Clinical noteUlnar Neuropathy With Normal Electrodiagnosis and Abnormal Nerve Ultrasound
Section snippets
Patient Identification
All patients in this study presented to the Diagnostic Neurology Laboratory at Wake Forest University School of Medicine between January 2007 and January 2008 and were referred for UNE. Inclusion criteria included paresthesias in the 4th and 5th digits, abnormal clinical sensory testing in the 4th and 5th digits and the dorsum of the ulnar aspect of the hand, and weakness in ulnar-innervated intrinsic hand muscles, all of which had to be present. All participants underwent electrodiagnostic
Discussion
This is the first study to describe an increased cross-sectional area in ulnar nerves of patients suspected to have UNE but presenting with normal electrodiagnostic findings. In all cases, ultrasound of the ulnar nerve showed focal enlargement proximal to and at the medial epicondyle. In addition to absolute nerve enlargement, other changes were noted, including reduced echogenicity in 3 of the subjects and enlargement compared with the contralateral ulnar nerve. The mean cross-sectional area
Conclusions
This case series shows that some patients with UNE and normal NCSs show abnormalities when their ulnar nerves are examined with high-resolution ultrasound, including an increased nerve cross-sectional area. Further research into this topic is needed to determine the frequency with which this occurs.
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Cited by (63)
The role of preoperative ultrasound in the management of peripheral nerve injuries
2024, Clinical Neurology and NeurosurgeryModern Treatment of Cubital Tunnel Syndrome: Evidence and Controversy
2023, Journal of Hand Surgery Global OnlineCitation Excerpt :The distance between the medial epicondyle and ulnar nerve at full elbow extension has also been found to be diagnostic for CuTS, with a distance of 0.53 cm having good sensitivity (71%) and specificity (90.7%).42 US has also been used to diagnose patients with CuTS with negative EDX43 as well as in patients with recurrent disease.44,45 However, compared with EDX, US has been shown to have lower sensitivity for detecting CuTS in the primary setting (71% vs 89%).46
Electrodiagnostic test results in people with a working diagnosis of cubital tunnel syndrome
2023, Journal of OrthopaedicsCycling-Related Compressive Neuropathy of the Deep Ulnar Motor Branch in the Hand: Is Sonography a Valid Tool?
2021, Ultrasound in Medicine and BiologyCitation Excerpt :In a recently published study by Pelosi and Mulroy (2019), which evaluated the sensitivity of ultrasound and electrodiagnostics in diagnosing ulnar neuropathies at the elbow, the authors reported that both electrophysiology and ultrasound had high sensitivity in localizing a pathologic segment in patients with clinical severe and moderate neuropathy, but relatively poor sensitivity in mild and even poorer in very mild neuropathies. Beekman et al. (2004) and Yoon et al. (2010) reported cases of sulcus nervi ulnaris syndrome with positive US imaging and clear clinical signs of neuropathy but normal electrophysiology. Those reported findings at the elbow might most likely be transferred to sports-related neuropathies of the DBUN with progressive but (in the beginning) subtle symptoms.
Diagnostic sensitivity of electrophysiology and ultrasonography in ulnar neuropathies of different severity
2019, Clinical NeurophysiologyCitation Excerpt :In addition, in a subgroup of patients with axonal ulnar neuropathies, electrophysiology is abnormal but non-localizing (Jabre and Wilbourn,1979; Shady Abuaisha and Boulton, 1998; Wilbourn, 1987). In recent years, high-resolution nerve ultrasound has emerged as a reliable and sensitive tool for investigating ulnar neuropathies, particularly helpful when electrodiagnostic tests are either non-localizing (Beekman et al., 2004, 2011; Omejec et al, 2015; Pelosi et al, 2018) or falsely negative (Beekman et al., 2004; Yoon et al, 2010). However, a recent study reported higher sensitivity of electrophysiology than ultrasound (Omejec et al, 2015).
Indications for neuromuscular ultrasound: Expert opinion and review of the literature
2018, Clinical Neurophysiology
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