To assess the correlation between ultrasonographic and electrodiagnostic findings to determine the localization of the ulnar trapping at the elbow.
Cross-sectional and noninterventional trial.
Physical medicine and rehabilitation department of a teaching hospital.
Patients (N=14) diagnosed with ulnar nerve entrapment using short-segment nerve conduction study.
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).
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.
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.
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)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Archives of Physical Medicine and Rehabilitation
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Cubital tunnel syndrome pathophysiology.Clin Orthop Relat Res. 1998; : 90-94
- The cubital tunnel syndrome: diagnosis and precise localization.Ann Neurol. 1979; 6: 56-59
- The clinical, electrophysiological and prognostic heterogeneity of ulnar neuropathy at the elbow.J Neurol Neurosurg Psychiatry. 2008; 79: 1364-1367
- Incidence of ulnar nerve entrapment at the elbow in repetitive work.Scand J Work Environ Health. 2004; 30: 234-240
- Practice parameter: electrodiagnostic studies in ulnar neuropathy at the elbow.Neurology. 1999; 52: 688-690
- Clinical, electrodiagnostic, and sonographic studies in ulnar neuropathy at the elbow.Muscle Nerve. 2004; 30: 202-208
- Ulnar nerve measurements in healthy individuals to obtain reference values.Rheumatol Int. 2013; 33: 1143-1147
- 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
- Reproducibility of ultrasonographic measurements of the ulnar nerve at the cubital tunnel.Ultrasound Med Biol. 2017; 43: 439-444
- Cross-sectional area reference values for nerve ultrasonography.Muscle Nerve. 2008; 37: 566-571
- Peripheral nerve size in normals and patients with polyneuropathy: an ultrasound study.Muscle Nerve. 2009; 40: 960-966
- Ultrasonographic measurements of the ulnar nerve at the elbow: role of confounders.J Ultrasound Med. 2008; 27: 737-743
- Bilaterality of ulnar neuropathy at the elbow.Electromyogr Clin Neurophysiol. 1991; 31: 195-198
- Nonoperative management of cubital tunnel syndrome: an 8-year prospective study.Neurology. 1993; 43: 1673-1677
- Ultrasonographic swelling ratio in the diagnosis of ulnar neuropathy at the elbow.Muscle Nerve. 2008; 38: 1231-1235
- 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
- STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies.Radiology. 2015; 277: 826-832
- Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement.Arch Phys Med Rehabil. 1999; 80: 357-359
- The electrodiagnosis of ulnar nerve entrapment at the elbow.Can J Neurol Sci. 2003; 30: 314-319
- What is the best way to assess focal slowing of the ulnar nerve?.Clin Neurophysiol. 2001; 112: 286-293
- Morphology and dynamics of the ulnar nerve in the cubital tunnel: observation by ultrasonography.J Hand Surg Br. 2000; 25: 85-89
- Short-segment nerve conduction studies in ulnar neuropathy at the elbow.Muscle Nerve. 2005; 31: 331-338
- Diagnostic accuracy of ultrasonographic and nerve conduction studies in ulnar neuropathy at the elbow.Clin Neurophysiol. 2015; 126: 1797-1804
- Ultrasound evaluation of ulnar neuropathy at the elbow: correlation with electrophysiological studies.Rheumatology. 2009; 48: 1098-1101
- Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel.J Hand Surg Am. 2006; 31: 1088-1093
- Precise localization of ulnar neuropathy at the elbow.Clin Neurophysiol. 2015; 126: 2390-2396
- Ulnar nerve and cubital tunnel ultrasound in ulnar neuropathy at the elbow.Arch Phys Med Rehabil. 2008; 89: 887-889
- Reliability of side-to-side sonographic cross-sectional area measurements of upper extremity nerves in healthy volunteers.J Ultrasound Med. 2013; 32: 457-462
- Sonographic measurements of the ulnar nerve and the cubital tunnel at the elbow: interobserver reproducibility.Radiography. 2005; 11: 277-283
- High-resolution ultrasonography of peripheral nerves: measurements on 14 nerve segments in 56 healthy subjects and reliability assessments.Ultraschall Med. 2014; 35: 459-467
Published online: October 05, 2017
© 2017 by the American Congress of Rehabilitation Medicine