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Comparison of Ultrasonography and Short-Segment Nerve Conduction Study in Ulnar Neuropathy at the Elbow

Published:October 05, 2017DOI:https://doi.org/10.1016/j.apmr.2017.09.111

      Abstract

      Objective

      To assess the correlation between ultrasonographic and electrodiagnostic findings to determine the localization of the ulnar trapping at the elbow.

      Design

      Cross-sectional and noninterventional trial.

      Setting

      Physical medicine and rehabilitation department of a teaching hospital.

      Participants

      Patients (N=14) diagnosed with ulnar nerve entrapment using short-segment nerve conduction study.

      Interventions

      The elbow area was divided into 4 segments with 2-cm intervals. All patients underwent ultrasonographic and electrodiagnostic examinations.

      Main Outcome Measures

      The nerve conduction velocity (NCV) of each segment was measured. The cross-sectional area (CSA) of the ulnar nerve was measured at 5 levels. The proximal CSA/distal CSA ratio (PDR) was calculated by proportioning the CSA values for each segment. The highest PDR was accepted as a trapping segment, whereas the segment with the lowest NCV was accepted electrophysiologically (provided it was <50m/s).

      Results

      A total of 80 PDR and NCV measurements were taken from 20 elbows. A statistically significant negative correlation (r=−.554; P<.001) was found between general PDR and NCV values. When we assumed that the NCV value <50m/s as the criterion standard for diagnosis, the cutoff value for the PDR was found to be 1.08, with a sensitivity of 70% and a specificity of 92.5%. The minimum NCV value and the maximum PDR value were mostly seen in the third segment compatible with the cubital tunnel.

      Conclusions

      Ultrasonography seems to be advantageous because it is more comfortable for the patient and requires shorter time than does electroneuromyography. To our knowledge, this is the first study to detect ulnar nerve entrapment by using not only CSA but also PDR as a ratio method with ultrasound.

      Keywords

      List of abbreviations:

      CSA (cross-sectional area), ENMG (electroneuromyography), ICC (intraclass correlation coefficient), NCV (nerve conduction velocity), PDR (proximal cross-sectional area/distal cross-sectional area ratio), UNE (ulnar nerve entrapment), US (ultrasound)
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      References

