Localization of Ulnar Neuropathy at the Wrist Using Motor and Sensory Ulnar Nerve Segmental Studies
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Purpose Diagnosing ulnar neuropathy at the wrist (UNW) is often challenging, and performing several short segmental studies have been suggested for achieving this. We aimed to determine the utility of ulnar nerve segmental studies at the wrist (UNSWs) in patients with suspected UNW. Methods Fourteen patients with typical symptoms of unilateral UNW were evaluated using conventional electrophysiological tests, UNSWs, and ultrasonography (US). In UNSWs, the ulnar nerve was stimulated at three sites (3 cm distal, just lateral, and 2 cm proximal to the pisiform), and recordings were made at the first dorsal interosseous (FDI) muscle and the fifth digit. Four types of UNW were identified by conventional ulnar nerve conduction studies based on motor and sensory fiber involvement. UNW was also categorized as either a proximal or distal lesion relative to the pisiform based on the UNSWs. The relationships between the conventional electrophysiological type, UNSW categorization results, and lesion location as verified by US were analyzed. Results Proximal UNW lesions were associated with involvement of the entire deep motor and the superficial sensory fibers (type I). Distal lesions were more closely related to deep motor fibers that innervated the FDI (type III). All five proximal and six distal lesions seen in US matched the lesion locations found on UNSWs. Conclusions Motor and sensory UNSW are considered useful assistive techniques for diagnosing UNW and localizing its lesion sites
Abstract
Background and Purpose Diagnosing ulnar neuropathy at the wrist (UNW) is often challenging, and performing several short segmental studies have been suggested for achieving this. We aimed to determine the utility of ulnar nerve segmental studies at the wrist (UNSWs) in patients with suspected UNW. Methods Fourteen patients with typical symptoms of unilateral UNW were evaluated using conventional electrophysiological tests, UNSWs, and ultrasonography (US). In UNSWs, the ulnar nerve was stimulated at three sites (3 cm distal, just lateral, and 2 cm proximal to the pisiform), and recordings were made at the first dorsal interosseous (FDI) muscle and the fifth digit. Four types of UNW were identified by conventional ulnar nerve conduction studies based on motor and sensory fiber involvement. UNW was also categorized as either a proximal or distal lesion relative to the pisiform based on the UNSWs. The relationships between the conventional electrophysiological type, UNSW categorization results, and lesion location as verified by US were analyzed. Results Proximal UNW lesions were associated with involvement of the entire deep motor and the superficial sensory fibers (type I). Distal lesions were more closely related to deep motor fibers that innervated the FDI (type III). All five proximal and six distal lesions seen in US matched the lesion locations found on UNSWs. Conclusions Motor and sensory UNSW are considered useful assistive techniques for diagnosing UNW and localizing its lesion sites
참고문헌 (18)
- Almeida V, "Lesion of the deep palmar branch of the ulnar nerve : causes and clinical outcome", Neurophysiol Clin, 40, pp.159~164 (2010)
- Seror P, "Electrophysiological pattern of 53 cases of ulnar nerve lesion at the wrist", Neurophysiol Clin, 43, pp.95~103 (2013)
- Nack Hwan Kim, "Ulnar Neuropathy at the Wrist in a Patient with Carpal Tunnel Syndrome after Open Carpal Tunnel Release", Annals of Rehabilitation Medicine, 36(2), pp.291~296 (2012), 대한재활의학회[DOI]
- Soong M, "Ulnar nerve palsy associated with fracture of the distal radius", J Orthop Trauma, 21, pp.113~116 (2007)
- Ginanneschi F, "Ulnar nerve compression neuropathy at Guyon’s canal caused by crutch walking : case report with ultrasonographic nerve imaging", Arch Phys Med Rehabil, 90, pp.522~524 (2009)
- Murata K, "Causes of ulnar tunnel syndrome : a retrospective study of 31 subjects", J Hand Surg Am, 28, pp.647~651 (2003)
- Cowdery SR, "Electrodiagnosis of ulnar neuropathy at the wrist : conduction block versus traditional tests", Neurology, 59, pp.420~427 (2002)
- Olney RK, "Ulnar nerve conduction study of the first dorsal interosseous muscle", Arch Phys Med Rehabil, 66, pp.16~18 (1985)
- Olney RK, "AAEE case report #15 : ulnar neuropathy at or distal to the wrist", Muscle Nerve, 11, pp.828~832 (1988)
- Ebeling P, "A clinical and electrical study of ulnar nerve lesions in the hand", J Neurol Neurosurg Psychiatry, 23, pp.1~9 (1960)
- McIntosh KA, "Short-segment incremental studies to localize ulnar nerve entrapment at the wrist", Neurology, 50, pp.303~306 (1998)
- Kim DH, "Reference values of fractionated neurography of the ulnar nerve at the wrist in healthy subjects", Clin Neurophysiol, 116, pp.2853~2857 (2005)
- 김동휘, "Ulnar Nerve Conduction Study of the First Dorsal Interosseous Muscle in Korean Subjects", Annals of Rehabilitation Medicine, 35(5), pp.658~663 (2011), 대한재활의학회
- Lee HJ, "Manual of Nerve Conduction Study and Surface Anatomy for Needle Electromyography" (2005), Lippincott Williams & Wilkins
- Oh SJ, "Clinical Electromyography : Nerve Conduction Studies" (1993), Lippincott Williams & Wilkins
- Venkatesh S, "The limitations of the dorsal ulnar cutaneous sensory response in patients with ulnar neuropathy at the elbow", Muscle Nerve, 18, pp.345~347 (1995)
- Mondelli M, "Diagnostic accuracy of sensory clinical findings of the hand dorsum and of neurography of the dorsal ulnar cutaneous nerve in ulnar neuropathy at the elbow", Arch Phys Med Rehabil, 100, pp.908~913 (2019)
- 김민제, "Diagnosis of Pure Ulnar Sensory Neuropathy Around the Hypothenar Area Using Orthodromic Inching Sensory Nerve Conduction Study: A Case Report", Annals of Rehabilitation Medicine, 42(3), pp.483~487 (2018), 대한재활의학회