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The Electrodiagnosis of Ulnar Nerve Entrapment at the Elbow

Published online by Cambridge University Press:  02 December 2014

Ralph Z. Kern
Ralph Z. Kern*
Affiliation:
Mount Sinai Hospital and the University Health Network; and the Division of Neurology, Department of Medicine, the University of Toronto, Toronto, Ontario, Canada
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Abstract

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Entrapment of the ulnar nerve at the elbow is the second most common focal peripheral neuropathy. Recent advances have facilitated the electrodiagnosis of this common nerve entrapment. The goals of electrodiagnosis are to localize ulnar nerve dysfunction, confirm that the disturbance is confined to the ulnar nerve, and assess the severity of ulnar nerve dysfunction. The goal of this review is to highlight the important advances in anatomy, neurophysiology and methodology that impact upon the electrodiagnosis of entrapment of the ulnar nerve at the elbow, illustrate the limits of electrodiagnosis, and discuss methodological issues that may be the subject of further study. Careful attention to elbow position, temperature, and conservative estimates of conduction block should be part of common practice. Awareness of anatomical variations in structural anatomy, anomalous innervation and fascicular arrangement of ulnar nerve fibers are required to interpret electrodiagnostic studies accurately. The most reliable finding is slowing of the ulnar across-elbow motor nerve conduction velocity to less than 50 m/sec while recording from the abductor digiti minimi muscle, and should be carefully interpreted in the presence of a polyneuropathy or other neurogenic process. Alternative techniques such as relative ulnar slowing in different ulnar nerve segments, use of alternative muscles, sensory and mixed nerve techniques provide complementary information, and like all nerve conduction studies are highly operator-dependent and should be used on a case by case basis. Recent studies have focused the electromyographer's attention on the use of shorter across-elbow segments (2-5 cm). This may offer a reasonable trade-off between sensitivity and measurement error and may result in improved electrodiagnosis.

Résumé:

RÉSUMÉ:

La compression du nerf cubital au niveau du coude est la deuxième neuropathie périphérique focale la plus fréquente. Des progrès récents en facilitent l'électrodiagnostic. Les buts de l'électrodiagnostic sont de localiser la dysfonction du nerf cubital, de confirmer que l'atteinte est limitée au nerf cubital et d'évaluer la sévérité de la dysfonction du nerf cubital. Le but de cette revue est de souligner les progrès importants réalisés en anatomie, en neurophysiologie et dans les outils diagnostiques qui ont un impact sur l'électrodiagnostic de la compression du nerf cubital au niveau du coude, d'illustrer les limites de l'électrodiagnostic et de discuter des aspects méthodologiques qu'il serait intéressant d'explorer davantage. On doit porter une attention particulière à la position du coude et à sa température, et une estimation conservatrice du blocage de conduction doit faire partie de la pratique courante. L'interprétation des études électrodiagnostiques nécessite une connaissance des variantes anatomiques structurales, des innervations anormales et de l'arrangement fasciculaire des fibres du nerf cubital. Le signe le plus fiable est le ralentissement de la vitesse de conduction quand le nerf franchit le coude à moins de 50 m/sec lors de l'enregistrement fait au niveau du muscle abducteur du petit doigt et devrait être interprété avec prudence en présence d'une polyneuropathie ou d'un autre processus neurogène. D'autres techniques comme le ralentissement cubital relatif dans différents segments du nerf cubital, l'utilisation d'autres muscles, des techniques pour les nerfs sensitifs et mixtes ajoutent une information complémentaire et, comme toutes les études de conduction nerveuse sont très dépendantes de l'opérateur, devraient être utilisées au cas par cas. Des études récentes ont attiré l'attention de l'électromyographiste sur l'utilisation de segments plus courts au niveau du coude (2 à 5 cm), ce qui peut offrir un compromis raisonnable entre la sensibilité et l'erreur de mesure et peut améliorer l'électrodiagnostic.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 4 , November 2003 , pp. 314 - 319
Copyright
Copyright © The Canadian Journal of Neurological 2003

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