage could be, under ceratin circumstances, classified as an occupational disease. Neurophysiological investigation is essential for the diagnosis of the ulnar nerve damage at the elbow. Reliable localization of the damage to the elbow region is prerequisite. Determination of the severity of the ulnar nerve damage is also important. For the purposes of obtaining an expert opinion, a standardized investigation guaranteeing comparable results from all EMG laboratories, is required. The authors discuss in detail the specific methodological parameters of a neurophysiological investigation of the ulnar nerve at the elbow. An investigational protocol is proposed that assesses the ulnar nerve in rectangular elbow flexion with the nerve stimulation at 4 cm below and 6 cm above the elbow and with registration from both, m. abductor digiti minimi and m. inteosseus dorsalis primus. Finally, the authors present the results from their own sample of patients assessed with the proposed protocol.

Key words:
ulnar nerve – expert opinion – neurophysiological investigation


Sources

1. Stewart JD. Focal Peripheral neuropathies. 3rd ed. Philadelphia: Lippincott Williams Wilkins 2000.

2. Ehler E, Ambler Z. Mononeuropatie. Praha: Galén 2002.

3. Bleecker ML. Occupational and clinical neurotoxicology. Baltimore: Williams & Wilkins 1994.

4. AAEM. Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement. Muscle Nerve 1999; 22(3): 408–411.

5. Kadaňka Z, Dufek J, Hromada J. Standard elektrofyziologického vyšetření syndromu karpálního tunelu pro potřeby hlášek choroby z povolání. Věstník MZd ČR 2003; 10: 3–4.

6. Lukáš E. Příspěvek k otázce paréz n. ulnaris profesionál­ního původu. Pracovní lékařství 1967; 19: 26–29.

7. Van Rijn RM, Huisstede BM, Koes BW, Burdorf A. Associations between work-related factors and specific disorders at the elbow: a systematic literature review Rheumatology 2009; 48(5): 528–536.

8. Feuerstein M, Shaw WS, Lincoln AE, Miller VI, Wood PM. Clinical and workplace factors associated with a return to modified duty in work-related upper extremity disorders. Pain 2003; 102(1–2): 51–61.

9. Odusote K, Eisen A. An electrophysiological quantitation of the cubital tunnel syndrome. Can J Neurol Sci 1979; 6(4): 403–410

10. Stewart JD. The variable clinical manifestations of ulnar neuropathies at the elbow. J Neurol Neurosurg Psychiatry 1987; 50(3): 252–258.

11. Shakir A, Micklesen PJ, Robinson LR. Which motor nerve conduction study is best in ulnar neuropathy at the elbow? Muscle Nerve 2004; 29(4): 585–590.

12. Kadaňka Z, Bednařík J, Voháňka S. Praktická elektromyografie. Brno: IDVPZ 1994.

13. Feinberg E. Nerve entrapment syndromes about the elbow. Top Clin Chiropr 1999; 6(4): 20–32.

14. Marras C, Midroni G. Proximal Martin-Gruber anastomosis mimicking ulnar neuropathy at the elbow. Muscle Nerve 1999; 22(8): 1132–1135.

15. Kimura J. Handbook of clinical neurophysiology. Volume 7. Peripheral Nerve diseases. Ediburgh: Elsevier 2006.

16. Dawson DM, Halett M, Wilbourn AJ. Entrapment neuropathies. 3rd ed. Philadelphia: Lippincott-Raven 1999.

17. Kincaid JC, Phillips IL, Daube JR. The evaluation of suspected ulnar neuropathy at the elbow. Normal conduction study values. Arch Neurol 1986; 43(1): 44–47.

18. Richardson JK, Green DF, Jamieson SC, Valentin FC. Gender, body mass and age as risk factors for ulnar mononeuropathy at the elbow. Muscle Nerve 2001; 24(4): 551–554.

19. Landau ME, Barner KC, Campbell WW. Optimal screening distance for ulnaris neuropathy at the elbow. Muscle Nerve 2003; 27(5): 570–574.

20. Kern RZ. The Electrodiagnosis of Ulnar Nerve Entrapment at the Elbow. Can J Neurol Sci 2003; 30(4): 314–319.

21. Todnem K, Michler RP, Wader TE, Engstrom M, Sand T. The impact of extended electrodiagnostic studies in ulnar neuropathy at the elbow. BMC Neurol 2009; 9: 52.

22. Merlevede K, Theys P, van Hees J. Diagnosis of ulnar neuropathy. Muscle Nerve 2000; 23(4): 478–481.

23. Kanakamedala RV, Somnos DG, Porter RW, Zucker RS. Ulnar nerve entrapment at the elbow localized by short segment stimulation. Arch Phys Med Rehabil 1988; 69(11): 959–963.

24. Kitzinger HB, Aszmann OC, Moser VL. Significance of electroneurographic parameters in the dia­gnosis of chronic neuropathy of the ulnar nerve at the elbow. Handchir Mikrochir Plast Chir 2005; 37(4): 276–281.

25. Azrieli Y, Weimer L, Lovelace R, Gooch C. The utility of segmental nerve conduction studies in ulnar mononeuropathy at the elbow. Muscle Nerve 2003; 27(1): 46–50.

26. Herrmann DN, Preston DC, McIntosh KA, Logigian EL. Localisation of ulnar neuropathy with conduction block across the elbow. Muscle Nerve 2001; 24(5): 698–700.

27. Landau ME, Barner KC, Murray ED, Campbell WW. Cold elbow syndrome: spurious slowing of ulnar nerve conduction velocity. Muscle Nerve 2005; 32(6): 815–817.

28. Kothari MJ, Heistand M, Rutkove SB. Three ulnar nerve conduction studies in patients with ulnar neuropathy at the elbow. Arch Phys Med Rehabil 1998; 79(1): 87–89.

29. Beekman R, van der Plas JP, Uitdehaag BMJ, Schellens RLLA, Visser LH. Clinical, electrodiagnostic, and sonographic studies in ulnar neuropathy at the elbow. Muscle Nerve 2004; 30(2): 202–208.

30. Friedrich JM, Robinson LR. Prognostic indicators from electrodiagnostic studies for ulnar neuropathy at the elbow. Muscle Nerve 2011; 43(4): 596–600.

31. Dunselman HH, Visser LH. The clinical, electrophysiological and prognostic heterogeneity of ulnar neuropathy at the elbow. J Neurol Neurosurg Psychiatry 2008; 79(12): 1364–1367.

32. Joon SY, Walker FO, Cartwright MS. Ulnar neuro­pathy with a normal electrodiagnostic and abnormal nerve ultrasound. Arch Phys Med Rehabil 2010; 91(2): 318–320.

33. Takahashi N, Robinson LR. Can we accurately measure the onset latency to the first dorsal interosseus? Muscle Nerve 2011; 43(1): 129–132.

Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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