Electrophysiologic Findings of Ulnar Neuropathy at the Elbow According to the Level of the Lesion
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective To determine whether electrophysiologic findings of ulnar neuropathy at the elbow (UNE) are associated with anatomic location or a pathophysiologic mechanism, electrophysiologic findings of ulnar neuropathy above the elbow (UNAE) and below the elbow (UNBE) were compared. Method Electrophysiologic findings of 56 patients with UNE were analyzed: segmental ulnar motor conduction study with abductor digiti quinti (ADQ) and first dorsal interosseous (FDI) recordings, ulnar and dorsal ulnar cutaneous nerve (DUCN) sensory action potentials, and needle electromyographic findings. Based on anatomic location, lesions were divided into UNAE and UNBE. Based on pathophysiologic findings, they were classified into three groups (focal demyelination, axonal degeneration, and mixed lesion). Results Twenty-eight patients were diagnosed with UNAE, and 28 with UNBE. Of the patients with UNAE, 4 had focal demyelination, 2 showed axonal degeneration, and 22 were of mixed lesions. Of patients with UNBE, 5 had focal demyelination, 6 showed axonal degeneration, and 17 were of mixed lesions. No significant differences in pathophysiologic mechanisms, or in electrophysiologic findings, were observed between UNAE and UNBE. The proportion of positive findings of focal demyelination was higher in FDI recording than in ADQ recording; however, this finding was not statistically significant (p＞0.05). Thirty of 31 patients with abnormal DUCN had axonal degeneration with or without focal demyelination, whereas 9 of 25 patients with normal DUCN had focal demyelination only (p＜0.05). Conclusion Electrophysiologic findings did not relate to the anatomic location of UNE, but could relate to the pathophysiologic severity or fascicular involvement of the lesion.
Abstract
Objective To determine whether electrophysiologic findings of ulnar neuropathy at the elbow (UNE) are associated with anatomic location or a pathophysiologic mechanism, electrophysiologic findings of ulnar neuropathy above the elbow (UNAE) and below the elbow (UNBE) were compared. Method Electrophysiologic findings of 56 patients with UNE were analyzed: segmental ulnar motor conduction study with abductor digiti quinti (ADQ) and first dorsal interosseous (FDI) recordings, ulnar and dorsal ulnar cutaneous nerve (DUCN) sensory action potentials, and needle electromyographic findings. Based on anatomic location, lesions were divided into UNAE and UNBE. Based on pathophysiologic findings, they were classified into three groups (focal demyelination, axonal degeneration, and mixed lesion). Results Twenty-eight patients were diagnosed with UNAE, and 28 with UNBE. Of the patients with UNAE, 4 had focal demyelination, 2 showed axonal degeneration, and 22 were of mixed lesions. Of patients with UNBE, 5 had focal demyelination, 6 showed axonal degeneration, and 17 were of mixed lesions. No significant differences in pathophysiologic mechanisms, or in electrophysiologic findings, were observed between UNAE and UNBE. The proportion of positive findings of focal demyelination was higher in FDI recording than in ADQ recording; however, this finding was not statistically significant (p＞0.05). Thirty of 31 patients with abnormal DUCN had axonal degeneration with or without focal demyelination, whereas 9 of 25 patients with normal DUCN had focal demyelination only (p＜0.05). Conclusion Electrophysiologic findings did not relate to the anatomic location of UNE, but could relate to the pathophysiologic severity or fascicular involvement of the lesion.
참고문헌 (16)
- Karatas A, "Regional anatomic structures of the elbow that may potentially compress the ulnar nerve", J Shoulder Elbow Surg, 18, pp.627~631 (2009)
- Robertson C, "A review of compressive ulnar neuropathy at the elbow", J Manipulative Physiol Ther, 28, pp.34~ (2005)
- Tackmann W, "Sensitivity and localizing significance of motor and sensory electroneurographic parameters in the diagnosis of ulnar nerve lesions at the elbow", A reappraisal. J Neurol, 231, pp.204~211 (1984)
- Olney RK, "Conduction block in compression neuropathy: recognition and quantification", Muscle Nerve, 7, pp.662~667 (1984)
- Stewart JD, "The variable clinical manifestations of ulnar neuropathies at the elbow", J Neurol Neurosurg Psychiatry, 50, pp.252~258 (1987)
- Shakir A, "Which motor nerve conduction study is best in ulnar neuropathy at the elbow?", Muscle Nerve, 29, pp.585~590 (2004)
- Hoffman MD, "Paired study of the dorsal cutaneous ulnar and superficial radial sensory nerves", Arch Phys Med Rehabil, 69, pp.591~594 (1988)
- Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement, "American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation", Muscle Nerve, 22, pp.408~411 (1999)
- Bozentka DJ, "Cubital tunnel syndrome pathophysiology", Clin Orthop Relat Res, 351, pp.90~94 (1998)
- Kincaid JC, "AAEE minimonograph #31: the electrodiagnosis of ulnar neuropathy at the elbow", Muscle Nerve, 11, pp.1005~1015 (1988)
- Thibault MW, "Use of the AAEM guidelines in electrodiagnosis of ulnar neuropathy at the elbow", Am J Phys Med Rehabil, 84, pp.267~273 (2005)
- Oh SJ, "Clinical electromyography nerve conduction studies", pp.635~645 (2003), Lippincott Williams & Wilkins
- Jabre JF, "Ulnar nerve lesions at the wrist: new technique for recording from the sensory dorsal branch of the ulnar nerve", Neurology, 30, pp.873~876 (1980)
- Kim DJ, "Dorsal cutaneous ulnar nerve conduction. Diagnostic aid in ulnar neuropathy", Arch Neurol, 38, pp.321~322 (1981)
- 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)
- Campbell WW, "Sparing of the flexor carpi ulnaris in ulnar neuropathy at the elbow", Muscle Nerve, 12, pp.965~967 (1989)