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Войти в исследования Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2016
Proposal for electrodiagnostic evaluation of patients with suspected ulnar neuropathy at the elbow.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Omejec Gregor, Podnar Simon
Аннотация
OBJECTIVE: To develop an evidence-based electrodiagnostic (EDx) approach to patients with suspected ulnar neuropathy at the elbow (UNE).
METHODS: We prospectively recruited patients with suspected UNE, took a history and performed clinical neurologic, EDx and ultrasonographic (US) examinations. Ulnar motor and mixed nerve 5 × 2 cm, 2 × 4 cm and 10 cm studies across the elbow were compared regarding sensitivity and precise localization of UNE.
RESULTS: In 175 evaluated patients, the highest sensitivity/precise localization was demonstrated by the motor 5 × 2 cm study (93%/92%), followed by the 2 × 4 cm study (89%/83%) and the 10-cm study (82%/0%). The sensitivities of mixed ulnar nerve studies to diagnose/precisely localize UNE were 12-23%/27-36% lower than the corresponding motor studies.
CONCLUSIONS: Based on our data, we suggest starting EDx evaluation of UNE with a motor 2 × 4 cm study (recording from either the abductor digiti minimi or the first dorsal interosseous muscles), with two additional stimulation sites being added if the initial result is negative. This results in a motor 4 × 2 cm study. In all suspected UNE patients, an antidromic sensory study to the 5th finger should also be performed.
SIGNIFICANCE: The proposed EDx protocol is robust, sensitive and time efficient. We hope that it will improve the diagnosis of UNE.
METHODS: We prospectively recruited patients with suspected UNE, took a history and performed clinical neurologic, EDx and ultrasonographic (US) examinations. Ulnar motor and mixed nerve 5 × 2 cm, 2 × 4 cm and 10 cm studies across the elbow were compared regarding sensitivity and precise localization of UNE.
RESULTS: In 175 evaluated patients, the highest sensitivity/precise localization was demonstrated by the motor 5 × 2 cm study (93%/92%), followed by the 2 × 4 cm study (89%/83%) and the 10-cm study (82%/0%). The sensitivities of mixed ulnar nerve studies to diagnose/precisely localize UNE were 12-23%/27-36% lower than the corresponding motor studies.
CONCLUSIONS: Based on our data, we suggest starting EDx evaluation of UNE with a motor 2 × 4 cm study (recording from either the abductor digiti minimi or the first dorsal interosseous muscles), with two additional stimulation sites being added if the initial result is negative. This results in a motor 4 × 2 cm study. In all suspected UNE patients, an antidromic sensory study to the 5th finger should also be performed.
SIGNIFICANCE: The proposed EDx protocol is robust, sensitive and time efficient. We hope that it will improve the diagnosis of UNE.