        • Bozentka D.J.
        Cubital tunnel syndrome pathophysiology.
        Clin Orthop Relat Res. 1998; : 90-94
        • Miller R.G.
        The cubital tunnel syndrome: diagnosis and precise localization.
        Ann Neurol. 1979; 6: 56-59
        • Dunselman H.H.
        • Visser L.H.
        The clinical, electrophysiological and prognostic heterogeneity of ulnar neuropathy at the elbow.
        J Neurol Neurosurg Psychiatry. 2008; 79: 1364-1367
        • Descatha A.
        • Leclerc A.
        • Chastang J.F.
        • Roquelaure Y.
        • Study Group on Repetitive Work
        Incidence of ulnar nerve entrapment at the elbow in repetitive work.
        Scand J Work Environ Health. 2004; 30: 234-240
        • American Association of Electrodiagnostic Medicine
        • American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation
        Practice parameter: electrodiagnostic studies in ulnar neuropathy at the elbow.
        Neurology. 1999; 52: 688-690
        • Beekman R.
        • Van Der Plas J.P.
        • Uitdehaag B.M.
        • Schellens R.L.
        • Visser L.H.
        Clinical, electrodiagnostic, and sonographic studies in ulnar neuropathy at the elbow.
        Muscle Nerve. 2004; 30: 202-208
        • Yalcin E.
        • Onder B.
        • Akyuz M.
        Ulnar nerve measurements in healthy individuals to obtain reference values.
        Rheumatol Int. 2013; 33: 1143-1147
        • Bedewi M.A.
        • Yousef A.M.
        • Abd-Elghany A.A.
        • El-Sharkawy M.S.
        • Awad E.M.
        Estimation of ultrasound reference values for the ulnar nerve fascicular number and cross-sectional area in young males: a cross-sectional study.
        Medicine (Baltimore). 2017; 96: e6204
        • Fink A.
        • Teggeler M.
        • Schmitz M.
        • Janssen J.
        • Pisters M.
        Reproducibility of ultrasonographic measurements of the ulnar nerve at the cubital tunnel.
        Ultrasound Med Biol. 2017; 43: 439-444
        • Cartwright M.S.
        • Passmore L.V.
        • Yoon J.S.
        • Brown M.E.
        • Caress J.B.
        • Walker F.O.
        Cross-sectional area reference values for nerve ultrasonography.
        Muscle Nerve. 2008; 37: 566-571
        • Zaidman C.M.
        • Al-Lozi M.
        • Pestronk A.
        Peripheral nerve size in normals and patients with polyneuropathy: an ultrasound study.
        Muscle Nerve. 2009; 40: 960-966
        • Thoirs K.
        • Williams M.A.
        • Phillips M.
        Ultrasonographic measurements of the ulnar nerve at the elbow: role of confounders.
        J Ultrasound Med. 2008; 27: 737-743
        • Harmon R.L.
        Bilaterality of ulnar neuropathy at the elbow.
        Electromyogr Clin Neurophysiol. 1991; 31: 195-198
        • Dellon A.L.
        • Hament W.
        • Gittelshon A.
        Nonoperative management of cubital tunnel syndrome: an 8-year prospective study.
        Neurology. 1993; 43: 1673-1677
        • Yoon J.S.
        • Walker F.O.
        • Cartwright M.S.
        Ultrasonographic swelling ratio in the diagnosis of ulnar neuropathy at the elbow.
        Muscle Nerve. 2008; 38: 1231-1235
        • Bayrak A.O.
        • Bayrak I.K.
        • Turker H.
        • Elmali M.
        • Nural M.S.
        Ultrasonography in patients with ulnar neuropathy at the elbow: comparison of cross-sectional area and swelling ratio with electrophysiological severity.
        Muscle Nerve. 2010; 41: 661-666
        • Bossuyt P.M.
        • Reitsma J.B.
        • Bruns D.E.
        • et al.
        STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies.
        Radiology. 2015; 277: 826-832
        • American Association of Electrodiagnostic Medicine
        • American Academy of Physical Medicine and Rehabilitation
        • American Academy of Neurology
        Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement.
        Arch Phys Med Rehabil. 1999; 80: 357-359
        • Kern R.Z.
        The electrodiagnosis of ulnar nerve entrapment at the elbow.
        Can J Neurol Sci. 2003; 30: 314-319
        • van Dijk J.G.
        • Meulstee J.
        • Zwarts M.J.
        • Spaans F.
        What is the best way to assess focal slowing of the ulnar nerve?.
        Clin Neurophysiol. 2001; 112: 286-293
        • Okamoto M.
        • Abe M.
        • Shirai H.
        • Ueda N.
        Morphology and dynamics of the ulnar nerve in the cubital tunnel: observation by ultrasonography.
        J Hand Surg Br. 2000; 25: 85-89
        • Visser L.H.
        • Beekman R.
        • Franssen H.
        Short-segment nerve conduction studies in ulnar neuropathy at the elbow.
        Muscle Nerve. 2005; 31: 331-338
        • Omejec G.
        • Žgur T.
        • Podnar S.
        Diagnostic accuracy of ultrasonographic and nerve conduction studies in ulnar neuropathy at the elbow.
        Clin Neurophysiol. 2015; 126: 1797-1804
        • Volpe A.
        • Rossato G.
        • Bottanelli M.
        • et al.
        Ultrasound evaluation of ulnar neuropathy at the elbow: correlation with electrophysiological studies.
        Rheumatology. 2009; 48: 1098-1101
        • Wiesler E.R.
        • Chloros G.D.
        • Cartwright M.S.
        • Shin H.W.
        • Walker F.O.
        Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel.
        J Hand Surg Am. 2006; 31: 1088-1093
        • Omejec G.
        • Podnar S.
        Precise localization of ulnar neuropathy at the elbow.
        Clin Neurophysiol. 2015; 126: 2390-2396
        • Yoon J.S.
        • Hong S.J.
        • Kim B.J.
        • et al.
        Ulnar nerve and cubital tunnel ultrasound in ulnar neuropathy at the elbow.
        Arch Phys Med Rehabil. 2008; 89: 887-889
        • Tagliafico A.
        • Martinoli C.
        Reliability of side-to-side sonographic cross-sectional area measurements of upper extremity nerves in healthy volunteers.
        J Ultrasound Med. 2013; 32: 457-462
        • Thoirs K.
        • Williams M.
        • Wilkinson M.
        Sonographic measurements of the ulnar nerve and the cubital tunnel at the elbow: interobserver reproducibility.
        Radiography. 2005; 11: 277-283
        • Boehm J.
        • Scheidl E.
        • Bereczki D.
        • Schelle T.
        • Arányi Z.
        High-resolution ultrasonography of peripheral nerves: measurements on 14 nerve segments in 56 healthy subjects and reliability assessments.
        Ultraschall Med. 2014; 35: 459-467